Successful treatment of trichomoniasis with tinidazole following desensitization in a patient allergic to metronidazole

2020 ◽  
pp. 095646242096391 ◽  
Author(s):  
Mark Biagi ◽  
Wendy Slipke ◽  
Alexa Smalley ◽  
Geoffrey Tsaras
Keyword(s):  
Adverse Effects ◽  
Allergic Reaction ◽  
Successful Treatment ◽  
Cross Reactivity ◽  
Alternative Therapies ◽  
Burning Sensation ◽  
Effective Alternative ◽  
Whole Body ◽  
History Of

Metronidazole desensitization is recommended in patients with trichomoniasis and history of an allergic reaction to metronidazole due to presumed cross reactivity with tinidazole and lack of reliably safe and effective alternative therapies. We report our experiences in a patient with persistent trichomoniasis who failed to complete metronidazole desensitization due to a burning sensation over her whole body and pruritus but was later successfully desensitized to tinidazole without experiencing any adverse effects.

Successful treatment with secnidazole for trichomoniasis in the setting of metronidazole hypersensitivity

2021 ◽  
pp. 095646242110349
Author(s):  
Wesley D Kufel ◽  
Elizabeth A Asiago-Reddy ◽  
Katie A Parsels ◽  
Soma Sanyal ◽  
Jennifer L Coyne
Keyword(s):  
Infectious Disease ◽  
Effective Treatment ◽  
Treatment Option ◽  
Successful Treatment ◽  
Treatment Options ◽  
Cross Reactivity ◽  
Potential Treatment ◽  
History Of ◽  
Microbiological Cure ◽  
Disease Specialist

Limited effective treatment options currently exist for trichomoniasis management among patients with metronidazole hypersensitivity. We report a patient with a documented history of metronidazole hypersensitivity who initially was treated with nitazoxanide but demonstrated clinical and microbiological failure. Secnidazole was subsequently used for treatment, which resulted in clinical and microbiological cure without observation of cross-reactivity. Secnidazole may represent a potential treatment option for trichomoniasis in patients with metronidazole hypersensitivity after consultation with an infectious disease specialist.

Intra-anal use of imiquimod: what is the clinical evidence?

2019 ◽  
Vol 30 (10) ◽  
pp. 1018-1024
Author(s):  
Ioannis D Gkegkes ◽  
Christos Iavazzo ◽  
Apostolos P Stamatiadis
Keyword(s):  
Human Papillomavirus ◽  
Adverse Effects ◽  
Clinical Evidence ◽  
Complete Healing ◽  
Burning Sensation ◽  
High Grade ◽  
Imiquimod Cream ◽  
Off Label ◽  
Anal Lesions ◽  
Intraepithelial Lesions

Imiquimod has been demonstrated to be rather effective in patients with anal as well as perianal high-grade squamous intraepithelial lesions (HSILs). Nevertheless, until now the intra-anal use of imiquimod has been considered off-label. The aim of this study is to review the clinical evidence related to the intra-anal use of imiquimod in the treatment of human papillomavirus-related anal lesions. A systematic search in PubMed and Scopus was performed. In total, 422 patients were included. The most common referred comorbidity was HIV infection (281 patients, 66.6%). The principal clinical entities, which were treated with intra-anal imiquimod, were HSILs. The most frequent formulation was self-applied imiquimod cream. In the HSIL group, there was complete healing in 74 patients (35%) and partial in 44 patients (20.9%), while in the wart group, there was complete healing in 128 patients (67%). Recurrence of HSIL was present in 19 patients (15%), while in cases with warts recurrence was present in 38 patients (19.8%). The most common adverse events were pain, itching, and burning sensation. In conclusion, the adverse effects associated with the intra-anal use of imiquimod seem to be minor. The present clinical evidence suggests that imiquimod may be proposed as effective, safe, and relatively well tolerated treatment.

scholarly journals Delayed-Type Hypersensitivity Reaction to Red Tattoo Ink Triggered by Ledipasvir/Sofosbuvir for Hepatitis C: A Case Report

2021 ◽  
pp. 379-383
Author(s):  
Meghan L. McPhie ◽  
Kevin Y.M. Ren ◽  
J. Michael Hendry ◽  
Sonja Molin ◽  
Thomas Herzinger
Keyword(s):  
Case Report ◽  
Hepatitis C ◽  
Adverse Effects ◽  
Hypersensitivity Reaction ◽  
Allergic Reaction ◽  
Delayed Type Hypersensitivity ◽  
Histological Features

Tattoos have become increasingly popular worldwide making adverse effects from tattoos a growing concern. In our report, we present a 51-year-old man who developed an unusual allergic reaction to the red ink portions of his tattoos that coincided with the initiation of ledipasvir/sofosbuvir treatment for his hepatitis C. Clinical and histological features were consistent with a delayed-type hypersensitivity reaction to red ink.

