Successful Treatment of Severe Lamotrigine Intoxication with CytoSorb Hemoadsorption

2021 ◽  
pp. 1-4
Author(s):  
Caterina Reuchsel ◽  
Falk Alexander Gonnert
Keyword(s):  
Therapeutic Option ◽  
Combined Treatment ◽  
Clinical Signs ◽  
Stable Condition ◽  
Drug Level ◽  
Short Term ◽  
Intractable Seizures ◽  
Anti Epileptic Drug ◽  
Severe Intoxication ◽  
Extracorporeal Removal

Severe intoxication with the anti-epileptic drug, lamotrigine can cause cardiovascular collapse, neurotoxicity – expressed as intractable seizures, and even death. As there is currently no known specific antidote, extracorporeal removal therapies such as CytoSorb hemoadsorption might represent a promising therapeutic option. We report on a deeply comatosed 60-year-old woman who was treated in our intensive care unit with severe lamotrigine intoxication. To support removal from the blood, combined treatment with continuous veno-venous hemodialysis and CytoSorb hemoadsorption was started. Pre- and post-adsorber drug level measurements showed the rapid elimination of lamotrigine accompanied by an impressive clinical improvement in the patient. Two days after treatment discontinuation, there were no more clinical signs of intoxication and the patient could be extubated, followed by transfer to the stroke unit in a stable condition the following day. In the absence of a viable antidote, for the efficient short-term removal of lamotrigine, hemoadsorption with the CytoSorb device could represent a feasible treatment option for patients with severe lamotrigine intoxication.

Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption

2020 ◽  
pp. 1-4
Author(s):  
Thomas Georg Karl Breuer ◽  
Daniel Robert Quast ◽  
Stephan Wiciok ◽  
Adnan Labedi ◽  
Gisa Ellrichmann
Keyword(s):  
Renal Failure ◽  
Intensive Therapy ◽  
Plasma Concentrations ◽  
Clinical Signs ◽  
Stable Condition ◽  
Drug Level ◽  
Steroid Glycoside ◽  
Elimination Kinetics ◽  
Fab Fragment ◽  
Digitoxin Intoxication

While several intoxications can be successfully treated with specific antidotes, intoxications with the steroid glycoside digitoxin still represent a major challenge. Besides conventional approaches, CytoSorb® hemoadsorption might be another treatment option. We report on an 81-year-old female patient treated in our intensive care unit (ICU) with severe digitoxin intoxication, acute renal failure, and urinary tract infection (UTI). As physiological digitoxin elimination kinetics are known to appear slow, and also in regard to the renal failure, the decision was made to initiate continuous renal replacement therapy combined with CytoSorb hemoadsorption. The patient was hemodynamically stabilized within the first 4 h of treatment and initially required catecholamines to be stopped within 24 h of treatment. Pre- and post-adsorber drug level measurements showed a rapid elimination of digitoxin. Antibiotic treatment with piperacillin/tazobactam was initiated, and despite CytoSorb hemoadsorption therapy and its known potential to reduce plasma concentrations of several drugs, the UTI was successfully treated. After 3 days of CytoSorb treatment, digitoxin plasma levels were stable and almost normalized, and no clinical signs of intoxication were present. Five days after presentation, the patient was transferred from the ICU in a stable condition. CytoSorb hemoadsorption may be an easily available, efficient, and less cost-intensive therapy option than treatment with the Fab fragment, which is the currently recommended therapy for digitalis intoxications. Therefore, the use of CytoSorb might represent an alternative treatment for life-threatening complications of digitoxin intoxications.

scholarly journals When a Ciliate Meets a Flagellate: A Rare Case of Colpoda spp. and Colpodella spp. Isolated from the Urine of a Human Patient. Case Report and Brief Review of Literature

Biology ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 476
Author(s):  
Vlad S. Neculicioiu ◽  
Ioana A. Colosi ◽  
Dan A. Toc ◽  
Andrei Lesan ◽  
Carmen Costache
Keyword(s):  
Respiratory Insufficiency ◽  
Combined Treatment ◽  
Primary Care Clinic ◽  
Clinical Signs ◽  
Heart Association ◽  
Chronic Obstructive ◽  
Human Patient ◽  
Care Clinic ◽  
Morphological Criteria ◽  
Patient Reported

