scholarly journals Cryptococcosis complicating diabetes mellitus: a scoping review

2021 ◽  
Vol 8 ◽  
pp. 204993612110147
Author(s):  
Lauryn Nsenga ◽  
Jonathan Kajjimu ◽  
Ronald Olum ◽  
Sandra Ninsiima ◽  
Andrew Peter Kyazze ◽  
...  

Background: A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented. Objective: The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM. Methods: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded. Results: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% ( n = 18) of the cases. Median age was 60.5 (range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% ( n = 18). Among those with meningitis mortality was 36.2%. Conclusion: A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.

Author(s):  
Nikita Mohan ◽  
Muhammad Ali Fayyaz ◽  
Christopher del Rio ◽  
Navpreet Kaur Rajinder Singh Khurana ◽  
Sampada Sandip Vaidya ◽  
...  

Abstract Background The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. Objective To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2. To identify neuro-invasive pathways of COVID infection. Methods Relevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. Results Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. Conclusion The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.


2021 ◽  
pp. rapm-2020-102154
Author(s):  
Elke ME Bos ◽  
Koen van der Lee ◽  
Johan Haumann ◽  
Marcel de Quelerij ◽  
W Peter Vandertop ◽  
...  

BackgroundBesides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear.ObjectiveThis review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block.Evidence reviewWe systematically searched MEDLINE, Embase and the Cochrane Library from their inception to May 2020 for case reports/series, cohort studies and reviews of intracranial hematoma or abscess associated with neuraxial block. Quality of evidence was assessed using the critical appraisal of a case study checklist by Crombie.FindingsWe analyzed 232 reports, including 291 patients with hematoma and six patients with abscess/empyema. The major part of included studies comprised single case reports with a high risk of bias. Of the patients with hematoma, 48% concerned obstetric patients, the remainder received neuraxial block for various perioperative indications or pain management. Prior dural puncture was reported in 81%, either intended (eg, spinal anesthesia) or unintended (eg, complicated epidural catheter placement). Headache was described in 217 patients; in 101 patients, symptoms resembled postdural puncture headache (PDPH). After treatment, 11% had partial or no recovery and 8% died, indicating the severity of this complication. Intracranial abscess after neuraxial block is seldom reported; six reports were found.ConclusionDiagnosis of intracranial hematoma is often missed initially, as headache is assumed to be caused by cerebrospinal hypotension due to cerebrospinal fluid leakage, known as PDPH. Prolonged headache without improvement, worsening symptoms despite treatment or epidural blood patch, change of headache from postural to non-postural or new neurological signs should alert physicians to alternative diagnoses.


2020 ◽  
pp. 194589242097676
Author(s):  
Fabiana Allevi ◽  
Gian Luca Fadda ◽  
Cecilia Rosso ◽  
Federica Martino ◽  
Carlotta Pipolo ◽  
...  

Background Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. Objective The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. Methods Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. Results Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. Conclusions Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.


2012 ◽  
Vol 16 (5) ◽  
pp. 300-305 ◽  
Author(s):  
Michael Sawchuk ◽  
Frank Spano ◽  
Wei Jing Loo ◽  
Lyn Guenther

