scholarly journals Lumbar puncture in patients on anticoagulants

2020 ◽  
Vol 20 (2) ◽  
pp. 51-58
Author(s):  
Monika Białecka ◽  
◽  
Anna Machoy-Mokrzyńska ◽  
Anna Pierzchlińska ◽  
◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Neurological Disorders ◽  
Current Knowledge ◽  
Vitamin K Antagonists ◽  
Invasive Procedure ◽  
Diagnostic Methods ◽  
Safe Procedure ◽  
Aggregation Effect ◽  
New Anticoagulants ◽  
Platelet Receptor

Lumbar puncture is an important invasive procedure often used in the diagnosis of neurological disorders. Generally, lumbar puncture is a safe procedure, with a very low incidence of serious complications, the risk of which, however, may increase in the group of patients on anticoagulant therapy (anticoagulants and platelet anti-aggregation agents). This applies to both the risk of haemorrhagic complications and the risk of thrombotic events during temporary discontinuation of anticoagulants. This paper presents the current knowledge on the management in patients receiving anticoagulants (vitamin K antagonists, new anticoagulants, heparins, fondaparinux) and platelet anti-aggregation agents (P2Y12 platelet receptor antagonists, glycoprotein IIb/IIIa inhibitors, acetylsalicylic acid) who require lumbar puncture. Furthermore, we present the issue of bridging therapy in patients at a high risk of thrombotic complications. In the case of neurological indications for a lumbar puncture in a patient on anticoagulants or anti-aggregation therapy, the urgency of the procedure and the risk of adverse effects should be assessed and other diagnostic methods should be considered in the first place. If there is a need for an urgent lumbar puncture, treatment modification or the use of drugs to reverse the anticoagulant or anti-aggregation effect may be necessary. Each case must be treated individually, considering medical and family history, comorbidities and other medications taken by the patient. Most of the available recommendations related to the presented problem have been developed by anaesthetic associations. There is a need to popularise the principles of management in patients on anticoagulants who require lumbar puncture due to neurological disorders.

scholarly journals Current Knowledge of Endolysosomal and Autophagy Defects in Hereditary Spastic Paraplegia

Cells ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1678
Author(s):  
Liriopé Toupenet Marchesi ◽  
Marion Leblanc ◽  
Giovanni Stevanin
Keyword(s):  
Nervous System ◽  
Motor Neurons ◽  
Neurological Disorders ◽  
Hereditary Spastic Paraplegia ◽  
Current Knowledge ◽  
Spastic Paraplegia ◽  
Functional Convergence ◽  
The Common ◽  
Hsp Genes

Hereditary spastic paraplegia (HSP) refers to a group of neurological disorders involving the degeneration of motor neurons. Due to their clinical and genetic heterogeneity, finding common effective therapeutics is difficult. Therefore, a better understanding of the common pathological mechanisms is necessary. The role of several HSP genes/proteins is linked to the endolysosomal and autophagic pathways, suggesting a functional convergence. Furthermore, impairment of these pathways is particularly interesting since it has been linked to other neurodegenerative diseases, which would suggest that the nervous system is particularly sensitive to the disruption of the endolysosomal and autophagic systems. In this review, we will summarize the involvement of HSP proteins in the endolysosomal and autophagic pathways in order to clarify their functioning and decipher some of the pathological mechanisms leading to HSP.

Adenomyosis – its possible effect on endometrial function and receptivity

2021 ◽  
Vol 86 (3) ◽  
pp. 205-209
Author(s):  
Karel Crha ◽  
◽  
Michal Ješeta ◽  
Radovan Pilka ◽  
Pavel Ventruba ◽  
...  
Keyword(s):  
Epithelial Mesenchymal Transition ◽  
Current Knowledge ◽  
Histopathological Examination ◽  
Transvaginal Ultrasound ◽  
Embryo Implantation ◽  
Diagnostic Methods ◽  
Mesenchymal Transition ◽  
New Information

Summary Objective: There have been many studies on adenomyosis, which can impair the quality of life of a woman. There are various kinds of opinions on the pathogenesis, diagnostics and treatment of adenomyosis. The goal of this article is to present the current knowledge of adenomyosis and its impact on the endometrial function and receptivity. Methods: PubMed/Medline, Web of Sciences and Scopus were searched for the articles in English indexed until February 2021 with terms of: adenomyosis, endometrial receptivity, and infertility. Results: Recent studies on angiogenesis and epithelial-mesenchymal transition in the endometrium bring new information on the ethiology and pathogenesis of adenomyosis. In clinical practice, the main diagnostic methods of adenomyosis include transvaginal ultrasound, magnetic resonance imaging or hysteroscopy, although the definitive confirmation is set by histopathological examination. The rules of #Enzian classification of endometriosis should be applied for the classification of adenomyosis. The treatment of adenomyosis should consider individual clinical presentation and reproductive plans of a patient and should be performed in centers for the treatment of endometriosis. Conclusion: Adenomyosis affects endometrial vascularisation and epithelial-mesenchymal transition/mesenchymal-epithelial transition; thus, it can be the cause of irregular uterine bleeding or embryo implantation failure. The research and analysis of endometrial proteome could lead to the new ways of adenomyosis treatment.

