Development of Management Strategies for Immune Related Adverse Effects of Immunotherapies used in Oncological Treatment

Treatment resistant schizophrenia (TRS) is often encountered in clinical practice. Clozapine remains the drug of choice in the management of TRS. Several studies have shown that clozapine is the most effective antipsychotic medication to date for TRS. But it is also well known that it has multiple side effects. Some side effects are transient and relatively benign, while other adverse effects are menacing, serious and life-threatening. Delirium may occur with clozapine and is a therapeutic challenge as there is always a risk of precipitating delirium on clozapine rechallenge. Limited management strategies are available as alternatives for the management of psychiatric illness stabilized on clozapine. In this case report, we describe an older adult patient who developed delirium on clozapine. The aims of this case report are to discuss the mechanism by which clozapine leads to delirium, revisit various factors which could possibly lead to delirium, and discuss the different management strategies available for management of psychiatric illness for a patient previously stabilized on clozapine.

Download Full-text

Differences in Adverse Effect Profiles of Corticosteroids in Palliative Care Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118797283 ◽

2018 ◽

Vol 36 (2) ◽

pp. 158-168 ◽

Cited By ~ 2

Author(s):

Leanna R. Jaward ◽

Thomas A. O’Neil ◽

Adam Marks ◽

Michael A. Smith

Keyword(s):

Adverse Effect ◽

Palliative Care ◽

Adverse Effects ◽

Symptom Management ◽

Care Setting ◽

Management Strategies ◽

Common Factors ◽

Inclusion Criteria ◽

Pubmed Database ◽

Palliative Care Setting

Background: Corticosteroids are frequently utilized in the palliative care setting to combat symptoms such as fatigue, dyspnea, pain, weakness, anorexia, cachexia, nausea, and vomiting. Often times, adverse effects arise with corticosteroid use, and it is unclear whether switching to another corticosteroid would reduce the risk of specific adverse effects or what measures can be taken to alleviate the adverse effects. Objective: This article aims to review the differentiating pharmacokinetics, potency, and adverse effect profiles of corticosteroids and summarize their clinical applicability. Methods: A literature review of “corticosteroids” and “palliative care” was performed using the PubMed database through July 2018. Original studies relevant to the purpose of this study were identified and those that met inclusion criteria were included. Results: Although corticosteroids share many common factors, including similar pharmacokinetic, pharmacodymanic, and adverse effect profiles, they have significant differences when the details of these variables are reviewed. Providers that prescribe corticosteroids for symptom management should be aware of these differences and the recommended management strategies. Conclusions: Recognition of corticosteroid induced adverse effect profiles and possible management strategies is crucial to optimal symptom management in palliative care patients.

Download Full-text

Autoimmune progesterone dermatitis following vaginal progesterone exposure in pregnancy

Obstetric Medicine ◽

10.1177/1753495x18771255 ◽

2018 ◽

Vol 12 (2) ◽

pp. 100-102 ◽

Cited By ~ 4

Author(s):

Tomi T Kanninen ◽

Michael L Moretti ◽

Nisha A Lakhi

Keyword(s):

Differential Diagnosis ◽

Adverse Effects ◽

Hypersensitivity Reaction ◽

Management Strategies ◽

Cutaneous Lesions ◽

Vaginal Progesterone ◽

Delivery Unit ◽

Pregnant State ◽

Delayed Hypersensitivity Reaction ◽

In Pregnancy

In the non-pregnant state, exogenous as well as endogenous fluctuations of progesterone have been demonstrated to cause a rare delayed hypersensitivity reaction known as autoimmune progesterone dermatitis. We describe the case of a 20-year-old woman in her second pregnancy who presented to our delivery unit at 31 weeks and 3 days gestation for a cutaneous breakout with pruritic pustules, blisters, and crusts across her chest back and extremities 23 days after the initiation of vaginal progesterone. After suspension of the vaginal progesterone, the patient’s cutaneous lesions resolved. Differential diagnosis and management strategies are discussed. With the increased use of progesterone during pregnancy, complications arising from their use will rise. Clinicians should be aware of their potential adverse effects and consider autoimmune progesterone dermatitis in the differential diagnosis of patients presenting with pruritic lesion in pregnancy.

