Trigeminal Neuralgia: Treatment Failure with Auriculotherapy: Two Case Reports

Objective: To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. Data Sources: A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. Study Selection and Data Extraction: English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. Data Synthesis: Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. Relevance to Patient Care and Clinical Practice: A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. Conclusions: Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.

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Trigeminal neuralgia due to vertebrobasilar dolichoectasia: Three case reports

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology ◽

10.1016/j.tripleo.2009.04.039 ◽

2009 ◽

Vol 108 (3) ◽

pp. e50-e55 ◽

Cited By ~ 7

Author(s):

Noboru Noma ◽

Azusa Kobayashi ◽

Hiroshi Kamo ◽

Yoshiki Imamura

Keyword(s):

Trigeminal Neuralgia ◽

Case Reports ◽

Vertebrobasilar Dolichoectasia

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Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes

Journal of Neurosurgery ◽

10.3171/2017.12.jns171647 ◽

2019 ◽

Vol 130 (6) ◽

pp. 1877-1888

Author(s):

Mark G. Bigder ◽

Sandeep Krishnan ◽

E. Francis Cook ◽

Anthony M. Kaufmann

Keyword(s):

Trigeminal Neuralgia ◽

Treatment Failure ◽

Rank Test ◽

Control Group ◽

Chi Square ◽

Time To Treatment ◽

Pain Scores ◽

Kaplan Meier ◽

Time To Treatment Failure ◽

Chi Square Test

OBJECTIVEPatients with multiple sclerosis (MS)–associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.METHODSTime to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test.RESULTSTTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR.CONCLUSIONSTTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.

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Treatment failure in trichomoniasis and persistance of the parasite after Lactobacillus immunotherapy; two case reports

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/0028-2243(90)90021-r ◽

1990 ◽

Vol 34 (1-2) ◽

pp. 171-178 ◽

Cited By ~ 5

Author(s):

R.M.F. van der Weiden ◽

W.I. van der Meijden ◽

D.H. Bogchelman ◽

A.M. Polderman

Keyword(s):

Treatment Failure ◽

Case Reports

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Effectiveness of Repeat Glycerol Rhizotomy in Treating Recurrent Trigeminal Neuralgia

Neurosurgery ◽

10.1227/neu.0b013e31823f5eb6 ◽

2011 ◽

Vol 70 (5) ◽

pp. 1125-1134 ◽

Cited By ~ 13

Author(s):

Matthew Bender ◽

Gustavo Pradilla ◽

Sachin Batra ◽

Alfred See ◽

Neal Bhutiani ◽

...

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Treatment Failure ◽

Median Time ◽

Retrospective Cohort ◽

Cox Regression ◽

Time To Treatment ◽

Cox Regression Analysis ◽

Sensory Change ◽

Time To Treatment Failure

Abstract BACKGROUND: Percutaneous glycerol rhizotomy (GR) is used to treat trigeminal neuralgia (TN), with satisfactory pain relief lasting 2 to 3 years in most patients after the first intervention. The efficacy of subsequent GRs, however, has not been studied. OBJECTIVE: To compare the pain relief and durability achieved by the first GR with those obtained after subsequent GRs in a retrospective cohort of TN patients. METHODS: Between 1998 and 2010, 548 patients with TN underwent 708 GRs. After exclusions, 430 initial GRs (GR1) and 114 subsequent GRs (GR2+) were compared in terms of initial pain relief, durability, sensory change, and complications. Durability was assessed by determining median time to treatment failure for all GRs achieving complete pain relief without medications (n = 375: 264 failures, 111 censored). Predictors of initial pain relief were assessed by logistic regression, and predictors of failure were assessed by Cox regression analysis. RESULTS: After GR1, pain relief results were as follows: 285 patients (66%) were pain free without medications, 26 (6%) were pain free with medications, 66 (15%) improved, and 53 (12%) were unchanged. After GR2+, results were as follows: 90 patients (79%) were pain free without medications, 6 (5%) were pain free with medications, 7 (6%) improved, and 11 (10%) were unchanged (P = .03). Median time to treatment failure was 26 months after GR1 and 25 months after GR2+ (P = .34). On multivariate analysis, prior GR was a positive predictor of initial pain relief (odds ratio, 2.067; 95% confidence interval, 1.243-3.437; P = .005) and had no effect on durability. CONCLUSION: TN patients experienced greater pain relief and equivalent durability after GR2+ beyond the initial treatment.

