Journal articles: 'Pre-symptomatic patients'

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Gorospe, J. R., S. Naidu, A. B. Johnson, V. Puri, G. V. Raymond, S. D. Jenkins, R. C. Pedersen, et al. "Molecular findings in symptomatic and pre-symptomatic Alexander disease patients." Neurology 58, no. 10 (May 28, 2002): 1494–500. http://dx.doi.org/10.1212/wnl.58.10.1494.

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Levina, Marina, and Roswell Quinn. "From symptomatic to pre-symptomatic patient: the tide of personal genomics." Journal of Science Communication 10, no. 03 (September 21, 2011): C03. http://dx.doi.org/10.22323/2.10030303.

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Personal Genomics Companies are an emerging form of biotechnology startup that bring rapidly advancing whole genome technologies to a variety of commercial venues. With a combination of direct-to-consumer marketing, social media, and Web 2.0 applications these companies seek to create novel uses, including entertainment, for what is described as predictive medicine – that is the use of genetic marketers to create health forecasts that would allow individual’s healthcare to be tailored to their individual genomic data. In this brief piece, the authors use a critical cultural approach to question how this combination of genomics research, marketing, and communications technologies may alter both patient experiences and research processes. In it we argue these companies radically expand the definition of a patient by claiming all consumers are simply pre-symptomatic patients. Moreover, by placing genomic data on both the marketplace and cyberspace, personal genomic companies seek to create new avenues of research that alter how we define (and access) research agendas and human subjects. Therefore, beyond commonly discussed issues of ethics and privacy rights, Personal Genomics has the potential to alter both healthcare priorities and distribution.

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Salter, Matthew, Ryan Powell, Jennifer Back, Francis Grand, Christina Koutsothanasi, Jayne Green, Ewan Hunter, Aroul Ramadass, Jurjen Westra, and Alexandre Akoulitchev. "Genomic architecture differences at the HTT locus underlie symptomatic and pre-symptomatic cases of Huntington’s disease." F1000Research 7 (November 6, 2018): 1757. http://dx.doi.org/10.12688/f1000research.15828.1.

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Background:Huntington’s disease (HD) is a progressive neurodegenerative condition that causes degeneration of neurons in the brain, ultimately leading to death. The root cause of HD is an expanded trinucleotide cytosine-adenine-guanine (CAG) repeat in the “huntingtin gene” (HTT). While there is a rough correlation between the number of CAG repeats and disease onset, the development of clinical symptoms can vary by decades within individuals and little is known about this pre-symptomatic phase.Methods:Using peripheral blood samples from HD patients and healthy controls we usedEpiSwitch™, a validated high-resolution industrial platform for the detection of chromosome conformations, to assess chromatin architecture in the immediate vicinity of theHTTgene. We evaluated chromatin conformations at 20 sites across 225 kb of theHTTlocus in healthy controls, verified symptomatic HD patients (CAG, n>39) and patients with CAG expansions who had not yet manifested clinical symptoms of HD.Results:Discrete chromosome conformations were observed across the patient groups. We found two constitutive interactions (occurring in all patient groups) and seven conditional interactions which were present in HD, but not in healthy controls. Most important, we observed three conditional interactions that were present only in HD patients manifesting clinical symptoms (symptomatic cases), but not in presymptomatic cases. Of the patients in the symptomatic HD cohort, 86% (6 out of 7) demonstrated at least one of the specific chromosome conformations associated with symptomatic HD.Conclusion:Our results provide the first evidence that chromatin architecture at theHTTlocus is systemically altered in patients with HD, with conditional differences between clinical stages. Given the high clinical need in having a molecular tool to assess disease progression in HD, these results strongly suggest that the non-invasive assessment of chromosome conformation signatures can be a valuable addition to prognostic assessment of HD patients.

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Salter, Matthew, Ryan Powell, Jennifer Back, Francis Grand, Christina Koutsothanasi, Jayne Green, Ewan Hunter, Aroul Ramadass, Jurjen Westra, and Alexandre Akoulitchev. "Genomic architecture differences at the HTT locus underlie symptomatic and pre-symptomatic cases of Huntington’s disease." F1000Research 7 (March 26, 2019): 1757. http://dx.doi.org/10.12688/f1000research.15828.2.

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Background:Huntington’s disease (HD) is a progressive neurodegenerative condition that causes degeneration of neurons in the brain, ultimately leading to death. The root cause of HD is an expanded trinucleotide cytosine-adenine-guanine (CAG) repeat in the “huntingtin gene” (HTT). While there is a rough correlation between the number of CAG repeats and disease onset, the development of clinical symptoms can vary by decades within individuals and little is known about this pre-symptomatic phase.Methods:Using peripheral blood samples from HD patients and healthy controls we usedEpiSwitch™, a validated high-resolution industrial platform for the detection of chromosome conformations, to assess chromatin architecture in the immediate vicinity of theHTTgene. We evaluated chromatin conformations at 20 sites across 225 kb of theHTTlocus in healthy controls, verified symptomatic HD patients (CAG, n>39) and patients with CAG expansions who had not yet manifested clinical symptoms of HD.Results:Discrete chromosome conformations were observed across the patient groups. We found two constitutive interactions (occurring in all patient groups) and seven conditional interactions which were present in HD, but not in healthy controls. Most important, we observed three conditional interactions that were present only in HD patients manifesting clinical symptoms (symptomatic cases), but not in presymptomatic cases. Of the patients in the symptomatic HD cohort, 86% (6 out of 7) demonstrated at least one of the specific chromosome conformations associated with symptomatic HD.Conclusion:Our results provide the first evidence that chromatin architecture at theHTTlocus is systemically altered in patients with HD, with conditional differences between clinical stages. Given the high clinical need in having a molecular tool to assess disease progression in HD, these results strongly suggest that the non-invasive assessment of chromosome conformation signatures can be a valuable addition to prognostic assessment of HD patients.

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Leonelli, Fabio M., Roberto De Ponti, and Giuseppe Bagliani. "Clinical Approach to Symptomatic and Asymptomatic Patients with Ventricular Pre-excitation." Cardiac Electrophysiology Clinics 12, no. 4 (December 2020): 527–39. http://dx.doi.org/10.1016/j.ccep.2020.08.004.

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Serpino, C., V. Sciruicchio, K. Ricci, F. Giovanni, and M. De Tommaso. "44. Features of laser evoked potentials in pre-symptomatic Huntington disease patients." Clinical Neurophysiology 124, no. 11 (November 2013): e199. http://dx.doi.org/10.1016/j.clinph.2013.06.071.

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de Souza, Rainha J., Aaron de Souza, and Meera D. Nagvekar. "F-wave studies in diabetes mellitus: A comparison between pre-symptomatic and symptomatic patients with distal sensory polyneuropathy." Neurology, Psychiatry and Brain Research 30 (December 2018): 125–31. http://dx.doi.org/10.1016/j.npbr.2018.09.002.

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., Rashmi. "A Descriptive Study to Assess the Knowledge regarding Home Based Care of Corona Positive Patients (Mild, Pre-symptomatic) and Quarantined People among the Students of Selected Nursing College, New Delhi." International Journal of Nursing & Midwifery Research 07, no. 03 (March 16, 2021): 12–15. http://dx.doi.org/10.24321/2455.9318.202020.

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A descriptive study was conducted to assess the knowledge regarding home based care of corona positive patients (mild, pre symptomatic) and quarantined people among the students of selected nursing college. Objective of the study was to assess the knowledge of students regarding home based care of corona positive patients (mild and pre-symptomatic) and quarantined people. By using non experimental descriptive research design it was conducted among 79 subjects who were studying in DGNM 2nd year and DGNM 3rd year of Rufaida College of Nursing by non probability convenience sampling technique. The tool developed for the data collection was a self structured knowledge questionnaire. The data was analyzed using descriptive statistics. Findings revealed that out of 79 subjects, 84.81% had average knowledge followed by 11.39% having good knowledge, 2.53% having poor knowledge and 1.27% having excellent knowledge regardinghome based care of corona positive patients (mild, pre-symptomatic) and quarantined people.

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McLaughlin, Nancy, and Michel W. Bojanowski. "Aneurysmal Surgery in the Presence of Angiographic Vasospasm: An Outcome Assessment." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 33, no. 2 (July 2006): 181–88. http://dx.doi.org/10.1017/s0317167100004947.

