Faculty of Medicine

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Outcome predictors of post-COVID conditions in the European Academy of Neurology COVID-19 registry.
(Springer science + Business Media, 2024-06)
Leone MA
;
Helbok R
;
Bianchi E
;
Yasuda CL
;
Konti M
Several neurological manifestations are part of the post-COVID condition. We aimed to: (1) evaluate the 6-month outcome in the cohort of patients with neurological manifestations during the COVID-19 acute phase and surviving the infection, and find outcome predictors; (2) define the prevalence and type of neurological symptoms persistent at six months after the infection. Data source was an international registry of patients with COVID-19 infection and neurological symptoms, signs or diagnoses established by the European Academy of Neurology. Functional status at six-month follow-up was measured with the modified Rankin scale (mRS), and defined as: "stable/improved" if the mRS at six months was equal as or lower than the baseline score; "worse" if it was higher than the baseline score. By October 30, 2022, 1,003 lab-confirmed COVID-19 patients were followed up for a median of 6.5 months. Compared to their pre-morbid status, 522 patients (52%) were stable/improved, whereas 465 (46%) were worse (functional status missing for 16). Age, hospitalization, several pre-COVID-19 comorbidities, and COVID-19 general complications were predictors of a worse status. Amongst neurological manifestations, stroke carried the highest risk for worse outcome (OR 5.96), followed by hyperactive delirium (2.8), and peripheral neuropathies (2.37). On the other hand, hyposmia/hypogeusia (0.38), headache (0.40), myalgia (0.45), and COVID-19 vaccination (0.52) were predictors of a favourable prognosis. Persisting neurological symptoms or signs were reported by 316/1003 patients (31.5%), the commonest being fatigue (n = 133), and impaired memory or concentration (n = 103). Our study identified significant long-term prognostic predictors in patients with COVID-19 and neurological manifestations.
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Impact of anthropometric factors on outcomes in atrial fibrillation patients: analysis on 10 220 patients from the European Society of Cardiology (ESC)-European Heart Rhythm Association (EHRA) EurObservational Research Programme on Atrial Fibrillation (EORP-AF) general long-term registry
(Oxford University Press (OUP), 2022-06-07)
Boriani, Giuseppe
;
Vitolo, Marco
;
Malavasi, Vincenzo L
;
Proietti, Marco
;
Fantecchi, Elisa
Abstract Aim To investigate the association of anthropometric parameters [height, weight, body mass index (BMI), body surface area (BSA), and lean body mass (LBM)] with outcomes in atrial fibrillation (AF). Methods and results Ten-thousand two-hundred twenty patients were enrolled [40.3% females, median age 70 (62–77) years, followed for 728 (interquartile range 653–745) days]. Sex-specific tertiles were considered for the five anthropometric variables. At the end of follow-up, survival free from all-cause death was worse in the lowest tertiles for all the anthropometric variables analyzed. On multivariable Cox regression analysis, an independent association with all-cause death was found for the lowest vs. middle tertile when body weight (hazard ratio [HR] 1.66, 95%CI 1.23–2.23), BMI (HR 1.65, 95%CI 1.23–2.21), and BSA (HR 1.49, 95%CI 1.11–2.01) were analysed in female sex, as well as for body weight in male patients (HR 1.61, 95%CI 1.25–2.07). Conversely, the risk of MACE was lower for the highest tertile (vs. middle tertile) of BSA and LBM in males and for the highest tertile of weight and BSA in female patients. A higher occurrence of haemorrhagic events was found for female patients in the lowest tertile of height [odds ratio (OR) 1.90, 95%CI 1.23–2.94] and LBM (OR 2.13, 95%CI 1.40–3.26). Conclusions In AF patients height, weight, BMI, BSA, and LBM were associated with clinical outcomes, with all-cause death being higher for patients presenting lower values of these variables, i.e. in the lowest tertiles of distribution. The anthropometric variables independently associated with other outcomes were also different between male and female subjects.
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Clinical characteristics of human brucellosis in different age groups in the Republic of North Macedonia-A case series
(Springer Science and Business Media LLC, 2024-12-04)
;
Khezzani, Bachir
;
;
Osmani Lloga, Arlinda
;
Background Brucellosis is a zoonotic infection that presents a major challenge to public health worldwide. Aim This research compares demographic characteristics, clinical features, and outcomes across different age groups in patients with human brucellosis. Material and methods Between 2003 and 2022 a total of 508 patients with brucellosis were subjected to diagnostics and treatment at the Clinic for Infectious Diseases in Skopje. The patients were classified into three age groups: children (up to 14 years old), adults (from 14–64 years) and older adults (older than 64 years). The demographics, clinical characteristics, and outcomes between patients from the different age groups were retrospectively evaluated. Results A family history of brucellosis (p < 0.001), fever (p = 0.013), and hepatosplenomegaly (p < 0.001) were significantly more prevalent in children compared to other age groups. Direct contact with animals (p < 0.001), arthralgia (p = 0.007), and weight loss (p = 0.004) were significantly less frequent in children, whereas the duration of illness before brucellosis diagnosis was significantly shorter in children (p < 0.001) compared to other age groups. Sacroiliitis was more predominant in adults than children (p = 0.043), while focal hematological involvement was more prevalent in children than in adults (p = 0.004). Spondylitis was more dominant in the old age group compared to the other two age groups (p < 0.001). Favorable outcomes were achieved in 88.5% of children, 89.9% of adults, and 87.1% of older patients with specific treatment. Conclusion Brucellosis presents highly variable clinical and epidemiological features across all age groups; however, certain characteristics may be associated with age.
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Venous thromboembolism in centenarians: Findings from the RIETE registry
(Elsevier, 2016)
Lacruz B
;
Tiberio G
;
Núñez MJ
;
López-Jiménez L
;
Riera-Mestre A
Background: The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain. Methods: We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100years. Results: Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168±42IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148±51IU/kg/day). During the course of anticoagulant therapy (mean duration, 139days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported. Conclusions: Among patients with acute VTE aged ≥100years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency.

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