Care of the Cocaine User with Nasal Deformity

2017 ◽  
Vol 33 (04) ◽  
pp. 411-418 ◽  
Author(s):  
Anil Joshi ◽  
Alwyn D'Souza ◽  
Abigail Walker
Keyword(s):  
Surgical Approach ◽  
Case Reports ◽  
Case Series ◽  
Careful Consideration ◽  
Western World ◽  
Free Text ◽  
Nasal Deformity ◽  
Psychiatric Comorbidities ◽  
Operative Care ◽  
Number Of Patients

AbstractCocaine is the most commonly used stimulant in the Western world, and its use is increasing not only in young people but also in people older than 40 years. Intranasal use is associated with several pathologies, ranging from crusting and blockage, to fibrosis and scarring, to destruction of the osteocartilaginous structures of the midface. As its use becomes more prevalent in society, the reconstructive surgeon can accordingly expect to be faced with an increasing number of patients with cocaine-related nasal deformity. However, the use of cocaine adds a significant layer of complexity to the perioperative and operative care that requires careful consideration by the whole health care team. We present a practical evidence-based guide to management of reconstruction of the cocaine nose, taking in all aspects of periprocedural care. Finally, we present a model for surgical approach based on best evidence and the experience of the senior author. A search was performed of the Medline, Embase, and Cochrane Collection database using both MeSH keywords and free text words, identifying key articles on the epidemiology, pathophysiology, and medical and psychiatric comorbidities of cocaine users. Both case series and case reports reporting cocaine-associated defects and their reconstruction were reviewed together with the senior authors (A.D.S., A.J.), and a series of recommendations synthesized based on these recommendations. The nasal deformities associated with cocaine use represent only the tip of the iceberg of underlying associated pathology. The surgeon who embarks upon reconstruction of the cocaine nose should be aware of possible coexisting medical and psychiatric comorbidities that may complicate both the patient's motivations for surgery and their fitness to undergo anesthesia. Ultimately, successful reconstructive outcomes are critically dependent on holistic perioperative care and the surgeon's ability to be flexible in their surgical approach.

Cholinesterase Inhibitors and Memantine: Best Practices

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S16) ◽  
pp. 34-35 ◽  
Author(s):  
Rachelle S. Doody
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Best Practices ◽  
Cholinesterase Inhibitors ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Case Series ◽  
Added Value ◽  
Case Control Studies ◽  
Number Of Patients

Today’s therapies must be put in the context of both currently available treatments as well as treatment trials with exciting potential for use in the near future. Current clinical trial methodologies do not allow for clear separation of symptomatic treatments from disease-modifying therapies; it may be unproductive to maintain this distinction given the current range of treatments available. A more currently relevant focus is added value. Therapies should aim to provide added value through incremental benefits above and beyond existing treatments, as well as enduring benefits.Alzheimer’s disease (AD) treatment guidelines are not used by physicians only. Healthcare payers often make use of these guidelines to delimit coverage. Cost concerns will also impact AD treatments after generic cholinesterase inhibitors are made available; it is widely believed that a great number of patients will switch to generics. Therefore, treatment guidelines must account for the possible adverse effects of switching therapies as well as the desirability of persistent treatment. There are many AD treatment guidelines, among them the American Academy of Neurology (AAN) Management of Dementia Guidelines, which are currently being revised. The Institute for the Study on Aging (ISOA) Management of Alzheimer’s Disease in Managed Care Guideline also presents a different approach for a different audience.The first step to creating evidence-based best practices guidelines is to determine what is meant by “evidence.” A system of classification exists for examining forms of evidence: Class I evidence is provided by one or more well-designed, randomized, controlled clinical trials, including overviews or meta-analyses of such trials. Class II evidence is provided by well-designed observational studies with concurrent controls; for example, case-control studies that generate hypotheses about epidemiologic associations. Class III evidence is provided by expert opinion, case series, case reports, and studies with historical controls.

scholarly journals ECMO in Poisoning

2017 ◽  
Vol 01 (02) ◽  
pp. 82-88
Author(s):  
Vivek Gupta ◽  
Gurpreet S. Wander
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Case Series ◽  
Supportive Therapy ◽  
Tissue Perfusion ◽  
Western World ◽  
Hemodynamic Compromise ◽  
The World