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ABSTRACT:Background and Purpose:The timing of aneurysmal surgery for patients presenting within the period at risk for vasospasm (VS) is controversial. The goal of this study is to review our experience of surgically treated patients in the presence of angiographic VS.Materials and Methods:From 1990-2004, 894 consecutive patients presented with an aneurysmal subarachnoid hemorrhage (SAH) and were treated with a policy of early surgery. We retrospectively analyzed the patients that had pre-operative angiographic VS. In this study, symptomatic VS was diagnosed when a decreased level of consciousness and/or focal deficit occurred after SAH in the presence of angiographic VS without confounding factors. Functional outcome was assessed three months after SAH using the Glasgow Outcome Scale.Results:Of the 40 patients studied, 62.5% were in good clinical grade Hunt & Hess (H&H 1-2) on admission; 25%, intermediate grade (H&H 3); 12.5%, poor grade (H&H 4-5). Surgery was performed 24 hours or less after initial angiography in 87.5% of patients and less than 48 hours in 97.5%. Pre-operative symptomatic VS was diagnosed in 25%. Postoperatively, angiographic VS was documented in 87.2%. Of the 30% of patients that presented post-operative symptomatic VS, 66.7% also demonstrated pre-operative symptomatic VS. The functional outcome was favorable in 92.5% of the studied patients. Two deaths occurred in patients presenting pre-operative early radiological and symptomatic VS.Conclusion:Aneurysmal surgery, especially between 3-12 days following SAH, in the presence of asymptomatic pre-operative angiographic VS can be associated with a good outcome. Early surgery is not contra-indicated and might enable optimal treatment of VS.

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Basile, Luca, Víctor Guadalupe-Fernández, Manuel Valdivia Guijarro, Ana Martinez Mateo, Pilar Ciruela Navas, and Jacobo Mendioroz Peña. "Diagnostic Performance of Ag-RDTs and NAAT for SARS-CoV2 Identification in Symptomatic Patients in Catalonia." Viruses 13, no. 5 (May 14, 2021): 908. http://dx.doi.org/10.3390/v13050908.

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The use of rapid antigenic tests (Ag-RDTs) to diagnose a SARS-CoV-2 infection has become a common practice recently. This study aimed to evaluate performance of Abbott PanbioTM Ag-RDTs with regard to nucleic acid amplification testing (NAAT) in the early stages of the disease. A cohort of 149,026 infected symptomatic patients, reported in Catalonia from November 2020 to January 2021, was selected. The positivity rates of the two tests were compared with respect to the dates of symptom onset. Ag-RDTs presented positivity rates of 84% in the transmission phases of the disease and 31% in the pre-symptomatic period, compared to 93% and 91%, respectively, for NAAT. The detection of many false negatives with Ag-RDTs during the pre-symptomatic period demonstrates the risk of virus dissemination with this diagnostic technique if used outside the symptomatic period.

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Joshi, Pravin, Narayan Belbase, Rohit Kumar Mishra, Mukesh Karki, and Lalit Kumar Das. "Clinicodemographic Profile and Outcome of Patients with Symptomatic Meckel's Diverticulum: Preliminary Findings." Journal of College of Medical Sciences-Nepal 16, no. 1 (March 31, 2020): 37–40. http://dx.doi.org/10.3126/jcmsn.v16i1.26769.

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Background: Meckel's diverticulum is the commonest gastrointestinal congenital anomaly. Though most of the cases do not present clinically, they are challenging to diagnose if become symptomatic. Spectrum of clinical presentation may be different from umbilical fistula, omphalomesenteric cyst to fibrous band from diverticulum to umbilicus. Bleeding, obstruction and infection are the most common complications. Vast majority of them are detected only intra-operatively. Methods: We analyzed our patients who were intra-operatively diagnosed as symptomatic Meckel's Diverticulum. Socio-demographic profile and immediate outcome of operated patients was analyzed from patient's records. Results: Total 9 patients were operated for symptomatic Diverticulitis. All patients were diagnosed intraoperatively. Intestinal obstruction was the commonest presentation. Diverticulectomy was the most common procedure performed followed by wedge resection and segmental bowel resection. Conclusions: Symptomatic Meckel’s Diverticulum is difficult to diagnose pre-operatively. Vast majority of them are found only intra-operatively. Most of the patients do well after resection of Meckel's Diverticulum. Keywords: Meckel’s diverticulum; surgery; symptoms.

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Schneider, R., P. McKeever, T. Kim, C. Graff, J. van Swieten, A. Karydas, A. Boxer, et al. "P.002 Exosomal miR-204-5 and miR-632 in CSF are candidate biomarkers for frontotemporal dementia: a GENFI study." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (June 2018): S16. http://dx.doi.org/10.1017/cjn.2018.104.

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Background: To determine whether exosomal microRNAs (miRNAs) in CSF of patients with FTD can serve as diagnostic biomarkers, we assessed miRNA expression in the Genetic FTD Initiative (GENFI) cohort and in sporadic FTD. Methods: GENFI participants were either carriers of a pathogenic mutation or at risk of carrying a mutation because a first-degree relative was a symptomatic mutation carrier. Exosomes were isolated from CSF of 23 -pre-symptomatic and 15 symptomatic mutation carriers, and 11 healthy non-mutation carriers. Expression of miRNAs was measured using qPCR arrays. MiRNAs differentially expressed in symptomatic compared to pre-symptomatic mutation carriers were evaluated in 17 patients with sporadic FTD, 13 patients with sporadic Alzheimer’s disease (AD), and 10 healthy controls (HCs). Results: In the GENFI cohort, miR-204-5p and miR-632 were significantly decreased in symptomatic compared to pre-symptomatic mutation carriers. Decrease of miR-204-5p and miR-632 revealed receiver operator characteristics with an area of 0.89 [90% CI: 0.79-0.98] and 0.81 [90% CI: 0.68-0.93], and when combined an area of 0.93 [90% CI: 0.87-0.99]. In sporadic FTD, only miR-632 was significantly decreased compared to sporadic AD and HCs. Decrease of miR-632 revealed an area of 0.89 [90% CI: 0.80-0.98]. Conclusions: Exosomal miR-204-5p and miR-632 have potential as diagnostic biomarkers for genetic FTD and miR-632 also for sporadic FTD.

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Christodoulou, Christiana C., Margarita Zachariou, Marios Tomazou, Evangelos Karatzas, Christiana A. Demetriou, Eleni Zamba-Papanicolaou, and George M. Spyrou. "Investigating the Transition of Pre-Symptomatic to Symptomatic Huntington’s Disease Status Based on Omics Data." International Journal of Molecular Sciences 21, no. 19 (October 8, 2020): 7414. http://dx.doi.org/10.3390/ijms21197414.

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Huntington’s disease is a rare neurodegenerative disease caused by a cytosine–adenine–guanine (CAG) trinucleotide expansion in the Huntingtin (HTT) gene. Although Huntington’s disease (HD) is well studied, the pathophysiological mechanisms, genes and metabolites involved in HD remain poorly understood. Systems bioinformatics can reveal synergistic relationships among different omics levels and enables the integration of biological data. It allows for the overall understanding of biological mechanisms, pathways, genes and metabolites involved in HD. The purpose of this study was to identify the differentially expressed genes (DEGs), pathways and metabolites as well as observe how these biological terms differ between the pre-symptomatic and symptomatic HD stages. A publicly available dataset from the Gene Expression Omnibus (GEO) was analyzed to obtain the DEGs for each HD stage, and gene co-expression networks were obtained for each HD stage. Network rewiring, highlights the nodes that change most their connectivity with their neighbors and infers their possible implication in the transition between different states. The CACNA1I gene was the mostly highly rewired node among pre-symptomatic and symptomatic HD network. Furthermore, we identified AF198444 to be common between the rewired genes and DEGs of symptomatic HD. CNTN6, DEK, LTN1, MST4, ZFYVE16, CEP135, DCAKD, MAP4K3, NUPL1 and RBM15 between the DEGs of pre-symptomatic and DEGs of symptomatic HD and CACNA1I, DNAJB14, EPS8L3, HSDL2, SNRPD3, SOX12, ACLY, ATF2, BAG5, ERBB4, FOCAD, GRAMD1C, LIN7C, MIR22, MTHFR, NABP1, NRG2, OTC, PRAMEF12, SLC30A10, STAG2 and Y16709 between the rewired genes and DEGs of pre-symptomatic HD. The proteins encoded by these genes are involved in various biological pathways such as phosphatidylinositol-4,5-bisphosphate 3-kinase activity, cAMP response element-binding protein binding, protein tyrosine kinase activity, voltage-gated calcium channel activity, ubiquitin protein ligase activity, adenosine triphosphate (ATP) binding, and protein serine/threonine kinase. Additionally, prominent molecular pathways for each HD stage were then obtained, and metabolites related to each pathway for both disease stages were identified. The transforming growth factor beta (TGF-β) signaling (pre-symptomatic and symptomatic stages of the disease), calcium (Ca2+) signaling (pre-symptomatic), dopaminergic synapse pathway (symptomatic HD patients) and Hippo signaling (pre-symptomatic) pathways were identified. The in silico metabolites we identified include Ca2+, inositol 1,4,5-trisphosphate, sphingosine 1-phosphate, dopamine, homovanillate and L-tyrosine. The genes, pathways and metabolites identified for each HD stage can provide a better understanding of the mechanisms that become altered in each disease stage. Our results can guide the development of therapies that may target the altered genes and metabolites of the perturbed pathways, leading to an improvement in clinical symptoms and hopefully a delay in the age of onset.

