scholarly journals 518 - AUTOIMMUNE DEMENTIA – WHEN TO SUSPECT?

2021 ◽  
Vol 33 (S1) ◽  
pp. 67-68
Author(s):  
Filipa Caetano ◽  
Margarida Araújo ◽  
Ana Samouco ◽  
Serafim Carvalho
Keyword(s):  
Inflammatory Markers ◽  
Literature Search ◽  
Neurodegenerative Disorder ◽  
Clinical Presentations ◽  
Serologic Markers ◽  
History Of ◽  
Specific Autoantibody ◽  
Fluctuating Course ◽  
Reversible Condition ◽  
Histopathologic Findings

AbstractBackground:Autoimune dementias are underrecognized clinical entities, frequently misdiagnosed as neurodegenerative or prion disorders. However, the prognosis is vastly different since immunotherapy can treat these conditions and restore functionality.Research objective:To reflect on autoimmune dementias, briefly presenting the autoimmune syndromes, how to diagnose them and some clinical cues to be attentive of.Methods:Literature search on Pubmed and Google Scholar.Results:The incidence and prevalence of autoimmune dementias are unknown, but autoimmune and inflammatory causes account for 20% of dementia in patients younger than 45 years of age.Autoimmune dementias are classified according to syndromic presentation, specific serologic markers, or histopathologic findings.Patients with autoimmune dementias usually present with an acute or subacute disorder of memory, thinking, or behaviour. Clinical clues that can help clinicians identify autoimmune dementias include six of the following: (i) rapidly progressive or fluctuating course; (ii) multifocal and diverse clinical presentations; (iii) personal or family history of autoimmunity; (iv) detection of inflammatory markers in the cerebrospinal fluid; (v) presence of a neural-specific autoantibody and (vi) favourable response to a trial of immunotherapy. Also, unsuspected cancer, new or recurrent, may manifest neurologically as autoimmune dementia.In evaluating patients with dementia and autoimmune disease, clinicians should be aware of the possible coexistence of these disorders.Conclusions:Recognition of clinical and serologic clues to autoimmune dementia allows early and sustained treatment. Misdiagnosis of a potentially reversible condition as a progressive neurodegenerative disorder can have devastating consequences for the patient and family.

scholarly journals Marijuana Induced Gingival Enlargement

2019 ◽  
Vol 3 (1) ◽  
pp. 25-28
Author(s):  
Robins Dhakal ◽  
Shashi Kant Chaudhary ◽  
Ripu Singh ◽  
Shivalal Sharma ◽  
Ashish Shrestha
Keyword(s):  
Scaling And Root Planing ◽  
Provisional Diagnosis ◽  
Gingival Overgrowth ◽  
Clinical Presentations ◽  
Gingival Enlargement ◽  
Patient Reported ◽  
History Of ◽  
Marijuana Consumption ◽  
Histopathologic Findings

Different aetiologies with various clinical presentations are evident in cases of gingival enlargement. We report a case of 34-year-old male who presented with the chief complaint of gingival overgrowth in upper and lower front teeth region. Patient was systemically healthy and gave no history of common medications known to cause gingival enlargement. He had a history of marijuana consumption for two consecutive years following which gingival swelling increased in severity. Based on clinical and histopathologic findings, provisional diagnosis of combined inflammatory + marijuana induced gingival enlargement was made. Treatment consisted of scaling and root planing followed by sextant wise gingivectomy. Results were stable until three months follow-up. Signs of inflammation were evident when the patient reported after 1.5 years.