Salicylate toxicity from chronic bismuth subsalicylate use

2020 ◽  
Vol 13 (11) ◽  
pp. e236929
Author(s):  
Sheliza Halani ◽  
Peter E Wu
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Hearing Impairment ◽  
Reference Range ◽  
The Elderly ◽  
Intravenous Fluids ◽  
Over The Counter ◽  
Bismuth Subsalicylate ◽  
Salicylate Concentration ◽  
History Of

A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. An initial workup for infectious, metabolic and structural causes was unrevealing. However, further history discovered that he had been ingesting one to two bottles of Pepto-Bismol (bismuth subsalicylate) daily for gastro-oesophageal reflux symptoms. On his second day of admission, the plasma salicylate concentration was 2.08 mmol/L (reference range 1.10–2.20 mmol/L), despite no sources of salicylate in hospital. He was diagnosed with chronic salicylate toxicity and Pepto-Bismol use was discontinued. The patient was treated supportively with isotonic intravenous fluids only and plasma salicylate concentration fell to less than 0.36 mmol/L. Concurrently, all his symptoms resolved. This case highlights the potential adverse effects of over-the-counter medications. The diagnosis of chronic salicylate toxicity is challenging, specifically in the elderly and in undifferentiated presentations, as it can be missed if not suspected.

The Role of the Representative: Some Empirical Observations on the Theory of Edmund Burke

1959 ◽  
Vol 53 (3) ◽  
pp. 742-756 ◽  
Author(s):  
Heinz Eulau ◽  
John C. Wahlke ◽  
William Buchanan ◽  
Leroy C. Ferguson
Keyword(s):  
Decision Making ◽  
Political Theory ◽  
Empirical Research ◽  
Body Politic ◽  
Whole Body ◽  
Edmund Burke ◽  
Political Systems ◽  
General Consensus ◽  
History Of

The problem of representation is central to all discussions of the functions of legislatures or the behavior of legislators. For it is commonly taken for granted that, in democratic political systems, legislatures are both legitimate and authoritative decision-making institutions, and that it is their representative character which makes them authoritative and legitimate. Through the process of representation, presumably, legislatures are empowered to act for the whole body politic and are legitimized. And because, by virtue of representation, they participate in legislation, the represented accept legislative decisions as authoritative. But agreement about the meaning of the term “representation” hardly goes beyond a general consensus regarding the context within which it is appropriately used. The history of political theory is studded with definitions of representation, usually embedded in ideological assumptions and postulates which cannot serve the uses of empirical research without conceptual clarification.

scholarly journals Evaluation of whole-body modalities for diagnosis of multifocal osteonecrosis—a pilot study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shunichi Yokota ◽  
Keita Sakamoto ◽  
Yukie Shimizu ◽  
Tsuyoshi Asano ◽  
Daisuke Takahashi ◽  
...  
Keyword(s):  
Study Data ◽  
Whole Body ◽  
Hematologic Disease ◽  
Hip Joints ◽  
Patient Demographics ◽  
Examination Time ◽  
History Of ◽  
Body Magnetic Resonance Imaging ◽  
The Cost ◽  
Body Bone

Abstract Background This study aimed to investigate the ability of whole-body bone scintigraphy (WB-BS) in the detection of multifocal osteonecrosis (ON) compared to whole-body magnetic resonance imaging (WB-MRI) and to clarify the characteristics of patients with multifocal ON among those with ON of the femoral head (ONFH) using WB-MRI. Methods Forty-six patients who had symptomatic ONFH and underwent surgery in our hospital from April 2019 to October 2020 were included in the study. Data on patient demographics, including age, sex, body mass index (BMI), history of corticosteroid intake, alcohol abuse, smoking, and symptomatic joints, were collected from their medical records. All patients underwent WB-MRI and WB-BS before surgery. Results The agreement in the detection of ON by WB-MRI vs the uptake lesions by WB-BS in the hip joints was moderate (κ = 0.584), while that in other joints was low (κ < 0.40). Among the 152 joints with ON detected by WB-MRI, 92 joints (60.5%) were symptomatic, and 60 joints (39.5%) were asymptomatic. Twelve out of the 46 (26.0%) patients had multifocal (three or more distinct anatomical sites) ON. Nonetheless, while WB-BS detected symptomatic ON detected by WB-MRI as uptake lesions in 82.6% (76/92) of the joints, asymptomatic ON detected by WB-MRI was detected as uptake lesions in 21.7% (13/60) of the joints. All patients with multifocal ON had a history of steroid therapy, which was significantly higher than that in patients with oligofocal ON (P = 0.035). The patients with a hematologic disease had multifocal ON at a higher rate (P = 0.015). Conclusions It might be difficult for WB-BS to detect the asymptomatic ON detected by WB-MRI compared to symptomatic ON. Considering the cost, examination time, and radiation exposure, WB-MRI might be useful for evaluating multifocal ON. Larger longitudinal studies evaluating the benefits of WB-MRI for detecting the risk factors for multifocal ON are required.

