Rabies encephalitis

Rabies is an almost always fatal disease that physicians and patients dread due to its dismal prognosis and limited treatment options. Transmission of this disease occurs through the bite of dogs and wild animals (like jackal in our case). Other rare forms of transmission may be through inhalation in bat-infested caves and human-to-human transmission by infected corneal transplants, solid organ and tissue transplantation, and sometimes in laboratory settings. Its diagnosis is usually clinical in the absence of availability of special laboratory investigations at the point-of-care facility. Few people have described the role of imaging in diagnosis. We hereby report a patient with rabies encephalitis, having a history of jackal bite and classical MRI findings that we can use for early diagnosis in the absence of typical clinical features and specialised diagnostic testing.

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Retargeting of NK-92 Cells against High-Risk Rhabdomyosarcomas by Means of an ERBB2 (HER2/Neu)-Specific Chimeric Antigen Receptor

Cancers ◽

10.3390/cancers13061443 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1443

Author(s):

Leonie D. H. Gossel ◽

Catrin Heim ◽

Lisa-Marie Pfeffermann ◽

Laura M. Moser ◽

Halvard B. Bönig ◽

...

Keyword(s):

High Risk ◽

Tumor Cells ◽

Chimeric Antigen Receptor ◽

Treatment Options ◽

Antigen Receptor ◽

Proof Of Concept ◽

Cell Monolayers ◽

Novel Treatment ◽

Dismal Prognosis

The dismal prognosis of pediatric and young adult patients with high-risk rhabdomyosarcoma (RMS) underscores the need for novel treatment options for this patient group. In previous studies, the tumor-associated surface antigen ERBB2 (HER2/neu) was identified as targetable in high-risk RMS. As a proof of concept, in this study, a novel treatment approach against RMS tumors using a genetically modified natural killer (NK)-92 cell line (NK-92/5.28.z) as an off-the-shelf ERBB2-chimeric antigen receptor (CAR)-engineered cell product was preclinically explored. In cytotoxicity assays, NK-92/5.28.z cells specifically recognized and efficiently eliminated RMS cell suspensions, tumor cell monolayers, and 3D tumor spheroids via the ERBB2-CAR even at effector-to-target ratios as low as 1:1. In contrast to unmodified parental NK-92 cells, which failed to lyse RMS cells, NK-92/5.28.z cells proliferated and became further activated through contact with ERBB2-positive tumor cells. Furthermore, high amounts of effector molecules, such as proinflammatory and antitumoral cytokines, were found in cocultures of NK-92/5.28.z cells with tumor cells. Taken together, our data suggest the enormous potential of this approach for improving the immunotherapy of treatment-resistant tumors, revealing the dual role of NK-92/5.28.z cells as CAR-targeted killers and modulators of endogenous adaptive immunity even in the inhibitory tumor microenvironment of high-risk RMS.

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Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation

Biomedicines ◽

10.3390/biomedicines9060614 ◽

2021 ◽

Vol 9 (6) ◽

pp. 614

Author(s):

Pasquale Ambrosino ◽

Antonio Molino ◽

Ilenia Calcaterra ◽

Roberto Formisano ◽

Silvia Stufano ◽

...

Keyword(s):

Endothelial Function ◽

Pulmonary Rehabilitation ◽

Pulmonary Function Tests ◽

Care Facility ◽

Forced Expiratory Volume ◽

Vascular Events ◽

Inclusion Study ◽

History Of ◽

Dependent Flow

Background: Growing evidence points to a key role of endothelial dysfunction in the pathogenesis of COVID-19. In this study, we evaluated changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of convalescent COVID-19 patients undergoing pulmonary rehabilitation (PR). Methods: After swab test negativization, convalescent COVID-19 patients referring to a post-acute care facility for PR were consecutively screened for inclusion. Study procedures were performed at the time of hospitalization and discharge. Results: We enrolled 82 convalescent COVID-19 patients (85.4% males, mean age 60.4 years). After PR, a significant improvement in most pulmonary function tests and exercise capacity was documented. FMD changed from 2.48% ± 2.01 to 4.24% ± 2.81 (p < 0.001), corresponding to a 70.9% increase. Significantly higher changes in FMD were found in patients without a history of vascular events as compared to those with (+2.04% ± 2.30 vs. +0.61% ± 1.83, p = 0.013). Values of forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLCO%) significantly and directly correlated with FMD both at baseline and after PR. Patients with normal FEV1% (≥80% predicted) during the overall study period or those normalizing FEV1% after PR showed a more significant FMD change as compared to patients with persistently impaired FEV1% (<80% predicted) (p for trend = 0.029). This finding was confirmed in a multivariate analysis. Conclusions: Clinically evaluated endothelial function improves after PR in convalescent COVID-19 patients. A direct and persistent association between the severity of pulmonary and vascular disease can be hypothesized. Endothelial function testing may be useful in the follow-up of convalescent COVID-19 patients.

