scholarly journals Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia—Case Reports and Discussion

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Zoe Harrison ◽  
Owen Haeney ◽  
William Brereton
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Relevant Literature ◽  
Treatment Resistance ◽  
Antipsychotic Treatment ◽  
Forensic Mental Health ◽  
Forensic Hospital ◽  
Novel Approach ◽  
Appropriate Therapy ◽  
Schizophrenia Case

Treatment resistance in schizophrenia is often encountered in clinical practice, with clozapine usually recommended as the appropriate therapy. However, where clozapine proves ineffective or cannot be tolerated due to side effects, treatment options are limited. In patients within forensic mental health services, residual symptomatology often presents a barrier to discharge and can have lasting effects on prospects for rehabilitation as well as risk to self and others. This paper presents a review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment. In all three patients, it improved clinical efficacy as well as tolerability, resulting in improvement that allowed discharge from the forensic hospital.

A Novel Approach to Managing a Strangulated De Garengeot’s Hernia

2020 ◽  
pp. 000313482094355
Author(s):  
Francis J. Simpson ◽  
Katherine Fay ◽  
Vivian Wang ◽  
David Elwood
Keyword(s):  
Surgical Technique ◽  
Significant Variation ◽  
Case Reports ◽  
Relevant Literature ◽  
Vermiform Appendix ◽  
Open Approach ◽  
Hernia Defect ◽  
Elderly Female ◽  
Novel Approach ◽  
De Garengeot’S Hernia

De Garengeot’s hernia, the presence of an incarcerated vermiform appendix within a femoral hernia, is a rare general surgery emergency that predominantly affects elderly female patients. Due to its rarity, there is significant variation in surgical technique; however, most case reports favor an open approach. Here we present a case of a De Garengeot’s hernia with a unique hybrid open and laparoscopic repair, utilizing the hernia defect as a port site. We will also review the relevant literature.

Pandrug-resistant Gram-negative bacteria: a systematic review of current epidemiology, prognosis and treatment options

2019 ◽  
Author(s):  
Stamatis Karakonstantis ◽  
Evangelos I Kritsotakis ◽  
Achilleas Gikas
Keyword(s):  
Case Reports ◽  
Controlled Trial ◽  
Treatment Options ◽  
Relevant Literature ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Treatment Regimens ◽  
Synergistic Combinations

Abstract Background The literature on the epidemiology, mortality and treatment of pandrug-resistant (PDR) Gram-negative bacteria (GNB) is scarce, scattered and controversial. Objectives To consolidate the relevant literature and identify treatment options for PDR GNB infections. Methods A systematic search in MEDLINE, Scopus and clinical trial registries was conducted. Studies reporting PDR clinical isolates were eligible for review if susceptibility testing for all major antimicrobials had been performed. Characteristics and findings of retrieved studies were qualitatively synthesized. Results Of 81 studies reviewed, 47 (58%) were published in the last 5 years. The reports reflected a worldwide dissemination of PDR GNB in 25 countries in 5 continents. Of 526 PDR isolates reported, Pseudomonas aeruginosa (n=175), Acinetobacter baumannii (n=172) and Klebsiella pneumoniae (n=125) were most common. PDR GNB were typically isolated in ICUs, but several studies demonstrated wider outbreak potential, including dissemination to long-term care facilities and international spread. All-cause mortality was high (range 20%–71%), but appeared to be substantially reduced in studies reporting treatment regimens active in vitro. No controlled trial has been performed to date, but several case reports and series noted successful use of various regimens, predominantly synergistic combinations, and in selected patients increased exposure regimens and newer antibiotics. Conclusions PDR GNB are increasingly being reported worldwide and are associated with high mortality. Several treatment regimens have been successfully used, of which synergistic combinations appear to be most promising and often the only available option. More pharmacokinetic/pharmacodynamic and outcome studies are needed to guide the use of synergistic combinations.

scholarly journals 185 Second Generation Antipsychotics and Catatonia: A Literature Review

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 105-106
Author(s):  
Ryan Slauer ◽  
Mina Boazak ◽  
Michael Lowley ◽  
Jeffrey Lawrence ◽  
Zachary Hudson ◽  
...  
Keyword(s):  
Second Generation ◽  
Case Reports ◽  
Controlled Trial ◽  
Treatment Options ◽  
Antipsychotic Treatment ◽  
Patient Demographics ◽  
Second Generation Antipsychotics ◽  
Psychiatric Units ◽  
Pubmed Search ◽  
Pharmacologic Agents