scholarly journals P043 Fascinating phosphate: seek and you will find

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jyoti Bakshi ◽  
Clare Batten
Keyword(s):  
Back Pain ◽  
Degenerative Change ◽  
Nasal Bone ◽  
Rare Condition ◽  
Whole Body ◽  
Excision Biopsy ◽  
Small Lesion ◽  
History Of ◽  
The Right ◽  
Fgf 23

Abstract Background/Aims  A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods  The case is discussed below. Results  Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR &lt; 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion  Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure  J. Bakshi: None. C. Batten: None.

Thrombocytopenia in Rocky Mountain Spotted Fever

PEDIATRICS ◽  
1966 ◽  
Vol 37 (2) ◽  
pp. 386-386
Author(s):  
WINIFIELD STRYKER
Keyword(s):  
Spotted Fever ◽  
Rocky Mountain ◽  
Whole Body ◽  
Rocky Mountain Spotted Fever ◽  
History Of

The case of Rocky Mountain Spotted Fever with multiple coagulation disturbances reported in Pediatrics (36:627, 1965) was similar to a recent patient's. This was a 2½ year old girl with a 9 day history of fever and rash. She was comatose and had papular lesions, many of which were hemorrhagic, involving the whole body (including palms and soles) plus many small flat petechiae. A sibling had died 2 days before with an identical history.

Purulent Otitis Media: Differences Between Populations in Different Environments

PEDIATRICS ◽  
1974 ◽  
Vol 53 (2) ◽  
pp. 135-136
Author(s):  
Patrick Manning ◽  
Mary Ellen Avery ◽  
Alan Ross
Keyword(s):  
Hearing Loss ◽  
Adverse Effects ◽  
Language Development ◽  
Otitis Media ◽  
Early Life ◽  
Educational Programs ◽  
Previous Issue ◽  
High Incidence ◽  
History Of ◽  
Tympanic Membranes

The paper by Kaplan and colleagues in a previous issue starts by emphasizing the unusually high incidence of otitis media among Eskimo children. Forty-one percent of their cohort of 489 Alaskan Eskimo children, followed for ten years, had perforations or scars of the tympanic membranes; significant hearing losses were present in 16% of the group. Among the 374 children with a history of otorrhea, 291 (78%) had their first attack before their second birthday. The adverse effects of hearing loss in early life on language development were underscored by the authors, who quite properly point out the need for special educational programs.

TOOTH-RASHES AS DESCRIBED BY MICHAEL UNDERWOOD (1737-1820), THE FOUNDER OF MODERN PEDIATRICS

PEDIATRICS ◽  
1969 ◽  
Vol 43 (3) ◽  
pp. 459-459
Author(s):  
T. E. C.
Keyword(s):  
Scarlet Fever ◽  
Erythema Nodosum ◽  
Whole Body ◽  
Deciduous Teeth ◽  
History Of ◽  
History Of Pediatrics ◽  
Benign Nature ◽  
Almost All ◽  
As If

I know of no contemporary pediatrician who believes that the cutting of deciduous teeth causes skin rashes. But, almost all the great figures in the history of pediatrics believed firmly that teething was associated with a riety of rashes. Michael Underwood, who more than anyone else laid the foundation of modern pediatrics, wrote about tooth-rashes as follows: A very common rash, appears chiefly in teething children, which yery much resembles the measles, and has been sometimes mistaken for it. It is preceded by sickness at the stomach, but is attended by very little fever; though the rash continues very florid for three days, like the measles, but does not dry off in the manner of that disease. . . . While the double or eye-teeth are cutting, I have noticed a rash Which at its first appearance is very similar to the above, and has likewise been mistaken for the measles. It, however, soon spreads into larger spots and patches of bright red, and afterwards of a darker hue, resembling the ill-looking petechiae which appear in bad fevers, but is, nevertheless, of a benign nature. It is, indeed, attended with some fever, arising possibly from the irritation occasioned by teething, and has been followed by small and hard round tumours on the legs, which softening in two or three days, always appear as if they would suppurate, though I believe they never do . . . [? erythema nodosum, T. E. C., Jr.] I have seen a third kind of rash, in appearance resembling the measles, and, like it, covering the whole body, but with larger intermediate patches, like the eruption in the scarlet fever. . . .

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