In Support of Initial Parenteral Medical Management of Intrathecal Baclofen Withdrawal in Spasticity Patients

2021 ◽  
pp. 875512252110392
Author(s):  
Brian L. LaRowe ◽  
Vicki M. Nussbaum
Keyword(s):  
Case Reports ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Patient Characteristics ◽  
Clinical Problem ◽  
Clinical Situation ◽  
Intrathecal Baclofen ◽  
Wide Range ◽  
Baclofen Withdrawal

Background: Spasticity may present as a wide range of symptoms and conditions. With this protean presentation, a consensus regarding the best course of treatment does not exist. Those patients most severely affected may receive significant benefit from intrathecal baclofen delivery. However, this therapy may itself lead to patient injury in the event of withdrawal. Objective: Withdrawal from intrathecal baclofen may devolve rapidly into a situation in which the patient may incur significant morbidity and even death. A focused, prompt treatment plan would afford the patient the best possible outcome. Methods: The medical literature was reviewed for reports of plans of treatment of baclofen withdrawal and the results obtained. The nature of this problem does not lend itself to a typical study design, depending on case reports and basic pharmacological science application. The paucity of such reports severely limits categorical comparison of patient characteristics and clinical circumstances. Clinical situations, patient characteristics, and therapies were considered and compared. Outcomes of the varied treatments were evaluated for efficacy. Results: Inaccurate diagnoses, delayed correct diagnoses, and the absence of a consistent, treatment plan contributed to widely disparate outcomes. Prompt, correct diagnosis and intensive care unit–based continuous benzodiazepine infusion with titration led to a controlled clinical situation and maximized patient outcomes. Conclusions: Patients going through withdrawal from intrathecal baclofen achieved best outcomes when treated with a continuous infusion and titration of an intravenous benzodiazepine. A well-defined treatment protocol employing this management, reporting serial outcomes, would enable further refinement of the treatment of this clinical problem.

Assessment of changes in biochemical parameters and their role as markers of pathological processes

2020 ◽  
pp. 57-63
Author(s):  
Olga Alekseevna Petrischeva
Keyword(s):  
Biochemical Parameters ◽  
Laboratory Tests ◽  
Correct Diagnosis ◽  
Molecular Genetic ◽  
Clinical Situation ◽  
Test Results ◽  
Genetic Studies ◽  
Maximum Information ◽  
Wide Range ◽  
The One

The data of laboratory tests can often provide up to 70% of information about the disease, and the test results can help the doctor not only in the correct diagnosis and competent prescription of treatment, but also should be aimed at conducting a subsequent assessment of its effectiveness. At the present stage, laboratory tests are represented by a wide range of clinical, immunological, biochemical, microbiological, histological and molecular genetic studies. Evaluation of some parameters (for example, a clinical blood test and a general urinalysis) is carried out practically at each patient's request for medical help, while others are evaluated only if there are indications. For example, if a patient complains of severe dysuric disorders, determining the level of amylase in this case will be uninformative, but urinalysis according to Nechiporenko will contribute to the correct diagnosis. A doctor of a clinical specialty, on the one hand, must clearly understand which tests can help in making a diagnosis and will carry the maximum information content, and, on the other hand, try to avoid unnecessary prescription of tests that have low evidence in a particular clinical situation. One of the most frequently prescribed tests is the conduct of biochemical studies, therefore, in today's article we will try to figure out how biochemical parameters change in various pathological processes, and what information they can bring.

scholarly journals Idiopathic left-sided buccal abscess – a case report

New Medicine ◽  
2020 ◽  
Vol 24 (2) ◽  
Author(s):  
Maria Wolniewicz ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Case Report ◽  
3D Visualization ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Neck Region ◽  
Clinical Problem ◽  
Head And Neck Region ◽  
Dental Origin ◽  
Important Clinical Problem ◽  
Systemic Antibiotics

Abscesses of the head and neck region account for an important clinical problem. They are most frequently of dental origin (mainly due to carious changes or state after dental interventions), especially when located in the buccal region (about 1/3 cases). The correct diagnosis is the key to determine the proper treatment protocol: systemic antibiotics and/or surgical procedure (usually drainage) in order to prevent further progression of the inflammatory process (including transgression of the blood-brain barrier). Ultrasound is a sufficient first line diagnostic tool for the changes localized in the superficial spaces. Additionally, it is helpful in monitoring the effectiveness of the introduced treatment. Alternatively, MRI could be used, enabling more thorough 3D visualization of the affected areas and tissues differentiation, but due to its cost and availability its role is restricted, especially in monitoring (when examination needs to be repeated regularly). Below we would like to present a case report of our teenage patient, who developed idiopathic left-sided buccal abscess.