An often-overlooked side of the population aging process and the steady rise of non-communicable diseases reflects the emergence of novel infectious pathogens on the background of an altered host immune response. The aim of this article was to present the first record of a ciliate and flagellate protozoa recovered from the urine of an elderly patient and to review the existing medical literature involving these parasites. A 70-year-old female patient was admitted for breathing difficulties on the basis of an acute exacerbation of COPD (Chronic obstructive pulmonary disease) with respiratory insufficiency. The patient reported a long history of multiple comorbidities including COPD Gold II, chronic respiratory insufficiency, chronic heart failure NYHA III (New York Heart Association Functional Classification), type 2 diabetes and morbid obesity. During routine examinations, we ascertained the presence of two unusual protozoa, a ciliate and a flagellate, in the patient’s urine samples, identified on morphological criteria to be most likely Colpoda spp. and Colpodella spp., with similarities to C. steinii and C. gonderi. The presence of these parasites was not associated with any clinical signs of urinary disease. Following a combined treatment with ceftriaxone and metronidazole, we observed the disappearance of these pathogens upon discharge from the primary care clinic. This study highlights the importance of including unusual pathogens in the differential diagnosis of cases which involve immunosuppression.

scholarly journals Use of MitraClip system for severe mitral regurgitation in cardiogenic shock: results from a multicentre observational Italian experience (the MITRA-SHOCK study)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Falasconi ◽  
L Pannone ◽  
F Melillo ◽  
M Adamo ◽  
F Ronco ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Therapeutic Option ◽  
Strong Predictor ◽  
Medical Emergency ◽  
Short Term ◽  
Italian Experience ◽  
Procedural Success ◽  
Mitraclip System

Abstract Background/Introduction Cardiogenic shock (CS) is a medical emergency and a frequent cause of death. CS can be complicated by mitral regurgitation (MR). The presence of at least moderate MR in the setting of shock was associated with about three-times higher odds of 1-year mortality. In the setting of refractory CS, percutaneous mitral valve repair (PMVR) can be a potential therapeutic option. Purpose The aim of the study was to evaluate the efficacy of percutaneous approach of severe MR in patients with CS assessing short-term clinical outcomes. Methods In this study we retrospectively included patients with CS and concomitant severe MR treated with Mitraclip system. We enrolled 28 patients from 5 Italian centers between 2012 and 2019. MitraClip implantation was performed according to each hospital standard care. CS was defined utilizing the Diagnostic Criteria of Cardiogenic Shock used in the SHOCK trial. Procedural success was defined as the presence of moderate or less MR after MitraClip implantation. Results All patients presented at least severe MR. All treated patients were at high surgical risk (STS mortality score 36.4±11.7%). Procedural success was obtained in 24 patients (86%). A mean of 1.71±0.76 clips per patients were implanted. In-hospital complications occurred in 13 patients (46%): 7 minor bleedings (25% of patients), 7 major bleedings (25%), 8 acute kidney injuries (28%). In-hospital mortality was 25% and the reported causes of death were cardiovascular in all patients. At Cox multivariate analysis procedural success was a strong predictor of in-hospital survival (HR 0.11, CI 95% 0.02–0.67, p=0.017). Conclusions PMVR with Mitraclip system in patients with CS and concomitant MR demonstrated high procedural success and acceptable safety. It can be considered a bailout option in this setting of patients with high short-term mortality. Larger prospective studies are needed. In-hospital mortality predictors Funding Acknowledgement Type of funding source: None

scholarly journals Dexamethasone Preconditioning Improves the Response of Collagen-Induced Arthritis to Treatment with Short-Term Lipopolysaccharide-Stimulated Collagen-Loaded Dendritic Cells