Download Full-text

A Conceptual Time-Varying Flood Resilience Index for Urban Areas: Munich City

Water ◽

10.3390/w11040830 ◽

2019 ◽

Vol 11 (4) ◽

pp. 830 ◽

Cited By ~ 13

Author(s):

Chen ◽

Leandro

Keyword(s):

Adverse Effects ◽

Urban Areas ◽

Management Strategies ◽

Original System ◽

Flood Management ◽

Time Varying ◽

Recovery Capacity ◽

Resilience Index ◽

Inundation Modelling ◽

Flooding Events

In response to the increased frequency and severity of urban flooding events, flood management strategies are moving away from flood proofing towards flood resilience. The term ‘flood resilience’ has been applied with different definitions. In this paper, it is referred to as the capacity to withstand adverse effects following flooding events and the ability to quickly recover to the original system performance before the event. This paper introduces a novel time-varying Flood Resilience Index (FRI) to quantify the resilience level of households. The introduced FRI includes: a) Physical indicators from inundation modelling for considering the adverse effects during flooding events, and b) social and economic indicators for estimating the recovery capacity of the district in returning to the original performance level. The district of Maxvorstadt in Munich city is used for demonstrating the FRI. The time-varying FRI provides a novel insight into indicator-based quantification methods of flood resilience for households in urban areas. It enables a timeline visualization of how a system responds during and after a flooding event.

Download Full-text

Canadian Expert Panel Recommendations on the Management of CNS Symptoms Related to Efavirenz

Canadian Journal of Infectious Diseases ◽

10.1155/2001/645147 ◽

2001 ◽

Vol 12 (suppl c) ◽

pp. 20C-30C ◽

Cited By ~ 3

Author(s):

M John Gill ◽

Anita Rachlis ◽

Sharon Walmsley ◽

Mark Halman ◽

The Efavirenz Consensus Working Group

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Health Care Providers ◽

Highly Active Antiretroviral Therapy ◽

Primary Care Physicians ◽

Sleep Disturbances ◽

Present Report ◽

Management Strategies ◽

Routine Practice ◽

Care Providers

Efavirenz is a potent antiretroviral agent used in combination with other antiretroviral agents as part of highly active antiretroviral therapy. Efavirenz is generally well tolerated because the majority of its adverse effects are self-limiting, with central nervous symptoms and rash being the most frequent. In routine practice, the discontinuation rate of efavirenz due to adverse effects appears higher than that described in clinical trials. To minimize early treatment interruption and maximize the benefit of long term viral suppression that can be achieved with efavirenz therapy, health care providers and patients have identified that there is a need for information, education about and practical tools for the management of efavirenz-related side effects. To this end, a panel of experts in the care of HIV patients consisting of primary care physicians, infectious disease specialists, psychiatrists and pharmacists was convened. Through the evaluation of current literature and discussion among the group, the panel arrived at consensus recommendations. The present report outlines general management recommendations that apply to adverse effects related to efavirenz initiation, as well as specific management strategies for central nervous system symptoms such as agitation, sleep disturbances, dreams, dizziness, impaired concentration and depression. It is hoped that these practical recommendations will aid clinicians in minimizing and improving patient tolerance of side effects, thereby achieving improved adherence and patient outcomes.