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

A Brief History of Psoriasis Management in Canada

2020 ◽  
Vol 24 (3) ◽  
pp. 273-277
Author(s):  
Khalad Maliyar ◽  
Patrick Fleming ◽  
Boluwaji Ogunyemi ◽  
Charles Lynde
Keyword(s):  
20Th Century ◽  
Coal Tar ◽  
Historical Review ◽  
Chronic Inflammatory Disease ◽  
Biologic Therapies ◽  
First Line ◽  
Revolutionary Change ◽  
Clinical Presentations ◽  
History Of ◽  
The 19Th Century

Psoriasis is a chronic, inflammatory disease with a varying degree of clinical presentations. Managing psoriasis has always been arduous due to its chronicity and its propensity to relapse. Prior to the development of targeted biologic therapies, there were few effective treatments for psoriasis. Ancient psoriasis therapies included pinetar, plant extracts, psychotherapy, arsenic, and ammoniated mercury. In the 19th century, chrysarobin was developed. Then, in the early half of the 20th century, anthralin and coal tar were in widespread use. In the latter half of the 20th century, treatments were limited to topical first-line therapies, systemic drugs, and phototherapy. However, as the treatment of psoriasis has undergone a revolutionary change with the development of novel biologic therapies, patients with moderate to severe psoriasis have been able to avail therapies with high efficacy and durability along with an acceptable safety profile. This article is a brief historical review of the management of psoriasis prior to the inception of biologics and with the development of novel biologic therapies.

scholarly journals Multiple-System Atrophy in Long-Term Professional Painter: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Yusa Nagai ◽  
Riko Kitazawa ◽  
Miku Nakagawa ◽  
Munenori Komoda ◽  
Takeshi Kondo ◽  
...  
Keyword(s):  
Multiple System Atrophy ◽  
Medulla Oblongata ◽  
Neurodegenerative Disorder ◽  
Histopathological Examination ◽  
Neuronal Loss ◽  
Cytoplasmic Inclusion ◽  
Multiple Organ ◽  
Old Japanese ◽  
History Of

Introduction. Multiple system atrophy (MSA) is a rare and severe adult-onset, sporadic, and progressive neurodegenerative disorder. Here, we describe an autopsy case of MSA in a long-term professional painter. Although typical glial cytoplasmic inclusion (GCI) was not observed in a routine histological examination, strong α-synuclein immunostaining in the nucleus confirmed the diagnosis of MSA.Case Presentation. A 48-year-old Japanese man with a long occupational history of professional painter was sent to the emergency room, where he died of multiple organ failure. The patient had suffered tremors and inarticulateness at age 28, developed diabetes at 42 and was diagnosed with spinocerebellar degeneration at 46. A histopathological examination showed severe neuronal loss, gliosis, and tissue rarefaction in the paleostriatum, striate body of the substantia nigra, the pons, and the olivary nucleus of the upper medulla oblongata, intermediolateral of the spinal gray matter (sacral region). α-synuclein-positive GCI in oligodendroglia was occurred in the cerebral cortex, the midbrain, the medulla oblongata, and the spinal cord. These findings confirmed the presence of multiple-system atrophy (OPCA+SDS).Conclusion. Although the pathogenesis of MSA is still unclear, prolonged, and extensive exposure to organic solvents, together with a hyperglycemic morbidity attributed to diabetes, may have contributed to the onset and clinical course of the present case.

scholarly journals Patients With a History of Idiopathic Deep Venous Thrombosis Have Long-Term Increased Levels of Inflammatory Markers and Markers of Endothelial Damage

2016 ◽  
Vol 23 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Mateja Kaja Jezovnik ◽  
Jawed Fareed ◽  
Pavel Poredos
Keyword(s):  
Inflammatory Markers ◽  
High Sensitivity ◽  
Endothelial Damage ◽  
Control Group ◽  
Necrosis Factor Alpha ◽  
Reactive Protein ◽  
Inflammatory Parameters ◽  
History Of ◽  
Hemostatic Markers

