Approach to Tremor Disorders

2021 ◽  
Vol 41 (06) ◽  
pp. 731-743
Author(s):  
Andrea Lee ◽  
Harini Sarva
Keyword(s):  
Botulinum Toxin ◽  
Diagnostic Tests ◽  
Laboratory Testing ◽  
Treatment Options ◽  
Assistive Devices ◽  
Multiple Networks ◽  
Systemic Manifestations

AbstractTremor disorders are diverse and complex. Historical clues and examination features play a major role in diagnosing these disorders, but diagnosis can be challenging due to phenotypic overlap. Ancillary testing, such as neuroimaging or laboratory testing, is driven by the history and examination, and should be performed particularly when there are other neurological or systemic manifestations. The pathophysiology of tremor is not entirely understood, but likely involves multiple networks along with the cerebello-thalamo-cortical pathways. Treatment options include medications, botulinum toxin, surgery, and nonpharmacologic interventions utilizing physical and occupational therapies and assistive devices. Further work is needed in developing accurate diagnostic tests and better treatment options for tremor disorders.

A Systematic Review of the Omohyoid Muscle Syndrome (OMS): Clinical Presentation, Diagnosis, and Treatment Options

2021 ◽  
pp. 000348942199503
Author(s):  
Jerome Zhiyi Ong ◽  
Alex Chengyao Tham ◽  
Jian Li Tan
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Traumatic Event ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Neck Mass ◽  
Good Prognosis ◽  
Common Symptom ◽  
Management Options ◽  
Omohyoid Muscle

Objective: Omohyoid muscle syndrome (OMS) is a condition that causes a X-shaped lateral neck lump on swallowing, caused by the failure of the central tendon of the omohyoid muscle to restrict movement of the muscle during swallowing. We aim to review the etiology, pathophysiology, diagnostic tests, and management options for this condition. Data Sources: Pubmed, MEDLINE, EMBASE, and Cochrane databases were searched for all articles and abstracts related to OMS up to 29th July 2020. Review Methods: A systematic review was performed, data extracted from relevant full text articles. Both quantitative data and qualitative data were analyzed. Results: Twenty cases of OMS were reported. Patients presented at a mean age of 36.0. All cases were Asian. There is a 7:3 ratio of males to females. The most common symptom was a transient neck mass. Most cases were managed conservatively with good prognosis. Open or endoscopic transection of the muscle and ultrasound-guided botulinum toxin injection were 3 treatment options, with no recurrence at 4 years, 6 months, and 6 months respectively. Conclusion: OMS could be genetic as all cases were Asian in ethnicity. The deep cervical fascia which usually envelopes the omohyoid muscle may be weakened by stress as 20% of cases had a preceding traumatic event. Real-time ultrasonography establishes the diagnosis, demonstrating the anterolateral displacement of the sternocleidomastoid muscle by a thickened omohyoid muscle during swallowing. Surgical transection can achieve cure, but due to limited studies available, they should be reserved for patients who are extremely bothered. Intramuscular injection of botulinum toxin is an effective alternative, but recurrence is expected.

Coagulopathy in Cardiac Surgery: Etiology and Treatment Options

2020 ◽  
pp. 313-322
Author(s):  
Dana Teodorescu ◽  
Caroline Larkin
Keyword(s):  
Cardiac Surgery ◽  
Laboratory Testing ◽  
Blood Count ◽  
Complete Blood Count ◽  
Point Of Care ◽  
Treatment Options ◽  
Coagulation Factors ◽  
Bleeding Diathesis ◽  
Standard Laboratory ◽  
Post Cardiac Surgery

This chapter reviews the causes and outlines an approach to the management of coagulopathy following cardiac surgery. Bleeding after cardiac surgery is common and expected up to a rate of 2 mL/kg/h for the first 6 hours. A more significant hemorrhage needs to be investigated and treated. Causes are often multifactorial. It is imperative that surgical causes be excluded early concomitant to providing resuscitation, investigating other medical causes for bleeding, and treating coagulopathy empirically until laboratory testing becomes available. The most frequent causes for coagulopathy post–cardiac surgery are excess heparinization, prolonged cardiopulmonary bypass time, hypothermia, acidosis, and preexisting bleeding diathesis. The management of coagulopathy implies maintenance of the normal physiological conditions for coagulation, reversal of excess heparinization, treatment of hyperfibrinolysis, maintaining normal levels of coagulation factors, and transfusion of platelets if thrombocytopenia or platelet dysfunction occurs. The chapter reviews what is involved in standard laboratory testing (complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, etc.) for coagulopathy. Also discussed is point-of-care testing and how the results from these tests should be interpreted. The chapter details the various blood products that are required in this scenario and suggests doses and transfusion thresholds.

