Summary Salivary gland mucosa‐associated lymphoid tissue (MALT) lymphomas (SGML) are rare, as are data concerning their behaviour. We analysed clinical features at presentation, particularly the association with Sjoegren syndrome (SS) and hepatitis C virus (HCV) infection, and outcome in 33 cases of SGML diagnosed between March 1985 and April 2003. There were five males and 28 females, with a median age of 61 years. At presentation, 12/33 (36%) had multiple salivary glands or mucosal involvement and four had bone marrow infiltration. Ann Arbor stage was IE in 15 (46%), IIE in four (12%) and IV in 14 patients (42%). Fifteen patients had a history of SS (46%), two of other autoimmune diseases, seven of HCV infection. No case had both SS and HCV. Of the 29 treated patients, 17 received surgery or local radiotherapy; 69% achieved complete remission. Histological transformation occurred in four (12%). Five patients died (three of lymphoma, two of unrelated causes). The 5 year‐overall survival (OS), cause‐specific survival and progression‐free survival was 85 ± 8%, 94 ± 6% and 65 ± 10% respectively. Overall, the disease course was indolent, despite the advanced stage at diagnosis, and local therapy often appeared to be adequate. The only prognostic factors influencing OS were histological transformation and age. The close association of SGML with either autoimmune diseases or HCV infection in our series (73%) confirms their possible role in the pathogenesis of these lymphomas.
health through health promotion (HP) as an integrated part of the clinical pathway. Good examples can be found in for instance the area of surgery (2). Better health gain influences treatment, outcome and prognosis on both short and long-term. In the systematic implementation of health promotion in clinical pathways, there is also an additional benefit of
Long-term sequelae of symptomatic infection caused by SARS-CoV-2 are largely undiscovered. We performed a prospective cohort study on consecutively hospitalized Sars-CoV-2 patients (March–May 2020) for evaluating COVID-19 outcomes at 6 and 12 months. After hospital discharge, patients were addressed to two follow-up pathways based on respiratory support needed during hospitalization. Outcomes were assessed by telephone consultation or ambulatory visit. Among 471 patients, 80.9% received no respiratory support during hospitalization; 19.1% received non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). 58 patients died during hospitalization, therefore 413 were enrolled for follow-up. At 6 months, among 355 patients, the 30.3% had any symptoms, 18.0% dyspnea, 6.2% neurological symptoms. Fifty-two out of 105 had major damages in interstitial computed tomography images. NIV/IMV patients had higher probability to suffer of symptoms (aOR = 4.00, 95%CI:1.99–8.05), dyspnea (aOR = 2.80, 95%CI:1.28–6.16), neurological symptoms (aOR = 9.72, 95%CI:2.78–34.00). At 12 months, among 344, the 25.3% suffered on any symptoms, 12.2% dyspnea, 10.1% neurological symptoms. Severe interstitial lesions were present in 37 out of 47 investigated patients. NIV/IMV patients in respect to no respiratory support, had higher probability of experiencing symptoms (aOR = 3.66, 95%CI:1.73–7.74), neurological symptoms (aOR = 8.96, 95%CI:3.22–24.90). COVID-19 patients showed prolonged sequelae up to 12 months, highlighting the need of follow-up pathways for post-COVID-19 syndrome.
Objective In this study, we aimed to highlight the common early‐stage clinical and laboratory variables independently related to the acute phase duration in patients with uncomplicated coronavirus disease (COVID‐19) pneumonia. Methods In hospitalized patients, the acute phase disease duration was followed using the Brescia‐COVID respiratory severity scale (BCRSS). Noninvasive ventilation was administered based on clinical judgment. Patients requiring oropharyngeal intubation were excluded from the study. For parameters to be measured at the hospital entrance, age, clinical history, National Early Warning Score2 (NEWS2, a multiparametric score system), partial pressure of oxygen in arterial blood/fraction of inspired oxygen (P/F ratio), C‐reactive protein, and blood cell count were selected. Results In 64 patients, age (direct relationship), P/F, and platelet number (inverse relationship) independently accounted for 43% of the acute phase duration of the disease (p<0.001). Conclusions For the first time, the present results revealed that the acute phase duration of non‐complicated pneumonia, resulting from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is independently predicted from a patient's age, as well as based on the hospital entrance values of P/F ratio and peripheral blood platelet count. This article is protected by copyright. All rights reserved.
Neurotuberculosis is a potentially fatal disease which requires prompt diagnosis and immediate multidrug antitubercular treatment as per international guidelines. There is evidence that the bacterial spread can continue even during therapy at least in its initial stages. We monitored our patient not only with chest X-rays but with brain MRI during the first 6 weeks. To our surprise on serial MRI, during treatment, we found several new localization of the disease in a pauci-symptomatic patient. These included vessel wall inflammation (vasculitis), arachnoiditis and hypophysitis. At 4 weeks of treatment, the patient complained of dizziness and vomiting which were first dismissed as treatment side-effects but MRI revealed multiple cortical venous hemorrhagic infarcts. We report this case to emphasize the importance of neuroimaging even in case of the most subtle symptoms and that disease can continue to progress in the initial phase of treatment which may require additional therapeutic intervention.
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