Multiple Myeloma or Brucellosis: A Case Report

2020 ◽  
Vol 20 (1) ◽  
pp. 102-105 ◽  
Author(s):  
Hossein A. Rahdar ◽  
Mansoor Kodori ◽  
Mohamad R. Salehi ◽  
Mahsa Doomanlou ◽  
Morteza Karami-Zarandi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Brucella Melitensis ◽  
Severe Disease ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Bone Marrow Aspiration ◽  
Major Health Problem ◽  
Brucella Infection ◽  
Wide Range ◽  
Parental Treatment

Background: Brucellosis, a major health problem in developing countries, is a multisystem infection with a broad spectrum of clinical manifestations. Hematological complications, ranging from an intravascular coagulopathy to mild homeostasis disorders (such as gammopathy), have been reported in brucella infection. These signs and symptoms may lead to misdiagnosis of brucellosis with other hematological diseases. Case: A 65-year-old male whose occupation was shepherding was referred to our hospital as a known case of multiple myeloma with continuous fever, muscle weakness, and night sweating after taking 2 courses of chemotherapy. The laboratory diagnosis of multiple myeloma had been based on the observation of a high percent of plasma cells in the bone marrow aspiration. At follow- up, the result of patient's fever workup, with 2 sets of blood cultures, was positive for Brucella melitensis. Isolated brucella was confirmed as B. melitensis by 16S rRNA sequencing. Brucellosis serologic test was performed by agglutination test and positive results were obtained. The patient was discharged with the cessation of fever and general improvement after the end of the parental treatment phase of brucella bacteremia. Conclusions: Brucella infection may cause a severe disease, mimicking a primary hematological disease, which could complicate the correct diagnosis. In brucellosis cases, due to the wide range of symptoms, in addition to cultivation and serological methods, molecular methods should also be used to prevent inappropriate diagnosis and additional costs.

Acupuncture in Ophthalmology

1992 ◽  
Vol 10 (1) ◽  
pp. 18-21
Author(s):  
Margaret Macdonald
Keyword(s):  
Acupuncture Treatment ◽  
Case Reports ◽  
Wide Range ◽  
Selection Of

A selection of case reports shows that acupuncture treatment should be considered in a wide range of ophthalmic problems.

Pramipexole in unipolar and bipolar depression

2004 ◽  
Vol 28 (12) ◽  
pp. 438-440 ◽  
Author(s):  
Eromona Whiskey ◽  
David Taylor
Keyword(s):  
Affective Disorders ◽  
Bipolar Depression ◽  
Case Reports ◽  
Unipolar Depression ◽  
Clinical Implications ◽  
Clinical Use ◽  
Limited Data ◽  
Double Blind ◽  
Reference Sections ◽  
Wide Range

Aims and MethodTo review the evidence for this use of pramipexole in the treatment of unipolar and bipolar depression, a literature search on Embase and Medline was conducted in December 2003. The search was updated in July 2004. The reference sections of retrieved papers were searched for further relevant references.ResultsThere are limited data on the clinical use of pramipexole in affective disorders. Only two double-blind trials in bipolar depression and one in unipolar depression were retrieved. Most information is in the form of case reports and open studies. No dose-response relationships have been established and a wide range of doses has been employed in the reports.Clinical ImplicationsIn view of the fact that the evidence for the use of pramipexole is still limited at the time of writing, its routine clinical use cannot be recommended. The data appear promising, but further research is required to determine its role in affective disorders.

scholarly journals DECLINE OF CLINICAL ART AND TECNOLOGICAL MEDICINE BOOM

2021 ◽  
pp. 123-133
Author(s):  
José Antonio Rodríguez Montes
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Practice ◽  
New Technologies ◽  
Clinical Skills ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Bedside Teaching ◽  
The Past

Currently there is a consensus that the clinical art have been greatly deteriorating during the past 50 years. This problem has raised worldwide attention through as increase in publications, courses, symposia and congress. The erosion of bedside teaching and the consequent decline of clinical skills, notably wrongfull and inadequate use of new technologies. At as result, it becomes difficult if not impossible obtain an appropiate collection of the synptoms sufferick for the sick. Together with the medical history, the physical examination is mandatory for the correct diagnosis and developing the treatment plan. In this paper, the decline of clinical art is exposed and how this ancient heritage of medical practice can be recovered.

scholarly journals Adenomatoid Hyperplasia of The Oral Cavity: A Diagnostic Dilemma

2021 ◽  
Author(s):  
Ali ALTINDAĞ ◽  
Poyzan Bozkurt ◽  
Burak Bilecenoğlu ◽  
Kaan Orhan
Keyword(s):  
Oral Cavity ◽  
Correct Diagnosis ◽  
Age Distribution ◽  
Salivary Gland Tumor ◽  
Histological Evaluation ◽  
Gland Tumor ◽  
Diagnostic Dilemma ◽  
Location Data ◽  
Wide Range ◽  
Review Study