Introduction: Although the role of inflammation in DVT has been investigated in different studies, there is no definite answer as to whether increased systemic inflammation is the cause or the consequence of DVT. Aim: To follow inflammatory parameters in a cohort of patients with idiopathic DVT. Methods: Out of 49 patients with an acute idiopathic DVT, which were investigated four months after an acute episode (DEVTA 1), 43 patients were included in the follow-up study investigating inflammatory markers and hemostatic markers of endothelial damage five years after an acute DVT (DEVTA 2). A control group consisted of 43 sex and age matched healthy subjects (CONTROLS). Results: The levels of inflammatory markers were significantly higher in DEVTA 2 in comparison to CONTROLS: tumor necrosis factor alpha 2.0 pg/mL (1.1-2.3) vs 1.3 pg/mL (0.8-1.9), p < .001, high sensitivity C-reactive protein 3.2 mg/L (1.5-5.2) vs 1.7 mg/L (0.9-3.0), p = .008, interleukin-6 (IL-6) 2.7 pg/mL (2.0-3.5) vs 2.1 pg/mL (1.5-2.6), p = .025, IL-8 5.0 pg/mL (3.6-7.3) vs 2.4 pg/mL (1.8-2.8), p < .001. IL-10 was significantly decreased (0.9 pg/mL (0.7-1.8) vs 1.8 (1.5-2.2), p < .001. Most of the proinflammatory markers remained elevated in the DEVTA 2 in comparison to DEVTA 1. Markers of endothelial damage were higher in DEVTA 2 in comparison to CONTROLS and higher than in DEVTA 1. Conclusion: Patients with idiopathic DVT have long-term increased inflammatory markers and markers of endothelial damage. These findings favor the hypothesis that inflammation is a cause and not merely a consequence of acute DVT.

Marriage, monogamy and HIV: a profile of HIV-infected women in south India

2000 ◽  
Vol 11 (4) ◽  
pp. 250-253 ◽  
Author(s):  
S Newmann ◽  
P Sarin ◽  
N Kumarasamy ◽  
E Amalraj ◽  
M Rogers ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hiv Risk ◽  
South India ◽  
Reproductive Age ◽  
Indian Women ◽  
Clinical Presentations ◽  
Vertical Transmission Of Hiv ◽  
History Of ◽  
The Mean ◽  
Heterosexual Sex

A retrospective study was conducted on 134 HIV-infected females evaluated at an HIV/AIDS centre in south India to characterize their socio-demographics, HIV risk factors and initial clinical presentations. The mean age was 29 years; 81% were housewives; 95% were currently or previously married; 89% reported heterosexual sex as their only HIV risk factor; and 88% reported a history of monogamy. The majority were of reproductive age, thus the potential for vertical transmission of HIV and devastating impacts on families is alarming. Nearly half of these women initially presented asymptomatically implying that partner recruitment can enable early HIV detection. Single partner heterosexual sex with their husband was the only HIV risk factor for the majority of women. HIV prevention and intervention strategies need to focus on married, monogamous Indian women whose self-perception of HIV risk may be low, but whose risk is inextricably linked to the behaviour of their husbands.

scholarly journals P045 Nothing is too 'cagey' for the rheumatologist

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad F Kazmi
Keyword(s):  
Weight Loss ◽  
Inflammatory Markers ◽  
Low Grade ◽  
Careful Monitoring ◽  
Chronic Infections ◽  
Asian Origin ◽  
Travel History ◽  
Chest Clinic ◽  
History Of ◽  
Inflammatory Changes