Pleuroscopy early experience in the exudative pleural effusion of unknown etiology

2021 ◽  
Vol 17 ◽  
Author(s):  
Atefeh Fakharian ◽  
Hamidreza Jabbardarjani ◽  
Mohamad Reza Masjedi ◽  
Masoud Shamaei
Keyword(s):  
Pleural Effusion ◽  
Previous History ◽  
Invasive Procedure ◽  
Therapeutic Interventions ◽  
Unknown Etiology ◽  
Safe Procedure ◽  
Pathologic Diagnosis ◽  
Medical Thoracoscopy ◽  
History Of ◽  
Exudative Pleural Effusion

Background: Pleuroscopy (medical thoracoscopy) is a minimally invasive procedure to inspect and perform a biopsy of the pleural space as well as to perform therapeutic interventions; pleural fluid drainage and pleurodesis. Material and Methods: In a retrospective study in Kasra Hospital, Tehran-Iran, the patients with exudative pleural effusion of unknown etiology who underwent pleuroscopy, were evaluated. These patients had negative smear and culture for infective agents. Also, the cytological review was negative for malignancy. Results: 62 patients had undergone pleuroscopy, of which 29 (46.7) were men. After the final evaluation, 47 patients (75.8%) had a definite pathologic diagnosis, of which 39 (82.9%) were cancer. Through these 39 cases, 18 cases (46.1%) had a history of the previously confirmed cancer, in which pleural pathology was consistent with the initial diagnosis. In 21 cases (53.9%), metastatic cancers were detected without a previous history. From a total of 47 cases with definite pathologic diagnosis, 8 cases (17%) had histopathologic evidence of granulomatous lesions consistent with tuberculosis and 15 patients (24%) showed non-specific inflammatory lesions. There was no morbidity and mortality among these patients. Discussion: Considering that pleuroscopy is a safe procedure with high diagnostic accuracy, malignancy is the most finding in the exudative pleural effusion of unknown etiology. This increases the importance of this procedure in these cases to prevent wasting the time and smear-negative anti-TB treatment.

scholarly journals Life-threatening visceral complications after intragastric balloon insertion: Is the device, the patient or the doctor to blame?

2019 ◽  
Vol 07 (02) ◽  
pp. E122-E129 ◽  
Author(s):  
George Stavrou ◽  
Georgia Tsaousi ◽  
Katerina Kotzampassi
Keyword(s):  
Weight Loss ◽  
Bowel Obstruction ◽  
Esophageal Perforation ◽  
Intragastric Balloon ◽  
Gastric Perforation ◽  
Low Cost ◽  
Invasive Procedure ◽  
Safe Procedure ◽  
Bariatric Endoscopy ◽  
Mandatory Education

Abstract Background and aim Intragastric balloon placement is established as a safe, relatively low-cost and well-tolerated minimally invasive procedure for weight loss, giving encouraging results under the strict prerequisite that the obese patient will enroll in a medically supervised weight loss program. This retrospective study reviews already published cases of severe visceral complications for the purpose of assigning responsibility to the device, the patient, or the doctor. Methods We reviewed PubMed and Scopus archived publications describing intragastric balloon (BIB/Orbera)-related severe visceral complications, i. e. perforations and obstructions. Results Twenty-two cases of gastric perforation, two cases of esophageal perforation and 10 cases of bowel obstruction were found. For the gastric perforation the endoscopist was responsible in nine cases, the patient in four, and the balloon itself in nine. For the two cases of esophageal perforation, the endoscopists were responsible, while for the 12 cases of bowel obstruction, the patient was responsible for seven and the device for the other five cases. Conclusion BIB/Orbera balloon insertion remains a safe procedure, with a minimum of complications related to hollow viscera. Mandatory education and accreditation of physicians dealing with bariatric endoscopy and strict supervision of the obese individuals, while living with the balloon, will eliminate such complications.

Old and new anticoagulants

2011 ◽  
Vol 31 (01) ◽  
pp. 21-27 ◽  
Author(s):  
U. Harbrecht
Keyword(s):  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
New Oral Anticoagulants ◽  
Thrombin Inhibitors ◽  
Clotting Factor ◽  
Direct Thrombin Inhibitors ◽  
Self Monitoring ◽  
New Anticoagulants ◽  
Gastrointestinal Side Effects

