scholarly journals CIDP mimics: a case series

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Orly Moshe-Lilie ◽  
Erik Ensrud ◽  
Thomas Ragole ◽  
Chahin Nizar ◽  
Diana Dimitrova ◽  
...  
Keyword(s):  
Weight Loss ◽  
Neuropathic Pain ◽  
Conduction Block ◽  
Case Series ◽  
Initial Response ◽  
Axonal Loss ◽  
Significant Weight Loss ◽  
Monoclonal Protein ◽  
Electrophysiological Findings ◽  
Systemic Symptoms

Abstract Background To report our experience with a group of patients referred for refractory CIDP who fulfilled “definite” electrodiagnostic EFNS criteria for CIDP but were found to have an alternate diagnosis. Methods Patients who were seen between 2017 and 2019 for refractory CIDP that fulfilled “definite” electrodiagnostic ENFS criteria for CIDP, but had an alternate diagnosis, were included. Patients who correctly had CIDP, anti MAG neuropathy, or MMN with conduction block, were excluded from the study. Demographics, clinical and electrophysiological characteristics, pertinent workup, final alternate diagnoses, and outcomes were collected. Results Seven patients were included: POEMS (n = 5), CANOMAD (n = 1), and neurolymphomatosis (n = 1). Most patients reported neuropathic pain and leg swelling (n = 6) or significant weight loss (n = 4). All patients had a monoclonal protein, and most patients who were tested had an elevated VEGF and CSF cyto-albuminologic dissociation. Electrophysiology showed pronounced intermediate more than distal demyelination, and axonal loss in the lower extremities. Response to steroids or IVIG varied, but some patients did respond to these treatments, especially early in the disease. Conclusion Pain, systemic symptoms, suggestive electrophysiological findings, and/or a serum monoclonal protein should raise suspicion for CIDP mimics. Initial response to steroids or IVIG, over reliance on CSF, and electrophysiology findings can all be misleading.

Simultaneous occurrence of Hodgkin disease and tuberculosis in children and adolescents.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20022-e20022
Author(s):  
David A. Veron ◽  
Patricia Obando ◽  
Mauricio Castellanos ◽  
Karen S. Fernandez
Keyword(s):  
Weight Loss ◽  
Advanced Disease ◽  
Case Series ◽  
Signs And Symptoms ◽  
Disease Stage ◽  
Simultaneous Occurrence ◽  
Rare Entity ◽  
Tb Treatment ◽  
Night Sweats ◽  
Systemic Symptoms

e20022 Background: The simultaneous co-existence (TB) and Hodgkin lymphoma (HL) is a rare entity is a rare entity. The similarities in signs and symptoms of both diseases: cough, fever, weight loss, night sweats, cervical or hiliar adenopathy can lead to delays in the diagnosis of either two entities. In addition, HL treatment with immunosupressors could lead to reactivation or worsening of TB imposing challenges on the initiation of HL treatment. Methods: Retrospective review of HL patients in Guatemala and Argentina from 2010 – 2019. Results: Ten patients with TB-HL were identified. Eight patients were from Guatemala and, 2 from Argentina. There were 4 females and 6 males. Age ranged from 4 – 17 years (mean 10.5 years, media 9 years). Eight patients were suspected to have TB by the referring physician and were found to have TB-HL upon histological and microbial testing of the same lymph node. Two patients were found to have TB-HL by tissue culture at the time of relapse. Initial systemic symptoms included fever (n = 7), weight loss (n = 5), and night sweats (n = 5). Two patients had no systemic symptoms but lymphadenopathy alone. Time for referral to oncology center ranged from 0.5 to 6 months. Histology consisted of nodular sclerosis (n = 5), mixed cellularity (n = 2), lymphocyte predominant (n = 1), lymphocyte depleted (n = 1), unknown (n = 1). Eight patients had advanced disease (stage IIB, IIIB and IVB) and, two stage IIA. HL treatment was given according to the institutional standards depending on stage and risk stratification with ABVD, OEPA/COPDac +/- Radiation therapy, and ICE for relapse. Five patients started anti TB treatment simultaneously with chemotherapy, and five others after completing 1 or 2 cycles of chemotherapy. TB treatment consisted of Isoniazid, Rifampin, Pyrazinamide +/- Ethambutol for 2 months followed by Isoniazid and rifampin for 30-52 weeks. Eight patients have been followed for 3 – 8 years and are alive without evidence of recurrence of TB or HL. One patient died during therapy, another died for causes not related to TB or HL having achieved remission for both. Conclusions: These small case series demonstrates that TB therapy can be given simultaneously with chemotherapy without risking worsening TB infection. Coexistence of TB and HL appears to correlate with advanced disease (higher stage and systemic symptoms) although it does not appear to affect outcomes. In areas were TB is endemic or the prevalence of TB is high, microbiology investigations of biopsy specimen should considered as part of the examination of tissue specimen that is considered to have HL.

