Therapeutic options for emergency gastrointestinal malignancy in COVID19 pandemic. The role of operative endoscopy

Eosinophilic asthma is a common phenotype of severe asthma, occurring in at least half of patients. In recent years, there have been significant changes in the approaches to the treatment of severe bronchial asthma and, above all, eosinophilic asthma. The article discusses the role of eosinophils in the pathogenesis of severe asthma, the detection of the phenotype of severe eosinophilic asthma, and modern approaches to targeting severe asthma with an eosinophilic phenotype using biological agents. A special emphasis is placed on preparations of monoclonal antibodies to interleukin-5, in particular, mepolizumab, recently approved for clinical use in our country.

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An unusual presentation of synchronous bladder metastases from an oesophageal adenocarcinoma

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7126 ◽

2021 ◽

Vol 103 (7) ◽

pp. e227-e230

Author(s):

D Wignall ◽

R Sawant ◽

A Gkentzis ◽

L Lee

Keyword(s):

Multidisciplinary Approach ◽

Clinical Evidence ◽

Oesophageal Carcinoma ◽

Oesophageal Adenocarcinoma ◽

Gastrointestinal Malignancy ◽

Direct Invasion ◽

Bladder Abnormalities ◽

Upper Gastrointestinal ◽

Progressive Dysphagia

Adenocarcinoma of the bladder is a rare form of malignancy accounting for fewer than 2% of bladder tumours. It is most commonly a result of direct invasion from prostatic, rectal or gynaecological primaries and less commonly presents from distant haematological or lymphatic metastasis. We report a rare case of oesophageal carcinoma metastasising to the bladder. It involves a 71-year-old man with progressive dysphagia and diagnostic computerised tomography findings of thickening in the oesophagus, bladder and common bile duct. Subsequent endoscopic biopsies of the oesophageal and bladder abnormalities showed immunohistochemical features consistent with upper gastrointestinal malignancy. This report aims to add to current clinical evidence of this route of metastasis and also highlight some of the key markers used by pathologists in interpretation of specimens. It also emphasises the essential role of a multidisciplinary approach for the diagnosis of such rare conditions.

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CURRENT THERAPEUTIC OPTIONS FOR CORONAVIRUS DISEASE-2019 – A PHARMACOLOGICAL REVIEW

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i8.38342 ◽

2020 ◽

pp. 42-50

Author(s):

SASMI MB ◽

MARIA JOSE ◽

PRAVEENLAL KUTTICHIRA

Keyword(s):

Case Reports ◽

Treatment Options ◽

Case Series ◽

Standard Of Care ◽

Therapeutic Options ◽

Cochrane Library ◽

Global Public Health ◽

Medical Subject Headings ◽

Published Evidence

Objectives: Coronavirus pandemic is currently a global public health emergency. With expanding knowledge of the virus and the disease, new therapeutic targets are emerging widely. There is limited evidence about the use of different treatment options in coronavirus disease-2019 (COVID-19). This review aims to summarize the available evidence regarding therapeutic options in treating coronavirus infection. Methods: We searched PubMed, Google Scholar, and Cochrane library using pre-specified Medical Subject Headings terms about the role of therapeutic options in COVID-19 patients. Results: The majority of the published evidence is either case reports or small observational studies. Antimalarial like hydroxychloroquine reported equivocal results with five studies got positive results and five without any added benefit compared with standard of care. Lopinavir/ ritonavir monotherapy does not show any significant role except in combination with other antiviral drugs but encouraging results are emerging with remdesivir. Studies with favipiravir are inconclusive with some exhibit benefit and others not. Limited case series have shown that tocilizumab and convalescent plasma to be useful as adjuvant therapy in critically ill patients. Conclusion: There is currently no strong evidence for the efficacy of different therapeutic agents in the treatment of COVID-19. More data from ongoing and future trials will add more insight into the role of various drugs.

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The Role of Dysfunctional Adipose Tissue in Pancreatic Cancer: A Molecular Perspective

Cancers ◽

10.3390/cancers12071849 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1849 ◽

Cited By ~ 4

Author(s):

Davide Brocco ◽

Rosalba Florio ◽

Laura De Lellis ◽

Serena Veschi ◽

Antonino Grassadonia ◽

...