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Salter, Matthew, Ryan Powell, Jennifer Back, Francis Grand, Christina Koutsothanasi, Jayne Green, Ewan Hunter, Aroul Ramadass, Jurjen Westra, and Alexandre Akoulitchev. "Genomic architecture differences at the HTT locus associated with symptomatic and pre-symptomatic cases of Huntington’s disease in a pilot study." F1000Research 7 (May 13, 2019): 1757. http://dx.doi.org/10.12688/f1000research.15828.3.

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Background:Huntington’s disease (HD) is a progressive neurodegenerative condition that causes degeneration of neurons in the brain, ultimately leading to death. The root cause of HD is an expanded trinucleotide cytosine-adenine-guanine (CAG) repeat in the “huntingtin gene” (HTT). While there is a rough correlation between the number of CAG repeats and disease onset, the development of clinical symptoms can vary by decades within individuals and little is known about this pre-symptomatic phase.Methods:Using peripheral blood samples from HD patients and healthy controls we usedEpiSwitch™, a validated high-resolution industrial platform for the detection of chromosome conformations, to assess chromatin architecture in the immediate vicinity of theHTTgene. We evaluated chromatin conformations at 20 sites across 225 kb of theHTTlocus in a small cohort of healthy controls, verified symptomatic HD patients (CAG, n>39) and patients with CAG expansions who had not yet manifested clinical symptoms of HD.Results:Discrete chromosome conformations were observed across the patient groups. We found two constitutive interactions (occurring in all patient groups) and seven conditional interactions which were present in HD, but not in healthy controls. Most important, we observed three conditional interactions that were present only in HD patients manifesting clinical symptoms (symptomatic cases), but not in presymptomatic cases. Of the patients in the symptomatic HD cohort, 86% (6 out of 7) demonstrated at least one of the specific chromosome conformations associated with symptomatic HD.Conclusion:Our results provide the first evidence that chromatin architecture at theHTTlocus is systemically altered in patients with HD, with conditional differences between clinical stages. Given the high clinical need in having a molecular tool to assess disease progression in HD, these results strongly suggest that the non-invasive assessment of chromosome conformation signatures warrant further study as a prognostic tool in HD.

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Hong, Lu-Xiao, Aifen Lin, Ze-Bao He, Hai-Hong Zhao, Jian-Gang Zhang, Chao Zhang, Ling-Jun Ying, et al. "Mask wearing in pre-symptomatic patients prevents SARS-CoV-2 transmission: An epidemiological analysis." Travel Medicine and Infectious Disease 36 (July 2020): 101803. http://dx.doi.org/10.1016/j.tmaid.2020.101803.

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Gündüz, Ayten, Gamze Türkoğlu, and Yusuf Yakupoğulları. "Symptomatic Reinfections in COVID-19 Patients: A Retrospective Study in the Pre-Vaccination Period." Journal of Molecular Virology and Immunology 2, no. 3 (August 25, 2021): 107–14. http://dx.doi.org/10.46683/jmvi.2021.37.

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Dumont, Claire, Elena Galli, Emmanuel Oger, Maxime Fournet, Erwan Flecher, Christophe Leclercq, Jean-Philippe Verhoye, and Erwan Donal. "Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: importance of pre-operative tricuspid annulus diameter." European Heart Journal - Cardiovascular Imaging 19, no. 3 (March 7, 2017): 319–28. http://dx.doi.org/10.1093/ehjci/jex031.

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Lu, Po-Haong, Grace J. Lee, Paul M. Thompson, Luis Medina, Alex Leow, Giovanni Coppola, Jeffrey L. Cummings, and John M. Ringman. "P2-381: A tensor-based morphometry study of brain volume changes in symptomatic and pre-symptomatic patients with familial Alzheimer's disease." Alzheimer's & Dementia 6 (July 2010): S428. http://dx.doi.org/10.1016/j.jalz.2010.05.1433.

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Watson, G. J., S. Glover, S. Allen, and R. M. Irving. "Outcome of facial physiotherapy in patients with prolonged idiopathic facial palsy." Journal of Laryngology & Otology 129, no. 4 (March 18, 2015): 348–52. http://dx.doi.org/10.1017/s0022215115000675.

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AbstractObjective:This study investigated whether patients who remain symptomatic more than a year following idiopathic facial paralysis gain benefit from tailored facial physiotherapy.Methods:A two-year retrospective review was conducted of all symptomatic patients. Data collected included: age, gender, duration of symptoms, Sunnybrook facial grading system scores pre-treatment and at last visit, and duration of treatment.Results:The study comprised 22 patients (with a mean age of 50.5 years (range, 22–75 years)) who had been symptomatic for more than a year following idiopathic facial paralysis. The mean duration of symptoms was 45 months (range, 12–240 months). The mean duration of follow up was 10.4 months (range, 2–36 months). Prior to treatment, the mean Sunnybrook facial grading system score was 59 (standard deviation = 3.5); this had increased to 83 (standard deviation = 2.7) at the last visit, with an average improvement in score of 23 (standard deviation = 2.9). This increase was significant (p < 0.001).Conclusion:Tailored facial therapy can improve facial grading scores in patients who remain symptomatic for prolonged periods.

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Smathers, Sarah, Regan Deming, Lauren Le Goff, David Lenar, Cheryl Gebeline-myers, Jeanette Trella, Susan E. Coffin, Susan E. Coffin, and Julia S. Sammons. "487. Patient Outcomes of Contact Tracing for COVID-19 in a Pediatric Hospital." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S309—S310. http://dx.doi.org/10.1093/ofid/ofaa439.680.

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Abstract Background Contact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system. Methods Exposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms. Results From March 2020 – present, we identified 38 EPE that involved 10 employees; 26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking. Conclusion We describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps. Disclosures All Authors: No reported disclosures

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Dzieżyc, K., M. Karliński, T. Litwin, and A. Członkowska. "Compliant treatment with anti-copper agents prevents clinically overt Wilson's disease in pre-symptomatic patients." European Journal of Neurology 21, no. 2 (December 7, 2013): 332–37. http://dx.doi.org/10.1111/ene.12320.

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Schuchert, Andreas, Carmine Muto, Themistoklis Maounis, Rita Omega Ella, Alexander Polauck, and Luigi Padeletti. "Relationship between pre-implant ejection fraction and outcome after cardiac resynchronization therapy in symptomatic patients." Acta Cardiologica 69, no. 4 (August 2014): 424–32. http://dx.doi.org/10.1080/ac.69.4.3036659.

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San, Luis, Antonio Ciudad, Enrique Álvarez, Julio Bobes, and Inmaculada Gilaberte. "Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: Prevalence and associations in a cross-sectional study." European Psychiatry 22, no. 8 (November 2007): 490–98. http://dx.doi.org/10.1016/j.eurpsy.2007.06.005.

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AbstractPurposeProgress in therapeutic options for schizophrenia has revived long-term expectations of researchers, practitioners and patients. At present, definitions of therapeutic outcome include both maintained symptomatic remission and appropriate functioning in a conceptual framework that targets patient's recovery as the ultimate goal. We aimed to know the prevalence and clinical features of patients with schizophrenia achieving these outcomes.MethodsA multi-centre, cross-sectional study was performed in more than 100 mental health facilities within Spain. Recently published consensus-based operational criteria for symptomatic remission and the Global Assessment of Functioning scale were used to evaluate outcomes. Other clinical aspects like depressive symptoms, social cognition, premorbid adjustment and patients' attitudes to medication were also evaluated.ResultsData from 1010 patients were analysed. Of these, 452 (44.8%) were at clinical remission, but only 103 (10.2%) showed an adequate social and/or vocational functioning. Factors predicting both outcomes were better pre-morbid adjustment (odds ratio, OR = 1.56) and better social cognitive function (OR = 1.14). Other factors, like treatment adherence, current or past psychotherapy and patient's age were not associated to functionality but only to clinical remission. Current substance use and previous rehabilitation were associated to a lower likelihood of symptomatic remission.ConclusionAlthough symptomatic remission in patients with schizophrenia is a realistic and reachable goal, future efforts should be directed to a sustained appropriate functioning in these patients.