This review study presents literature review and discusses the clinical significance of Adenomatoid Hyperplasia, a commonly misdiagnosed lesion. This rare entity has been seldom presented and is not well enough described in the literature. Only 15 reports with 95 cases could be attained during the online literature search using the keywords: Adenomatoid, Tumor, Hyperplasia, Minor salivary Glands. Data revealed a tendency towards the male gender. Age distribution of patients did not reveal a tendency towards a specific age group but presented a peak incidence in the 4th and 5th decades. Location data revealed a tendency towards the palate, especially the hard palate. Most of the presented cases were asymptomatic and the most common initial diagnosis made was salivary gland tumor. It was concluded that, adenomatoid hyperplasia of the oral cavity may resemble a wide range of pathologies and in order to differentiate and to achieve a correct diagnosis, histological evaluation is fundamental.

scholarly journals The growth factor/ cytokine midkine may participate to cytokine storm and contribute to the pathogenesis of SARS-CoV-2 infected patients

2021 ◽  
Author(s):  
Sema Ketenci ◽  
Şükrü Aynacıoğlu
Keyword(s):  
Tissue Repair ◽  
Inflammatory Diseases ◽  
Treatment Protocol ◽  
Inflammatory Cells ◽  
Clinical Situation ◽  
Lung Damage ◽  
Cytokine Storm ◽  
Hypoxic Conditions ◽  
Cytokine Levels ◽  
Important Cytokine

The current coronavirus disease 2019 (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged in Wuhan, China and has rapidly become global challenges, creating major challenges to health systems in almost every country in the world it has turned into a pandemic. COVID-19 poses a risky clinical situation that can range from mild illness to severe respiratory failure requiring admission to intensive care. It is known to cause cytokine storm in some critically ill patients. However, more and more evidence showed that there is a dramatic increase in cytokine levels in patients diagnosed with COVID-19. Midkine (MK) is involved in various physiological and pathological processes, which some of them are desired and beneficial such as controlling tissue repair and antimicrobial effects, but some others are harmful such as promoting inflammation, carcinogenesis and chemo-resistance. Also, MK is expressed in inflammatory cells and released by endothelial cells under hypoxic conditions. Considering all this information, there are strong data that MK, an important cytokine known to increase in inflammatory diseases, may overexpressed in patients who are positive for COVID-19. The overexpression of MK reveals a picture leading to fibrosis in the lung damage. Therefore, questions arise about how the concentration of MK changes in CoVID-19 patients and can we use it as an inflammation biomarker or in the treatment protocol in the future.

The EMDR Integrative Group Treatment Protocol for Patients With Cancer

2016 ◽  
Vol 10 (3) ◽  
pp. 199-207 ◽  
Author(s):  
Ignacio Jarero ◽  
Lucina Artigas ◽  
Susana Uribe ◽  
Laura Evelyn García
Keyword(s):  
Stress Responses ◽  
Traumatic Stress ◽  
Group Treatment ◽  
Terminal Illness ◽  
Treatment Protocol ◽  
Individual Treatment ◽  
Adult Women ◽  
Patients With Cancer ◽  
Wide Range ◽  
Adolescents And Adults

Experiencing cancer is a peculiar stressor within the infrastructure of posttraumatic stress disorder (PTSD) because this debilitating disease involves ongoing stressors and is both acute and potentially chronic. The experience can include a wide range of associated adverse events, such as tumor detection, diagnosis, severity of disease, and prognosis; aggressive treatment; disfigurement and bodily dysfunction; side effects of treatment; impaired physical, social, and occupational functioning; and sometimes, recurrence and diagnosis of terminal illness. This article provides a detailed description of the clinical application of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) Adapted for Adolescents and Adults Living with Ongoing Traumatic Stress for the patients with cancer. This protocol administers the eight phases of EMDR individual treatment to a group of patients using an art therapy format (i.e., drawings) and the butterfly hug (a self-administered bilateral stimulation method to process traumatic material). A previous study (Jarero et al., 2015) showed that after 6 sessions of EMDR-IGTP, there was a significant decrease in PTSD symptoms related to the diagnosis and treatment of different types of cancer in adult women. Effects were maintained at 90-day follow-up. In this article, we discuss how this protocol can be used to effectively provide intensive EMDR treatment to large groups of patients, and we provide detailed instructions for its provision to address one of the major psychological dimensions of cancer: the ongoing traumatic stress responses experienced by patients with cancer. A clinical example illustrates the treatment process.

Sign in / Sign up

Export Citation Format

Share Document