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

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.

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

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.

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

1994 ◽  
Vol 103 (3) ◽  
pp. 167-172 ◽  
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.

scholarly journals Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement

2008 ◽  
Vol 22 (5) ◽  
pp. 457-459 ◽  
Author(s):  
Michael F Byrne ◽  
Naoki Chiba ◽  
Harminder Singh ◽  
Daniel C Sadowski ◽  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Rapid Onset ◽  
Position Statement ◽  
Patient Comfort ◽  
Medical Evidence ◽  
Onset Of Action ◽  
Propofol Sedation ◽  
The Past ◽  
Canadian Association ◽  
Rapid Clearance

Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.

Rabies encephalitis

2021 ◽  
Vol 14 (4) ◽  
pp. e239249
Author(s):  
Shyam Chand Chaudhary ◽  
Akash Khandelwal ◽  
Ruchika Tandon ◽  
Kamal Kumar Sawlani
Keyword(s):  
Point Of Care ◽  
Treatment Options ◽  
Diagnostic Testing ◽  
Care Facility ◽  
Solid Organ ◽  
Mri Findings ◽  
Dismal Prognosis ◽  
Corneal Transplants ◽  
History Of

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.

Risankizumab in moderate-to-severe plaque psoriasis

Immunotherapy ◽  
2019 ◽  
Vol 11 (16) ◽  
pp. 1357-1370 ◽  
Author(s):  
Linda Serrano ◽  
Victoria Maloney ◽  
Kenneth B Gordon
Keyword(s):  
Biologic Therapy ◽  
Treatment Options ◽  
Rapid Onset ◽  
Chronic Inflammatory Disease ◽  
Current Treatment ◽  
Multiple Organ ◽  
Turn Of The Century ◽  
Severe Psoriasis ◽  
Organ Systems ◽  
Us Fda

Psoriasis is a chronic inflammatory disease affecting multiple organ systems affecting approximately 2% of the population worldwide. The etiology is multifactorial etiology with multiple co-morbidities complicating the disease. Therapeutic options for patients with moderate-to-severe psoriasis have made tremendous strides since the turn of the century and biologic agents are now generally considered to be safe, efficacious and common options for these patients. However, some patients remain recalcitrant to the current treatment options. Risankizumab is a newly US FDA-approved biologic therapy that inhibits IL-23p19 subunit, which is specific to IL-23. Risankizumab has proven rapid onset, safety and efficacy in moderate-to-severe psoriasis and is currently being studied in other diseases utilizing the IL-23 pathway.

scholarly journals The Evolving Paradigm in the Management of Intracranial Atherosclerotic Disease

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.

Oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients: An overview of its pharmacological and clinical characteristics

2005 ◽  
Vol 1 (1) ◽  
pp. 36 ◽  
Author(s):  
Kyriaki Mystakidou, MD, PhD ◽  
Emmanuela Katsouda, MD ◽  
Efi Parpa, BA, MA ◽  
Marinos L. Tsiatas, MD, PhD ◽  
Lambros Vlahos, MD, PhD
Keyword(s):  
Cancer Patients ◽  
Pain Treatment ◽  
Breakthrough Pain ◽  
Rapid Onset ◽  
Review Article ◽  
Brand Name ◽  
Fentanyl Citrate ◽  
Onset Of Action ◽  
Oral Transmucosal Fentanyl Citrate

Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (OTFC; brand name Actiqm, Cephalon Inc., West Chester, PA), a new opioid formulation with a unique delivery system, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), making it an effective treatment for cancer patients who already receive opioids and experience flares of pain. This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.

Unruptured Intracranial Aneurysms and Multiple Aneurysms

2002 ◽  
Vol 15 (5) ◽  
pp. 589-596
Author(s):  
M. Fontanella ◽  
D. Garbossa ◽  
V. Luparello
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Treatment Options ◽  
Clinical Status ◽  
International Study ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Risk Of Treatment

Surgery on unruptured intracranial aneurysms (UIAs) could be a good strategy for prevention of haemorrhage, but management decisions require an accurate assessment of the risks of various treatment options, compared with the natural history of subarachnoid haemorrhage (SAH). The International Study for Unruptured Aneurysms (ISUIA) showed that the natural history is different for patients with UIAs who have not experienced SAH, than it is for patients with a history of prior SAH due to a separate aneurysm, in whom the risk is increased. The size of the UIAs is the best predictor of future rupture and the site can also be. The role of elective neuroradiological screening is the subject of discussion. In fact, the possibility of treatment should be considered on the basis of the patient's age and clinical status. Factors that favour surgery include a young patient with a long life expectancy, previously ruptured aneurysms, a familiarity, large and symptomatic aneurysms and low risk of treatment. The role of endovascular treatment is also discussed.