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Nara, Yugo, Akihisa Kataoka, Yusuke Watanabe, Nakashima Makoto, Hirofumi Hioki, Hideyuki Kawashima, Nagura Fukuko, et al. "Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis." Open Heart 6, no. 1 (May 2019): e000988. http://dx.doi.org/10.1136/openhrt-2018-000988.

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ObjectiveThe effect of postoperative blood flow status on the prognosis of patients with low-gradient severe aortic stenosis (AS) has not been examined. Severe AS is associated with a higher mortality rate after transcatheter aortic valve implantation (TAVI). We examined the prognostic value of low-flow status by comparing stroke volume indices (SVi) before and after TAVI in patients with symptomatic, low-gradient severe AS.MethodsA total of 1613 patients with severe symptomatic AS who underwent TAVI in 14 Japanese institutes for low-gradient severe AS (418 patients, median age 84 years, 32.5% men) were prospectively enrolled. The primary endpoint was cardiovascular mortality during follow-up after TAVI, and independent predictors were evaluated. Receiver operating characteristic curves were generated to determine the optimal cut-off value of post-TAVI SVi for predicting cardiovascular mortality, and the receiver operating characteristic curves of pre-TAVI and post-TAVI SVi were compared.ResultsThe cardiovascular mortality rate was 4.1% (17 patients) during follow-up (median 9.2 months). Multivariate analysis revealed post-TAVI SVi to be an independent predictor of cardiovascular mortality (per 10 mL/m2 decrease; HR, 2.0; 95% CI 1.28 to 3.12). The optimal cut-off value of post-TAVI SVi was 41.4 mL/m2. Post-TAVI SVi showed significantly larger area under the curve than pre-TAVI SVi (0.74 (95% CI 0.69 to 0.79) vs 0.61 (95% CI 0.56 to 0.65), p<0.05).ConclusionsPost-TAVI SVi is a better predictor of cardiovascular mortality than pre-TAVI SVi in patients with symptomatic low-gradient severe AS. Low-flow and low-normal-flow status (35≤ SVi <40 mL/m2) require careful management after TAVI.

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FREITAS, F. T. M., A. P. S. CABRAL, E. N. C. BARROS, M. J. O. BURIGO, R. D. PROCHNOW, L. A. SILVA, M. A. WIDDOWSON, and J. SOBEL. "Pre-symptomatic transmission of pandemic influenza H1N1 2009: investigation of a family cluster, Brazil." Epidemiology and Infection 141, no. 4 (July 16, 2012): 763–66. http://dx.doi.org/10.1017/s0950268812001501.

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SUMMARYWe investigated the first cluster of pandemic influenza H1N1 2009 reported in Brazil in May 2009. The index case-patient had travelled from the USA and had contact with 11 relatives before she presented with symptoms. We conducted face-to-face or telephone interviews with the index case-patient and all suspect cases. We found evidence of pre-symptomatic transmission of the virus to four of her contacts. This finding has public health implications because it indicates that viral transmission in communities may not be prevented solely by isolating symptomatic case-patients.

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Burns, P., and C. Timon. "Thyroid pathology and the globus symptom: are they related? A two year prospective trial." Journal of Laryngology & Otology 121, no. 3 (August 2, 2006): 242–45. http://dx.doi.org/10.1017/s0022215106002465.

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Introduction: The globus sensation is a constant feeling of a lump in the throat and may be associated with thyroid enlargement. A two year prospective study was set up to ascertain the relationship between thyroid pathology and globus symptoms.Materials and methods: All patients undergoing thyroid surgery over a two year period were included. Patients were questioned pre- and post-operatively. Globus symptom scores were recorded using a visual analogue scale. The size, weight and histological features of the removed specimens were correlated and statistical analysis performed.Results: Two hundred patients were included in the study; 58 were symptomatic for globus pharyngeus pre-operatively, and 80 per cent of these patients' symptoms resolved post-operatively (p≤0.0001). Patients with histological features of inflammation showed the greatest improvement (p≤0.0001).Conclusion: As many as one-third of patients with a thyroid mass will complain of a globus-like symptom. Patients undergoing thyroid surgery, who are symptomatic for globus pharyngeus, can expect that their symptoms will improve following surgery.

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Dwarakanath, Akshay, Vinod Palissery, and Mark W. Elliott. "Prevalence of and treatment outcomes for patients with obstructive sleep apnoea identified by preoperative screening compared with clinician referrals." European Respiratory Journal 48, no. 1 (March 30, 2016): 151–57. http://dx.doi.org/10.1183/13993003.01503-2015.

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Obstructive sleep apnoea (OSA) has implications perioperatively. We compared the prevalence of OSA and outcome with continuous positive airway pressure (CPAP) in patients diagnosed through preoperative screening and following referrals from other clinicians.Among 1412 patients (62% males) the prevalence of OSA, Epworth Sleepiness Score (ESS), the number referred for CPAP, and short and longer term use of CPAP were compared between the two groups.The prevalence of OSA was similar (62%versus58%). There were differences in mean±sdage (61±16versus55±13 years; p<0.0001), ESS (11±6versus8±5; p<0.0001) and oxygen desaturation index (22±20versus19±17; p=0.039). Clinician-referred patients were more likely to be offered CPAP (p<0.0001; OR 2.84). Pre-assessment patients with mild OSA were less likely to continue CPAP long term (p=0.002; OR 6.8). No difference was seen between moderate and severe OSA patients.The prevalence of OSA was similar in both groups but pre-assessment patients were younger and less symptomatic. Preoperative screening of patients is worthwhile, independent of any effect of CPAP upon surgical outcomes; younger and less symptomatic patients are identified earlier. Pre-assessment patients with mild OSA were less likely to use CPAP; this should be considered when offering CPAP to these patients prior to surgery.

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Ney, Barbara, Stefano Lanzi, Luca Calanca, and Lucia Mazzolai. "Multimodal Supervised Exercise Training is Effective in Improving Long Term Walking Performance in Patients with Symptomatic Lower Extremity Peripheral Artery Disease." Journal of Clinical Medicine 10, no. 10 (May 11, 2021): 2057. http://dx.doi.org/10.3390/jcm10102057.

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This study aimed to evaluate the effect of a multimodal supervised exercise training (SET) program on walking performance for 12 months in patients with symptomatic lower extremity peripheral artery disease (PAD). Consecutive patients with Fontaine stage II PAD participating in the SET program of our hospital were retrospectively investigated. Walking performance, assessed using a treadmill with measures of the pain-free and maximal walking distance (PFWD, MWD, respectively), and 6 min walking distance (6MWD), were tested before and following SET, as well as at 6 and 12 months after SET completion. Ninety-three symptomatic patients with PAD (65.0 ± 1.1 y) were included in the study. Following SET, the walking performance significantly improved (PFWD: +145%, p ≤ 0.001; MWD: +97%, p ≤ 0.001; 6MWD: +15%, p ≤ 0.001). At 6 months, PFWD (+257%, p ≤ 0.001), MWD (+132%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-SET condition. At 12 months, PFWD (+272%, p ≤ 0.001), MWD (+130%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-training condition. The walking performance remained significantly improved in both women and men for up to 12 months (p ≤ 0.001). Multimodal SET is effective at improving walking performance in symptomatic patients with PAD, with improvements lasting up to 12 months.

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Wolters, Emma E., Janne M. Papma, Sander C. J. Verfaillie, Denise Visser, Emma Weltings, Colin Groot, Emma L. van der Ende, et al. "[18F]Flortaucipir PET Across Various MAPT Mutations in Presymptomatic and Symptomatic Carriers." Neurology 97, no. 10 (July 1, 2021): e1017-e1030. http://dx.doi.org/10.1212/wnl.0000000000012448.