Abstract Background/Aims  Rheumatological conditions can present with a number of non-specific features like arthralgia, fever, fatigue, weight loss along with raised inflammatory markers and positive antibodies. Due to this, when similar symptoms are referred for input it is very important to consider other ‘mimics’. We report a case of Pigeon fancier’s lung presenting with these symptoms which was referred as likely connective tissue disease. Methods  A 52-year-old lady of South Asian origin was referred by her GP with six month history of 3kg weight loss, arthralgia, fatigue, low grade fever and persistently raised inflammatory markers (ESR ranging from 50-64 mm/hr, CRP 10-14 mg/L, normal BMI). On further questioning there was history of mouth ulcers, non-specific rash, occasional cough but no Raynaud’s or joint swelling. Blood investigations showed weakly positive ANA and RF but negative ENA, DNA, antiCCP , CK, C3,C4. C-ANCA was positive but PR3 negative. CXR was clear and tests for chronic infections including TB were negative. Due to lack of objective CTD signs, plan was to take a careful monitoring approach to see if clinical features evolved. A month later due to worsening cough, a CT chest/abdomen arranged by GP showed ground-glass changes consistent with pneumonitis and hence her rheumatology appointment was expedited to see if there was an autoimmune unifying diagnosis. She was also referred by her GP to the chest clinic in view of CT report and mild shortness of breath. Results  On further review, again there were no objective CTD signs. On direct questioning there was history of travelling before worsening chest symptoms to South Asia. Also around a year before her symptoms started she was given an African grey parrot. Based on this, serology for Avian precipitin was checked which showed strongly positive IgG antibodies to avian antigens (Budgerigar droppings and feathers, Pigeon feathers IgG Abs) confirming the diagnosis of pigeon fanciers lung. She fulfilled the diagnostic criteria and was asked to avoid the trigger. Urgent respiratory input was arranged where diagnosis was agreed with and disease was deemed sub-acute in presentation. Due to PFTs showing low transfer factor of 38%, Prednisolone was started with significant improvement within few days. Review of CT chest only showed inflammatory changes and no established fibrosis predicting excellent prognosis as delay in treatment can cause irreversible pulmonary fibrosis. Conclusion  A number of conditions can mimic rheumatological conditions which usually turn out to be either infectious or malignant in origin. This case highlights the importance of considering other differentials and along with taking a travel history also asking for other possible triggers like pets. In similar scenarios the diagnosis may be ‘cagey’ but as rheumatologists we are expected to answers questions which others can’t. Disclosure  M.F. Kazmi: None.

scholarly journals Salivary Pro-Inflammatory Markers and Smoking Status Influences the Treatment Effectiveness of Periodontal Disease Patients with Hypertension

2021 ◽  
Vol 18 (14) ◽  
pp. 7364
Author(s):  
Kun-Tsung Lee ◽  
Zhu-Ling Guo ◽  
Nai-Chia Teng ◽  
Kuei-Ling Christine Hsu ◽  
I-Hui Chen ◽  
...  
Keyword(s):  
Periodontal Disease ◽  
Recovery Rate ◽  
Inflammatory Markers ◽  
Treatment Effectiveness ◽  
Smoking Status ◽  
Periodontal Diseases ◽  
Probing Depth ◽  
Before And After ◽  
Therapeutic Procedures ◽  
History Of

Background: Hypertension and periodontal diseases share several risk factors. Inflammation biomarkers in saliva are related to hypertension and periodontal disease. The aim of this study was to explore the role of the salivary inflammatory biomarkers in the treatment effectiveness of patients with hypertension and periodontal disease. Methods: This observational study enrolled 160 subjects diagnosed with periodontitis, 40 of which had a history of hypertension. All subjects had completed scaling and root planning therapeutic procedures within four weeks. The clinical periodontal parameters (i.e., bleeding on probing, plaque control record (PCR), and probing depth (PD)) were evaluated before and after the treatment. Pro-inflammatory markers were determined using a commercial kit. Results: The recovery rate (PD 4–9 mm) in non-hypertensive subjects was significantly higher than in hypertensive subjects (60.47% vs. 52.60%, respectively; p = 0.04). All clinical parameters, excluding PCR, positively correlated with salivary IL-1β at baseline and after completing treatment. Our results showed that increased salivary IL-1β levels were positively associated with decreased PCR (β = −27.65 and p = 0.05) and PD recovery rate (β = −17.05 and p = 0.02) in hypertensive subjects. Conclusions: The present study sheds important light on the clinical use of salivary pro-inflammatory cytokines as valuable biomarkers for predicting the treatment effectiveness of patients suffering from hypertension and periodontitis.

scholarly journals The State of Clinical Librarianship in Canada: a Review of the Literature, 1970–2013

