scholarly journals Leprosy neuropathy: clinical presentations

2013 ◽  
Vol 71 (9B) ◽  
pp. 661-666 ◽  
Author(s):  
Osvaldo J M Nascimento
Keyword(s):  
Late Onset ◽  
Early Recognition ◽  
Skin Lesions ◽  
Multidrug Therapy ◽  
Clinical Presentations ◽  
Peripheral Nerve Involvement ◽  
Inflammatory Neuropathy ◽  
Leprosy Neuropathy ◽  
Autonomic Dysfunctions

Leprosy is a chronic infectious peripheral neuropathy caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. Early detection of leprosy and treatment by multidrug therapy are the most important steps in preventing deformity and disability. Thus the early recognition of the clinical leprosy presentation is essential. Mononeuritis, mononeuritis multiplex (MM), polyneuritis (MM summation) are the most frequent. The frequent anesthetic skin lesions are absent in the pure neuritic leprosy presentation form. Isolated peripheral nerve involvement is common, including the cranial ones. Arthritic presentation is occasionally seen, usually misdiagnosed as rheumatoid arthritis. Attention should be given to autonomic dysfunctions in leprosy. There are clinical presentations with severe neuropathic pain - painful small-fiber neuropathy. Leprous late-onset neuropathy (LLON) clinical presentation should be considered facing a patient who develop an inflammatory neuropathy many years after a previous skin leprosy treatment.

scholarly journals Assessment and Management of Cardiotoxicity in Hematologic Malignancies

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Anca Bojan ◽  
Tunde Torok-Vistai ◽  
Andrada Parvu
Keyword(s):  
Side Effects ◽  
Kinase Inhibitors ◽  
Late Onset ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Proteasome Inhibitors ◽  
Myocardial Damage ◽  
Hematologic Malignancies ◽  
Life Threatening

With the increasing overall survival of cancer patients due to recent discoveries in oncology, the incidence of side effects is also rising, and along with secondary malignancies, cardiotoxicity is one of the most concerning side effects, affecting the quality of life of cancer survivors. There are two types of cardiotoxicity associated with chemotherapy; the first one is acute, life-threatening but, fortunately, in most of the cases, reversible; and the second one is with late onset and mostly irreversible. The most studied drugs associated with cardiotoxicity are anthracyclines, but many new agents have demonstrated unexpected cardiotoxic effect, including those currently used in multiple myeloma treatment (proteasome inhibitors and immunomodulatory agents), tyrosine kinase inhibitors used in the treatment of chronic myeloid leukemia and some forms of acute leukemia, and immune checkpoint inhibitors recently introduced in treatment of refractory lymphoma patients. To prevent irreversible myocardial damage, early recognition of cardiac toxicity is mandatory. Traditional methods like echocardiography and magnetic resonance imaging are capable of detecting structural and functional changings, but unable to detect early myocardial damage; therefore, more sensible biomarkers like troponins and natriuretic peptides have to be introduced into the current practice. Baseline assessment of patients allows the identification of those with high risk for cardiotoxicity, while monitoring during and after treatment is important for early detection of cardiotoxicity and prompt intervention.

Pediatric Eating Disorders

2017 ◽  
pp. 293-308
Author(s):  
Emily K. Gray ◽  
Kamryn T. Eddy
Keyword(s):  
Eating Disorders ◽  
Eating Behaviors ◽  
Early Recognition ◽  
Feeding And Eating Disorders ◽  
Clinical Presentations ◽  
Assessment And Treatment ◽  
Assessment Strategies ◽  
Disordered Eating Patterns ◽  
Maladaptive Eating

Eating disorders typically appear during childhood or adolescence, but they can go unrecognized by clinicians or parents, delaying diagnosis and treatment. Early recognition and treatment is essential because early disordered eating patterns can be associated with an eating disorder diagnosis in adolescence or adulthood. Children presenting with an eating or feeding disorder offer a unique set of challenges. The feeding and eating disorders share a common pattern of maladaptive eating behaviors and impaired quality of life, and although the diagnoses have distinct clinical concerns, issues pertaining to assessment and treatment are overlapping. This chapter reviews the clinical presentations of feeding and eating disorders in youth aged 7–13 years, including assessment strategies and treatment approaches.

scholarly journals Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil

2022 ◽  
Vol 16 (1) ◽  
pp. e0010070
Author(s):  
Izabela Jardim Rodrigues Pitta ◽  
Mariana de Andrea Vilas-Boas Hacker ◽  
Ligia Rocha Andrade ◽  
Clarissa Neves Spitz ◽  
Robson Teixeira Vital ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Nerve Biopsy ◽  
Skin Lesions ◽  
Multidrug Therapy ◽  
Therapeutic Decisions ◽  
Significant Difference ◽  
Leprosy Neuropathy ◽  
Before And After ◽  
Classical Symptom

Introduction Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. Objective This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). Methods Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. Results Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. Discussion The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.

scholarly journals Epilepsy in Down Syndrome: A Highly Prevalent Comorbidity

2021 ◽  
Vol 10 (13) ◽  
pp. 2776
Author(s):  
Miren Altuna ◽  
Sandra Giménez ◽  
Juan Fortea
Keyword(s):  
Down Syndrome ◽  
Functional Outcomes ◽  
Clinical Presentation ◽  
Late Onset ◽  
Current Knowledge ◽  
Epileptic Seizures ◽  
Myoclonic Epilepsy ◽  
Increased Risk ◽  
Number Of Individuals