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ObjectiveTo assess the [18F]flortaucipir binding distribution across MAPT mutations in presymptomatic and symptomatic carriers.MethodsWe compared regional [18F]flortaucipir binding potential (BPND) derived from a 130-minute dynamic [18F]flortaucipir PET scan in 9 (pre)symptomatic MAPT mutation carriers (4 with P301L [1 symptomatic], 2 with R406W [1 symptomatic], 1 presymptomatic L315R, 1 presymptomatic S320F, and 1 symptomatic G272V carrier) with 30 cognitively normal controls and 52 patients with Alzheimer disease.Results[18F]Flortaucipir BPND images showed overall highest binding in the symptomatic carriers. This was most pronounced in the symptomatic R406W carrier in whom tau binding exceeded the normal control range in the anterior cingulate cortex, insula, amygdala, temporal, parietal, and frontal lobe. Elevated medial temporal lobe BPND was observed in a presymptomatic R406W carrier. The single symptomatic carrier and 1 of the 3 presymptomatic P301L carriers showed elevated [18F]flortaucipir BPND in the insula, parietal, and frontal lobe compared to controls. The symptomatic G272V carrier exhibited a widespread elevated cortical BPND, with at neuropathologic examination a combination of 3R pathology and encephalitis. The L315R presymptomatic mutation carrier showed higher frontal BPND compared to controls. The BPND values of the S320F presymptomatic mutation carrier fell within the range of controls.ConclusionPresymptomatic MAPT mutation carriers already showed subtle elevated tau binding, whereas symptomatic MAPT mutation carriers showed a more marked increase in [18F]flortaucipir BPND. Tau deposition was most pronounced in R406W MAPT (pre)symptomatic mutation carriers, which is associated with both 3R and 4R tau accumulation. Thus, [18F]flortaucipir may serve as an early biomarker for MAPT mutation carriers in mutations that cause 3R/4R tauopathies.

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Ceesay, M. Mansour, Sujal R. Desai, Joanna Cleverley, Lisa Berry, Melvyn Smith, Jim Wade, Ghulam J. Mufti, and Antonio Pagliuca. "Pre-symptomatic (Baseline) computed tomography predicts invasive pulmonary aspergillosis in high-risk adult haemato-oncology patients." British Journal of Haematology 182, no. 5 (July 24, 2017): 723–27. http://dx.doi.org/10.1111/bjh.14858.

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Wellens, Hein J. J., Pedro Brugada MD, and Joep LRM Smeets. "MANAGEMENT OF PATIENTS WITH PRE-EXCITATION. VALUE OF ELECTROPHYSIOLOGICAL STUDY IN THE SYMPTOMATIC AND ASYMPTOMATIC PATIENT." Pacing and Clinical Electrophysiology 12, no. 7 (July 1989): 1270. http://dx.doi.org/10.1111/j.1540-8159.1989.tb01986.x.

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Kivity, Yogev, Kenneth N. Levy, Stéphane Kolly, and Ueli Kramer. "The Therapeutic Alliance Over 10 Sessions of Therapy for Borderline Personality Disorder: Agreement and Congruence Analysis and Relation to Outcome." Journal of Personality Disorders 34, no. 1 (February 2020): 1–21. http://dx.doi.org/10.1521/pedi_2019_33_376.

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The authors examined whether alliance dynamics are affected by tailoring the therapeutic relationship to the individual patient in brief psychotherapy of borderline personality disorder. Sixty patients were randomized to 10-session Good Psychiatric Management (GPM-BV) or GPM combined with Motive-Oriented Therapeutic Relationship techniques (MOTR+GPM-BV). Patient- and therapist-rated alliance was assessed weekly. Self-reported symptomatic distress was assessed pre-, mid-, and posttreatment. In MOTR+GPM-BV, stronger therapist-rated alliance predicted lower symptomatic distress in the same timepoint, but not in a lag, whereas symptomatic distress predicted therapist-rated alliance in a lag. Therapist-rated alliance was lower than patient-rated alliance in GPM-BV but not in MOTR+GPM-BV. In MOTR+GPM-BV, higher agreement on strong alliance tended to predict lower symptomatic distress. Patient- and therapist-rated alliances were temporally congruent, but congruence did not predict outcome. Addressing the relationship needs of patients may partly exert its salutary effect by increasing agreement between patients' and therapists' experience of the alliance.

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Rosenthal, D. I., T. Mendoza, and C. Cleeland. "Identifying head and neck cancer patients at risk for high symptom burden during treatment." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6066. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6066.

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6066 Background: Treatment for head and neck cancer (HNC) is well known to be associated with high levels of toxicity and symptom burden, but patients vary in the severity of treatment related symptom burden. The pre-treatment identification of patient characteristics most at risk for high treatment related symptom levels would be helpful for clinical and trial symptom intervention planning. Methods: 134 patients with HNC participated in the study. Patients completed the M. D. Anderson Symptom Assessment Inventory - Head and Neck module (MDASI-HN) prior to radiotherapy (RT) or chemoradiotherapy (CRT) and again six weeks after treatment began. Cluster analysis was used to identify those who were highly symptomatic due to their disease prior to treatment and those who became highly symptomatic due to treatment. We used validated MDASI-HN score ranges to define symptom severity with scores 5–6 defined as ‘moderate‘ and 7 or more as ‘severe.’ Logistic regression was used to determine which baseline symptoms may predict group membership of highly symptomatic patients at the end of therapy. Results: 18% (22/120) of HNC patients were symptomatic prior to therapy. This subset of patients reported moderate levels of pain, fatigue, sleep disturbance, feeling sad and emotional distress. At six weeks after beginning treatment, 59% (73/124) of patients were highly symptomatic. The cluster of symptoms at this point included moderate levels of pain, fatigue, nausea, mouth sores and excessive mucus and severe levels of poor appetite, dry mouth, difficulty chewing and loss of taste for food. Approximately 54% (50/92) of patients who were not symptomatic at the beginning of treatment became symptomatic at the end of treatment. Patients with moderate to severe pain before beginning treatment are 4 times more likely to be severely symptomatic at the end of treatment (p < 0.009). Conclusions: As expected, only a minority of patients with HNC were highly symptomatic prior to therapy, while the majority of patients had high levels of symptoms toward the end of therapy. Patients with moderate to severe pain before beginning treatment are more likely to be have greater symptom burden at the end of treatment, so may benefit from more intensive symptom interventions. No significant financial relationships to disclose.

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McKean, David, Siok Li Chung, Rebecca te Water Naudé, Bernard McElroy, Jonathan Baxter, Aniruddha Pendse, Joseph Papanikitas, James Teh, and Richard Hughes. "Elasticity of the coracohumeral ligament in patients with frozen shoulder following rotator interval injection: a case series." Journal of Ultrasonography 20, no. 83 (December 18, 2020): 300–306. http://dx.doi.org/10.15557/jou.2020.0052.

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Aim of the study: To evaluate changes in the elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder treated with ultrasound-guided rotator interval injections. Methods: Shear wave elastography was used to evaluate elasticity of the coracohumeral ligament in symptomatic and asymptomatic shoulders in the shoulder-neutral position and 30° external rotation. A total of 24 shoulders were assessed. Symptomatic shoulders were treated with targeted steroid injection via the rotator interval and manipulation under local anaesthetic block. Follow-up assessment of the elasticity of the coracohumeral ligament was obtained at 10 weeks post-injection. Results: In all subjects, the coracohumeral ligament elastic modulus was larger at 30° external rotation than in the neutral position. In patients with adhesive capsulitis, the coracohumeral ligament thickness and elastic modulus was significantly greater in the symptomatic shoulder in the neutral position and 30° ER. Treated patients had an excellent response with improved Oxford Shoulder Score and reduced visual analogue scale pain scores. Median Oxford Shoulder Score was 13.5 pre-injection and 34 at 10 weeks postinjection. Median visual analogue scale pain scores measured 8.5 pre-injection, 3.5 at 1 day, 2 at 1 week, and 2.5 at 10 weeks. Improved Oxford Shoulder Score and visual analogue scale pain score was associated with a trend to normalisation of the elastic modus of the coracohumeral ligament. Conclusion: In patients with adhesive capsulitis of the shoulder, shear wave elastography demonstrated the coracohumeral ligament is stiffer in the symptomatic shoulder than in the unaffected shoulder. Treatment with the ultrasound-guided rotator interval injection is associated with improved Oxford Shoulder Score, reduced visual analogue scale pain scores, and reduced stiffness in the coracohumeral ligament.

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Hofer, A., T. Bodner, A. Kaufmann, G. Kemmler, U. Mattarei, N. M. Pfaffenberger, M. A. Rettenbacher, E. Trebo, N. Yalcin, and W. W. Fleischhacker. "Symptomatic remission and neurocognitive functioning in patients with schizophrenia." Psychological Medicine 41, no. 10 (March 22, 2011): 2131–39. http://dx.doi.org/10.1017/s0033291711000353.