2014 ◽  
Vol 34 (2) ◽  
pp. 69 ◽  
Author(s):  
Helen Halbert
Keyword(s):  
United States ◽  
Professional Training ◽  
Literature Search ◽  
The United States ◽  
Formative Period ◽  
Review Of The Literature ◽  
Job Titles ◽  
Medical Librarian ◽  
History Of ◽  
Insight Into

This paper examines the history of clinical librarianship in Canada from 1970 to 2013 as seen through the lens of practitioner narratives and published literature. While no reviews of clinical librarianship in Canada were found in the literature search, there were many project descriptions in articles and published reports that have provided insight into the field during its formative period in Canada from the 1970s. In addition to tracing narrative histories from 1970 to 2013, the author has continued to wonder why these important stories have never properly been told. Was it because the scope of clinical librarianship, its expected and embodied professional duties, was not regulated (as it is in the United States and United Kingdom)? Is it because the American Library Association accredited library schools in Canada do not offer appropriate curricula and professional training? It seems clear that some librarians in Canada were pioneers in the way that Gertrude Lamb was in the United States, but they did not call themselves clinical librarians. Consequently, they opted for more generic job titles such as medical librarian and health librarian. Whatever the reasons for this, it is within this framework that the author begins an exploration of clinical librarianship in Canada. The paper's aim is to provide a view into clinical librarianship in Canada back to the 1970s to ensure the story is properly told.

scholarly journals The Natural History of Infantile Neuroaxonal Dystrophy

2020 ◽  
Author(s):  
Fadie D Altuame ◽  
Gretchen Foskett ◽  
Paldeep Atwal ◽  
Sarah Endemann ◽  
Mark Midei ◽  
...  
Keyword(s):  
Natural History ◽  
Neurodegenerative Disorder ◽  
Gastrointestinal Disease ◽  
Cerebellar Atrophy ◽  
Neuroaxonal Dystrophy ◽  
Fine Motor ◽  
Speech Impairment ◽  
Infantile Neuroaxonal Dystrophy ◽  
Significant Difference ◽  
History Of

Abstract Background: Infantile neuroaxonal dystrophy (INAD) is a rapidly progressive neurodegenerative disorder of early onset causing premature death. It results from biallelic pathogenic variants in PLA2G6, which encodes a calcium‐independent phospholipase A2. Objective: We aim to outline the natural history of INAD and provide a comprehensive description of its clinical, radiological, laboratory, and molecular findings. Materials and Methods: We comprehensively analyzed the charts of 28 patients: 16 patients from Riyadh, Saudi Arabia, 8 patients from North and South America and 4 patients from Europe with a molecularly confirmed diagnosis of PLA2G6‐associated neurodegeneration (PLAN) and a clinical history consistent with INAD.Results: In our cohort, speech impairment and loss of gross motor milestones were the earliest signs of the disease. As the disease progressed, loss of fine motor milestones and bulbar dysfunction were observed. Temporo-frontal function was among the last of the milestones to be lost. Appendicular spastic hypertonia, axial hypotonia, and hyperreflexia were common neurological findings. Other common clinical findings include nystagmus (60.7%), seizures (42.9%), gastrointestinal disease (42.9%), skeletal deformities (35.7%), and strabismus (28.6%). Cerebellar atrophy and elevations in serum AST and LDH levels were consistent features of INAD. There was a statistically significant difference when comparing patients with non-sense/truncating variants compared with missense/in-frame deletions in the time of initial concern (p = 0.04), initial loss of language (p = 0.001), initial loss of fine motor skills (p = 0.009), and initial loss of bulbar skills (p = 0.007).Conclusion: INAD is an ultra-rare neurodegenerative disorder that presents in early childhood, with a relentlessly progressive clinical course. Knowledge of the natural history of INAD may serve as a resource for healthcare providers to develop a targeted care plan and may facilitate the design of clinical trials to treat this disease.

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