scholarly journals Takotsubo syndrome in patients with myasthenia gravis: a systematic review of previously reported cases

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Devarajan Rathish ◽  
Minuri Karalliyadda
Keyword(s):  
Systematic Review ◽  
Myasthenia Gravis ◽  
Case Reports ◽  
Rare Condition ◽  
Myasthenic Crisis ◽  
Takotsubo Syndrome ◽  
Clinical Presentations ◽  
Life Threatening ◽  
Care Guidelines ◽  
The Common

Abstract Background Myasthenia gravis associated takotsubo syndrome is a rare condition. This study aimed to explore its typical presentation, investigations and treatment through a systematic review of previously reported cases. Methods Databases and reference lists of the selected articles were searched for case reports on Myasthenia gravis associated takotsubo syndrome. CARE guidelines were used for the quality assessment of the selected articles. Results Sixteen cases were selected out of 580 search results. Western Pacific, American and European regions contributed to 88% of the cases. Females were most affected (81%). Features of both myasthenia gravis and takotsubo syndrome were the common clinical presentations. All cases had a myasthenic crisis. Half of the cases had no prior diagnosis of myasthenia gravis. Pyridostigmine and prednisolone were useful for myasthenia gravis while dobutamine was most commonly used for takotsubo syndrome. All cases survived except four (25%). Conclusions Myasthenia gravis associated takotsubo syndrome via a myasthenic crisis is rare but life-threatening. Therefore, predisposition due to emotional and physical triggers needs to be avoided for its prevention. The rare entity should be suspected even in patients without a prior diagnosis of Myasthenia gravis.

A Systematic Review on Airbag-Induced Burns

2020 ◽  
Author(s):  
Sarah P Erpenbeck ◽  
Eva Roy ◽  
Jenny A Ziembicki ◽  
Francesco M Egro
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Good Prognosis ◽  
Chemical Burns ◽  
Automobile Crashes ◽  
Chemical Mechanisms ◽  
Number Of Patients ◽  
Common Risk Factors ◽  
The Common ◽  
Ocular Burns

Abstract Airbags significantly reduce fatalities and injuries in automobile crashes, but they have been found to be associated with burns. Specifically, airbags can cause burns through thermal or chemical mechanisms and commonly affect the arms, hands, face, and eyes. While most airbag-induced burns are minor, some may cause unfavorable outcomes. Our study aimed to systematically review airbag-induced burns to assess etiology, type, and treatment of these injuries. A systematic review of case reports pertaining to airbag-induced cutaneous and ocular burns was conducted. Data reviewed included type/location of burns, severity of burn, total number of patients, treatment, complications, and outcome after treatment. We identified 21 case reports that met our inclusion criteria with a total of 24 patients reported in the studies. Of the studies identified, 38% were chemical burns and 25% were thermal burns. Most commonly the upper extremities were burned in 42% of cases, followed by eyes (25%) and face (21%). Most burns identified were superficial partial thickness (58%). Treatment outcomes were good for cutaneous burns, with 95% healing without complication. However, ocular injuries lead to permanent impaired eye function in 71% of cases. In our systematic review, we highlighted the common risk factors, prognosis, and treatment for thermal, chemical, and ocular burns. Airbag-induced burns have a relatively good prognosis but must be recognized and treated immediately to reduce the risk of serious sequelae.

scholarly journals Management of rheumatic complications of immune checkpoint inhibitor therapy – an oncological perspective

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_7) ◽  
pp. vii29-vii39 ◽  
Author(s):  
Neil M Steven ◽  
Benjamin A Fisher
Keyword(s):  
Adverse Events ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Cancer Control ◽  
Myasthenic Crisis ◽  
Life Threatening ◽  
Checkpoint Inhibitor Therapy ◽  
The Common ◽  
Risk And Benefit