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BackgroundA cross-sectional study was conducted in participants with schizophrenia to explore a potential association between the patients' remission status and neurocognitive functioning and to examine whether these factors have an impact on functional outcome.MethodPsychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale with symptom remission being assessed by applying the severity component of the recently proposed remission criteria. Tests for the cognitive battery were selected to cover domains known to be impaired in patients with schizophrenia. Next to pre-morbid intelligence, attention performance, executive functioning, verbal fluency, verbal learning and memory, working memory and visual memory were assessed. The joint effect of remission status and neurocognitive functioning on treatment outcome was investigated by logistic regression analysis.ResultsOut of 140 patients included in the study, 62 were symptomatically remitted. Mean age, education and sex distribution were comparable in remitted and non-remitted patients. Remitted patients showed significantly higher values on tests of verbal fluency, alertness and optical vigilance. Both symptomatic remission as well as performance on tests of working memory and verbal memory had a significant effect on the patients' employment status.ConclusionsIn the present study neuropsychological measures of frontal lobe functioning were associated with symptomatic remission from schizophrenia. In addition, both symptomatic remission and performance on tests of working memory and verbal memory had a significant effect on the patients' employment status. Longitudinal follow-up data are needed to determine how the associations of these determinants of functional outcome interact and change over time.

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Zama, Ivan N., and Millicent Edgar. "Management of Symptomatic Ascites in Hospice Patients With Paracentesis." American Journal of Hospice and Palliative Medicine® 29, no. 5 (October 13, 2011): 405–8. http://dx.doi.org/10.1177/1049909111420130.

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Refractory ascites causes significant distress to patients and can be managed in various ways. In hospice patients where the goal of care is to preserve comfort and foster better quality of life, diuretics should be tried first; however, in resistant cases, home-based paracentesis should be entertained. Home-based paracentesis is a safe and simple procedure that can be done blindly, if done under standard precautions there is minimal associated risk of bleeding, infection or perforation and no need for pre or post-laboratory testing or the correction of high international normalization ratio or thrombocytopenia. Home-based paracentesis is cost effective, provides immediate symptomatic relief, good patient and caregiver satisfaction and obviates the associated distress to the patient and family of transporting the patient for either outpatient or inpatient paracentesis.

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Shahid, Zainab, Emily Baldrige, Sally Trufan, Courtney Schepel, Antoinette R. Tan, Jimmy J. Hwang, Laura W. Musselwhite, et al. "Upper respiratory tract SARS-CoV-2 viral shedding in cancer patients." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18776-e18776. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18776.

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e18776 Background: SARS-CoV-2 virus has been shown to persist in respiratory tract in immunocompromised patients. However, such data are lacking for both asymptomatic and symptomatic SARS-CoV-2 infection in cancer patients. We share our single center experience on duration of SARS-CoV-2 viral presence in the upper respiratory tract of cancer patients with SARS-CoV-2 infection (asymptomatic and symptomatic) detected by viral PCR. Methods: This is retrospective review of cancer patients with documented SARS-CoV-2 infection and measurement of viral shedding at Levine Cancer Institute. Testing indications were COVID-19 symptomatic illness, pre-procedural and pre-chemo testing. Prolonged shedding was defined as presence of viral RNA beyond 30 days after first positive test. To document viral clearance, patients required 2 negative SARS-CoV-2 PCR test separated by at least 24 hours and maximum 3 weeks apart either by nasopharyngeal or nasal PCR swab. Differences in distributions were identified between patients shedding virus more than 30 days and less than 30 days using uni- and multivariable logistic regression models. Statistical significance was set at p < 0.10 to enter the multivariable model, and p < 0.05 to remain. Results: Demographic data: median age 62 (range 20-93); 58.5% females; 70% White, 21% Black, and 7.4% Hispanics. Comorbidities included hypertension 43.2%, diabetes 16.7% and chronic lung disease 3.7%. Underlying malignancies were breast cancer 25%, hematologic cancer 22%, lung cancer 16% and genitourinary 11%. Chemotherapy was received by 26.5% patients within 4 weeks prior to testing. 162 patients were identified median duration of 18 days (range 4-90 days). Of these, 76% patients were tested for non-symptomatic indication with median duration of shedding 17 days (range 6-80) and 23% were tested for clinical symptoms with median duration of shedding 29 days (range 4-90) (p = < 0.001); 50% of patients never developed symptoms, whereas 35% patients with non-symptomatic testing indication, subsequently developed symptoms. Viral clearance by day 30, day 45, day 60 and day 90 was 78%, 93%, 97% and 100% respectively. Univariate analysis did not show difference between patients with prolonged shedding vs those shedding less than 30 days for age, gender, race, ethnicity, underlying malignancy, co-morbidities including body mass index, diabetes, chronic lung conditions, hypertension, or receipt of cytotoxic chemo. Multivariable analysis showed that presence of symptoms at any point during SARS-CoV-2 infection (OR 5.9, 95% CI 2.4-14.5, p < 0.001) was associated with prolonged shedding. Conclusions: Symptomatic SARS-CoV-2 infection is associated with prolonged viral shedding in cancer patients. Cancer patients can have asymptomatic SARS-CoV-2 infection. More studies are warranted to understand viral kinetics and its clinical implications in cancer patients.

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Cusumano, Jaclyn A., Matthew Hermenau, Melissa Gaitanis, Michelle Travis, Kerry L. LaPlante, Timothy Y. Tran, and Kevin W. McConeghy. "Evaluation of post–flexible cystoscopy urinary tract infection rates." American Journal of Health-System Pharmacy 77, no. 22 (August 22, 2020): 1852–58. http://dx.doi.org/10.1093/ajhp/zxaa270.

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Abstract Purpose The risk of urinary tract infection (UTI) development after flexible cystoscopy (FC) is not well described. It remains difficult to assess the role of pre-FC antimicrobial prophylaxis to reduce UTI risk. Methods In fall 2017, the urology service at the Providence Veterans Affairs Medical Center implemented routine oral antimicrobial prophylaxis in its outpatient FC clinic. Outpatients were randomly selected for a retrospective chart review to compare patients who received pre-FC antimicrobials (cefuroxime 500 mg tablet or sulfamethoxazole/trimethoprim [800 mg/160 mg] tablet) and those who underwent FC prior to fall 2017 and did not receive prophylaxis. The primary outcome was presence of symptomatic UTI within 30 days post FC. Secondary outcomes included symptomatic UTI that met colony-forming unit (CFU)/mL guideline requirements, and UTI treatment received. Potential risk factors for UTI were also assessed. Results A total of 296 patients were included in the final analysis: 139 who did not receive and 157 who received a prophylactic antimicrobial before FC. Rates of symptomatic UTI, symptomatic UTI meeting CFU/mL guideline requirements, and postprocedure treatment for UTI were similar with and without antimicrobial prophylaxis (2.5% vs 2.2% [P > 0.99], 1.9% vs 1.4% [P > 0.99], and 2.5% vs 4.3% [P = 0.53], respectively). The mean number of days from FC to the start of UTI treatment was 7.9 (range, 1-18 days). Age over 65 years was the only risk factor present in all patients with a post-FC UTI, irrespective of antimicrobial prophylaxis. Conclusion The rate of post-FC symptomatic UTI was lower than rates previously described in the literature. The role of antimicrobial prophylaxis prior to FC warrants further exploration.

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Andaloro, C., I. La Mantia, V. Castro, and C. Grillo. "Comparison of nasal and olfactory functions between two surgical approaches for the treatment of concha bullosa: a randomised clinical trial." Journal of Laryngology & Otology 133, no. 10 (September 30, 2019): 913–17. http://dx.doi.org/10.1017/s0022215119001968.

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AbstractObjectiveConcha bullosa may be associated with paranasal sinus infections and nasal obstruction. Middle concha mucosa membranes have olfactory neurofibrils. This study investigated the impact of routinely used concha bullosa surgery techniques – crushing and lateral laminectomy – on nasal and olfactory functions.MethodsForty-three adult patients who had undergone surgery for a symptomatic concha bullosa completed the odour test, nasal obstruction visual analogue scale, 22-item Sino-Nasal Outcome Test, and peak nasal inspiratory flow test, pre-operatively and three months post-operatively. The pre- and post-operative results within and between the two treatment groups were compared.ResultsIntragroup comparison of mean pre- versus post-treatment changes revealed statistically significant findings for the nasal obstruction visual analogue scale, Sino-Nasal Outcome Test, peak nasal inspiratory flow and olfaction tests (all p < 0.05). However, there were no statistically significant changes when comparing the scores between the groups (intergroup comparison).ConclusionLateral laminectomy and crushing in concha bullosa surgery have no negative effects on olfactory function. Concha bullosa surgery provides positive outcomes regarding nasal complaints in symptomatic patients.

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Lyratzopoulos, Georgios. "Understanding variation in the timeliness of diagnosis of cancer in symptomatic patients." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 301. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.301.

