scholarly journals Atypical HIV-vacuolar myelopathy: a case report

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Tau Mongezi ◽  
Joseph Sibi ◽  
George Jerry ◽  
Ibañez-Valdés Lourdes de Fátima ◽  
Dubula Tozama ◽  
...  
Keyword(s):  
Supportive Therapy ◽  
Kidney Injury ◽  
Therapy Response ◽  
Immunoglobulin Therapy ◽  
Cervical Region ◽  
Sensory Level ◽  
Inadequate Response ◽  
Spinal Cord Atrophy ◽  
Vacuolar Myelopathy ◽  
Thoracic Cord

Abstract Background Here, we report an atypical HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIV-VM) and immunoglobulin therapy response. Case A 26-year-old lady who was 4 weeks postpartum presented to us with acute flaccid quadriparesis, with no sensory level. Extensive workup ruled out other causes of myelopathy. She developed a stage 3 acute kidney injury, and MRI showed diffuse cord atrophy involving the lower cervical and thoracic cord. The patient received IV-immunoglobulin, ARVs, and supportive therapy with inadequate response. Unfortunately, she developed nosocomial pneumonia and died. Discussion In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this pathological process also affected the spinal cord's cervical region, leading to flaccid tetraplegia, with high CD4 level, without response to the treatment, including intravenous immunoglobulin. Keynotes Vacuolar myelopathy, HIV, Immunoglobulin therapy, flaccid tetraplegia, hypokalaemia. Renal failure.

scholarly journals Atypical HIV-Vacuolar Myelopathy. Case Report and Literature Review.

2020 ◽  
Author(s):  
Mongezi Tau ◽  
Sibi Joseph ◽  
Jerry George ◽  
Lourdes de Fatima Ibañez-Valdés ◽  
Thozama Dubula ◽  
...  
Keyword(s):  
Supportive Therapy ◽  
Kidney Injury ◽  
Therapy Response ◽  
Immunoglobulin Therapy ◽  
Cervical Region ◽  
Sensory Level ◽  
Inadequate Response ◽  
Spinal Cord Atrophy ◽  
Vacuolar Myelopathy ◽  
Thoracic Cord

Abstract Background: Here, we report an atypical presentation of HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIVVM) and immunoglobulin therapy response.Case: A 26-year-old lady who was four weeks postpartum presented to us with acute flaccid quadriparesis, with no sensory level. Extensive workup ruled out other causes of myelopathy. She developed a stage 3 acute kidney injury, and MRI showed diffuse cord atrophy involving the lower cervical and thoracic cord. The patient received IV-immunoglobulin, ARV's, and supportive therapy with inadequate response. Unfortunately, she developed nosocomial pneumonia and died. Discussion: In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this pathological process also affected the spinal cord's cervical region, leading to flaccid tetraplegia, no responding to the treatment, including intravenous immunoglobulin.

scholarly journals Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Research ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-17 ◽  
Author(s):  
Xinhui Wang ◽  
Xuexian Fang ◽  
Zhaoxian Cai ◽  
Xiaotian Wu ◽  
Xiaotong Gao ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Severity ◽  
Clinical Data ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Global Scale ◽  
Systemic Review ◽  
Increased Risk

The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.

scholarly journals Neuropathology of two Brazilian autopsied cases of tropical spastic paraparesis / HTLV-I associated myelopathy (TSP/HAM) of long evolution

2002 ◽  
Vol 60 (3A) ◽  
pp. 531-536 ◽  
Author(s):  
Carlos Maurício de Castro-Costa ◽  
René Dom ◽  
Herwig Carton ◽  
Patrick Goubau ◽  
Terezinha de Jesus Teixeira Santos ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Grey Matter ◽  
Spastic Paraparesis ◽  
Tropical Spastic Paraparesis ◽  
Spinal Cord Atrophy ◽  
Thoracic Cord

We report on a neuropathological analysis of two cases of TSP/HAM originating from Brazil. These two cases had, respectively, an evolution of 13 and 40 years. The main neuropathological findings consisted of spinal cord atrophy, mainly the lower thoracic cord, diffuse degeneration of the white and grey matter, rare foci of mononuclear and perivascular cuffs, and hyaline hardening of arteriolae. The supraspinal structures were normal, excepting for a slight gliosis in the cerebellum. An analysis on the long evolutive cases as described in the literature is outlined in this study.