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Corina Peña ◽  
David Gárate ◽  
Juan Contreras-Levicoy ◽  
Octavio Aravena ◽  
Diego Catalán ◽  
...  
Keyword(s):  
T Cells ◽  
Dendritic Cells ◽  
Cd4 T Cells ◽  
Combined Treatment ◽  
Type Ii Collagen ◽  
Cytokine Profile ◽  
Clinical Disease ◽  
Type Ii ◽  
Collagen Induced Arthritis ◽  
Short Term

Background. Pharmacologically modulated dendritic cells (DCs) have been shown to restore tolerance in type II collagen-(CII-) induced arthritis (CIA). We examined the effect of dexamethasone (DXM) administration as a preconditioning agent, followed by an injection of lipopolysaccharide-(LPS-) stimulated and CII-loaded DCs on the CIA course.Methods. After CIA induction, mice pretreated with DXM were injected with 4-hour LPS-stimulated DCs loaded with CII (DXM/4hLPS/CII/DCs).Results. Mice injected with DXM/4hLPS/CII/DCs displayed significantly less severe clinical disease compared to animals receiving 4hLPS/CII/DCs alone or those in which only DXM was administered. Cytokine profile evaluation showed that CD4+ T cells from DXM/4hLPS/CII/DCs and 4hLPS/CII/DCs groups release higher IL-10 levels than those from mice receiving DXM alone or CIA mice. CD4+ T cells from all DC-treated groups showed less IL-17 release when compared to the CIA group. On the contrary, CD4+ T cells from DXM/4hLPS/CII/DCs and 4hLPS/CII/DCs groups released higher IFN-γlevels than those from CIA group.Conclusion. A combined treatment, including DXM preconditioning followed by an inoculation of short-term LPS-stimulated CII-loaded DCs, provides an improved strategy for attenuating CIA severity. Our results suggest that this benefit is driven by a modulation in the cytokine profile secreted by CD4+ T cells.

scholarly journals Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

2018 ◽  
Vol 12 (3) ◽  
pp. 570-577 ◽  
Author(s):  
Jeffrey Sun ◽  
Cheuk-Kwan Sun ◽  
Cheuk-Kay Sun
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Vascular Malformations ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Common Hepatic Duct ◽  
Low Grade ◽  
Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

scholarly journals Efficacy and Safety of a Combination of Shenmai Injection plus Chemotherapy for the Treatment of Lung Cancer: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Guo-wei Qin ◽  
Tong-tong Xu ◽  
Xiang-wei Lv ◽  
Shi-min Jiang ◽  
Ke-jia Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Adverse Effects ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Efficacy And Safety ◽  
Short Term ◽  
Shenmai Injection ◽  
Term Efficacy

Objective. To perform a systematic evaluation of the efficacy and safety of combined treatment of Shenmai injection and chemotherapy for lung cancer. Methods. A literature search for randomized controlled trials (RCTs) describing the treatment of lung cancer by Shenmai injection and chemotherapy or chemotherapy alone was performed using the PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Value In Paper (VIP), China BioMed, and Wanfang databases. The databases were searched for entries published before September 1, 2019. Results. Thirty-seven RCTs, comprising a total of 2808 cases, were included in the present meta-analysis. Of these, 1428 cases were treated by Shenmai injection plus chemotherapy, and 1380 cases were treated only by chemotherapy. The results of meta-analysis showed that the combined treatment (Shenmai injection plus chemotherapy) increased the short-term efficacy of treatment (relative risk [RR] = 1.183, 95% confidence interval [CI] = 1.043–1.343, P < 0.01 ) and improved patients’ quality of life (RR = 1.514, 95%CI = 1.211–1.891, P < 0.01 ) compared with chemotherapy alone. With regard to the adverse effects, the combined treatment markedly reduced the incidence of white blood cell (WBC) reduction (RR = 0.846, 95%CI = 0.760–0.941, P < 0.01 ), platelet reduction (RR = 0.462, 95% CI = 0.330–0.649, P < 0.01 ), and hemoglobin reduction (RR = 0.462, 95% CI = 0.330–0.649, P < 0.01 ) and alleviated drug-induced liver injury (RR = 0.677, 95%CI = 0.463–0.990, P < 0.05 ). However, it did not offer a significant protective effect (RR = 0.725, 95%CI = 0.358–1.468, P < 0.05 ). The effect of the combined treatment on the occurrence of vomiting was considerable (RR = 0.889, 95%CI = 0.794–0.996, P < 0.05 ), and the combined treatment markedly increased the immunity of patients with lung cancer. Conclusion. The combined treatment of Shenmai injection plus chemotherapy enhanced the short-term efficacy of chemotherapy, improved the patient quality of life, alleviated the adverse effects of chemotherapeutics, and increased the patient immunity. These results should be confirmed by large-scale, high-quality RCTs.