scholarly journals Treating Diabetes Utilizing a Low Carbohydrate Ketogenic Diet and Intermittent Fasting Without Significant Weight Loss: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Kristen Gavidia ◽  
Tro Kalayjian
Keyword(s):  
Weight Loss ◽  
Weight Reduction ◽  
Substantial Reduction ◽  
Case Series ◽  
The United States ◽  
Intermittent Fasting ◽  
Significant Weight Loss ◽  
Patient Centered ◽  
Low Carbohydrate ◽  
Clinically Significant

Prediabetes and diabetes are leading causes of morbidity and mortality in the United States and are growing in prevalence up to 45% of the population over the past 50 years. Current guidelines from the ADA recommend focusing on energy balance, portion sizes, and weight loss while cautioning that no ideal macronutrient composition has been determined. The guidelines also do not recommend intermittent fasting. In contrast, we report three cases of a substantial reduction in A1C without clinically significant weight loss using a unique, patient-centered program that utilizes low carbohydrate diets with intermittent fasting. These results call into question the role of weight reduction in the management of diabetes while highlighting the unique importance of carbohydrate restriction and intermittent fasting. In this study, we demonstrate a case series of three patients with a substantial reduction in A1C and significantly reducing the need for pharmacotherapy without clinically significant weight loss. Although anecdotal, these results call into question the emphasis of ADA on weight reduction and energy intake reduction for the management of diabetes.

Abstract #615: Hispanic People Achieve Clinically Significant Weight loss with Liraglutide 3.0 Mg for Weight Management

2015 ◽  
Vol 21 ◽  
pp. 121
Author(s):  
Patrick O’Neil ◽  
W. Timothy Garvey ◽  
J. Michael Gonzalez-Campoy ◽  
Pablo Mora ◽  
Rafael Violante Ortiz ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Significant Weight Loss ◽  
Hispanic People ◽  
Clinically Significant

Primary hyperparathyroidism in pregnancy: Uncommon manifestation of significant weight loss

2020 ◽  
Author(s):  
Timea Varga ◽  
Isuri Kurera ◽  
James Clark ◽  
Benjamin Field ◽  
Vidhu Nayyar ◽  
...  
Keyword(s):  
Weight Loss ◽  
Primary Hyperparathyroidism ◽  
Significant Weight Loss ◽  
In Pregnancy

scholarly journals Combining ecological momentary assessment, wrist-based eating detection, and dietary assessment to characterize dietary lapse: A multi-method study protocol

2021 ◽  
Vol 7 ◽  
pp. 205520762098821
Author(s):  
Stephanie P Goldstein ◽  
Adam Hoover ◽  
E Whitney Evans ◽  
J Graham Thomas
Keyword(s):  
Weight Loss ◽  
Eating Behavior ◽  
Ecological Momentary Assessment ◽  
Structured Interview ◽  
Self Report ◽  
Significant Weight Loss ◽  
Clinically Significant ◽  
Ecological Momentary ◽  
Momentary Assessment ◽  
Lapse Behavior

Objectives Behavioral obesity treatment (BOT) produces clinically significant weight loss and health benefits for many individuals with overweight/obesity. Yet, many individuals in BOT do not achieve clinically significant weight loss and/or experience weight regain. Lapses (i.e., eating that deviates from the BOT prescribed diet) could explain poor outcomes, but the behavior is understudied because it can be difficult to assess. We propose to study lapses using a multi-method approach, which allows us to identify objectively-measured characteristics of lapse behavior (e.g., eating rate, duration), examine the association between lapse and weight change, and estimate nutrition composition of lapse. Method We are recruiting participants (n = 40) with overweight/obesity to enroll in a 24-week BOT. Participants complete biweekly 7-day ecological momentary assessment (EMA) to self-report on eating behavior, including dietary lapses. Participants continuously wear the wrist-worn ActiGraph Link to characterize eating behavior. Participants complete 24-hour dietary recalls via structured interview at 6-week intervals to measure the composition of all food and beverages consumed. Results While data collection for this trial is still ongoing, we present data from three pilot participants who completed EMA and wore the ActiGraph to illustrate the feasibility, benefits, and challenges of this work. Conclusion This protocol will be the first multi-method study of dietary lapses in BOT. Upon completion, this will be one of the largest published studies of passive eating detection and EMA-reported lapse. The integration of EMA and passive sensing to characterize eating provides contextually rich data that will ultimately inform a nuanced understanding of lapse behavior and enable novel interventions. Trial registration: Registered clinical trial NCT03739151; URL: https://clinicaltrials.gov/ct2/show/NCT03739151