Background: Psoriasis and vitiligo are both autoimmune diseases with an increased incidence noted in genetic relatives. They share similar trigger factors and have been observed to coexist in individuals. Objective: The purpose was to review the literature on the coexistence of psoriasis and vitiligo and to determine if there is a higher than expected prevalence of psoriasis in patients with vitiligo and vice versa. Methods: A literature review was conducted using Medline, EMBASE, and the Cochrane Library from 1968 to 2010. All articles that included reports of individuals with both psoriasis and vitiligo in the English language were documented. Results: We identified 338 articles, among which 35 case reports and 7 case series were mentioned. For each case series, the prevalence of psoriasis in patients with vitiligo, or vice versa, falls within the prevalence range of the background population on which the study was based. Conclusion: An increase in the expected prevalence of psoriasis in individuals with vitiligo, or vice versa, was not found in our study, suggesting that the coexistence of the two diseases appears to be due to chance alone. Large epidemiologic studies are required to address with certainty whether psoriasis is more common in individuals with vitiligo and vice versa. Renseignements de base: Le psoriasis et le vitiligo sont deux affections auto-immunes qui ont une incidence accrue observée chez les membres de la famille apparentée. Ils partagent des facteurs déclencheurs similaires, et des études ont démontré leur coexistence chez les personnes. Objectif: Le but était de faire une analyse documentaire sur la coexistence du psoriasis et du vitiligo et de déterminer s'il y a une prévalence plus élevée que prévu du psoriasis chez les patients atteints de vitiligo et vice versa. Méthodes: Une analyse documentaire a été effectuée en utilisant Medline, EMBASE, et la Cochrane Library de 1968 à 2010. Tous les articles comportant des rapports sur des personnes souffrant à la fois de psoriasis et de vitiligo rédigés en anglais ont été documentés. Résultats: Nous avons trouvé 338 articles, parmi lesquels 35 exposés de cas et 7 séries de cas ont été mentionnés. Pour chaque série de cas, la prévalence du psoriasis chez les patients atteints de vitiligo, ou vice versa, s'inscrit dans la fourchette de prévalence de la population de base qui a fait l'objet de l'étude. Conclusion: Notre étude n'a pas démontré une augmentation de la prévalence de psoriasis attendue chez les personnes atteintes de vitiligo, ou vice versa, ce qui suggère que la coexistence des deux affections semble être due au seul hasard. D'importantes études épidémiologiques sont nécessaires pour démontrer avec certitude que le psoriasis est plus fréquent chez les personnes atteintes de vitiligo et vice versa.


2021 ◽  
pp. 026921632110229
Author(s):  
Nathalie Dieudonné Rahm ◽  
Ghizlaine Morawska ◽  
Sophie Pautex ◽  
Nadia Elia

Background: Providing unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of sedation monitoring are used to assess the level of consciousness and analgesia during sedation in intensive care units and during procedures. Aim: To determine whether reported devices impact the outcomes of palliative sedation. Design: Systematic review and narrative synthesis of research published between January 2000 and December 2020. Data sources: Embase, Google Scholar, PubMed, CENTRAL, and the Cochrane Library. All reports describing the use of any monitoring device to assess the level of consciousness or analgesia during palliative sedation were screened for inclusion. Data concerning safety and efficacy were extracted. Patient comfort was the primary outcome of interest. Articles reporting sedation but that did not meet guidelines of the European Association for Palliative Care were excluded. Results: Six reports of five studies were identified. Four of these were case series and two were case reports. Together, these six reports involved a total of 67 sedated adults. Methodological quality was assessed fair to good. Medication regimens were adjusted to bispectral index monitoring values in two studies, which found poor correlation between monitoring values and observational scores. In another study, high nociception index values, representing absence of pain, were used to detect opioid overdosing. Relatives and caregivers found the procedures feasible and acceptable.


2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Karol Zelenik ◽  
Lucia Stanikova ◽  
Katarina Smatanova ◽  
Michal Cerny ◽  
Pavel Kominek

Objectives. To review surgical techniques used in the treatment of laryngoceles over the last two decades and point out developments and trends.Materials and Methods. PubMed, the Cochrane Library, and the JBI Library of Systematic Reviews were searched using the term “laryngocele.” Demographic data, type of laryngocele, presence of a laryngopyocele, type of treatment and need for a tracheotomy were assessed.Results. Overall, data on 86 patients were analyzed, culled from 50 articles, of which 41 were case reports and 9 were case series. No single systematic review or meta-analysis or randomized controlled trial has been published on the topic. Altogether, 71 laryngoceles in 63 patients met the criteria for further analysis focusing on surgical treatment. An external approach was selected in 25/29 (86.2%) cases of combined laryngoceles. Microlaryngoscopic resection using a CO2laser was performed in three cases and endoscopic robotic surgery in one case. The majority of patients with an internal laryngocele, 31/42 (73.8%), were treated using the microlaryngoscopy approach.Conclusions. Microlaryngoscopy involving the use of a CO2laser has become the main therapeutic procedure for the treatment of internal laryngoceles during the past 20 years. An external approach still remains the main therapeutic approach for the treatment of combined laryngoceles.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Henry Wu ◽  
Vishnu Jeyalan ◽  
Rajkumar Chinnadurai ◽  
Arvind Ponnusamy

