scholarly journals Clinical presentation of strokes confined to the insula: a systematic review of literature

2021 ◽  
Author(s):  
Vincenzo Di Stefano ◽  
Maria Vittoria De Angelis ◽  
Chiara Montemitro ◽  
Mirella Russo ◽  
Claudia Carrarini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Insular Cortex ◽  
Affective Processing ◽  
Appropriate Treatment ◽  
Insula Cortex ◽  
Atypical Presentations ◽  
High Level ◽  
To Receive ◽  
Insular Region

Abstract Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. Results We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. Conclusions The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.

Corticosteroid-associated lupus pancreatitis: a case series and systematic review of the literature

Lupus ◽  
2019 ◽  
Vol 28 (6) ◽  
pp. 731-739 ◽  
Author(s):  
P Dwivedi ◽  
R R Kumar ◽  
A Dhooria ◽  
M B Adarsh ◽  
S Malhotra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Lupus Erythematosus ◽  
Case Series ◽  
University Hospital ◽  
High Dose ◽  
Appropriate Treatment ◽  
Pubmed Search ◽  
To Receive ◽  
Significant Mortality

Background Acute pancreatitis is an uncommon complication that occurs in 0.85% to 4% of patients with systemic lupus erythematosus (SLE). In some patients, it occurs within days to weeks of starting medium-to-high dose corticosteroids. The authors have used the term ‘corticosteroid-associated lupus pancreatitis’ for these patients, and they report a case series and perform a systematic review of previously published reports. Methods For the purpose of this study, corticosteroid-associated lupus pancreatitis was defined as occurrence of acute pancreatitis in patients with SLE (fulfilling the 1997 ACR), within 3 weeks of starting therapy with medium-to-high dose corticosteroids – either newly initiated or escalated from a lower dose. All patients with SLE admitted in the last 2.5 years in a North Indian university hospital were reviewed, and those with pancreatitis who fulfilled the above criteria were included in the case series. For the systematic review, a PUBMED search using the keywords ‘lupus’ and ‘pancreatitis’ was performed, and reports in English were reviewed for an association with corticosteroids. Results Among 420 admissions of SLE patients, six patients (1.4%) fulfilled criteria for corticosteroid-associated lupus pancreatitis. All were female, with mean age and disease duration of 19.7 ± 3.3 and 3.8 ± 2.5 years respectively. All had active disease and developed acute pancreatitis within 48–72 hours of newly initiating medium-to-high dose corticosteroids (in three patients) or escalating them to medium–high dose (in three patients). After the development of pancreatitis, corticosteroids were continued in all except one patient. In addition, two patients received pulse methylprednisolone, two received pulse cyclophosphamide and one was started on azathioprine. Three patients died during hospitalization, all with severe pancreatitis. On systematic review, among 451 cases of lupus pancreatitis reported, 23 (5%) fulfilled criteria for ‘corticosteroid-associated lupus pancreatitis’. A majority of them had pancreatitis within 3 days of starting treatment with medium-to-high dose corticosteroids. The mortality in these patients was 37.5%. Conclusion In a small but substantial proportion of patients with lupus who develop pancreatitis, it occurs within days to weeks of starting medium-to-high dose corticosteroids. Many of these patients continue to receive corticosteroids, and some receive more aggressive immunosuppression. However, they have significant mortality, and further studies are required to identify appropriate treatment in this subgroup of patients.

scholarly journals Interoceptive active inference and self-representation in social anxiety disorder (SAD): exploring the neurocognitive traits of the SAD self

2020 ◽  
Author(s):  
Philip Gerrans ◽  
Ryan J Murray
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Anterior Cingulate ◽  
Affective Processing ◽  
Prediction Errors ◽  
Active Inference ◽  
Symptom Profile ◽  
Insula Cortex ◽  
High Level

Abstract This article provides an interoceptive active inference (IAI) account of social anxiety disorder (SAD). Through a neurocognitive framework, we argue that the cognitive and behavioural profile of SAD is best conceived of as a form of maladaptive IAI produced by a negatively biased self-model that cannot reconcile inconsistent tendencies to approach and avoid social interaction. Anticipated future social interactions produce interoceptive prediction error (bodily states of arousal). These interoceptive states are transcribed and experienced as states of distress due to the influence of inconsistent and unstable self-models across a hierarchy of interrelated systems involved in emotional, interoceptive and affective processing. We highlight the role of the insula cortex, in concert with the striatum, amygdala and dorsal anterior cingulate in the generation and reduction of interoceptive prediction errors as well as the resolution of social approach-avoidance conflict. The novelty of our account is a shift in explanatory priority from the representation of the social world in SAD to the representation of the SAD self. In particular, we show how a high-level conceptual self-model of social vulnerability and inadequacy fails to minimize prediction errors produced by a basic drive for social affiliation combined with strong avoidant tendencies. The result is a cascade of interoceptive prediction errors whose attempted minimization through action (i.e. active inference) yields the symptom profile of SAD. We conclude this article by proposing testable hypotheses to further investigate the neurocognitive traits of the SAD self with respect to IAI.