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Diagnosis of Metastatic Breast Cancer—A Case Report Using Molecular Cancer Classification

Oncology & Hematology Review (US) ◽

10.17925/ohr.2011.07.2.116 ◽

2011 ◽

Vol 07 (02) ◽

pp. 116

Author(s):

Yogesh Gandhi ◽

Sunil Gandhi ◽

◽

Keyword(s):

Breast Cancer ◽

Case Report ◽

Effective Treatment ◽

Cancer Diagnosis ◽

Treatment Options ◽

Metastatic Breast ◽

Complete Response ◽

Molecular Profiling ◽

History Of

An accurate cancer diagnosis is critical as it can direct the use of site-directed, and potentially more effective, treatment options for specific types of cancer. A differential or uncertain diagnosis could prevent cancer patients from receiving optimal treatment, thus affecting their overall prognosis. Advances in molecular technology have led to the development of molecular cancer classifiers that can direct or confirm the diagnosis of metastatic cancers which would otherwise be considered uncertain or unknown. This case report describes the role of molecular diagnostics in the evaluation of a patient with a large pancreatic mass and a history of breast cancer. Results from a 92-gene molecular profiling assay (CancerTYPE ID®) predicted that this new mass was breast cancer. This diagnosis allowed for effective treatment and complete response in this patient.

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Characterization of unresectable cholangiocarcinoma patients treated with or without chemoradiation.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.403 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 403-403

Author(s):

Jane Elizabeth Rogers ◽

Van Nguyen ◽

Graciela M. Nogueras-Gonzalez ◽

Christopher H. Crane ◽

Prajnan Das ◽

...

Keyword(s):

Progression Free Survival ◽

Median Number ◽

Primary Objective ◽

First Line ◽

Dismal Prognosis ◽

History Of ◽

Mixed Histology

403 Background: Curative treatment for cholangiocarcinoma (CC) is surgical resection. Unfortunately, most CC patients (pts) present with unresectable disease in which gemcitabine plus platinum (GEM-P) chemotherapy is the mainstay of treatment (tx). Advanced CC has a dismal prognosis with 5-year survival reported at 5-10 %. Data regarding chemoradiation (CRT) in pts with unresectable CC (uCC) remains limited. Methods: We retrospectively reviewed uCC pts from 1/1/2009 to 7/31/2013. Primary objective: to evaluate the percentage of pts treated with CRT and the median number of chemotherapy cycles given prior to CRT. Secondary objectives: response to first-line tx, progression free survival (PFS) with or without CRT, overall survival (OS) with or without CRT, and duration of CRT control. Inclusion criteria: uCC diagnosis, received tx, and had follow-up at our institution. Exclusion criteria: pts who received liver-directed therapy other than CRT, mixed histology tumors, and a history of other malignancies. Results: 114 pts were included with 62% having intrahepatic CC. Disease control (DC) (response + stable disease) with first-line tx was 75% with 71% receiving GEM-P +/- erlotinib first-line. 65% of pts received CRT with a median of 6 chemotherapy cycles given prior to CRT. DC after CRT was 62% with a median duration of radiation control of 6.4 mths. Median PFS and OS for all pts were 13.4 mths and 27.8 mths, respectively. Median PFS in the CRT group was 14.5 mths versus 11.4 mths in the no CRT group (p = 0.105). Median OS in the CRT cohort was 29.4 mths, while median OS without CRT was 22.4 mths (p = 0.005). Median OS and PFS after CRT for pts with DC on first-line tx were 32.0 months (95% CI = 24-44 mths) and 15.7 mths (95% CI =13.5-18.8 mths), respectively. Pts who progressed on first-line tx and received CRT had a median OS of 23.8 mths (95% CI = 7-30 months) and median PFS of 4.2 mths (95% CI = 2.3-9 mths). Conclusions: Our retrospective review reveals a significant improvement in median OS with CRT in uCC pts. Those with DC on first-line tx showed improvement in PFS and OS with CRT. Patient selection is key with the benefit being highest in pts with DC with first-line tx. Our results warrant further investigation of the role of CRT in uCC.