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301 Background: Diagnosing cancer promptly in symptomatic patients is a priority for healthcare systems worldwide, but little is known about how initiatives can be targeted to patients at greater risk. Methods: UK data on the number of consultations with a family doctor before specialist referral (‘pre-referral consultations’); the time interval from presentation to referral (‘primary care interval’); and stage at diagnosis, were analysed using multivariable regression models. Results: Both patient experience (41,299 patients, 24 cancers) and clinical audit (13,031 patients, 18 cancers) data indicated wide variation in two correlated measures* of the difficulty of suspecting the diagnosis of cancer once the patient had presented to their family doctor. For example, >30% of patients with multiple myeloma, pancreatic and lung cancer experienced three or more pre-referral consultations; in contrast, this was true for <10% of patients with breast cancer and melanoma (p<0.001). Adjusting for diagnostic case-mix, younger and ethnic minority patients, and women, were more likely to experience three or more pre-referral consultations. Data from 88,657 patients (10 cancers) suggested socio-demographic disparities in stage at diagnosis for some only cancers: For patients with melanoma, breast and endometrial cancer, lower socioeconomic status was associated with higher risk of advanced stage at diagnosis and for, these three cancers, the same was true for older age. Conclusions: Different diagnostic intervals vary widely by cancer diagnosis and patient characteristics. Notable disparities in stage at diagnosis are apparent for ‘easy-to-suspect’ cancers (which are associated with minimal delay post-presentation), strongly implicating psychosocial patient factors as the source of these disparities. These findings can help to appropriately target early diagnosis policy initiatives and future research to patients at greater risk of prolonged diagnostic intervals. *Number of pre-referral consultations with a primary care physician and length of primary care interval (Spearman’s r=0.70).

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Marinho, Joana Catarina Lima, Sara Marote, Maria Cândida Silva, and Jose Ferraz Gonçalves. "Benefits of blood transfusions in palliative care patients with advanced cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e24090-e24090. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24090.

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e24090 Background: Anemia is highly prevalent in patients with advanced cancer and adversely affects quality of life. There is limited data on the frequency, clinical utility and effectiveness of red blood cell transfusions (RBC), and no randomized controlled trials or clinical practice guidelines on this subject are available. The aim of this study was to evaluate clinician practices on RBC transfusion in an oncologic palliative care unit (PCU), its impact on patients’ symptoms, overall survival and to identify predictive factors for survival. Methods: Retrospective cohort study of all advanced cancer patients who had received RBC transfusions over a 3-year period, after admission to the PCU for symptomatic control, as inpatients or outpatients. All had histologically confirmed malignant tumors and were not under anti-cancer treatments. Patients’demographics, clinical and laboratory features, symptoms and mortality were reviewed. Survival analysis was estimated using the Kaplan-Meier method and Cox's regression was used for multivariate analysis. Results: We identified 179 patients with a median age of 68 years [30-93], 60% were male, with a mean Charlson comorbidity index of 8.9 (SD ±2.3). The majority had gastrointestinal (42%) and genitourinary (35%) malignancies. A total of 435 RBC units, during 301 transfusion episodes were recorded. The majority (58%) were performed as inpatients. A combination of symptoms with low haemoglobin (Hb) levels was the main reason for transfusion (80%). Asthenia/fatigue was the most frequent symptom (68%). Prior to transfusion, the majority (73%) had an ECOG-performance status (ECOG-PS) greater than 2. The mean pretransfusion Hb was 6.9 g/dL and 48% patients had an Hb above 7 g/dL. Symptomatic benefit post-transfusion was achieved in 36% of patients. A statistically significant association between ECOG-PS and symptomatic benefit was found (p = 0.005). Median overall survival post-transfusion was 41 days (IC95% 30.6-51.4). On multivariate analysis, Hb level pre-transfusion, ECOG-PS and symptomatic benefit with transfusions were significantly associated with survival. Conclusions: Transfusion practices are more liberal in palliative care, increasing iatrogenic risk, while consuming a valuable and limited resource. However, transfusion does provide symptom relief, and should be offered to advanced cancer patients with a higher level of functioning. Post-transfusion symptomatic benefit, and pre-transfusion ECOG-PS and hemoglobin levels seem to be independent predictors of survival. Further high-quality trials are needed to develop validated measures of objective functional changes to evaluate the clinical impact of transfusions and to identify patients most likely to be positively impacted by transfusion.

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Donck, Colleen, Jin Huh, Jack Seki, Eric Chen, and Erik Yeo. "Standard of Care Evaluation of Venous Thromboembolism Prophylaxis in Selected Solid Tumour Patients at a Tertiary Cancer Care Teaching Hospital." Blood 104, no. 11 (November 16, 2004): 4066. http://dx.doi.org/10.1182/blood.v104.11.4066.4066.

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Abstract Contemporary evidence suggests thromboprophylaxis in medical oncology patients may be effective, however, according to global surveys, is greatly underutilized despite the substantial risk of venous thromboembolism (VTE). To date, routine thromboprophylaxis of medical oncology inpatients has not been evaluated at a cancer care institution. Not equally common in all types of cancer, VTE is thought to present a higher risk in selected solid tumours of the CNS, lung, gastrointestinal and genitourinary tracts. Recommendations from the Sixth ACCP Consensus Conference on Antithrombotic Therapy include implementing institution-specific VTE prophylaxis guidelines for high-risk patients. The objectives of this study are to develop and implement targeted VTE prophylaxis guidelines for high-risk solid tumour inpatients during admission to a medical oncology ward and to evaluate the impact on prescribing practice. The study is a prospective, observational, before and after chart review with retrospective validation. VTE prophylaxis guidelines were developed through literature review and expert consensus. The results presented are the baseline pre-phase data over 14 weeks. Of nearly 240 charts assessed for eligibility criteria, 92 (39%) were stratified as high-risk according to the developed guidelines based on tumour site. Seventy-two of those patients identified as high-risk were followed prospectively to determine the baseline rates of thromboprophylaxis and venographically confirmed symptomatic VTE. Retrospective validation of results was performed in all 237 patients. Current results of the pre-phase revealed appropriate VTE prophylaxis with a low-molecular weight heparin based on the proposed guidelines in three eligible patients (5.3%). A total of 13 eligible patients (19%) received any form of pharmacological or non-pharmacological prophylaxis. The rate of symptomatic VTE was 11% (n = 10) among high-risk patients of which five patients developed pulmonary embolus (PE), four patients presented with deep vein thrombosis (DVT) and one patient developed portal vein thrombosis. Among non high-risk patients, the rate of symptomatic VTE was significantly lower at 3% (n = 5), among which three patients presented with PE and two patients developed DVT. In both groups, pulmonary embolus was the most common manifestation of VTE. No clinically significant bleeding occurred during prophylaxis. The rate of symptomatic VTE among the highly selected at-risk medical oncology population at this institution was substantially different than the non high-risk population and is in accordance with the literature. This study presents new data on the rates of symptomatic VTE and thromboprophylaxis for medical oncology patients in a hospital setting. The rate of VTE prophylaxis of 5.3% seen in the pre-phase appears unacceptably low given that appropriate pharmacological intervention may potentially reduce the VTE rate by as much as 50% as suggested by relevant literature. As such, implementation of VTE prophylaxis guidelines at this cancer care center is ongoing.

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Magini, Alessandro, Lorena Urbanelli, Virginia Ciccarone, Brunella Tancini, Mario Polidoro, Anna Maria Timperio, Lello Zolla, Andrea Tedde, Sandro Sorbi, and Carla Emiliani. "Fibroblasts from PS1 Mutated Pre-Symptomatic Subjects and Alzheimer's Disease Patients Share a Unique Protein Levels Profile." Journal of Alzheimer's Disease 21, no. 2 (August 11, 2010): 431–44. http://dx.doi.org/10.3233/jad-2010-091522.

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Gaunt, A., A. Guy, J. Newman, C. Tiivas, C. Marshall, D. J. Higman, and C. H. E. Imray. "Pre-operative transcranial Doppler (TCD) emboli detection in symptomatic patients to determine the timing of carotid surgery." British Journal of Surgery 96, S1 (January 2009): 8. http://dx.doi.org/10.1002/bjs.6517.

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Saedon, Mahmud, Charles E. Hutchinson, Christopher H. E. Imray, and Donald R. J. Singer. "ABCD2 risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis." Stroke and Vascular Neurology 2, no. 2 (March 17, 2017): 41–46. http://dx.doi.org/10.1136/svn-2017-000073.

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IntroductionABCD2 risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methodsWe studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%). 86 patients (age 70±1 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72±1 years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic (ROC) curves.Results140/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score ≥4. There was no significant difference in the NICE red flag criterion for early assessment (ABCD2 risk score ≥4) for patients with cerebral microemboli versus those without microemboli (59/86 vs 81/120 patients: OR 1.05 ABCD2 risk score ≥4 (95% CI 0.58 to 1.90, p=0.867)). The ABCD2 risk score was <4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD2 risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)).ConclusionsThe ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD2 ≥4), assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.