AbstractIntroductionCatatonia is an underrecognized neuropsychiatric syndrome affecting approximately 10% of individuals hospitalized on inpatient psychiatric units. First-line treatments for this condition include benzodiazepines (BZD) and/or electroconvulsive therapy (ECT). However, 20-40% of individuals do not respond to BZD alone and ECT is not always accessible. Second generation antipsychotics (SGA) have been used to treat catatonia in these circumstances. Here, we review the literature pertaining to the efficacy and safety of SGA in the treatment of catatonia.MethodsWe conducted a PubMed search for articles linking catatonia to antipsychotics, under the search heading “catatonia” or “kahlbaum” and “risperidone”, “amisulpride”, “iloperidone”, “olanzapine”, “aripiprazole”, “paliperidone”, “clozapine”, “brexpiprazole”, or “cariprazine”. Reports commenting on SGA treatment efficacy and/or their role in the development of catatonia were included in the analysis. Selected articles were reviewed for patient demographics, psychiatric/medical history, symptoms, cause of catatonia and treatment, and co-administered agents. For each SGA, we calculated the number of cases in which catatonia was likely improved with antipsychotic treatment, and the number of cases in which catatonia was precipitated or worsened with antipsychotic treatment (improved/worsened ratio). Case data was assessed using the Naranjo Adverse Drug Reaction Probability Scale. Descriptive statistics were used to analyze the data.ResultsAt the time this abstract was written, we reviewed 480 of the original 507 articles. One hundred and seventeen of the 480 met inclusion criteria. There was one randomized controlled trial (RCT), five prospective studies, four retrospective studies and 107 case reports. Of all reviewed literature quetiapine (34:3, 92%), aripiprazole (16:2, 89%), amisulpride (18:1, 95%), andclozapine (19:1, 95%) had the highest improved/worsened ratio, conversely paliperidone (0:5, 0%) had the lowest improved/worsened ratio.ConclusionOf the available literature quetiapine, amisulpride, aripiprazole, and clozapine were found to be relatively safe andeffective as treatment options in catatonia, while palipderidone was found to have reports pointing to its role in the development/worsening, but none on the improvement, of catatonia. These results need to be interpreted with caution. In the majority of cases where SGA’s were effective, patients were co- treated with other pharmacologic agents (most frequently benzodiazepines), making it difficult to assess the role of the antipsychotic alone. Also, given that the preponderance of studies were case reports, publication bias may be an important limitation. Further studies are needed to examine the safety and efficacy of SGA in treating catatonia.Funding AcknowledgementsNo funding.

scholarly journals Characteristics and Treatment Challenges of Non-Clear Cell Renal Cell Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3807
Author(s):  
Pierangela Sepe ◽  
Arianna Ottini ◽  
Chiara Carlotta Pircher ◽  
Andrea Franza ◽  
Melanie Claps ◽  
...  
Keyword(s):  
Renal Cell ◽  
Kinase Inhibitors ◽  
Clear Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Single Agent ◽  
Growth Factor Receptor ◽  
Mtor Inhibitors ◽  
Cell Renal Cell Carcinoma ◽  
Clear Cell Rcc

Non-clear cell renal cell carcinomas (RCC) comprise several rare and poorly described diseases, often characterized by bad prognosis and with no standard treatments available. The gap in their clinical management is linked to the poor molecular characterization in handling the treatment of non clear-cell RCC with untailored therapies. Due to their rarity, non-clear RCC are in fact under-represented in prospective randomized trials. Thus, treatment choices are based on extrapolating results from clear cell RCC trials, retrospective data, or case reports. Over the last two decades, various options have been considered as the mainstay for the treatment of metastatic RCC (mRCC), including angiogenesis inhibitors, vascular endothelial growth factor receptor inhibitors, other tyrosine kinase inhibitors (TKIs), as well as MET inhibitors and mammalian targeting of rapamycin (mTOR) inhibitors. More recently, the therapeutic armamentarium has been enriched with immunotherapy, alone or in combination with targeted agents that have been shown to significantly improve outcomes of mRCC patients, if compared to TKI single-agent. It has been widely proven that non-clear cell RCC is a morphologically and clinically distinct entity from its clear cell counterpart but more knowledge about its biology is certainly needed. Histology-specific collaborative trials are in fact now emerging to investigate different treatments for non-clear cell RCC. This review summarizes pathogenetic mechanisms of non-clear cell RCC, the evolution of treatment paradigms over the last few decades, with a focus on immunotherapy-based trials, and future potential treatment options.