AbstractSevere poisoning may lead to life-threatening situation or death due to cardiovascular dysfunction, arrhythmia, or cardiogenic shock. The poisoning substance varies in different parts of world; in the Western world, the drugs with cardiotoxic potential are more common, while pesticides and other household toxins are common in the rest of the world. However, most of these patients are relatively young and otherwise healthy irrespective of poisoning substances. Extracorporeal membrane oxygenation (ECMO) has regained interest in recent past and now its use is being explored for newer indications. The use of ECMO in poisoning has shown promising results as salvage therapy and can be used as bridge to recovery, antidote, and toxin removal with renal replacement therapy or transplant. The ECMO has been used in those poisoned patients who have persistent cardiogenic shock or refractory hypoxemia despite adequate supportive therapy. ECMO may be useful in providing adequate cardiac output and maintain tissue perfusion which helps in the redistribution of toxins from central circulation and facilitate the metabolism and excretion. However, the available literature is not sufficient and is based on case reports, case series, and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is an underutilized modality across the world. Though evidences suggest that early consideration of ECMO in severely poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial, the right time to start ECMO in poisoned patients, criteria to start ECMO, and prognostication prior to initiation of ECMO is yet to be answered. Future studies and publications may address these issues, whereas the ELSO (Extracorporeal Life Support Organization) data registry may help in collecting global data on poisoning more effectively.

scholarly journals 18 Years of Medication-Related Osteonecrosis of the Jaw (MRONJ) Research: Where Are We Now?—An Umbrella Review

2021 ◽  
Vol 11 (19) ◽  
pp. 8818
Author(s):  
Roberto Sacco ◽  
Monica Diuana Calasans-Maia ◽  
Julian Woolley ◽  
Oladapo Akintola ◽  
Carlos Fernando de Almeida Barros Mourão ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Case Reports ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
Umbrella Review ◽  
Severe Condition ◽  
Manual Search ◽  
Number Of Patients ◽  
Retrospective Cohort Studies ◽  
Study Designs

Background: Osteonecrosis of the jaw (ONJ) is a condition affecting patients exposed to medications used to treat benign and malignant conditions of bone tissue. Many studies have highlighted that ONJ is a severe condition, which is very challenging to manage, especially in individuals with oncologic disease. The aim of this umbrella review is to analyze all available interventional and non-interventional systematic reviews published on medication-related osteonecrosis of the jaw (MRONJ) and summarize this evidence. Material and methods: A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until June 2021. An additional manual search was also performed in systematic review registries (PROSPERO, INPLASY, JBI and OFS) to identify possible missing reviews. Data were extracted from relevant papers and analyzed according to the outcomes selected in this review. Results: The search generated 25 systematic reviews eligible for the analysis. The total number of patients included in the analysis was 80,840. Of the reviews, 64% (n = 16) were non-interventional and 36% (n = 9) were interventional. Study designs included case series 20.50% (n = 140), retrospective cohort studies 12.30% (n = 84) and case reports 12.20% (n = 83). It was unclear what study design was used for 277 studies included in the 25 systematic reviews. Conclusions: The data reviewed confirmed that the knowledge underpinning MRONJ in the last 20 years is still based on weak evidence. This umbrella review highlighted a widespread low-level quality of studies and many poorly designed reviews.

scholarly journals Fracture of the Posteromedial Tubercle of the Talus: Case Series of Fifteen Patients Along with Cadaveric Dissection and Anatomic Considerations for Surgical Approach

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Andrew M. Steffensmeier ◽  
Robert Matar ◽  
David Chung ◽  
Ruixian A. Yue ◽  
Tonya L. Dixon ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Surgical Approach ◽  
Medical Center ◽  
Case Reports ◽  
Case Series ◽  
Cadaveric Dissection ◽  
Subtalar Dislocation ◽  
Posterior Process ◽  
Subtalar Arthritis ◽  
Operative Fixation