Correlation of MRI-detected vulnerable carotid plaques with clinical presentation: a systematic review and meta-analysis

2020 ◽  
Vol 64 (3) ◽  
Author(s):  
Seyed M. Seyedsaadat ◽  
Asim Rizvi ◽  
Muayad Alzuabi ◽  
Sagar B. Dugani ◽  
M. Hassan Murad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Carotid Plaques

The timeframe for safe resumption of high-level mobility following traumatic brain injury is currently unknown: a systematic review

2021 ◽  
pp. 1-11
Author(s):  
Sara Gallow ◽  
Laura Hilet ◽  
Edwina Sutherland ◽  
Jennifer McGinley ◽  
John Olver ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
High Level

The use of eHealth to promote physical activity in people living with Parkinson’s disease: A systematic review

2021 ◽  
pp. 1-14
Author(s):  
Adam McDermott ◽  
Ciaran Haberlin ◽  
Jonathan Moran
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Risk Of Bias ◽  
Attrition Rate ◽  
Medical Subject Headings ◽  
Eligibility Criteria ◽  
Ehealth Intervention ◽  
High Level

BACKGROUND: People living with Parkinson’s disease (PD) are less active than healthy individuals. Ehealth is an emerging concept in healthcare which presents opportunities to promote physical activity (PA) in people with PD. The aim of this systematic review was to explore the effectiveness of ehealth in the promotion of PA in people living with PD. METHODS: Suitable articles were searched for using EMBASE, PsychInfo, Web of Science and OVID Medline databases using a combination of keywords and medical subject headings. Articles were included if they described an ehealth intervention designed to promote PA in people living with PD. Two reviewers screened studies for suitability and extracted data. Risk of bias was assessed using the Cochrane risk of bias 2 tool and the Downs and Black risk of bias checklist. Due to the heterogeneity of studies, a narrative synthesis of study interventions and results was completed rather than a quantitative analysis. RESULTS: 1449 articles were screened. Four studies met the eligibility criteria which included 652 participants. Web and mobile applications were used to design the PA interventions. PA levels were measured using self-reported questionnaires, Fitbits, activity monitors and accelerometers. Three of the studies reported improvements in aspects of PA. However, this was not consistently reported in all study participants. No adverse effects, a high level of enjoyment and a relatively low attrition rate (∼12.5%) were reported. CONCLUSION: Ehealth is a safe and feasible intervention to promote PA in this population. It is unclear whether ehealth is effective at promoting PA in people with PD. Keywords:

scholarly journals P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
MI Qureshi ◽  
HL Li ◽  
GK Ambler ◽  
KHF Wong ◽  
S Dawson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Endovascular Intervention ◽  
Randomised Trials ◽  
Peripheral Arterial ◽  
High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

scholarly journals Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

2021 ◽  
Author(s):  
Rishi Raj ◽  
Ghada Elshimy ◽  
Aasems Jacob ◽  
P. V. Akhila Arya ◽  
Dileep C. Unnikrishnan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Pituitary Adenoma ◽  
Gnrh Agonist ◽  
Tumor Size ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Surgery ◽  
Laboratory Evaluation ◽  
The Mean

Abstract Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

scholarly journals A Systematic Review of Characteristics Associated with COVID-19 in Children with Typical Presentation and with Multisystem Inflammatory Syndrome

2021 ◽  
Vol 18 (16) ◽  
pp. 8269
Author(s):  
Jeffrey Kornitzer ◽  
Jacklyn Johnson ◽  
Max Yang ◽  
Keith W. Pecor ◽  
Nicholas Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sore Throat ◽  
Literature Search ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Chinese Language ◽  
Clinical Information ◽  
Shortness Of Breath ◽  
Global Pandemic ◽  
Inflammatory Syndrome

Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.

scholarly journals The risk of venous thromboembolism and physical activity level, especially high level: a systematic review

2021 ◽  
Author(s):  
H. Danin-Mankowitz ◽  
A. Ugarph-Morawski ◽  
F. Braunschweig ◽  
P. Wändell
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Venous Thromboembolism ◽  
Activity Level ◽  
Case Control Studies ◽  
The Third ◽  
Area Of Interest ◽  
High Level ◽  
The Relationship

AbstractVenous thromboembolism (VTE) is the third most common cause of cardiovascular disease. Connection between high level of physical activity (PA) and the onset of VTE is unknown. We searched the literature on the possible association between PA level, especially high levels, and the risk of VTE. A systematic review was carried out to identify relevant articles on the relation between PA level and VTE. The initial search was conducted together with the Karolinska Institutet University Library in February 2018, with follow-up searches after that. In total, 4383 records were found and then screened for exclusion of duplicates and articles outside the area of interest. In total, 16 articles with data on 3 or more levels of PA were included. Of these, 12 were cohort and 4 were case-control studies. Totally 13 studies aimed at investigating VTE cases primarily, while three studies had other primary outcomes. Of the 16 studies, five found a U-shaped association between PA level and VTE risk, although non-significant in three of them. Two articles described an association between a more intense physical activity and a higher risk of VTE, which was significant in one. Nine studies found associations between increasing PA levels and a decreasing VTE risk. Available literature provides diverging results as to the association between high levels of PA and the risk of venous thromboembolism, but with several studies showing an association. Further research is warranted to clarify the relationship between high level PA and VTE.

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