Keyword(s):

Pancreatic Cancer ◽

Adipose Tissue ◽

Molecular Mechanisms ◽

Normal Weight ◽

Therapeutic Options ◽

Therapeutic Interventions ◽

Fat Accumulation ◽

Adipose Organ ◽

The Impact

Pancreatic cancer (PC) is a lethal malignancy with rising incidence and limited therapeutic options. Obesity is a well-established risk factor for PC development. Moreover, it negatively affects outcome in PC patients. Excessive fat accumulation in obese, over- and normal-weight individuals induces metabolic and inflammatory changes of adipose tissue microenvironment leading to a dysfunctional adipose “organ”. This may drive the association between abnormal fat accumulation and pancreatic cancer. In this review, we describe several molecular mechanisms that underpin this association at both local and systemic levels. We focus on the role of adipose tissue-derived circulating factors including adipokines, hormones and pro-inflammatory cytokines, as well as on the impact of the local adipose tissue in promoting PC. A discussion on potential therapeutic interventions, interfering with pro-tumorigenic effects of dysfunctional adipose tissue in PC, is included. Considering the raise of global obesity, research efforts to uncover the molecular basis of the relationship between pancreatic cancer and adipose tissue dysfunction may provide novel insights for the prevention of this deadly disease. In addition, these efforts may uncover novel targets for personalized interventional strategies aimed at improving the currently unsatisfactory PC therapeutic options.

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Interplay between Peptidoglycan Biology and Virulence in Gram-Negative Pathogens

Microbiology and Molecular Biology Reviews ◽

10.1128/mmbr.00033-18 ◽

2018 ◽

Vol 82 (4) ◽

Cited By ~ 15

Author(s):

Carlos Juan ◽

Gabriel Torrens ◽

Isabel Maria Barceló ◽

Antonio Oliver

Keyword(s):

Antimicrobial Resistance ◽

Future Development ◽

Essential Role ◽

Therapeutic Options ◽

Multiple Perspectives ◽

Weak Point ◽

Gram Negative ◽

Severe Infections ◽

Previous Step

SUMMARYThe clinical and epidemiological threat of the growing antimicrobial resistance in Gram-negative pathogens, particularly for β-lactams, the most frequently used and relevant antibiotics, urges research to find new therapeutic weapons to combat the infections caused by these microorganisms. An essential previous step in the development of these therapeutic solutions is to identify their potential targets in the biology of the pathogen. This is precisely what we sought to do in this review specifically regarding the barely exploited field analyzing the interplay among the biology of the peptidoglycan and related processes, such as β-lactamase regulation and virulence. Hence, here we gather, analyze, and integrate the knowledge derived from published works that provide information on the topic, starting with those dealing with the historically neglected essential role of the Gram-negative peptidoglycan in virulence, including structural, biogenesis, remodeling, and recycling aspects, in addition to proinflammatory and other interactions with the host. We also review the complex link between intrinsic β-lactamase production and peptidoglycan metabolism, as well as the biological costs potentially associated with the expression of horizontally acquired β-lactamases. Finally, we analyze the existing evidence from multiple perspectives to provide useful clues for identifying targets enabling the future development of therapeutic options attacking the peptidoglycan-virulence interconnection as a key weak point of the Gram-negative pathogens to be used, if not to kill the bacteria, to mitigate their capacity to produce severe infections.

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SEVERE PERTUSSIS IN CHILDHOOD: UPDATE AND CONTROVERSY - SYSTEMATIC REVIEW

Revista Paulista de Pediatria ◽

10.1590/1984-0462/;2019;37;3;00006 ◽

2019 ◽

Vol 37 (3) ◽

pp. 351-362

Author(s):

Márcia Borges Machado ◽

Saulo Duarte Passos

Keyword(s):

Systematic Review ◽

Whooping Cough ◽

Age Groups ◽

Severe Form ◽

Therapeutic Options ◽

Electronic Library ◽

Data Synthesis ◽

Control And Prevention ◽

Neonates And Infants

ABSTRACT Objective: Through a systematic review, this essay aimed at revising the concepts of severe pertussis, updating the epidemiology, pathophysiology, clinical presentation, antibiotic therapy and auxiliary therapeutic options for symptomatology and complications. Data sources: This review considered publications from the last 30years in the databases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane, Google Scholar, as well as protocols of the Ministry of Health and recommendations of the Centers for Disease Control and Prevention, related to childhood pertussis (whooping cough), with emphasis on its severe form. This research was based on keywords derived from the terms “pertussis”, “azithromycin”, “antitussives”, “leukocyte reduction” in Portuguese and English. Duplicate studies and those with unavailable full-text were excluded. Data synthesis: Among 556 records found, 54 were selected for analysis. Pertussis, as a reemerging disease, has affected all age groups, evidencing the transient immunity conferred by infection and vaccination. Severe cases occur in neonates and infants, with secondary viral and bacterial complications and malignant pertussis, a longside hyperleukocytosis, respiratory failure and shock. Macrolides continue to be the chosen antibiotics, while antitussives for coughing remain without efficacy. The prompt treatment in Intensive Care Units improved the prognostic in severe cases, and transfusion was promising among procedures for leukoreduction. Conclusions: Approaching severe pertussis in childhood remains a challenge for diagnostic and therapy, as the available therapeutic options are still unsatisfactory. Strategies of prevention are expected to reduce the occurrence of severe cases, while new studies should confirm the role of auxiliary therapies.

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