scholarly journals Retrobulbar triamcinolone for inflammatory choroidal neovascularization in pregnancy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Emilia Maggio ◽  
Maurizio Mete ◽  
Antonio Polito ◽  
Gloria Parrozzani ◽  
Grazia Pertile
Keyword(s):  
Choroidal Neovascularization ◽  
Vision Loss ◽  
Therapeutic Option ◽  
Correct Diagnosis ◽  
Management Approach ◽  
Management Options ◽  
Oral Corticosteroids ◽  
In Pregnancy ◽  
Myopic Cnv

Abstract Background Choroidal neovascularization (CNV) in pregnancy has rarely been described. A differential diagnosis between inflammatory, idiopathic, and myopic CNV may be challenging. Moreover, there is no consensus on management, and therapeutic options may be further limited by patient and physician concerns about potential risk to the fetus. Herein, we report a case of inflammatory CNV during pregnancy and describe a previously unreported management approach with retrobulbar triamcinolone injections. Case presentation A 36-year-old woman presented with vision loss and metamorphopsia in her right eye while 21 weeks pregnant. She was diagnosed with an inflammatory CNV based on the following multimodal imaging findings: a type 2 lesion with the “pitchfork sign” on OCT, along with the absence of tomographic signs of myopic CNV, and the presence on autofluorescence of multiple hyper-autofluorescent spots, interpreted as focal areas of inflammation at the level of the outer retina and inner choroid. The patient refused oral corticosteroids and any intravitreal injection therapies. Therefore, she was treated with two trans-Tenon’s retrobulbar injections of triamcinolone acetonide after explaining the procedure and acquiring consent. The treatment resulted in a regression of inflammatory signs and a reduction of neovascular activity. No adverse events occurred for the mother or the baby, neither during the pregnancy nor after delivery. Conclusion Inflammatory CNV may be rarely associated with pregnancy. The correct diagnosis is crucial to allow the consideration of all possible management options. To the best of our knowledge, this is the first reported case of treatment with retrobulbar triamcinolone injections. This may represent a suitable therapeutic option in the absence of any other therapeutic approaches.

scholarly journals Therapeutic approaches for non-alcoholic steatohepatitis

2021 ◽  
Vol 12 ◽  
pp. 204201882110343
Author(s):  
Luc F. Van Gaal ◽  
Jonathan Mertens ◽  
Sven Francque ◽  
Christophe De Block
Keyword(s):  
Type 2 Diabetes ◽  
Early Recognition ◽  
Therapeutic Option ◽  
Peroxisome Proliferator ◽  
Metabolic Disturbances ◽  
Phase Ii Trials ◽  
Management Options ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Steatohepatitis

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been reported as a novel worldwide epidemic, very often associated with obesity, metabolic syndrome, and type 2 diabetes. Both conditions have also been shown to be associated with a number of endocrine pathologies. Despite the epidemic, the complex pathophysiology and major complications, ranging from metabolic disturbances (diabetes and more) to cardiovascular disease, people with NASH are left with very few management options. The best and most approved therapeutic option is lifestyle intervention. Although pharmacotherapies based on pathophysiological background are in development, response rates appear modest, mainly for fibrosis treatment, which is the reason for lack of approved drug therapy. Previous drugs analyzed, such as pioglitazone and vitamin E, show weak efficacy. From different phase II trials, antidiabetic (injectable) drugs seem to be promising, both in mono- or bitherapy. Also, derivatives of peroxisome proliferator-activated receptors may have an interesting future, as well. For that reason, more focus should be given on prevention of this novel disease entity. In view of this booming epidemic, with a background of obesity and type 2 diabetes, and the important medical consequences, early recognition, prevention and intervention of NAFLD/NASH seems appropriate. In this review, we will focus on the different current and future therapeutic intervention options, taking into consideration the complex pathophysiology of this disease.