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Spontaneous Renal Artery Dissection in a Patient with Neurofibromatosis Type I

Case Reports in Cardiology ◽

10.1155/2016/4593932 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Nicolas W. Shammas ◽

Majid Z. Chammas ◽

Jon Robken ◽

Edmund Coyne

Keyword(s):

Renal Artery ◽

Treatment Options ◽

Diagnostic Testing ◽

Neurofibromatosis Type ◽

Artery Dissection ◽

Type I ◽

Neurofibromatosis Type I ◽

Endovascular Stenting ◽

History Of ◽

Endovascular Approach

We present a case of spontaneous renal artery dissection (SRAD) in a 28-year-old female with history of neurofibromatosis type I (NF-1) treated successfully with endovascular stenting. The clinical presentation, diagnostic testing, and treatment options are discussed. An endovascular approach with stenting was successfully performed after failure of medical treatment with subcutaneous low molecular weight heparin. Patient’s blood pressure and symptoms improved significantly. This may be the first reported case of SRAD in a patient with NF-1 successfully treated with endovascular stenting.

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Subglottic Hemangioma: Ten Years' Experience with the Carbon Dioxide Laser

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410300301 ◽

1994 ◽

Vol 103 (3) ◽

pp. 167-172 ◽

Cited By ~ 86

Author(s):

Kathleen C. Y. Sie ◽

Trevor McGill ◽

Gerald B. Healy

Keyword(s):

Carbon Dioxide ◽

Carbon Dioxide Laser ◽

Treatment Options ◽

Fatal Outcome ◽

Benign Neoplasm ◽

Senior Author ◽

Airway Patency ◽

Proliferative Phase ◽

History Of

Patients with subglottic hemangioma present with biphasic stridor during infancy. The natural history of this lesion is characterized by progressive airway obstruction during the proliferative phase of the lesion, followed by resolution of symptoms during the subsequent involutive phase. Although this is a benign neoplasm, it can be associated with a fatal outcome. Treatment options have been directed at maintaining airway patency during the proliferative phase. The senior author (G.B.H.) originally described the role of the carbon dioxide laser in management of these patients in 1980. Thirty-one patients were treated for subglottic hemangioma at The Children's Hospital, Boston, between 1980 and 1990. The 10-year experience of management of subglottic hemangioma with endoscopic vaporization using the carbon dioxide laser is reviewed to assess the efficacy of this technique.

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Therapeutics and Research Related to Glioblastoma: Advancements and Future Targets

Current Drug Metabolism ◽

10.2174/1389200221666200408083950 ◽

2020 ◽

Vol 21 (3) ◽

pp. 186-198 ◽

Cited By ~ 1

Author(s):

Vishal Chavda ◽

Vimal Patel ◽

Dhananjay Yadav ◽

Jigar Shah ◽

Snehal Patel ◽

...

Keyword(s):

Treatment Options ◽

Graphene Quantum Dots ◽

Primary Brain Tumor ◽

In Vitro Models ◽

Molecular Pathways ◽

Dismal Prognosis ◽

Novel Drugs

Glioblastoma, the most common primary brain tumor, has been recognized as one of the most lethal and fatal human tumors. It has a dismal prognosis, and survival after diagnosis is less than 15 months. Surgery and radiotherapy are the only available treatment options at present. However, numerous approaches have been made to upgrade in vivo and in vitro models with the primary goal of assessing abnormal molecular pathways that would be suitable targets for novel therapeutic approaches. Novel drugs, delivery systems, and immunotherapy strategies to establish new multimodal therapies that target the molecular pathways involved in tumor initiation and progression in glioblastoma are being studied. The goal of this review was to describe the pathophysiology, neurodegeneration mechanisms, signaling pathways, and future therapeutic targets associated with glioblastomas. The key features have been detailed to provide an up-to-date summary of the advancement required in current diagnosis and therapeutics for glioblastoma. The role of nanoparticulate system graphene quantum dots as suitable therapy for glioblastoma has also been discussed.

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The Evolving Paradigm in the Management of Intracranial Atherosclerotic Disease

International Journal of Vascular Medicine ◽

10.1155/2012/289852 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Ali K. Ozturk ◽

Ketan R. Bulsara

Keyword(s):

English Literature ◽

Treatment Options ◽

Atherosclerotic Disease ◽

Endovascular Techniques ◽

Intracranial Atherosclerotic Disease ◽

History Of ◽

Recurrent Strokes ◽

Rigorous Treatment ◽

Significant Health

Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke worldwide and represents a significant health problem. The pathogenesis and natural history of ICAD are poorly understood, and rigorous treatment paradigms do not exist as they do for extracranial atherosclerosis. Currently, the best treatment for ICAD remains aspirin therapy, but many patients who are placed on aspirin continue to experience recurrent strokes. As microsurgical and endovascular techniques continue to evolve, the role of extracranial to intracranial bypass operations and stenting are increasingly being reconsidered. We performed a PubMed review of the English literature with a particular focus on treatment options for ICAD and present evidence-based data for the role of surgery and stenting in ICAD against medical therapy alone.

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Epidemiology of NDM-Producing Enterobacteriaceae in Michigan

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.761 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s217-s218

Author(s):

Gurmat Gill ◽

Avnish Sandhu ◽

Jordan Polistico ◽

Reda Awali ◽

Sara McNamara ◽

...