Differential gene expression in septic shock patients according to the early supportive therapy response

2017 ◽  
Vol 42 ◽  
pp. 378 ◽  
Author(s):  
D. Braga ◽  
M. Barcella ◽  
S. Lupoli ◽  
A. Herpain ◽  
B. Bollen Pinto ◽  
...  
Keyword(s):  
Gene Expression ◽  
Septic Shock ◽  
Differential Gene Expression ◽  
Supportive Therapy ◽  
Therapy Response ◽  
Differential Gene

scholarly journals Predictive Factors of Response to Biological Disease Modifying Antirheumatic Drugs: Towards Personalized Medicine

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Claire I. Daïen ◽  
Jacques Morel
Keyword(s):  
Clinical Response ◽  
Immune Cell ◽  
Smoking Status ◽  
Therapy Response ◽  
Inadequate Response ◽  
Disease Characteristics ◽  
Cytokine Levels ◽  
Cell Phenotypes ◽  
The Impact ◽  
Necrosis Factor

Many therapies are now available for patients with rheumatoid arthritis (RA) who have an inadequate response to methotrexate including tumor necrosis factor inhibitors, abatacept, tocilizumab, and rituximab. Clinical response to drugs varies widely between individuals. A part of this variability is due to the characteristics of the patient such as age, gender, concomitant therapies, body mass index, or smoking status. Clinical response also depends on disease characteristics including disease activity and severity and presence of autoantibodies. Genetic background, cytokine levels, and immune cell phenotypes could also influence biological therapy response. This review summarizes the impact of all those parameters on response to biological therapies.

scholarly journals NSAIDs and PPIs - review of new reports

2021 ◽  
Vol 11 (9) ◽  
pp. 462-472
Author(s):  
Jakub Klas ◽  
Natalia Kluz ◽  
Klaudia Piwowar
Keyword(s):  
Side Effects ◽  
Enzyme Inhibitors ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Complementary Therapy ◽  
Cardiovascular Complications ◽  
Therapeutic Effects ◽  
Drug Induced ◽  
Hydrogen Atpase ◽  
Meta Analyses

The aim of this study is to systematise knowledge on non-steroidal anti-inflammatory drugs (NSAIDs) - cyclooxygenase (COX) enzyme inhibitors and proton pump inhibitors (PPIs) inhibiting potassium hydrogen ATPase. A review of recent reports on possible side effects and new therapeutic options will be presented. Results: Over the last few years, reports of PPI side effects have been published: drug-induced thrombocytopenia, severe hypomagnesemia, hyponatremia or rhabdomyolysis. In the case of NSAIDs, ancillary therapeutic effects in the supportive therapy of multiple myeloma or in the reduction of adenoma formation in the colon stand out, but also cases of acute kidney injury in children. On the basis of meta-analyses, attempts were made to demonstrate the effect of individual NSAIDs on the occurrence of cardiovascular complications, stroke or myocardial infarction Conclusions: Despite the fact that the indicated preparations were admitted to the list of drugs several decades ago, still their pharmacological potential (on the example of NSAIDs, which can be successfully used even in complementary therapy) has not been fully exploited. The aforementioned reports on side effects must not be forgotten. It is possible that the examples presented in the review will raise awareness in order to use these drugs with greater respect, in accordance with the recommendations in the leaflet.

scholarly journals Mesenchymal Stem Cell-Derived Extracellular Vesicles: A Potential Therapeutic Strategy for Acute Kidney Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-Kun Li ◽  
Cheng Yang ◽  
Ying Su ◽  
Jing-Chao Luo ◽  
Ming-Hao Luo ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Extracellular Vesicles ◽  
Cellular Therapy ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Therapeutic Effects ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Acute kidney injury (AKI) is a common and potential life-threatening disease in patients admitted to hospital, affecting 10%–15% of all hospitalizations and around 50% of patients in the intensive care unit. Severe, recurrent, and uncontrolled AKI may progress to chronic kidney disease or end-stage renal disease. AKI thus requires more efficient, specific therapies, rather than just supportive therapy. Mesenchymal stem cells (MSCs) are considered to be promising cells for cellular therapy because of their ease of harvesting, low immunogenicity, and ability to expand in vitro. Recent research indicated that the main therapeutic effects of MSCs were mediated by MSC-derived extracellular vesicles (MSC-EVs). Furthermore, compared with MSCs, MSC-EVs have lower immunogenicity, easier storage, no tumorigenesis, and the potential to be artificially modified. We reviewed the therapeutic mechanism of MSCs and MSC-EVs in AKI, and considered recent research on how to improve the efficacy of MSC-EVs in AKI. We also summarized and analyzed the potential and limitations of EVs for the treatment of AKI to provide ideas for future clinical trials and the clinical application of MSC-EVs in AKI.

scholarly journals Supportive treatment for cast nephropathy in patients with multiple myeloma; a pilot study

2021 ◽  
Vol 10 (2) ◽  
pp. e20-e20
Author(s):  
Giovanni Cancarini ◽  
Vincenzo Terlizzi ◽  
Anna Garatti ◽  
Letizia Zeni ◽  
Mattia Tonoli ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Sodium Bicarbonate ◽  
Low Dose ◽  
Survival Curve ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
University Hospital ◽  
Cast Nephropathy ◽  
Significant Survival ◽  
Student’S T