Personalized Behavioral Nutrition Intervention in Older Asian Americans with Type 2 Diabetes during COVID-19 Pandemic: Study Protocol for a Pilot, Hybrid, Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Jisook Ko ◽  
Yan Du ◽  
Rozmin Jiwani ◽  
Chengdong Li ◽  
Jing Wang
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Pilot Study ◽  
Glycemic Control ◽  
Asian Americans ◽  
Control Group ◽  
Management Approach ◽  
Self Monitoring ◽  
Behavioral Nutrition

BACKGROUND The COVID-19 pandemic has challenged the in-person-based self-management approach (i.e., face-to-face or group approach) of type 2 diabetes (T2D). Older adults with T2D, including Asian Americans (AAs), have experienced worsening of diabetes control due to various reasons, including uncertainty of continuous access to essential diabetes medications, devices, education, limited health literacy, as well as constant anxiety and stress. Hybrid clinical trials that incorporate virtual elements into the in-person-based study could provide these vulnerable populations with accessible and timely interventions OBJECTIVE The primary aims of this pilot study are to determine (1) the effect of personalized behavioral nutrition (PBN) intervention on glycemic control, weight control, and metabolites profiles; and (2) the acceptability of PBN. to enhance glycemic control using personalized behavioral nutrition. METHODS Participants will be recruited with a web-based registry, advertisements in ethnic newspapers, and social network services popular among AAs. A total of 60 AAs, aged 65 years or older, who are descendants of Chinese, Korean, or South Asian, and have a diagnosis of T2D will be randomized into two groups: a PBN group (n=30) and a control group (n=30). A 4-week PBN intervention comprises three components: 1) digital self-monitoring; 2) personal nutrition change goals and recommendations; and 3) diabetes nutrition educations. All participants will complete digital self-monitoring on diet, physical activity, and blood glucose. In addition, all participants will access an interactive digital platform to track their self-monitoring data and communicate with the research team. The effectiveness and acceptability of implementing the intervention will be assessed. RESULTS Funding support and institutional review board approval for this study have been secured. Data collection started in August 2020 and is ongoing. CONCLUSIONS To our knowledge, this is the first study to determine the effectiveness and acceptability of PBN utilizing a metabolomics approach and digital-assisted intervention with hybrid RCT among older AAs. The findings of this pilot study will inform the development of a full-scale PBN protocol and hybrid clinical trials that can be adapted for people with T2D in the ongoing pandemic.

scholarly journals Management of extra-abdominal fibromatosis in a musculoskeletal tumour centre in Hong Kong

2021 ◽  
pp. 221049172198908
Author(s):  
Lam Wei Sze Yvette ◽  
Fong Sin Tak ◽  
Mak Ka Lok
Keyword(s):  
Watchful Waiting ◽  
Surgical Excision ◽  
Treatment Modalities ◽  
Management Approach ◽  
Conservative Approach ◽  
Management Options ◽  
Musculoskeletal Tumour ◽  
Female Predominance ◽  
Tumour Location ◽  
Marginal Status

Introduction: Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre. Materials and Methods: Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed. Results: Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence. Conclusion: We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.

scholarly journals Plasma microRNA signature associated with retinopathy in patients with type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Donato Santovito ◽  
Lisa Toto ◽  
Velia De Nardis ◽  
Pamela Marcantonio ◽  
Rossella D’Aloisio ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
External Validation ◽  
Diabetic Patients ◽  
Disease Biomarkers ◽  
Response To Stress ◽  
Severity Of The Disease ◽  
Plasma Microrna

AbstractDiabetic retinopathy (DR) is a leading cause of vision loss and disability. Effective management of DR depends on prompt treatment and would benefit from biomarkers for screening and pre-symptomatic detection of retinopathy in diabetic patients. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression which are released in the bloodstream and may serve as biomarkers. Little is known on circulating miRNAs in patients with type 2 diabetes (T2DM) and DR. Here we show that DR is associated with higher circulating miR-25-3p (P = 0.004) and miR-320b (P = 0.011) and lower levels of miR-495-3p (P < 0.001) in a cohort of patients with T2DM with DR (n = 20), compared with diabetic subjects without DR (n = 10) and healthy individuals (n = 10). These associations persisted significant after adjustment for age, gender, and HbA1c. The circulating levels of these miRNAs correlated with severity of the disease and their concomitant evaluation showed high accuracy for identifying DR (AUROC = 0.93; P < 0.001). Gene ontology analysis of validated targets revealed enrichment in pathways such as regulation of metabolic process (P = 1.5 × 10–20), of cell response to stress (P = 1.9 × 10–14), and development of blood vessels (P = 2.7 × 10–14). Pending external validation, we anticipate that these miRNAs may serve as putative disease biomarkers and highlight novel molecular targets for improving care of patients with diabetic retinopathy.