Abstract Background and Aims Patients with transplanted kidneys are more susceptible to COVID-19 infections compared to those with native kidneys because of chronic immunosuppression and co-existing co-morbidities. A wide spectrum of renal pathologies has been reported from renal biopsies taken from patients with native kidneys following COVID-19 presentation. In comparison, biopsy-proven findings in the setting of kidney transplantation and COVID-19 diagnosis are seldom described. Our study aims to review early reported histological findings of transplant kidney biopsies from patients testing positive for COVID-19. Method This is a secondary analysis of a larger study (PROSPERO registration number: CRD42020218048) which reviewed the histopathological findings of kidney biopsies in adults with concurrent COVID-19 infection. A systematic literature search was conducted independently by two authors (HW, VJ) through ‘PubMed’, ‘Web of Science’, ‘Embase’ and ‘Medline-ProQuest’ using the following keywords: “COVID-19 AND Kidney Biopsy”, “COVID-19 AND Renal Biopsy”, “SARS-CoV-2 AND Kidney Biopsy” and “SARS-CoV-2 AND Renal Biopsy”. Articles were screened by three authors (HW, VJ, RC) for relevance and duplicates were removed. The study selection process was carried out as per the PRISMA guideline. In this analysis, we included all research articles reporting biopsies in transplanted kidneys in adults over age > 18 who tested positive with COVID-19 following a PCR swab test. We only included articles published in the English language. All relevant articles published before November 1st 2020 were included in this review. Information regarding demographic data, co-morbidities, renal presentation, renal parameters at time of COVID-19 diagnosis, management, need for renal replacement therapy and outcomes were extracted from selected articles. Results Our review identified 11 cases reporting transplant kidney biopsies in patients with positive COVID-19 status. These 11 cases were reported from 7 articles, which were either single case reports or part of a case series. Mean age of the reported cases was 43.6 years ± 10.7. Transplant kidney biopsies were taken from 4 female and 7 male patients, where 7 patients were of black ethnicity. The review involved 3 live donor and 6 deceased donor transplanted kidneys, and 2 cases did not report type of kidney transplant received. All of the documented cases presented with acute kidney injury. 9 patients have essential hypertension or hypertension secondary to other co-morbidities. Biopsy findings revealed 2 cases of acute T-cell mediated and antibody mediated rejection, 2 cases of acute tubular injury, 5 cases of either FSGS or collapsing FSGS and 1 report of post-transplant kidney infarction. Acute treatment received involved different regimes. All 11 patients were eventually discharged from hospital, where 2 patients required dialysis following discharge. Table 1 describes data from the extracted cases. Conclusion There are multiple histological pathologies observed amongst transplant kidney biopsies taken from patients admitted following COVID-19 diagnosis. Early results suggest aggressive medical treatment to manage inflammation, transplant rejection and co-morbidities such as hypertension may optimize general and renal-specific outcomes. Collation of further cases is required to determine a clearer association between COVID-19 and characteristics demonstrated from transplant kidney biopsies.


Author(s):  
Hamish Farquhar ◽  
Ana B Vargas-Santos ◽  
Huai Leng Pisaniello ◽  
Mark Fisher ◽  
Catherine Hill ◽  
...  