scholarly journals Takotsubo Syndrome: A Complex and Varied Clinical Syndrome

2016 ◽  
Vol 5 ◽  
Author(s):  
Louise Shewan ◽  
Michael Henein ◽  
Andrew Coats
Keyword(s):  
Clinical Presentation ◽  
Myocardial Dysfunction ◽  
Case Reports ◽  
Treatment Options ◽  
Clinical Score ◽  
Clinical Syndrome ◽  
Original Research ◽  
Takotsubo Syndrome ◽  
History Of

<p class="normal">This special issue includes expert reviews and original research on Takotsubo syndrome (TTS) including the history of its identification and the unravelling of the pathophysiology of the different variants of the syndrome. The role of neurological stress or catecholaminergic overload are reviewed, as is the role of CNS disorders triggering TTS. Clinical presentation patterns of TTS and the most useful diagnostic tests are reviewed, including original research into a novel clinical score the ‘GET QT' score to help in rapid differentiation of TTS from STEMI. There is also a review of TTS in the intensive care unit setting.  The mechanisms of TTS including the role and assessment of the microcirculation in generating the classical myocardial dysfunction are reviewed in detail, as are the pathophysiological pathways of recurrent TTS. Lastly Singh, Akashi and Horowitz review the emerging treatment options for TTS. They issue also includes multiple elegant and fascinating case reports. TTS has come of age and now urgently adequate sized RCT’s.  </p>

scholarly journals Safety and efficacy of methotrexate (0.3 mg/kg/week) versus a combination of methotrexate (0.15 mg/kg/week) with cyclosporine (2.5 mg/kg/day) in chronic plaque psoriasis: A randomised non-blinded controlled trial

2021 ◽  
Vol 87 ◽  
pp. 214-222
Author(s):  
Satyendra Kumar Singh ◽  
Sermili Rini Singnarpi
Keyword(s):  
Plaque Psoriasis ◽  
Controlled Trial ◽  
Treatment Options ◽  
T Test ◽  
Combination Group ◽  
Chronic Plaque Psoriasis ◽  
Onset Of Action ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test

Background: Psoriasis is a chronic, inflammatory, relapsing and remitting disease with no cure till date. There is a paucity of trials using a combination of methotrexate (MTX) and cyclosporine (CsA) in chronic plaque psoriasis, due to fear of added toxicity, although they are time tested treatment options for monotherapy. Aims: The study aimed to compare the efficacy and adverse effect profile of the standard recommended dose of MTX (i.e. 0.3mg/kg/week) versus a combination of reduced doses of MTX and CsA (i.e. MTX 0.15 mg/kg/week with CsA 2.5mg/kg/day) in patients with chronic plaque psoriasis. Methods: Study design was a non-blinded randomised controlled trial. Patients of chronic plaque psoriasis with PASI more than 10 were randomised in 1: 1 allocation to receive either 0.3 mg/kg/week of intramuscular MTX injection or a combination of 0.15 mg/kg/week of intramuscular MTX injection and 2.5 mg/kg/day of CsA rounded off to the nearest 25 mg. Patients were followed up at every 2 weeks for 12 weeks. The doses were kept fixed throughout the study period. Results: A total of 66 patients received MTX monotherapy, whereas 67 patients received the combination. At baseline, both groups were comparable in their BSA (P = 0.105, Student t-test) and PASI (P = 0.277, Student t-test), which reduced significantly at 12 weeks in both groups (P < 0.001, paired t-test). The achievement of PASI-75 (P = 0.005), PASI-90 (P < 0.001) and PASI-100 (P = 0.001) was more in the combination group (Chi square test). Intention to treat analysis using Chi square test also showed better outcomes for PASI-75 (P = 0.027), PASI-90 (P < 0.001) and PASI-100 (P = 0.001) in the combination group. Combination group also had earlier onset of action (P = 0.001, Chi square test). There was no significant difference between the groups in terms of laboratory and clinical adverse events. Limitations: Non-blinded, no comparison with CsA monotherapy arm, no follow up beyond 12 weeks. Conclusion: The combination of reduced doses of MTX and CsA is more efficacious with earlier onset of action and similar adverse effects as with MTX monotherapy.

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