Introduction: Cast nephropathy is a prevalent cause of acute kidney injury (AKI) in patients with myeloma. Objectives: The aim of this study is to define the outcome of a standardized supportive therapy for cast nephropathy. Patients and Methods: Retrospective analysis of the outcome of cast nephropathy in a University hospital for a period of five years. Data analysed; serum creatinine, estimated glomerular filtration rate (eGFR; mL/min/1.73 m2 BSA) and need for dialysis. Standardized therapy with the aim of preventing/removing tubular casts; fluid administration and mannitol to increase urine flow, sodium bicarbonate to alkalize the urine and low dose steroid to reduce peritubular inflammation. Statistical analysis: Student’s t-test or the Mann-Whitney test according to data distribution. A two-tailed P value <0.05 was considered statistically significant. Survival curve was drawn according to Kaplan and Meier. Results: Twenty-seven cases were reviewed. Upon admission, mean serum creatinine was 7.1±4.9 mg/dL and mean eGFR 6±4 mL/min/1.73 m2 BSA; 30% of patients had oligo-anuria. Diagnosis of cast nephropathy was presumptive in 23 patients, and renal biopsy proven in four. Hemodialysis was required by 10 (37%) patients, two of whom continued dialysis after discharge. At discharge, serum creatinine was 3.7±2.5 mg/dL and eGFR 20±13 mL/min/1.73 m2 BSA (P=0.002), and after a median of 3.4 months, the values were 2.9±2.1 mg/dL and 35±32 mL/min/1.73 m2 BSA, respectively. Patient survival was 60% after 24 months. Conclusion: Administration of fluid, mannitol, sodium bicarbonate and low-dose steroid may improve the outcome of cast nephropathy. Despite the fact that the study has many limitations, its findings could be the base for prospective controlled trials on cast nephropathy and could be useful in those countries where the expensive extracorporeal treatments are not available.

Complications of Immunoglobulin Therapy and Implications for Treatment of Inflammatory Neuropathy: A Review

2019 ◽  
Vol 14 (1) ◽  
pp. 3-13 ◽  
Author(s):  
Ahmed Abbas ◽  
Yusuf A. Rajabally.
Keyword(s):  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Kidney Injury ◽  
Immunoglobulin Therapy ◽  
Multifocal Motor Neuropathy ◽  
Evidence Base ◽  
Motor Neuropathy ◽  
Inflammatory Neuropathy ◽  
Inflammatory Neuropathies ◽  
Delayed Complications ◽  
Associated Risk Factors

Background: Intravenous Immunoglobulin (IVIg) forms a cornerstone of effective treatment for acute and chronic inflammatory neuropathies, with a class I evidence base in Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). It is generally considered to be a safe therapy however there are several recognised complications which are reviewed in this article. Discussion and Conclusion: Most adverse events are immediate and mild such as headache, fever and nausea although more serious immediate reactions such as anaphylaxis may rarely occur. Delayed complications are rare but may be serious, including thromboembolic events and acute kidney injury, and these and associated risk factors are also discussed. We emphasise the importance of safe IVIg administration and highlight practical measures to minimise complications of this therapy.

Peritoneal Dialysis in the Pediatric Intensive Care Unit Setting

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 183-185 ◽  
Author(s):  
Melvin Bonilla–Félix
Keyword(s):  
Intensive Care ◽  
Peritoneal Dialysis ◽  
Neonatal Intensive Care ◽  
Low Cost ◽  
Clinical Status ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Venous Catheter ◽  
Intermittent Hemodialysis ◽  
Dialysis Modality

Acute kidney injury (AKI) is a common complication in pediatric and neonatal intensive care units (ICUs). Renal replacement therapy (RRT) is frequently needed in children in whom supportive therapy is not enough to satisfy metabolic demands or to provide adequate nutrition in cases of oliguric kidney failure. The decision to begin dialysis should not be delayed, because experience in infants shows that the shorter the time from the ischemic insult to the beginning of dialysis, the higher the survival rate. The use of continuous RRT (CRRT) in pediatric patients in the ICU has almost tripled; at the same time, the use of peritoneal dialysis (PD) and intermittent hemodialysis has markedly declined. Patient age seems to be the most important factor influencing the decision on the choice of dialysis modality. Although CRRT is reported as the preferred dialysis modality for acutely ill children, PD is still the most common modality used in patients under 6 years of age. Among the several advantages that PD offers, relatively low cost is probably the most significant. Other advantages include technical simplicity, lack of a need for anticoagulation or placement of a central venous catheter, and excellent tolerance in hemodynamically unstable patients. Much controversy exists regarding the adequacy of PD in hypercatabolic patients in the ICU. Nonetheless, when Kt/V has been applied to acutely ill children, it has been shown that PD can provide adequate clearances for most infants. No prospective studies have evaluated the effect of dialysis modality on the outcomes of children with AKI in the ICU setting. The decision about dialysis modality should therefore be based on local expertise, resources available, and the patient's clinical status.

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