Abstract Immune checkpoint inhibitors (CPIs) are an effective treatment for many cancers but cause diverse immune-related adverse events (IrAEs). Rheumatological IrAEs include arthralgia, arthritis, tenosynovitis, myositis, polymyalgia rheumatica and sicca syndrome. CPI use can unmask RA as well as causing flares of prior autoimmune or connective tissue disease. Oncologists categorize and grade IrAEs using the Common Terminology Criteria for Adverse Events and manage them according to international guidelines. However, rheumatological events are unfamiliar territory: oncologists need to work with rheumatologists to elicit and assess symptoms, signs, results of imaging and autoantibody testing and to determine the use of steroids and DMARDs. Myositis may overlap with myasthenic crisis and myocarditis and can be life-threatening. Treatment should be offered on balance of risk and benefit, including whether to continue CPI treatment and recognizing the uncertainty over whether glucocorticoids and DMARDs might compromise cancer control.

scholarly journals Myasthenia Gravis following Low-Osmolality Iodinated Contrast Media

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Luca Bonanni ◽  
Michele Dalla Vestra ◽  
Andrea Zancanaro ◽  
Fabio Presotto
Keyword(s):  
Contrast Media ◽  
Myasthenia Gravis ◽  
Case Reports ◽  
Orotracheal Intubation ◽  
Myasthenic Crisis ◽  
Iodinate Contrast Agent ◽  
Iodinated Contrast ◽  
History Of ◽  
Total Body ◽  
Progressive Dysphagia

We describe the case of 79-year-old man admitted to our general hospital for a 6-week history of progressive dysphagia to solids and liquids associated with weight loss. To reach a diagnosis a total body CT scan with low-osmolality iodinate contrast agent was performed. Two hours later the patient developed an acute respiratory failure requiring orotracheal intubation and mechanical ventilation. The laboratory and neurological tests allow formulating the diagnosis of myasthenia gravis. In literature, other three case reports have associated myasthenic crisis with exposure to low-osmolality contrast media. This suggests being careful in administering low-osmolality contrast media in myasthenic patients.

scholarly journals Spontaneous Heterotopic Pregnancy with Unaffected Intrauterine Pregnancy: Systematic Review of Clinical Outcomes

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 665
Author(s):  
Mihaela Oancea ◽  
Razvan Ciortea ◽  
Doru Diculescu ◽  
Alexandra-Andreea Poienar ◽  
Mihaela Grigore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Case Reports ◽  
Laparoscopic Approach ◽  
Rare Condition ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
First Semester ◽  
Cochrane Reviews ◽  
Reproductive Techniques

Background and objective: Spontaneous heterotopic pregnancy (SHP) is a rare condition represented by the synchronous coexistence of an intrauterine and an ectopic pregnancy. It rarely occurs with natural conception and is usually a consequence of assisted reproductive techniques. Diagnosis of SHP can be a challenge for the clinician. The evolution of the intrauterine pregnancy is dependent on many factors, such as the location of the heterotopic pregnancy, gestational age at the time of diagnosis, the surgical procedure, the presence of other risk factors, early or delayed management. The aim of this systematic review of the literature was to extract existing evidence on spontaneous heterotopic pregnancy with otherwise unaffected intrauterine pregnancy. Materials and Methods: From a total of 1907 database entries identified in PubMed, EMBASE and Cochrane reviews, we selected 18 papers for narrative synthesis, for which we explored the diagnostic options, treatment, and outcome of these extremely rare epidemiologic occurrences. Manuscripts were assessed using the CARE guidelines for reporting case reports. Results: The main symptom was abdominal pain, and the preferred treatment approach was surgical, more precisely, using a laparoscopic approach. Most cases presented no risk factors, and the diagnosis was mostly made in the first semester. Conclusions: Normal follow-up and evolution of intrauterine pregnancy have been observed regardless of surgical approach (open or laparoscopic). Early diagnosis and treatment are advised, as they impact maternal and fetal outcomes. Evidence on this topic is scarce, predominantly comprised of case reports with variable degrees of adherence to dissemination guidelines. More studies on this topic are required to optimize care protocols for this type of pregnancy.

scholarly journals Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

2019 ◽  
Vol 12 ◽  
pp. 175628641986449 ◽  
Author(s):  
Josep Gamez ◽  
María Salvadó ◽  
Francesc Carmona ◽  
Miriam de Nadal ◽  
Laura Romero ◽  
...  
Keyword(s):  
Placebo Group ◽  
Myasthenia Gravis ◽  
General Anaesthesia ◽  
Intravenous Immunoglobulin ◽  
Univariate Analysis ◽  
Myasthenic Crisis ◽  
Double Blind ◽  
Single Centre Study ◽  
Life Threatening ◽  
The Mean