Keyword(s):

Treatment Options ◽

Care Facility ◽

The United States ◽

International Travel ◽

World Health ◽

Resistant Organism ◽

Priority List ◽

Travel History ◽

Contact Precautions ◽

History Of

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an urgent antibiotic-resistant threat by the CDC, and they are listed on the critical priority list by the World Health Organization due to the lack of antibiotic treatment options. New-Delhi metallo-β-lactamase (NDM) is an emerging mechanism of carbapenem resistance in the United States. We sought to understand the risk factors and clinical characteristics of patients with NDM CRE in Michigan to improve surveillance. Methods:A retrospective descriptive study was conducted in collaboration with the Michigan Department of Health and Human Services (MDHHS). CRE isolates submitted to MDHHS between April 2014 and July 2019 were tested for the presence of NDM using CDC PCR protocols. Additional information on case demographics, laboratory results, healthcare and antibiotic exposure history, and travel history were collected. Results: In total, 30 NDM cases were identified in Michigan during the study period. Of these 30 cases, 15 (50%) were men, and the median age was 73.5 years (range, 20–88 20). Also, 2 of these patients (6.6%) were immunocompromised; 2 patients (6.6%) had had extensive abdominal surgery, and 2 patients (6.6%) had recurrent hospitalization. Furthermore, 12 case isolates (40%) were collected in outpatient settings, whereas 16 (53%) were collected from inpatient settings. In addition, 13 (43%) patients were admitted from home and 4 (13%) presented from an extended-care facility. Urine was the most common site of isolation in 19 of 30 (63%) cases, followed by blood and tissue culture in 4 of 30 (13%) each. Escherichia coli was the most common organism (17 of 30, 57%), followed by Klebsiella pneumoniae (9 of 30, 30%). Also, 15 of 30 cases (50%) had a recent history of international travel, and of these, 9 of 15 (60%) reported travel to India. Among these 15 cases, 12 (80%) sought medical care in the countries they visited. Two cases (6.6%) had a documented history of multidrug-resistant organism colonization or infection. The mortality rate was 6.6% (2 of 30). The mean time from admission to implementation of contact precautions was 7.3 days (range, 0–20). Conclusions: Suspicion of NDM CRE strains should remain high in patients with a travel history from areas known as major reservoirs of NDM. Delay in implementing contact precautions, as noted in the present study, can lead to a greater risk of transmission. Early detection and subsequent isolation of NDM patients are essential strategies for preventing transmission within healthcare facilities. Future efforts include performing whole-genome sequencing of these isolates to assist in identifying potential epidemiological links among the affected patients.Funding: NoneDisclosures: None

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Position Statement on Secukinumab in the Management of Plaque Psoriasis: The Malaysian Perspective

Dermatology Research and Practice ◽

10.1155/2019/8923168 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Asmah Johar ◽

Suganthi Thevarajah ◽

Agnes Heng ◽

Lee Chin Chan ◽

Chin Chwen Ch’ng ◽

...

Keyword(s):

Plaque Psoriasis ◽

Treatment Options ◽

Panel Discussion ◽

Rapid Onset ◽

Position Statement ◽

Severe Psoriasis ◽

Onset Of Action ◽

History Of ◽

Discussion Panel

Psoriasis is a chronic inflammatory skin disease affecting nearly 10% of dermatologic patients in Malaysia. Treatment options include topical agents and phototherapy as well as nonbiologic and biologic systemic therapy. Mild psoriasis can often be managed with topical agents. However, managing moderate to severe psoriasis is more challenging and may require systemic treatment with nonbiologics or biologics. Despite the availability of several biologics, there are many unmet clinical needs, which may be addressed by secukinumab, an IL-17A inhibitor. This position statement is based on an expert panel discussion and is intended to provide dermatologists an overview of existing options as well as to provide a better understanding of secukinumab and how it can be integrated into current practice. During the discussion, panel members examined current approaches and the role of secukinumab in plaque psoriasis management. Panel members estimated that up to 30% of patients have moderate to severe psoriasis but only 1-2% receive biologics. Highlights from the discussion were that (i) the threshold for biologic use should be lower, in line with international guidelines; (ii) studies have shown that secukinumab has several advantages over other biologics which are greater efficacy, sustained efficacy over time, rapid onset of action, and early evidence of possible disease-modifying potential; and (iii) ideal candidates for secukinumab are all patients of moderate to severe psoriasis, including those with history of treatment failure, difficult-to-treat patterns of psoriasis (nail, scalp, and palmoplantar psoriasis), psoriatic arthritis, and comorbidities and those aiming for clear skin. Panel members recommend that secukinumab be considered first line option among biologic therapies.

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