scholarly journals Efficacy of Phototherapy With 308-nm Excimer Light for Skin Microbiome Dysbiosis and Skin Barrier Dysfunction in Canine Atopic Dermatitis

2021 ◽  
Vol 8 ◽  
Author(s):  
Ju-Yong Park ◽  
Seon-Myeong Kim ◽  
Jung-Hyun Kim
Keyword(s):  
Atopic Dermatitis ◽  
Relative Abundance ◽  
Barrier Function ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Skin Barrier ◽  
Skin Barrier Function ◽  
Skin Microbiome ◽  
Canine Atopic Dermatitis ◽  
Allergic Skin

The management of canine atopic dermatitis, an allergic skin disorder, is challenging. To investigate the effect of phototherapy using a 308-nm excimer light as a topical treatment for canine atopic dermatitis, 10 dogs with canine atopic dermatitis and 10 with non-allergic skin were enrolled in this study. Phototherapy was applied every 7 days for a total of 2 months. The skin microbiome, skin barrier function, and clinical outcomes were evaluated after phototherapy. Phototherapy significantly changed the composition of the skin microbiome of dogs with atopic dermatitis and significantly increased the relative abundance of the phyla Actinobacteria and Cyanobacteria. It significantly alleviated the clinical signs of canine atopic dermatitis without serious adverse effects. Transepidermal water loss, as a measure of skin barrier function, significantly decreased after phototherapy. In addition, phototherapy increased microbial diversity and decreased the relative abundance of Staphylococcus pseudintermedius associated with the severity of canine atopic dermatitis. These results suggest that the excimer light therapy is a suitable and safe therapeutic option for canine atopic dermatitis, which is also a spontaneous animal model of atopic dermatitis.

scholarly journals Experience of treatment with Berodual-N in industrial workers with COPD

2005 ◽  
pp. 103-106
Author(s):  
L. A. Stepanishcheva ◽  
G. L. Ignatova ◽  
E. V. Nikolaeva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Outpatient Treatment ◽  
Clinical Signs ◽  
Stable Condition ◽  
Chronic Obstructive ◽  
Symptomatic Therapy ◽  
Industrial Workers ◽  
Obstructive Pulmonary Disease ◽  
Stage 1 ◽  
Progressive Course

Chronic obstructive pulmonary disease (COPD) is an actual healthcare problem due to its widespread, progressive course and mortality. A great deal of the patients’ treatment takes a symptomatic therapy. Results of outpatient treatment with Berodual-N of patients with COPD stage 1 to 2 in stable condition are shown in the article. A significant improvement in clinical signs, lung function parameters (FEV1) and physical tolerance were noted.

Combining Cognitive-Behavioral Therapy and Pharmacotherapy for the Treatment of Panic Disorder

2006 ◽  
Vol 20 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Jasper A. J. Smits ◽  
Conall M. O’Cleirigh ◽  
Michael W. Otto
Keyword(s):  
Panic Disorder ◽  
Combination Treatment ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Strategies ◽  
Cognitive Behavior ◽  
Short Term ◽  
Medication Treatment ◽  
Novel Approaches

This article focuses on the role of combination treatment strategies in the management of panic disorder (PD). Despite short-term benefits, there is not consistent evidence for a longer-term advantage of combined treatment over cognitive-behavior therapy alone. In discussing this result, we place emphasis on ways in which medication treatment may interfere with the learning of safety in relation to feared cues in PD. These considerations are placed in the context of animal and human studies of factors that interfere with the extinction of fears. Strategies to overcome this interference are also discussed as are novel approaches to combination treatment.

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