Category: Ankle; Hindfoot; Trauma Introduction/Purpose: Fractures of the talus are among the most commonly fractured bone of the foot, with 10 to 21% involving the posterior process. These fractures have not been well characterized or reported in the literature and is limited to case reports and case series. The primary objective of this study is to characterize posterior process fractures, describe a surgical approach for open reduction internal fixation (ORIF) with the use of cadaveric dissection pictures of surgical technique and describe 15 cases. Methods: A search query of the institutional database was performed for all adult patients that sustained talar fractures at the University of Cincinnati Medical Center from 1/1/2010 to 12/31/2018. Patients sustaining posterior process talus fractures who underwent operative fixation and nonoperative treatment were identified. All radiographs and CT images were then reviewed by three orthopedic surgeons and the electronic medical record was reviewed for injury characteristics, method of operative fixation, and postoperative complications. Results: 15 cases of posterior process fractures were identified. Overall, 4 patients had fixation placed in the posterior process fracture while 11 did not. None of the patients who underwent ORIF of the posterior process developed subtalar arthritis at their latest follow-up, while 3 of the 11 (27.3%) that did not receive fixation suffered from subtalar arthritis and 1 (9.1%) required surgery for removal of retained loose bodies. 13 patients (86.67%) initially had plain radiographs that missed the diagnosis. Cadaveric specimens were used to illustrate surgical approach for ORIF of these talus fractures. Anatomic pictures of the surgical dissection were taken to show the extent of exposure to the posterior process fracture using traditional techniques, as well as methods of distraction to enhance visualization are demonstrated. Conclusion: Providers must have high suspicion for posterior process talus fractures as many are missed on the initial radiographs. CT scans are recommended for all patients with subtalar dislocations. Those with subtalar dislocation tend to have comminuted fragments. Significant morbidity is associated with this injury regardless of whether it is treated operatively or nonoperatively. We describe a surgical technique using distractors to adequately visualize the posteromedial process fracture of the talus.

111 Epileptic seizures in multiple sclerosis

2018 ◽  
Vol 89 (6) ◽  
pp. A44.1-A44
Author(s):  
Stephen Walsh ◽  
Joel Corbett ◽  
K Meng Tan ◽  
Simon Broadley
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Age Of Onset ◽  
Case Reports ◽  
Case Series ◽  
Clinical Information ◽  
Epileptic Seizures ◽  
Disease Course ◽  
Number Of Patients ◽  
Significant Difference

IntroductionEpileptic seizures have been described in association with multiple sclerosis (MS) in both anecdotal case reports and case series. The recent identification of specific antibodies to myelin oligodendrocyte glycoprotein (MOG) protein in a small number of patients with demyelinating disease which may resemble neuromyelitis optica or acute disseminated encephalopathy, which may involve seizures, raises the possibility that anti-MOG antibody related demyelination may account for the association of epilepsy with MS.MethodsWe have undertaken a retrospective review of cases of MS diagnosed at the Gold Coast MS clinic over a 10 year period. All cases were systematically asked if they had ever had an epileptic seizure either via a patient completed questionnaire or at a clinic visit. Demographic and clinical information were also recorded. These data have been analysed using descriptive statistics and appropriate tests for significant differences between those with epilepsy and those without.Results428 cases with complete data were identified. Those with a history of epilepsy were slightly younger (median (range); 44.5 (27–64) years vs 4715–88 years), but this difference was not statistically significantly different. The gender ratio was the same for both groups (9/12 (75%) for those with epilepsy and 326/416 (78%)). There was no significant difference in age of onset, disease course, relapse frequency or level of disability. Although numbers are small, seizure appear to occur most frequently earlier in the disease course and are rarely an ongoing issue.ConclusionThese data support earlier work indicating that epilepsy occurs in people with MS who are younger. This fits with the notion that seizures arise in the context of the inflammatory stage of multiple sclerosis rather than the degenerative phase. Further work needs to be undertaken to assess any association with anti-MOG antibodies and epileptic seizures in demyelinating disease.

scholarly journals Assessment of the possibility of vertical transmission of COVID-19: A systematic review and meta-analysis protocol

2020 ◽  
Author(s):  
Sareh Dashti ◽  
Tahereh Fathi Najafi ◽  
Hamid Reza Tohidinik ◽  
Narjes Bahri
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Observational Studies ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
World Health ◽  
Free Text ◽  
Care Providers