Food waste treatment option selection through spherical fuzzy AHP

2021 ◽  
pp. 1-11
Author(s):  
Aysu Melis Buyuk ◽  
Gul T. Temur
Keyword(s):  
Treatment Option ◽  
Food Waste ◽  
Waste Treatment ◽  
Fuzzy Ahp ◽  
Treatment Options ◽  
Analytic Hierarchy ◽  
Food Treatment ◽  
Novel Approach ◽  
Proposed Model ◽  
Option Selection

In line with the increase in consciousness on sustainability in today’s global world, great emphasis has been attached to food waste management. Food waste is a complex issue to manage due to uncertainties on quality, quantity, location, and time of wastes, and it involves different decisions at many stages from seed to post-consumption. These ambiguities re-quire that some decisions should be handled in a linguistic and ambiguous environment. That forces researchers to benefit from fuzzy sets mostly utilized to deal with subjectivity that causes uncertainty. In this study, as a novel approach, the spherical fuzzy analytic hierarchy process (SFAHP) was used to select the best food treatment option. In the model, four main criteria (infrastructural, governmental, economic, and environmental) and their thirteen sub-criteria are considered. A real case is conducted to show how the proposed model can be used to assess four food waste treatment options (composting, anaerobic digestion, landfilling, and incineration). Also, a sensitivity analysis is generated to check whether the evaluations on the main criteria can change the results or not. The proposed model aims to create a subsidiary tool for decision makers in relevant companies and institutions.

scholarly journals Advances in Targeting Cutaneous Melanoma

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2090
Author(s):  
Dimitri Kasakovski ◽  
Marina Skrygan ◽  
Thilo Gambichler ◽  
Laura Susok
Keyword(s):  
Cutaneous Melanoma ◽  
Clinical Investigation ◽  
Early Stage ◽  
Treatment Options ◽  
Treatment Resistance ◽  
Immune Checkpoint Blockade ◽  
Oncolytic Viruses ◽  
Cancer Site ◽  
Western World ◽  
Pharmacological Agents

To date, the skin remains the most common cancer site among Caucasians in the western world. The complex, layered structure of human skin harbors a heterogenous population of specialized cells. Each cell type residing in the skin potentially gives rise to a variety of cancers, including non-melanoma skin cancer, sarcoma, and cutaneous melanoma. Cutaneous melanoma is known to exacerbate and metastasize if not detected at an early stage, with mutant melanomas tending to acquire treatment resistance over time. The intricacy of melanoma thus necessitates diverse and patient-centered targeted treatment options. In addition to classical treatment through surgical intervention and radio- or chemotherapy, several systemic and intratumoral immunomodulators, pharmacological agents (e.g., targeted therapies), and oncolytic viruses are trialed or have been recently approved. Moreover, utilizing combinations of immune checkpoint blockade with targeted, oncolytic, or anti-angiogenic approaches for patients with advanced disease progression are promising approaches currently under pre-clinical and clinical investigation. In this review, we summarize the current ‘state-of-the-art’ as well as discuss emerging agents and regimens in cutaneous melanoma treatment.

scholarly journals Squamous cell carcinoma of the scrotum in HIV: two case reports

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Jeff John ◽  
Ken Kesner ◽  
John Lazarus
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Punch Biopsy ◽  
Delayed Treatment ◽  
Clinical Presentations ◽  
T1 N0 M0

Abstract Background Squamous cell carcinoma (SCC) of the scrotum was the first malignancy known to be associated with exposure to an occupational carcinogen—in this case, soot trapped in the breeches of chimney sweeps. Better civil rules and regulations and the replacement of hearths with other forms of heating have rendered SCC of the scrotum a rarity. We report two cases of scrotal SCC with vastly differing clinical presentations and management. Case presentation Case 1 had T1 N0 M0 disease and presented with a small (< 2 cm), innocuous-looking, non-healing ulcer of eight years duration. A punch biopsy revealed a superficially invasive SCC confirmed on immunohistochemical profiling. A wide local excision of the lesion was subsequently performed. Follow-up at three years showed no signs of recurrence. Case 2 presented with T4 N1 M1 disease and rapidly progressing locally destructive mass. A punch biopsy of the scrotal lesion confirmed invasive moderately differentiated focally keratinising SCC. The metastatic evaluation confirmed the presence of metastatic, extensive para-aortic lymphadenopathy. He was managed with cisplatin-based chemoradiotherapy. Conclusion Early detection and management of patients with SCC of the scrotum are essential. If the diagnosis is delayed, treatment options become limited, and the prognosis is poor. Notwithstanding the rarity of this disease, multicentre trials are needed to provide more precise guidelines as to the optimal management of these patients.

