Recurrency may predict final outcome in myasthenic crisis

2021 ◽  
Vol 429 ◽  
pp. 118342
Author(s):  
Erika Iori ◽  
Marco Mazzoli ◽  
Alessandra Ariatti ◽  
Virginia Agnoletto ◽  
Elisabetta Bastia ◽  
...  
Keyword(s):  
Final Outcome ◽  
Myasthenic Crisis

Percutaneous Cholecystostomy for Gallbladder Perforation: Early Response and Final Outcome in 10 Patients

1998 ◽  
Vol 38 (1) ◽  
pp. 41
Author(s):  
Jeong Min Lee ◽  
Young Min Han ◽  
Mi Suk Lee ◽  
Jin Kim ◽  
Hyo Seong Kowk ◽  
...  
Keyword(s):  
Early Response ◽  
Final Outcome ◽  
Gallbladder Perforation ◽  
Percutaneous Cholecystostomy

All Animals Are Equal, or Are They? The Ikhwān al-Ṣafāʾ’s Animal Epistle and its Unhappy End

2014 ◽  
Vol 16 (2) ◽  
pp. 42-88 ◽  
Author(s):  
Sarra Tlili
Keyword(s):  
The Body ◽  
Final Outcome ◽  
Human Beings ◽  
Main Text ◽  
Nonhuman Animals ◽  
Privileged Status

The Ikhwān al-Ṣafāʾ’s animal epistle is an intriguing work. Although in the body of the narrative the authors challenge anthropocentric preconceptions and present nonhuman animals in a more favourable light than human beings, inexplicably, the narrative ends by reconfirming the privileged status of humans. The aim of this paper is to propose an explanation for this discrepancy. I argue that the egalitarian message reflected in the body of the narrative is traceable back to the Qur'an, the main text with which the authors engage in the fable, whereas the final outcome is due to the Ikhwān's hierarchical worldview.

scholarly journals Myasthenia gravis in children: analysis of 18 patients

2001 ◽  
Vol 59 (3B) ◽  
pp. 681-685 ◽  
Author(s):  
Maria da Penha A. Morita ◽  
Alberto A. Gabbai ◽  
Acary S.B. Oliveira ◽  
Audrey S. Penn
Keyword(s):  
Myasthenia Gravis ◽  
Intravenous Immunoglobulin ◽  
Acetylcholine Receptor ◽  
Nerve Stimulation ◽  
Chest Ct ◽  
Clinical Severity ◽  
Myasthenic Crisis ◽  
Repetitive Nerve Stimulation ◽  
Follicular Hyperplasia ◽  
Receptor Antibodies

Myasthenia gravis (MG) in childhood is rare comprising 10 to 20 % of all myasthenic patients. We studied 18 patients with MG whose first symptoms started from 1 to 12 years of age, followed at the Department of Neurology of the UNIFESP-EPM, from January 1983 to August 1997. There were 10 girls and 8 boys (1.2:1). Eleven patients (61%) presented moderate or severe generalized disease and 4 (22%) had at least one myasthenic crisis. EMG with supramaximal repetitive nerve stimulation was diagnostic in 8 (47%) out of 17 patients, and chest CT was normal in 14 patients. Seropositivity to acetylcholine receptor antibodies was found in 81.6% (9 out of 11 tested) and the levels had no relation to clinical severity. Nine out of 16 patients (56%) worsened with pyridostigmine alone and were treated with prednisone. Four out of those nine continued worsening despite steroids and were subjected to thymectomy (all showed thymic lymphoid follicular hyperplasia). Three patients (75%) improved markedly after thymectomy and one (25%) worsened, eventually getting better with intravenous immunoglobulin and oral azathioprine. MG treatment, using all resources available, has to be individualized for each child.

scholarly journals Effective Early Treatment of AChR Antibody-Positive Myasthenia Gravis with Rituximab; the Experience from a Neuroimmunology Clinic in a Developing Country

2021 ◽  
Vol 13 ◽  
pp. 117957352110160
Author(s):  
Thomas Mathew ◽  
Kurian Thomas ◽  
Saji K John ◽  
Shruthi Venkatesh ◽  
Raghunandan Nadig ◽  
...  
Keyword(s):  
Observational Study ◽  
Myasthenia Gravis ◽  
Treatment Option ◽  
Early Treatment ◽  
Early Stage ◽  
Tertiary Care ◽  
Response To Treatment ◽  
Myasthenic Crisis ◽  
Achr Antibody ◽  
Significant Difference

Background: Rituximab is reserved for treating refractory myasthenia gravis (MG) patients. Here we report our experience with rituximab in AChR antibody positive generalized MG (gMG) and impending myasthenic crisis (IMC). Methods: This retrospective, observational study, conducted at a tertiary care, neuroimmunology clinic, analyzed the data of patients with AChR antibody positive gMG, treated with rituximab between 1st January 2016 and 30th October 2018. Results: Eleven patients with AChR antibody positive gMG received rituximab. Mean age of the cohort was 50.54 ± 18.71 years with 9 males. Seven out of 11 patients received rituximab in the early stage (<2 years from onset) and had good response to treatment. Four of the 5 patients with IMC improved with rituximab alone. In the 10 patients who regularly followed up, there was a significant difference between the QMG scores at baseline and at 1, 2, 6, 12, and 18 months ( P < .0001). Conclusion: Rituximab appears to be a potentially effective early treatment option for AChR antibody positive generalized MG and impending myasthenic crisis.

Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Martin A. Schaller-Paule ◽  
Helmuth Steinmetz ◽  
Friederike S. Vollmer ◽  
Melissa Plesac ◽  
Felix Wicke ◽  
...  
Keyword(s):  
Patient Safety ◽  
Clinical Reasoning ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Care Physician ◽  
Diagnostic Process ◽  
Myasthenic Crisis ◽  
Hospital Organization ◽  
Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

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