scholarly journals THE EMERGING ROLE OF BOTULINUM TOXIN IN THE TREATMENT OF OROFACIAL DISORDERS: LITERATURE UPDATE

2017 ◽  
Vol 10 (9) ◽  
pp. 21 ◽  
Author(s):  
Santhosh Kumar
Keyword(s):  
Botulinum Toxin ◽  
Clostridium Botulinum ◽  
Anaerobic Bacterium ◽  
Therapeutic Agent ◽  
Treatment Options ◽  
Treatment Protocols ◽  
Adequate Knowledge ◽  
Injection Techniques ◽  
General Dentists

Botulinum toxin (BTX) is a lethal neurotoxin produced by Gram-positive anaerobic bacterium called Clostridium botulinum. It is the first toxin used fortherapeutic purposes since 1989. BTX treatment is relatively safe and efficacious, less invasive, conservative, and the effects are faster and reversible.The purpose of this article is to review the literature regarding the applications of BTX in the treatment of various orofacial disorders, their mechanismof action, contraindications, and complications. From the recently published literature, it is clear that the role of BTX as a therapeutic agent for severalconditions is expanding. With the training of BTX-A injection techniques and adequate knowledge about treatment protocols, general dentists cansafely administer BTX injections. The ability to use Botox as an adjuvant and primary mode of the treatment for various maxillofacial disorders offersexciting treatment options for dentists and patients in the future.

Information needs of hematologic cancer survivors

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18547-18547 ◽  
Author(s):  
C. Soloe ◽  
K. Bandel ◽  
M. Jarblum ◽  
E. Willacy ◽  
S. Squire ◽  
...  
Keyword(s):  
Side Effects ◽  
Diagnostic Tests ◽  
Information Needs ◽  
Treatment Options ◽  
Structured Interviews ◽  
Cancer Centers ◽  
Cancer Types ◽  
Cancer Experience ◽  
Financial Issues

18547 Background: Little is known about how information needs of cancer survivors/patients (S/P), caregivers (CG), and non-caregiver relatives (NCG) evolve during the cancer experience. Methods: We conducted structured interviews of 21 leukemia, lymphoma, and multiple myeloma S/P, 13 CG, and 19 NCG, and asked them to prioritize information needs during the 4 cancer experience phases from a list of 13 topics. This research was supported by the Division of Cancer Prevention and Control of the Centers for Disease Control and Prevention. Results: Information preferences varied (Friedman’s test, P < 0.0001) by phase of the cancer experience. Topics ranked highest (median rank in parentheses) before treatment, during treatment, after treatment, and at relapse, respectively, were diagnostic tests (2), cancer/ cancer types (2.5), treatment options (3.4), hospitals/cancer centers (3.5), and insurance/financial issues (4); coping with treatment side effects (3), insurance/financial issues (4.5), treatment options (5), hospitals/cancer centers (5), and long term side effects (5); long term side effects (2), tests to detect recurrence (2), risk factors (3), diagnostic tests (4), and support groups (5); and tests to detect recurrence (3), insurance/financial issues (3), cancer/cancer types (4), diagnostic tests (5), and treatment options (5). Across the cancer experience, the highest priority topics for S/P, CG, and NCG, were cancer/ cancer types (4), treatment options (4), long term side effects (5), and risk factors (5); diagnostic tests (4.5), coping with side effects of treatment (5), and treatment options (5); and treatment options (3), diagnostic tests (4), and 5 other topics tied for 3rd place (6). In-depth, semi-structured interviews conducted with the surveys provided additional detail regarding responses collected in the prioritization exercise. Conclusions: Clinicians can help S/P, CG, and NCG by offering role- and cancer continuum-targeted information. No significant financial relationships to disclose.

scholarly journals Arrhythmias in Cardiac Sarcoidosis Bench to Bedside

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Lynda E. Rosenfeld ◽  
Mina K. Chung ◽  
Clifford V. Harding ◽  
Paolo Spagnolo ◽  
Johan Grunewald ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Cardiac Sarcoidosis ◽  
Treatment Options ◽  
Emission Tomography ◽  
Resonance Imaging ◽  
Optimal Care ◽  
Disease Mechanisms ◽  
Positron Emission ◽  
Life Saving ◽  
Fluorodeoxyglucose Positron Emission

Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and 18 F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using these new tools and to provide a framework for the optimal care of patients with this disease. We will review disease mechanisms as currently understood, associated arrhythmias including conduction abnormalities, and atrial and ventricular tachyarrhythmias, guideline-directed diagnostic criteria, screening of patients with extracardiac sarcoidosis, and the use of pacemakers and defibrillators in this setting. Treatment options, including those related to heart failure, and those which may help clarify disease mechanisms are included.

scholarly journals Community-led research discovers links between elusive symptoms and clinical tests

2017 ◽  
Author(s):  
Irene S. Gabashvili
Keyword(s):  
Diagnostic Tests ◽  
Treatment Options ◽  
Physical Symptoms ◽  
Medical Professionals ◽  
Clinical Tests ◽  
Human Breath ◽  
Body Regions ◽  
Life Threatening ◽  
Medical Referral ◽  
Body Odors

AbstractHuman breath and body odors have been used for diagnosis of serious and life-threatening conditions since the dawn of medical practice. More recently, it has been recognized that malodors without accompanying physical symptoms could be a sign of psychologically but not physically debilitating disorders such as Trimethylaminuria (TMAU). Self-reported intermittent odors without apparent cause, are, however, still treated with suspicion by medical professionals. Most cases of socially-disabling idiopathic malodor remain undiagnosed and there are no guidelines for diagnostic tests nor treatment options that extend beyond TMAU. Internationally-recruited volunteers with undiagnosed body odor and halitosis enrolled to participate in our study, registered as NCT02692495 at clinicaltrials.gov. Each volunteer underwent several blood and urine tests conducted by Biolab Medical Unit, a medical referral laboratory in London, specializing in nutritional and environmental medicine. Intestinal permeability measurements were strikingly different for subjects that named the nose/mouth as the malodor source(s) versus other, often unidentified, body regions. Furthermore, metabolite levels in blood and urine allowed matching of participants by dietary sensitivities and the type of odor reported, emphasizing the potential of harnessing patients’ olfactory observations. In discussing the anecdotal “People are Allergic to Me” condition (PATM), we show how it fits into the picture.

scholarly journals Saliva sampling is an excellent option to increase the number of SARS CoV2 diagnostic tests in settings with supply shortages

2020 ◽  
Author(s):  
Joaquín Moreno-Contreras ◽  
Marco A. Espinoza ◽  
Carlos Sandoval-Jaime ◽  
Marco A. Cantú-Cuevas ◽  
Héctor Barón-Olivares ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Viral Genome ◽  
Laboratory Testing ◽  
Diagnostic Procedure ◽  
Viral Rna ◽  
Healthcare Personnel ◽  
High Demand ◽  
Rna Detection ◽  
Golden Standard ◽  
Classical Protocol

AbstractAs part of any plan to lift or ease the confinement restrictions that are in place in many different countries, there is an urgent need to increase the capacity of laboratory testing for SARS CoV-2. Detection of the viral genome through RT-qPCR is the golden standard for this test, however, the high demand of the materials and reagents needed to sample individuals, purify the viral RNA, and perform the RT-qPCR test has resulted in a worldwide shortage of several of these supplies. Here, we show that directly lysed saliva samples can serve as a suitable source for viral RNA detection that is cheaper and can be as efficient as the classical protocol that involves column purification of the viral RNA. In addition, it surpasses the need for swab sampling, decreases the risk of the healthcare personnel involved in this process, and accelerates the diagnostic procedure.

Pediatric Complex Regional Pain Syndrome Type 1

2018 ◽  
Author(s):  
Bobbie Riley ◽  
Navil Sethna
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Tests ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Underlying Mechanism ◽  
Interventional Treatment ◽  
Syndrome Type ◽  
Delay In Diagnosis ◽  
Skin Hypersensitivity

Complex regional pain syndrome type 1 (CRPS-1) is a condition that affects adolescents and children under the age of 7. It usually follows minor injury and rarely occurs spontaneously. The pain is usually out of proportion to the inciting injury. Pain, allodynia, and/or hyperalgesia are severe enough to inhibit use of the affected limb. Delay in diagnosis and self and/or iatrogenic immobilization of the affected limb may lead to worsening pain, skin hypersensitivity and discoloration, swelling, and vasomotor and dystrophic abnormalities. The diagnosis of CRPS-1 and 2 is based on symptoms. There are no diagnostic tests that can confirm the presence or absence of CRPS-1. CRPS-2 diagnosis is established by nerve conduction test and electromyography. Clinical practice neuropathic guidelines are most effective for CRPS-2 treatment. Pharmacological and interventional treatment options for CRPS-1 are limited and usually ineffective because the underlying mechanism(s) are yet to be determined.

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