Synthesis and properties of a benzoxazine monomer containing maleimide and biphenyl groups

2021 ◽  
pp. 095400832199674
Author(s):  
Tao Guo ◽  
Yang Fan ◽  
Chang Bo ◽  
Zhang Qi ◽  
Han Tao ◽  
...  
Keyword(s):  
Weight Loss ◽  
Loss Rate ◽  
Proton Nuclear Magnetic Resonance ◽  
Significant Weight Loss ◽  
Scanning Calorimetry ◽  
Weight Loss Rate ◽  
Reaction Heat ◽  
H Nmr ◽  
Curing Reaction ◽  
Dsc Curves

Benzoxazine resin exhibits excellent properties and is widely used in many fields. Herein, the synthesis of a novel compound, the bis(2,4-dihydro-2 H-3-(4- N-maleimido)phenyl-1,3-benzoxazinyl)biphenyl (BMIPBB), has been reported, which was synthesized by reacting N-(4-aminophenyl)maleimide (APMI), formaldehyde, and 4,4’-dihydroxybiphenyl. 1,3,5-three(4-(maleimido)phenyl)-1,3,5-triazine (TMIPT) was formed as an intermediate during the reaction. The proton nuclear magnetic resonance (1H-NMR) and Fourier transform-infrared (FTIR) spectroscopy experiments were conducted to determine the structure of BMIPBB. BMIPBB was obtained as a reddish-brown solid in 40.1% yield. The thermal properties of BMIPBB were investigated using differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) techniques. Analysis of the DSC curves revealed that the broad peak representing the release of curing reaction heat appeared in the temperature range of 140–330°C. The peak temperature was 242.59°C and the heat of the reaction was 393.82 J/g, indicating that the rate of the curing reaction was low and the heat of the reaction was high. Analysis of the TGA results revealed that the weight loss rate was 5% at 110°C. The monomer exhibited a significant weight loss in the range of 320–500°C. The compound lost 50% of its weight at a temperature of 427°C.

scholarly journals Extrusion of both Superficial and Deep Cuffs of a Functional Double-Cuff Peritoneal Dialysis Catheter after Significant Weight Loss

2021 ◽  
pp. 190-194
Author(s):  
Aravindh S. Ganapathy ◽  
Myron S. Powell ◽  
James L. Pirkle
Keyword(s):  
Weight Loss ◽  
Peritoneal Dialysis ◽  
Subcutaneous Tissue ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Review Of The Literature ◽  
Significant Weight Loss ◽  
Exit Site ◽  
Special Circumstances ◽  
Uncommon Complication

Extrusion of the superficial cuff of a peritoneal dialysis (PD) catheter is an uncommon complication that may be associated with infection or malfunction. However, extrusion of both the superficial and deep cuffs of a double-cuff catheter is rare and uniformly associated with failure and peritonitis. We report a case of a presternal-type PD double-cuff catheter with extrusion of both cuffs through an abdominal exit site after 6 years of use that has remained functional, which has not been previously reported. In this case, the patient had achieved a 60-kg weight loss resulting in retraction of the subcutaneous tissue around both cuffs, while the catheter was held in place by the titanium connector between the presternal extension tubing and the inner, coiled catheter. In such special circumstances, extrusion of both cuffs may not necessitate urgent catheter removal. A review of the literature revealed previous cases of superficial cuff extrusions with catheters remaining functional but not with deep cuff extrusion.

scholarly journals Topical Treatments and Their Molecular/Cellular Mechanisms in Patients with Peripheral Neuropathic Pain—Narrative Review