Download Full-text

THE PROBLEM OF ADVERSE EFFECTS OF ONCOLOGICAL TREATMENT IN CHILDREN

6th SWS International Scientific Conference on Social Sciences ISCSS 2019 ◽

10.5593/sws.iscss.2019.4/s13.077 ◽

2019 ◽

Author(s):

Andrea Filova

Keyword(s):

Adverse Effects ◽

Oncological Treatment

Download Full-text

Adverse Effects of Chromium, Cadmium and Zinc on the Growth and Metabolic Activities of Pulse Crops and their Key Management Strategies: A Review

International Journal of Current Microbiology and Applied Sciences ◽

10.20546/ijcmas.2020.904.008 ◽

2020 ◽

Vol 9 (4) ◽

pp. 48-63

Author(s):

Srabani Kar ◽

Ravindra Prasad

Keyword(s):

Adverse Effects ◽

Key Management ◽

Management Strategies ◽

Pulse Crops ◽

Metabolic Activities

Download Full-text

Review on Hypothyroidism as per Ayurveda

The Healer ◽

10.51649/healer.46 ◽

2021 ◽

Vol 2 (1) ◽

pp. 74-79

Author(s):

Dr. Sirjana Shrestha

Keyword(s):

Developing Countries ◽

Thyroid Gland ◽

Adverse Effects ◽

Thyroid Dysfunction ◽

Management Strategies ◽

Thyroid Disorders ◽

Endocrine Disorder ◽

Long Run ◽

Contemporary Medicine ◽

Day By Day

Hyperthyroidism is one of the most common disorder of Thyroid gland which is increasing day by day globally especially in developing countries. Ayurvedic classics have no direct reference of Hyperthyroidism. Considering various factors, it can be compared with Atyagni or Tikshnagni or Bhasmaka Roga (related to increased agni). Approaximately 300 million people worldwide are affected by thyroid dysfunction as it is a common endocrine disorder. Globally about 1-5% population are affected by hyperthyroidism. The prevalence of thyroid disorders in Nepalese population is 4.32% and among them 13.7% population has Hyperthyroidism. Available treatments of Hyperthyroidism in contemporary medicine cause lots of adverse effects and complications in the long run. So, it is very necessary to find out an effective alternative treatment for hyperthyroidism. Therefore this study was an attempt to get the understanding of disease Hyperthyroidism as per Ayurveda through various Ayurvedic principles so as to set its management strategies. Keywords: Hyperthyroidism, Atyagni, Tiksnagni, Bhasmaka rog

Download Full-text

COVID-19 #StayAtHome Restrictions and Deep Vein Thrombosis: Case Report (Preprint)

10.2196/preprints.23443 ◽

2020 ◽

Author(s):

Edna Blum ◽

Youssef S Abdelwahed ◽

Eileen Spiess ◽

Ursula Mueller-Werdan ◽

David M Leistner ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Adverse Effects ◽

Social Isolation ◽

Social Life ◽

Management Strategies ◽

Vein Thrombosis ◽

Containment Measures ◽

Deep Vein ◽

Reduced Mobility ◽

Mobility Reduction

BACKGROUND The COVID-19 pandemic triggered countermeasures like #StayAtHome initiatives, which have changed the whole world. Despite the success of such initiatives in limiting the spread of COVID-19 to #FlattenTheCurve, physicians are now confronted with the adverse effects of the current restrictive pandemic management strategies and social distancing measures. OBJECTIVE We aim to draw attention to the particular importance and magnitude of what may be the adverse effects of COVID-19–related policies. METHODS We herein report a case of an otherwise healthy 84-year-old woman with deep vein thrombosis (DVT) due to COVID-19–related directives. #StayAtHome policies and consequential social isolation have diminished our patient’s social life and reduced her healthy movement behaviors. The patient spent long hours in a seated position while focusing on the intensive flow of media information regarding the pandemic. RESULTS Reduced mobility due to preventive social isolation during the COVID-19 pandemic was the only identified cause of the DVT. CONCLUSIONS While evaluating the effect of the COVID-19 pandemic and governmentally implemented containment measures, including social isolation and mobility reduction, adverse events should be considered. Digital approaches might play a crucial role in supporting public health.

Download Full-text