tailieunhanh - Báo cáo y học: " Utility of clinical assessment, imaging, and cryptococcal antigen titer to predict AIDS-related complicated forms of cryptococcal meningitis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Utility of clinical assessment, imaging, and cryptococcal antigen titer to predict AIDS-related complicated forms of cryptococcal meningitis. | Cachay et al. AIDS Research and Therapy 2010 7 29 http content 7 1 29 AIDS RESEARCH AND THERAPY RESEARCH Open Access Utility of clinical assessment imaging and cryptococcal antigen titer to predict AIDS-related complicated forms of cryptococcal meningitis 1 1 12 3 1 Edward R Cachay Joseph Caperna Amy M Sitapati Hamta Jafari Sean Kandel William C Mathews Abstract Background This study aimed to evaluate the prevalence and predictors of AIDS-related complicated cryptococcal meningitis. The outcome was complicated cryptococcal meningitis prolonged 14 days altered mental status persistent 14 days focal neurologic findings cerebrospinal fluid CSF shunt placement or death. Predictor variable operating characteristics were estimated using receiver operating characteristic curve ROC analysis. Multivariate analysis identified independent predictors of the outcome. Results From 1990-2009 82 patients with first episode of cryptococcal meningitis were identified. Of these 14 17 met criteria for complicated forms of cryptococcal meningitis prolonged altered mental status 6 persistent focal neurologic findings 7 CSF surgical shunt placement 8 and death 5 . Patients with complicated cryptococcal meningitis had higher frequency of baseline focal neurological findings head computed tomography CT abnormalities mean CSF opening pressure and cryptococcal antigen CRAG titers in serum and CSF. ROC area of log2 serum and CSF CRAG titers to predict complicated forms of cryptococcal meningitis were comparable 95 CI to vs. 95 CI to respectively c2 p . The ROC areas to predict the outcomes were similar for CSF pressure and CSF CRAG titers. In a multiple logistic regression model the following were significant predictors of the outcome baseline focal neurologic findings head CT abnormalities and log2 CSF CRAG titer. Conclusions During initial clinical evaluation a focal neurologic exam abnormal head CT and large cryptococcal burden .