Background: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. Methods: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. Results: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m2, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. Conclusions: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia.

scholarly journals Breast cancer: 2 case reports

2012 ◽  
Vol 87 (1) ◽  
pp. 123-126
Author(s):  
Aristóteles Rosmaninho ◽  
Glória Velho ◽  
Mónica Caetano ◽  
Manuela Selores
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Case Reports ◽  
Cancer Death ◽  
Female Patients ◽  
Ductal Breast Carcinoma ◽  
Clinical Presentations ◽  
Life Threatening

Breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among them worldwide. It includes a heterogeneous collection of diseases with various histologically defined subsets, clinical presentations, responses to treatment and outcomes. We describe 2 cases of female patients with ductal breast carcinoma. Dermatologists may have an important role in diagnosing such diseases.

scholarly journals A Five-Year Followup of Human Seminal Plasma Allergy in an 18-Year-Old Woman

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Ole D. Wolthers
Keyword(s):  
Seminal Plasma ◽  
Case Reports ◽  
Nasal Congestion ◽  
Rare Condition ◽  
Human Seminal Plasma ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Life Threatening ◽  
Low Prevalence

Case reports of women with the rare condition of human seminal plasma allergy have indicated that the condition may be associated with life-threatening anaphylactic reactions in relation to coitus. Few observations, if any, of long-term outcome of the condition are available. The aim of this paper was to present a case diagnosed in an 18-year-old girl who presented with generalized urticaria, nasal congestion and secretion, conjunctivitis, and periorbital and labial oedema 6–8 hours after coitus. During five years of followup the condition improved clinically significantly. Due to intimacy concerns and the low prevalence of the condition robust long term data on the natural course of the condition are difficult to obtain. The present case suggests that in some patients the condition may improve over time.

scholarly journals Haemorrhagic cholecystitis: a rare entity not to be forgotten

2018 ◽  
pp. bcr-2018-226469 ◽  
Author(s):  
Zi Qin Ng ◽  
Sharin Pradhan ◽  
Kim Cheah ◽  
Ruwan Wijesuriya
Keyword(s):  
Acute Cholecystitis ◽  
Case Reports ◽  
Rare Condition ◽  
Morbidly Obese ◽  
High Morbidity ◽  
Rare Entity ◽  
Management Options ◽  
Quadrant Pain ◽  
Morbidly Obese Patient ◽  
Clinical Presentations

Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.

scholarly journals Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?

2021 ◽  
Vol 14 (7) ◽  
pp. e244146
Author(s):  
Y Muralidhar Reddy ◽  
Santhosh Kumar B ◽  
Syed Osman ◽  
Jagarlapudi M K Murthy
Keyword(s):  
Myasthenia Gravis ◽  
Case Reports ◽  
Male Gender ◽  
Temporal Association ◽  
Time Interval ◽  
Myasthenic Crisis ◽  
Ocular Symptoms ◽  
Antiacetylcholine Receptor Antibody ◽  
The One ◽  
New Onset

Several case reports of COVID-19 in patients with myasthenia gravis (MG) have been documented. However, new-onset autoimmune MG following COVID-19 has been reported very rarely. We report one such case here. A 65-year-old man presented to us with dysphagia 6 weeks following mild COVID-19. He was evaluated and diagnosed as antiacetylcholine receptor antibody (AchR) positive, non-thymomatous, generalised MG. He subsequently developed myasthenic crisis and improved after treatment with intravenous immunoglobulin, prednisolone and pyridostigmine. Systematic literature review showed eight more similar cases. Analysis of all cases including the one reported here showed these features: mean age 55.8 years, male gender (5), time interval between COVID-19 and MG (5–56 days), generalised (5), bulbar and/or ocular symptoms (4), anti-AchR antibodies (7) and antimuscle-specific kinase antibodies (2). All have improved with immunotherapy. Although, many hypothesis are proposed to explain causal relationship between the two, it could as well be sheer coincidence.

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