SummaryVitamin-K-antagonists (VKA) and heparins have been complementary anticoagulants for prevention and treatment of thrombosis for almost 70 years. In contrast to heparins, VKA have not been modified pharmacologically, however treatment surveillance has improved by introducing INR and self-monitoring/management. Disclosure of the molecular basis of interaction with VKORC1, the target enzyme of VKA, has helped to better understand coumarin sensitivity and resistance. New oral anticoagulants have now been approved and stimulated expectations in patients and physicians to get rid of the burdening frequent controls of VKA without loss of efficacy and safety.This review will summarize the development and profile of the new substances. Main difference compared to VKA is their direct mode of action against one clotting factor which is factor IIa in dabigatran and factor Xa in rivaroxaban and other “xabanes” currently under intensive investigation. Half lifes of the new anticoagulants are much shorter than that of the mainly used coumarins (phenprocoumon, warfarin), making “anticoagulation bridging” unnecessary before surgery. Therapeutic width of direct thrombin inhibitors and factor Xa inhibitors is broader and they are given at fixed doses. Clinical studies in thromboprophylaxis, thromboembolism and atrial fibrillation indicate at least non-inferiority or even superior efficacy compared with enoxaparin and VKA at comparable safety outcomes. Limitations of the new substances may arise from gastrointestinal side effects, mode of metabolism and route of elimination. Specific antidots are not available for none of them.Undoubtedly, the new oral anticoagulants are very promising. But, although thousands of study patients already have been treated, there are questions to be answered such as treatment adherence in absence of monitoring, safety and efficacy in risk patients, dosage adjustment and interactions with other drugs, before conclusions can be drawn towards their potential to replace VKA.

Technological advances and changing indications for lumbar puncture in neurological disorders

2018 ◽  
Vol 17 (3) ◽  
pp. 268-278 ◽  
Author(s):  
Joost M Costerus ◽  
Matthijs C Brouwer ◽  
Diederik van de Beek
Keyword(s):  
Lumbar Puncture ◽  
Neurological Disorders ◽  
Technological Advances

scholarly journals Epigenetics and Neurological Disorders in ART

2019 ◽  
Vol 20 (17) ◽  
pp. 4169
Author(s):  
Marina La Rovere ◽  
Marica Franzago ◽  
Liborio Stuppia
Keyword(s):  
Neurological Disorders ◽  
Assisted Reproductive Technologies ◽  
Current Knowledge ◽  
Developed Countries ◽  
Reproductive Technologies ◽  
Epigenetic Modifications ◽  
Epigenetic Alterations ◽  
Long Term Effects ◽  
Increased Risk

About 1–4% of children are currently generated by Assisted Reproductive Technologies (ART) in developed countries. These babies show only a slightly increased risk of neonatal malformations. However, follow-up studies have suggested a higher susceptibility to multifactorial, adult onset disorders like obesity, diabetes and cardiovascular diseases in ART offspring. It has been suggested that these conditions could be the consequence of epigenetic, alterations, due to artificial manipulations of gametes and embryos potentially able to alter epigenetic stability during zygote reprogramming. In the last years, epigenetic alterations have been invoked as a possible cause of increased risk of neurological disorders, but at present the link between epigenetic modifications and long-term effects in terms of neurological diseases in ART children remains unclear, due to the short follow up limiting retrospective studies. In this review, we summarize the current knowledge about neurological disorders promoted by epigenetics alterations in ART. Based on data currently available, it is possible to conclude that little, if any, evidence of an increased risk of neurological disorders in ART conceived children is provided. Most important, the large majority of reports appears to be limited to epidemiological studies, not providing any experimental evidence about epigenetic modifications responsible for an increased risk.

scholarly journals BDNF signaling during the lifetime of dendritic spines

2020 ◽  
Vol 382 (1) ◽  
pp. 185-199 ◽  
Author(s):  
Marta Zagrebelsky ◽  
Charlotte Tacke ◽  
Martin Korte
Keyword(s):  
Dendritic Spines ◽  
Dendritic Spine ◽  
Neurological Disorders ◽  
Current Knowledge ◽  
Conclusive Evidence ◽  
Excitatory Synapses ◽  
Neuronal Homeostasis ◽  
Bdnf Signaling ◽  
Spine Number

Abstract Dendritic spines are tiny membrane specialization forming the postsynaptic part of most excitatory synapses. They have been suggested to play a crucial role in regulating synaptic transmission during development and in adult learning processes. Changes in their number, size, and shape are correlated with processes of structural synaptic plasticity and learning and memory and also with neurodegenerative diseases, when spines are lost. Thus, their alterations can correlate with neuronal homeostasis, but also with dysfunction in several neurological disorders characterized by cognitive impairment. Therefore, it is important to understand how different stages in the life of a dendritic spine, including formation, maturation, and plasticity, are strictly regulated. In this context, brain-derived neurotrophic factor (BDNF), belonging to the NGF-neurotrophin family, is among the most intensively investigated molecule. This review would like to report the current knowledge regarding the role of BDNF in regulating dendritic spine number, structure, and plasticity concentrating especially on its signaling via its two often functionally antagonistic receptors, TrkB and p75NTR. In addition, we point out a series of open points in which, while the role of BDNF signaling is extremely likely conclusive, evidence is still missing.

Sign in / Sign up

Export Citation Format

Share Document