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Capsaicin 8% patch in trigeminal neuralgia: Case reports

Australasian Medical Journal ◽

10.21767/amj.2018.3573 ◽

2019 ◽

Vol 12 (3) ◽

Author(s):

Maria Luz Canovas Martinez ◽

Nuria Adan ◽

Andrea Carballude ◽

Laura Lamelas ◽

Eva Villar ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Case Reports

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Resistance Mutations A30K and Y93N Associated with Treatment Failure with Sofosbuvir and Daclatasvir for Hepatitis C Virus Infection Non-Responder Patients: Case Reports

Viruses ◽

10.3390/v11111004 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1004

Author(s):

Vanessa D. Costa ◽

Patricia Pellegrini ◽

Vivian Rotman ◽

Ana Maria Pittella ◽

Estevão P. Nunes ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Treatment Failure ◽

Case Reports ◽

Rescue Therapy ◽

Combined Therapy ◽

Virologic Response ◽

Resistance Mutations ◽

Viral Determinants ◽

Direct Acting

In Brazil, hepatitis C treatment has been evolving significantly with the licensing of direct-acting antivirals (DAAs). However, viral determinants (amino acid substitutions in hepatitis C virus (HCV) genome and infective genotype) associated with host factors (hepatic condition and prior HCV therapy) might limit the achievement of sustained virologic response (SVR). Here, we described two case reports in which the occurrence of HCV NS5A mutations A30K (subtype 3a) and Y93N (subtype 1a) might have influenced daclatasvir (DCV)/sofosbuvir (SOF) combined therapy non-response. Despite high response rates for DAA combined therapies in Brazil, these case reports stated the importance of an investigation about how to manage a DAA treatment failure since a combination of factors, especially the occurrence of resistance substitutions, could impact a rescue therapy with new available antivirals in clinical routine.

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Randomized phase II trial of intravenous ascorbic acid (AA) as an adjunct to pazopanib for metastatic and unresectable clear cell renal cell carcinoma (ccRCC): A study of Academic and Community Cancer Research United (ACCRU) GU1703.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.tps679 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. TPS679-TPS679

Author(s):

Niraj Konchady Shenoy ◽

Fang-Shu Ou ◽

John C. Cheville ◽

Tushar Bhagat ◽

Benjamin Adam Gartrell ◽

...

Keyword(s):

Treatment Failure ◽

Case Reports ◽

Alternative Therapy ◽

Dehydroascorbic Acid ◽

Epigenetic Mechanism ◽

H2o2 Production ◽

Type I ◽

Cell Renal Cell Carcinoma ◽

High Iron Content ◽

Anti Cancer

TPS679 Background: AA has re-emerged as a promising anti-cancer agent based on recent knowledge of pharmacokinetics, discovery of unexpected mechanisms of action, and early phase trials with IV AA.(Shenoy et al, Cancer Cell 34: 2018, in press) We hypothesized that ccRCC would be particularly susceptible to anti-cancer effects of IV AA due to: a. TET dependent demethylation of the hypermethylated genome of ccRCC causing re-expression of tumor suppressors (Shenoy et al, AACR 2018 Targeting DNA methylation conf. A11; Hu et al, Clin Cancer Res 20:4349-60, 2014) b. H2O2 production causing intra-tumoral oxidative damage, hypothesized to be enhanced by high iron content in RCC microenvironment c. Intracellular accumulation of dehydroascorbic acid secondary to high HIF activity in ccRCC. Animal data and case reports support the hypothesis. Methods: Trial design: Patients (pts) with newly diagnosed metastatic/ unresectable ccRCC are randomized 1:1 to arm A (pazopanib 800 mg/d plus IV AA 1g/kg 3 times/week) or arm B (pazopanib 800 mg/d). Protocol treatment is for 10 cycles (unless PD, unacceptable AE, alternative therapy, or pt refusal), each cycle being 28 days. Primary endpoint is Treatment Failure-Free rate at 40 weeks (TFF40). Treatment Failure is defined as: Radiographic disease progression, off-protocol treatment due to AE, alternative therapy initiation (except metastasectomy post clinical benefit), or death. Secondary endpoints include OS, PFS, ORR and AE. Statistical methods: 82 eligible pts (41 in each in arm) will provide 81% power to detect a 19% increase of TFF40 from 45% in arm B to 64% in arm A assuming a one-sided type I error rate of 0.19 (EAST 6.4). Correlatives: Epigenetic mechanism: 5mC, 5hmC and H3K27me3 IHC, MeDIP/ hMeDIP seq, RNA seq. H2O2 mechanism: tumor microenvironment iron, tumor catalase IHC. Dehydroascorbic acid mechanism: HIF-1 alpha, HIF-2 alpha, GLUT-1 IHC. Key exclusion criteria: G6PD deficiency, renal disease (Cockcroft Gault CrCl < 55 ml/min). ClinicalTrials.gov Identifier: NCT03334409 Status: Open for accrual in 9/10 planned sites. Funding Source: Foundation. Clinical trial information: NCT03334409.

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