scholarly journals Management of Amelogenesis Imperfecta in Childhood: Two Case Reports

2021 ◽  
Vol 18 (13) ◽  
pp. 7204
Author(s):  
Mirja Möhn ◽  
Julia Camilla Bulski ◽  
Norbert Krämer ◽  
Alexander Rahman ◽  
Nelly Schulz-Weidner
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Permanent Dentition ◽  
Amelogenesis Imperfecta ◽  
Structural Defects ◽  
Type I ◽  
Oral Rehabilitation ◽  
Self Confidence ◽  
Health Quality ◽  
Masticatory System

Amelogenesis imperfecta (AI) is defined as an interruption of enamel formation due to genetic inheritance. To prevent malfunction of the masticatory system and an unaesthetic appearance, various treatment options are described. While restoration with a compomer in the anterior region and stainless steel crowns in the posterior region is recommended for deciduous dentition, the challenges when treating such structural defects in mixed or permanent dentition are changing teeth and growing jaw, allowing only temporary restoration. The purpose of this case report is to demonstrate oral rehabilitation from mixed to permanent dentition. The dentition of a 7-year-old patient with AI type I and a 12-year-old patient with AI type II was restored under general anesthesia to improve their poor aesthetics and increase vertical dimension, which are related to problems with self-confidence and reduced oral health quality of life. These two cases show the complexity of dental care for structural anomalies of genetic origin and the challenges in rehabilitating the different phases of dentition.

scholarly journals Successful endovascular stenting of a bleeding external iliac vein mycotic aneurysm in an oncologic patient: a case report

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Rupal S. Parikh ◽  
Shiyi Li ◽  
Christopher Shackles ◽  
Tamim Khaddash
Keyword(s):  
Mycotic Aneurysm ◽  
Case Reports ◽  
Treatment Options ◽  
Iliac Vein ◽  
Pelvic Abscess ◽  
Vascular Lesions ◽  
Endovascular Stenting ◽  
Oncologic Patient ◽  
External Iliac Vein ◽  
Effective Option

Abstract Background Mycotic aneurysms are rare vascular lesions, occurring in 0.6–2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events. Case presentation This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting, in an oncologic patient without alternative therapeutic options. Conclusion Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting, particularly as a last resort in patients without surgical treatment options.

scholarly journals Lomeguatrib Increases the Radiosensitivity of MGMT Unmethylated Human Glioblastoma Multiforme Cell Lines

2021 ◽  
Vol 22 (13) ◽  
pp. 6781
Author(s):  
Anna Kirstein ◽  
Daniela Schilling ◽  
Stephanie E. Combs ◽  
Thomas E. Schmid
Keyword(s):  
Glioblastoma Multiforme ◽  
Cell Lines ◽  
Dna Methyltransferase ◽  
Treatment Options ◽  
Treatment Resistance ◽  
Cell Cycle Distribution ◽  
Human Glioblastoma ◽  
Human Glioblastoma Multiforme ◽  
Mgmt Protein

Background: Treatment resistance of glioblastoma multiforme to chemo- and radiotherapy remains a challenge yet to overcome. In particular, the O6-methylguanine-DNA-methyltransferase (MGMT) promoter unmethylated patients have only little benefit from chemotherapy treatment using temozolomide since MGMT counteracts its therapeutic efficacy. Therefore, new treatment options in radiotherapy need to be developed to inhibit MGMT and increase radiotherapy response. Methods: Lomeguatrib, a highly specific MGMT inhibitor, was used to inactivate MGMT protein in vitro. Radiosensitivity of established human glioblastoma multiforme cell lines in combination with lomeguatrib was investigated using the clonogenic survival assay. Inhibition of MGMT was analyzed using Western Blot. Cell cycle distribution and apoptosis were investigated to determine the effects of lomeguatrib alone as well as in combination with ionizing radiation. Results: Lomeguatrib significantly decreased MGMT protein and reduced radiation-induced G2/M arrest. A radiosensitizing effect of lomeguatrib was observed when administered at 1 µM and increased radioresistance at 20 µM. Conclusion: Low concentrations of lomeguatrib elicit radiosensitization, while high concentrations mediate a radioprotective effect.

Sign in / Sign up

Export Citation Format

Share Document