Pharmaceutics ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 450
Author(s):  
Magdalena Kocot-Kępska ◽  
Renata Zajączkowska ◽  
Joanna Mika ◽  
David J. Kopsky ◽  
Jerzy Wordliczek ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Management ◽  
Clinical Studies ◽  
Neuronal Cells ◽  
Case Series ◽  
Narrative Review ◽  
Peripheral Sensitization ◽  
Cellular Mechanisms ◽  
Peripheral Neuropathic Pain ◽  
Topical Treatments

Neuropathic pain in humans results from an injury or disease of the somatosensory nervous system at the peripheral or central level. Despite the considerable progress in pain management methods made to date, peripheral neuropathic pain significantly impacts patients’ quality of life, as pharmacological and non-pharmacological methods often fail or induce side effects. Topical treatments are gaining popularity in the management of peripheral neuropathic pain, due to excellent safety profiles and preferences. Moreover, topical treatments applied locally may target the underlying mechanisms of peripheral sensitization and pain. Recent studies showed that peripheral sensitization results from interactions between neuronal and non-neuronal cells, with numerous signaling molecules and molecular/cellular targets involved. This narrative review discusses the molecular/cellular mechanisms of drugs available in topical formulations utilized in clinical practice and their effectiveness in clinical studies in patients with peripheral neuropathic pain. We searched PubMed for papers published from 1 January 1995 to 30 November 2020. The key search phrases for identifying potentially relevant articles were “topical AND pain”, “topical AND neuropathic”, “topical AND treatment”, “topical AND mechanism”, “peripheral neuropathic”, and “mechanism”. The result of our search was 23 randomized controlled trials (RCT), 9 open-label studies, 16 retrospective studies, 20 case (series) reports, 8 systematic reviews, 66 narrative reviews, and 140 experimental studies. The data from preclinical studies revealed that active compounds of topical treatments exert multiple mechanisms of action, directly or indirectly modulating ion channels, receptors, proteins, and enzymes expressed by neuronal and non-neuronal cells, and thus contributing to antinociception. However, which mechanisms and the extent to which the mechanisms contribute to pain relief observed in humans remain unclear. The evidence from RCTs and reviews supports 5% lidocaine patches, 8% capsaicin patches, and botulinum toxin A injections as effective treatments in patients with peripheral neuropathic pain. In turn, single RCTs support evidence of doxepin, funapide, diclofenac, baclofen, clonidine, loperamide, and cannabidiol in neuropathic pain states. Topical administration of phenytoin, ambroxol, and prazosin is supported by observational clinical studies. For topical amitriptyline, menthol, and gabapentin, evidence comes from case reports and case series. For topical ketamine and baclofen, data supporting their effectiveness are provided by both single RCTs and case series. The discussed data from clinical studies and observations support the usefulness of topical treatments in neuropathic pain management. This review may help clinicians in making decisions regarding whether and which topical treatment may be a beneficial option, particularly in frail patients not tolerating systemic pharmacotherapy.

scholarly journals Ocular and Systemic Manifestations in Paediatric Multisystem Inflammatory Syndrome Associated with COVID-19

2021 ◽  
Vol 10 (13) ◽  
pp. 2953
Author(s):  
Tzu-Chen Lo ◽  
Yu-Yen Chen
Keyword(s):  
Serum Antibody ◽  
Case Series ◽  
Pooled Analysis ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Systemic Manifestations ◽  
Polymerase Chain ◽  
Exposure History ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome

This study aimed to achieve a better understanding of the epidemiological and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). We searched PubMed and Embase between December 2019 and March 2021 and included only peer-reviewed clinical studies or case series. The proportions of patients who had conjunctivitis, systemic symptoms/signs (s/s), Kawasaki disease (KD), and exposure history to suspected/confirmed COVID-19 cases were obtained. Moreover, positive rates of the nasopharyngeal real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serum antibody for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recorded. Overall, 32 studies with 1458 patients were included in the pooled analysis. Around half of the patients had conjunctivitis. The five most common systemic manifestations were fever (96.4%), gastrointestinal s/s (76.7%), shock (61.5%), rash (57.1%), and neurological s/s (36.8%). Almost one-third presented complete KD and about half had exposure history to COVID-19 cases. The positivity of the serology (82.2%) was higher than that of the nasopharyngeal RT-PCR (37.0%). MIS-C associated with COVID-19 leads to several features similar to KD. Epidemiological and laboratory findings suggest that post-infective immune dysregulation may play a predominant role. Further studies are crucial to elucidate the underlying pathogenesis.

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