Abstract BackgroundThe novel coronavirus 2019 (COVID-19) outbreak has put a great burden on global health and healthcare systems. One of the vulnerable groups to COVID-19 infection and complications is the pregnant women. There is controversy regarding the possibility of vertical transmission of COVID-19 from mother to infant. The aim of this systematic review and meta-analysis was to assess the possibility of vertical transmission of COVID-19 based on currently published literature including observational studies. All published articles including case reports, case series,MethodsThis study will be conducted on all published observational studies, including cross-sectional studies, cohort, case-control, case reports, and case series, in peer reviewed journals in any language until the end of March 2020. Editorials, commentaries and letter to editors will be excluded from the review. Search will be conducted in international bibliographic databases including PubMed, Embase, and Web of Science based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Primary search will be performed in PubMed and Embase using the Coronavirus 2019 and vertical transmission keywords based on medical subject heading (MeSH) terms along with free text searching in combination with Boolean operations. The search strategy will be improved and finalized based on the results of the primary search. The World Health Organization (WHO) and google scholar websites will be searched as grey literature. Articles will be reviewed by two authors independently for the relevance of titles and abstracts. Data extraction of the included articles will be performed by two researchers using the Zotero and review manager (revMan) software. Heterogeneity of the articles will be assessed using DerSimonian & Laird Q test and I 2 statistic. The pooled estimated prevalence of vertical transmission of COVID-19 will be performed using the Metaprop command. Publication bias will be assessed using the Begg's rank correlation and the Egger weighted regression methods.DiscussionThe findings of this systematic review and meta-analysis will help practitioners and health care providers in decision making for the care and management of COVID-19 infected pregnant women. Systematic review registration In process

scholarly journals Using a 3D printer in cardiac valve surgery: a systematic review

2019 ◽  
Vol 65 (6) ◽  
pp. 818-824
Author(s):  
Liliana Fortini Cavalheiro Boll ◽  
Guilherme Oberto Rodrigues ◽  
Clarissa Garcia Rodrigues ◽  
Felipe Luiz Bertollo ◽  
Maria Claudia Irigoyen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Valve ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Valve Surgery ◽  
Heart Valve Prosthesis ◽  
3D Printer ◽  
Valve Prosthesis ◽  
Number Of Patients

SUMMARY BACKGROUND: The use of the 3D printer in complex cardiac surgery planning. OBJECTIVES: To analyze the use and benefits of 3D printing in heart valve surgery through a systematic review of the literature. METHODS: This systematic review was reported following the Preferred Reporting Items for Systematic Review and registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42017059034. We used the following databases: PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles about the keywords “Heart Valves”, “Heart Valve Prosthesis Implantation”, “Heart Valve Prosthesis”, “Printing, Three-Dimensional”, and related entry terms. Two reviewers independently conducted data extraction and a third reviewer solved disagreements. All tables used for data extraction are available at a separate website. We used the Cochrane Collaboration tool to assess the risk of bias of the studies included. RESULTS: We identified 301 articles and 13 case reports and case series that met the inclusion criteria. Our studies included 34 patients aged from 3 months to 94 years. CONCLUSIONS: Up to the present time, there are no studies including a considerable number of patients. A 3D-printed model produced based on the patient enables the surgeon to plan the surgical procedure and choose the best material, size, format, and thickness to be used. This planning leads to reduced surgery time, exposure, and consequently, lower risk of infection.

scholarly journals A Review of Cases of Human Cysticercosis in Canada

2012 ◽  
Vol 39 (3) ◽  
pp. 319-322 ◽  
Author(s):  
Oscar H. Del Brutto
Keyword(s):  
Case Reports ◽  
Clinical Manifestations ◽  
Case Series ◽  
Parasitic Disease ◽  
Striated Muscles ◽  
Citizenship Status ◽  
Household Contacts ◽  
The Past ◽  
Manual Search ◽  
Number Of Patients