239: Co-morbidities of pre-gestational type 2 diabetes in pregnancy in the California Health Discharge Database

2012 ◽  
Vol 206 (1) ◽  
pp. S118
Author(s):  
Alex Fong ◽  
Michelle Eno ◽  
Tiffany Chen ◽  
Steve Rad ◽  
Leticia Campbell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes In Pregnancy ◽  
Discharge Database ◽  
In Pregnancy

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

Identification of Type 2 von Willebrand Disease in Previously Diagnosed Type 1 Patients: a Reappraisal Using Phenotypes, Genotypes and Molecular Modelling

2000 ◽  
Vol 84 (12) ◽  
pp. 998-1004 ◽  
Author(s):  
Ioana Nitu-Whalley ◽  
Anne Riddell ◽  
K. Pasi ◽  
Dale Owens ◽  
M. Enayat ◽  
...  
Keyword(s):  
Molecular Modelling ◽  
Correct Diagnosis ◽  
Von Willebrand Disease ◽  
Single Amino Acid ◽  
Elisa Assay ◽  
Modelling Analysis ◽  
A1 Domain ◽  
Von Willebrand

SummaryIn order to investigate the possibility that qualitative type 2 defects in von Willebrand factor (VWF) occurred in patients previously diagnosed with quantitative type 1 von Willebrand disease (VWD), the phenotypes and genotypes were reanalysed in 30 patients who exhibited discrepant VWF activity/VWF:Ag ratios of less than 0.7. The capacity of VWF to bind to glycoprotein Ib (GpIb) was reassessed using the ristocetin co-factor activity (VWF:RiCo) assay compared to an in-house and a commercial ELISA assay (based on a mAb directed against the GpIb binding site on VWF). This was supplemented by multimeric analysis and the amplification and sequencing of a 936 bp fragment of exon 28 of the VWF gene with the aim of identifying mutations in the A1 domain. On reappraisal, using the VWF:RiCo assay all patients demonstrated a disproportionately reduced VWF:RiCo/VWF:Ag ratio, indicative of a qualitative defect, while abnormal ratios were detected in only seven kindreds using the in-house ELISA assay and in only one kindred with the commercial ELISA assay. Eight single amino acid substitutions were found in nine kindreds, four of which were novel candidate VWF mutations and four previously described in association with type 2 VWD. In agreement with the phenotype, the novel VWF mutations were located in the VWF-A1 crystal structure at positions that corresponded to potential type 2M defects. This study underlines the difficulties of correct diagnosis of the subtype of VWD and emphasises the importance of using sensitive phenotypic assays, the relevance of the VWF:RiCo/ VWF:Ag ratio, multimeric analysis and molecular modelling analysis.

Cytostatic Agents in the Management of Malignant Gliomas

1998 ◽  
Vol 5 (2) ◽  
pp. 150-162 ◽  
Author(s):  
Tom Mikkelsen
Keyword(s):  
Signal Transduction ◽  
Brain Tumors ◽  
Tumor Invasion ◽  
Proteinase Inhibitors ◽  
Malignant Gliomas ◽  
Cytotoxic Agents ◽  
Management Approach ◽  
Cytostatic Agents ◽  
Management Options ◽  
Malignant Brain Tumors

Background: Cytotoxic therapy for malignant gliomas is limited by poor delivery and drug resistance, and local therapy is ineffective in managing migratory cells. However, recent developments in malignant glioma therapy involve trials of cytostatic rather than conventional cytotoxic agents. Methods: The biology of the brain extracellular matrix, tumor invasion, and angiogenesis are reviewed, and the cytostatic agents that inhibit matrix metalloproteinases, angiogenesis, cell proliferation, and signal transduction are discussed, as well as studies of the angiogenic and migratory capacity of malignant brain tumors. Results: Two specific and interrelated areas, anti-invasion (migration) and anti-angiogenesis, are potential areas to develop new treatment strategies. Tumor invasion and angiogenesis are important components of the spread and biologic effects of malignant gliomas. Several proteinase inhibitors are in clinical trial, as well as anti-angiogenic agents and signal transduction cascade inhibitors. Conclusions: Biologic control of brain tumor cell populations may offer a new management approach to add to currently available management options for malignant brain tumors.

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