Abstract Objectives To evaluate the efficacy, defined as achieving target serum urate <6.0 mg/dl, and safety of urate-lowering therapies (ULT) for people with gout and CKD stages 3–5. Methods PubMed, The Cochrane Library, and EMBASE, were searched from 1 January 1959 to 31 January 2018 for studies that enrolled people with gout, who had an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of < 60 mL/min, and exposure to allopurinol, febuxostat, probenecid, benzbromarone, lesinurad or pegloticase. All study designs other than case reports were included, except for people on dialysis, for which we did include case reports. Results There were 36 reports with an analysis of efficacy and/or safety based upon renal function – allopurinol (n = 12), febuxostat (n = 10), probenecid (n = 3), benzbromarone (n = 5), lesinurad (n = 5), and pegloticase (n = 1). There were 108 reports that involved people with gout and renal impairment but did not contain any analysis on efficacy and/or safety based upon renal function – allopurinol (n = 84), febuxostat (n = 14), benzbromarone (n = 1), lesinurad (n = 3), and pegloticase (n = 6). Most studies excluded people with more severe degrees of renal impairment (eGFR or CrCl of < 30mL/min). For allopurinol in particular, there was significant variability in the dose of drug used, and efficacy in terms of urate lowering, across all levels of renal impairment. Conclusion There is a lack of evidence regarding efficacy and/or safety of currently used ULT according to different levels of renal function. Future studies should include patients with CKD and should report study outcomes stratified by renal function.


Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 167
Author(s):  
Pasquale Sansone ◽  
Luca Gregorio Giaccari ◽  
Caterina Aurilio ◽  
Francesco Coppolino ◽  
Valentina Esposito ◽  
...  

Background. Guillain-Barré syndrome (GBS) is the most common cause of flaccid paralysis, with about 100,000 people developing the disorder every year worldwide. Recently, the incidence of GBS has increased during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) epidemics. We reviewed the literature to give a comprehensive overview of the demographic characteristics, clinical features, diagnostic investigations, and outcome of SARS-CoV-2-related GBS patients. Methods. Embase, MEDLINE, Google Scholar, and Cochrane Central Trials Register were systematically searched on 24 September 2020 for studies reporting on GBS secondary to COVID-19. Results. We identified 63 articles; we included 32 studies in our review. A total of 41 GBS cases with a confirmed or probable COVID-19 infection were reported: 26 of them were single case reports and 6 case series. Published studies on SARS-CoV-2-related GBS typically report a classic sensorimotor type of GBS often with a demyelinating electrophysiological subtype. Miller Fisher syndrome was reported in a quarter of the cases. In 78.1% of the cases, the response to immunomodulating therapy is favourable. The disease course is frequently severe and about one-third of the patients with SARS-CoV-2-associated GBS requires mechanical ventilation and Intensive Care Unit (ICU) admission. Rarely the outcome is poor or even fatal (10.8% of the cases). Conclusion. Clinical presentation, course, response to treatment, and outcome are similar in SARS-CoV-2-associated GBS and GBS due to other triggers.


Author(s):  
Xuefeng Wei ◽  
Xu Zhang ◽  
Zimu Song ◽  
Feng Wang

Abstract Background and Study Aims Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. Materials and Methods We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. Results The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1–60 years), and patients <36 years of age accounted for 83.30% of the study cohort. Progressive limb weakness and numbness were the chief symptoms (accounting for ∼55.6%). The mean complaint duration was 0.89 ± 0.66 months for males and 2.72 ± 3.82 months for females (p = 0.028). Epidural (41.7%) was the most common site, and thoracic (47.3%) was the most frequent location. Most PNETs were peripheral, and magnetic resonance imaging (MRI) appearance was isointense or mildly hypointense on T1-weighted images and hyperintense on T2-weighted images. Homogeneous contrast enhancement was observed. The 1-year survival rate of patients who underwent chemoradiation after total or subtotal lesion resection was better compared with patients who did not undergo chemotherapy, radiotherapy, or total or subtotal resection. The modality of treatment was associated with survival time (p = 0.007). Conclusion Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.


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