Objective:Review of human cysticercosis in Canada, to estimate the magnitude of the disease and to describe the pattern of disease expression in this country.Methods:MEDLINE and manual search of case reports and case series of patients with cysticercosis diagnosed in Canada. Abstracted data included year of diagnosis, citizenship status, clinical manifestations, and form of cysticercosis.Findings:A total of 21 articles reporting 60 patients were found. Forty (67%) of these patients were diagnosed in the past two decades. Most cases came from Ontario (n=43) and Quebec (n=14). Immigrants accounted for 96% of the 28 cases in whom citizenship information was available. Neurocysticercosis was observed in 55 patients, and isolated compromise of striated muscles in the remaining five. Seizures was the primary or sole manifestation of the disease in 72% of patients, and most of them had parenchymal brain cysticerci (either viable cysts or calcifications). Two of seven patients were positive for Taenia eggs. In no case were household contacts of the patients investigated for taeniasis.Conclusions:An increasing number of patients with cysticercosis have been reported from Canada in the past two decades, suggesting that the prevalence of this parasitic disease may be on the rise. While most cases occur in immigrants, it is possible that at least some of these patients had acquired the disease in Canada.

scholarly journals Ivabradine: A Potential Therapeutic for Children With Refractory SVT

2021 ◽  
Vol 8 ◽  
Author(s):  
Nour K. Younis ◽  
Bernard Abi-Saleh ◽  
Farah Al Amin ◽  
Omar El Sedawi ◽  
Christelle Tayeh ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pediatric Patients ◽  
Case Reports ◽  
Combined Therapy ◽  
Case Series ◽  
Left Ventricular ◽  
Baseline Heart Rate ◽  
Treatment Resistant ◽  
Number Of Patients ◽  
Complete Reversal

Background: In April 2015, ivabradine was approved by the Food and Drug Administration for the treatment of patients with coronary artery disease and heart failure (HF). The use of this medication has been linked with improved clinical outcomes and reduced rates of hospitalization in patients with symptomatic HF and a baseline heart rate of 70 bpm and above. Nonetheless, little is known about the use of ivabradine in pediatric patients with supraventricular tachycardia (SVT). This use is not well-studied and is only endorsed by a few case reports and case series.Aim: This study discusses the off-label utilization of ivabradine in pediatric patients with SVT, and highlights its efficacy in treating treatment-resistant (refractory) SVT.Methods: We conducted a retrospective single-center observational study involving pediatric patients with SVT treated at our center between January 2016 and October 2020. We identified the total number of patients with SVT, and the number of patients with refractory SVT treated with Ivabradine. Similarly, we performed a thorough review of the databases of PubMed, Medline and Google Scholar to compare the clinical course of our patients to those described in the literature.Results: Between January 2016 and October 2020, 79 pediatric patients with SVT were seen and treated at our center. A treatment-resistant SVT was noted only in three patients (4%). Ivabradine was used in these patients as a single or combined therapy. The rest (96%) were successfully treated with conventional anti-arrhythmics such as β-blockers, flecainide, and other approved medications. In the ivabradine group, successful reversal to sinus rhythm was achieved in two of the three patients (66%), one patient was treated with a combination therapy of amiodarone and ivabradine, and the other patient was treated only with ivabradine.Conclusion: Overall, promissory results are associated with the use of ivabradine in pediatric patients with refractory SVT. Ivabradine appears to be a safe and well-tolerated medication that can induce adequate suppression of SVT, complete reversal to sinus rhythm, and effective enhancement of left ventricular function.

scholarly journals Eosinophilic Gastroenteritis: Case Report and Review in Search for Diagnostic Key Points

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Guillermo López-Medina ◽  
Manuel Gallo ◽  
Alejandro Prado ◽  
Iliana Vicuña-Honorato ◽  
Roxana Castillo Díaz de León
Keyword(s):  
Complete Blood Count ◽  
Case Reports ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Original Description ◽  
Eosinophilic Gastroenteritis ◽  
Diagnostic Challenge ◽  
Number Of Patients ◽  
Diagnostic Key ◽  
Low Incidence

Eosinophilic gastroenteritis is considered an uncommon disease with a low incidence rate that remains as a diagnostic challenge for the clinician, in spite of the fact that seventy years have passed since its original description. Hereby we present the case of a 29-year-old male without history of allergies who was evaluated for unspecific gastrointestinal symptoms, without relevant findings on physical examination and presenting an initial complete blood count (CBC) with severe eosinophilia. The patient was evaluated and the diagnosis of eosinophilic gastroenteritis was confirmed by histopathological findings. The relevance of the case resides in highlighting the lack of guidelines or consensus for histological diagnosis being virtually the only one available. To a similar extent, treatment evidence is based on case series with a reasonable number of patients and case reports.

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