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Esteban, Ignacio, Georgina Bergero, Camila Alves, Micaela Bronstein, Valeria Ziegler, Cristian Wood, Mauricio T. Caballero, et al. "Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression." Gates Open Research 5 (August 27, 2021): 143. http://dx.doi.org/10.12688/gatesopenres.13357.1.

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Background: SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown. Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression. Methods: We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied. Results: After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12). Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027). On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012). No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein). Conclusions: In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.

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Khabeer, Ahmed Abdul, Phani Bhushan Ivaturi, Y. L. Ravi Jadhav, and Venkatesh Dasoju. "A study on newer technique for reconstruction of pre auricular soft tissue defect with temporo-parietal fascia flap (Khabeer’s flap)." International Journal of Otorhinolaryngology and Head and Neck Surgery 4, no. 6 (October 24, 2018): 1485. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20184364.

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Background: A pre auricular sinus is a congenital abnormality, which occurs due to failure of fusion of primitive tubercles from which pinna develops. Pre auricular sinuses are usually asymptomatic and when symptomatic present usually as discharging sinus, associated with abscess formation anterior to root of helix. Symptomatic pre auricular sinus requires surgical excision to prevent recurrence and reinfection. Treatment of pre auricular sinus by conventional methods usually presents a dead space due to removal of sinus tract. The present study is to overcome this defect by a superficial temporalartery based temporo-parietal fascia flap or Khabeer’s flap. The objective of this study is to describe a novel technique for excision of pre auricular sinus using supra auricular approach and using a temporo-parietal fascia flap for covering the defect created after excision of pre auricular sinus.Methods: A prospective study was carried out in Department of Otorhinolaryngology, Gandhi Medical College/Gandhi Hospital Secunderabad from 2014 to 2017. All the patients admitted with symptomatic pre auricular sinus underwent surgical excision by supra auricular approach and at the end superficial temporal artery based flap was placed to fill the dead space. Results: A total of 20 pre auricular sinuses were operated during the study period. There were no recurrences, no collection of serous fluid and no cosmetic defect post operatively in any of the study subject.Conclusions: The newer approach was found to be safe as it does not confer any complications post operatively and can be used for management of pre auricular sinus.

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Twist, Clare J., Arlene Naranjo, Mary Lou Schmidt, Sheena C. Tenney, Susan L. Cohn, Holly J. Meany, Peter Mattei, et al. "Defining Risk Factors for Chemotherapeutic Intervention in Infants With Stage 4S Neuroblastoma: A Report From Children’s Oncology Group Study ANBL0531." Journal of Clinical Oncology 37, no. 2 (January 10, 2019): 115–24. http://dx.doi.org/10.1200/jco.18.00419.

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Purpose Infants with stage 4S neuroblastoma usually have favorable outcomes with observation or minimal chemotherapy. However, young infants with symptoms secondary to massive hepatomegaly or with unfavorable tumor biology are at high risk of death. Our aim was to improve outcomes for patients with symptomatic and/or unfavorable biology 4S neuroblastoma with a uniform treatment approach using a biology- and response-based algorithm. Patients and Methods The subset of patients with 4S disease with MYCN-not amplified tumors with impaired or impending organ dysfunction, or with unfavorable histology and/or diploid DNA index, were eligible. Patients were assigned to receive two, four, or eight cycles of chemotherapy on the basis of histology, diploid DNA index, chromosome arm 1p or 11q loss of heterozygosity (LOH) status, and symptoms. Results Forty-nine eligible patients were enrolled: 41 were symptomatic and 28 had unfavorable biology. Seventeen patients (symptomatic, favorable biology) were assigned two cycles, 21 patients (any unfavorable biologic feature without 1p or 11q LOH) were assigned four cycles, and 11 patients (unfavorable biology including 1p and/or 11q LOH [n = 7] or symptomatic with unknown biology [n = 4]), were assigned eight cycles. The 3-year overall survival was 81.4% ± 5.8%. Eight of nine deaths were in patients younger than 2 months of age at diagnosis (median, 9 days [range, 1 to 68 days]): five acute deaths were a result of hepatomegaly and associated toxicities; two were a result of late relapse in patients with unfavorable biology; and two were a result of treatment complications. No deaths occurred after protocol-mandated pre-emptive treatment of infants younger than 2 months with hepatomegaly, regardless of symptoms. A new scoring algorithm for emergent chemotherapy in patients with 4S disease was developed on the basis of this experience. Conclusion The outcome for 4S neuroblastoma can be improved with pre-emptive chemotherapy for evolving hepatomegaly or other baseline comorbidities in infants younger than 2 months of age.

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Kissel, Theresa, Karin Anna van Schie, Lise Hafkenscheid, Anders Lundquist, Heidi Kokkonen, Manfred Wuhrer, Tom WJ Huizinga, Hans Ulrich Scherer, René Toes, and Solbritt Rantapää-Dahlqvist. "On the presence of HLA-SE alleles and ACPA-IgG variable domain glycosylation in the phase preceding the development of rheumatoid arthritis." Annals of the Rheumatic Diseases 78, no. 12 (August 30, 2019): 1616–20. http://dx.doi.org/10.1136/annrheumdis-2019-215698.

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ObjectiveAnti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis (RA) patients display a unique feature defined by the abundant presence of N-linked glycans within the variable domains (V-domains). Recently, we showed that N-glycosylation sites, which are required for the incorporation of V-domain glycans, are introduced following somatic hypermutation. However, it is currently unclear when V-domain glycosylation occurs. Further, it is unknown which factors might trigger the generation of V-domain glycans and whether such glycans are relevant for the transition towards RA. Here, we determined the presence of ACPA-IgG V-domain glycans in paired samples of pre-symptomatic individuals and RA patients.MethodsACPA-IgG V-domain glycosylation was analysed using ultra-high performance liquid chromatography (UHPLC) in paired samples of pre-symptomatic individuals (median interquartile range (IQR) pre-dating time: 5.8 (5.9) years; n=201; 139 ACPA-positive and 62 ACPA-negative) and RA patients (n=99; 94 ACPA-positive and 5 ACPA-negative).ResultsV-domain glycans on ACPA-IgG were already present up to 15 years before disease in pre-symptomatic individuals and their abundance increased closer to symptom onset. Noteworthy, human leucocyte antigen class II shared epitope (HLA-SE) alleles associated with the presence of V-domain glycans on ACPA-IgG.ConclusionOur observations indicate that somatic hypermutation of ACPA, which results in the incorporation of N-linked glycosylation sites and consequently V-domain glycans, occurs already years before symptom onset in individuals that will develop RA later in life. Moreover, our findings provide first evidence that HLA-SE alleles associate with ACPA-IgG V-domain glycosylation in the pre-disease phase and thereby further refine the connection between HLA-SE and the development of ACPA-positive RA.

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Bethea, Audis, Elliot Adams, Frank C. Lucente, Damayanti Samanta, and Julton Tomanguillo Chumbe. "Improving Pharmacologic Prevention of VTE in Trauma: IMPACT-IT QI Project." American Surgeon 84, no. 6 (June 2018): 1097–104. http://dx.doi.org/10.1177/000313481808400672.

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Enoxaparin regimens commonly used for prophylaxis fail to achieve optimal anti-factor Xa levels in up to 70 per cent of trauma patients. Accordingly, trauma services at the study institution endeavored to develop a standardized approach to optimize pharmacologic prevention with enoxaparin. An enoxaparin venous thromboembolism (VTE) prophylaxis protocol implemented in October 2015 provided weight-adjusted initial dosing parameters with subsequent dose titration to achieve targeted anti-factor Xa levels. Symptomatic VTE rate was evaluated 12 months pre- and post-implementation. Data were obtained from the trauma registry and charts were reviewed from electronic medical records. The rate of symptomatic VTE significantly declined post-implementation (2.0% vs 0.9%, P = 0.009). Enoxaparin use was comparable in these two phases validating that the decline in symptomatic VTEs was not due to an increase in enoxaparin use. Symptomatic VTE rate for patients who received enoxaparin in the post-implementation cohort decreased from 3.2 to 1.0 per cent (P = 0.023, 95% confidence interval = 0.124–0.856). There was also a significant decrease in the rate of symptomatic deep vein thrombosis (2.8% vs 0.9%, P = 0.040, 95% confidence interval = 0.117–0.950). This approach to VTE prophylaxis with enoxaparin resulted in a significant reduction in symptomatic VTE rates. Implementation of similar practices may be equally impactful in other institutions that use enoxaparin.

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Journal articles on the topic 'Pre-symptomatic patients'

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