Individuals with Down syndrome (DS) have an increased risk for epilepsy during the whole lifespan, but especially after age 40 years. The increase in the number of individuals with DS living into late middle age due to improved health care is resulting in an increase in epilepsy prevalence in this population. However, these epileptic seizures are probably underdiagnosed and inadequately treated. This late onset epilepsy is linked to the development of symptomatic Alzheimer’s disease (AD), which is the main comorbidity in adults with DS with a cumulative incidence of more than 90% of adults by the seventh decade. More than 50% of patients with DS and AD dementia will most likely develop epilepsy, which in this context has a specific clinical presentation in the form of generalized myoclonic epilepsy. This epilepsy, named late onset myoclonic epilepsy (LOMEDS) affects the quality of life, might be associated with worse cognitive and functional outcomes in patients with AD dementia and has an impact on mortality. This review aims to summarize the current knowledge about the clinical and electrophysiological characteristics, diagnosis and treatment of epileptic seizures in the DS population, with a special emphasis on LOMEDS. Raised awareness and a better understanding of epilepsy in DS from families, caregivers and clinicians could enable earlier diagnoses and better treatments for individuals with DS.

scholarly journals Challenge in diagnosis of late onset necrotizing enterocolitis in a term infant: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunadi ◽  
Dian Nirmala Sirait ◽  
Aditya Rifqi Fauzi ◽  
Ninditya Nugroho ◽  
Fadil Fahri ◽  
...  
Keyword(s):  
Ct Scan ◽  
Necrotizing Enterocolitis ◽  
Intestinal Inflammation ◽  
Late Onset ◽  
Gastrointestinal Disease ◽  
Early Recognition ◽  
Ileocecal Valve ◽  
Abdominal Distention ◽  
Clinical Deterioration ◽  
Wall Thickening

Abstract Background Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up. Case presentation Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure. Conclusion Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

Can Early Onset Schizophrenia be Prevented by Early Recognition and Treatment?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
F. Resch ◽  
P. Parzer ◽  
R. Oelkers-Ax ◽  
R. Brunner
Keyword(s):  
Late Onset ◽  
Early Recognition ◽  
Event Related Potentials ◽  
Subjective Experiences ◽  
Prodromal Phase ◽  
Basic Symptoms ◽  
Delayed Initiation ◽  
Adult Psychiatry ◽  
Related Potentials ◽  
Psychotic Features

In adult psychiatry early recognition and treatment of schizophrenia has become a major goal because of manifold evidence of a relation between delayed initiation of treatment and an unfavourable developmental course. The duration of untreated psychosis (DUP) seems to be significantly prolonged in adolescents compared to adults due to both a protracted sub-threshold development of psychotic features and the failure of families and health professionals to take seriously the initial signs of psychosis that mimic quasi normal adolescent emotional perturbations. Although in adults studies have shown a subset of prodromal signs and attenuated psychotic features to have predictive evidence for the development of schizophrenia, these symptoms however seem of limited specificity in adolescence. Basic symptoms represent subjective experiences of the prodromal phase and will be presented in a sample of schizophrenic adolescents in comparison to non-psychotic patients and normal controls. Results reveal that basic symptoms do not show any specificity for schizophrenia, but schizophrenics present with higher amounts of basic symptoms in the prodromal phase compared to non-psychotic controls. For early recognition a combination of psychopathological and biological markers seems fruitful. First data on perceptual closure and event related potentials of the optic system will be presented that seem to differentiate between early and late onset schizophrenia.

scholarly journals Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

2020 ◽  
Vol 4 (1) ◽  
pp. e000740
Author(s):  
Netsanet Workneh Gidi ◽  
Robert L Goldenberg ◽  
Assaye K Nigussie ◽  
Elizabeth McClure ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Late Onset ◽  
Early Recognition ◽  
Neonatal Outcomes ◽  
P Value ◽  
Prolonged Hospitalisation ◽  
Increased Risk ◽  
Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

scholarly journals Management of Adult Renal Tumours: Review of Nine (9) Years Experience

2020 ◽  
Vol 2 (5) ◽  
Author(s):  
Ngwobia Peter Agwu ◽  
Abdullahi Khalid ◽  
Uzodimma Ejike Onwuasoanya ◽  
Abdullahi Abdulwahab-Ahmed ◽  
Abubakar Sadiq Muhammad ◽  
...  
Keyword(s):  
Late Presentation ◽  
Molecular Therapy ◽  
Female Ratio ◽  
Review Period ◽  
Urological Malignancies ◽  
Clinical Presentations ◽  
Renal Tumours ◽  
Male To Female ◽  
Management Challenge

Background: Renal tumours appear to be relatively uncommon in our routine urological practice compared to other urological malignancies of bladder and prostate origins. Their presentations are often late despite increasing availability and affordability of routine imaging modalities for early detection. This therefore poses management challenge in our environment. This study aims to review our 9-year experience with the management of renal tumours at the Urology Unit of a tertiary health facility in North-western Nigeria Methodology: A retrospective review of 20 patients managed for renal tumour at our facility from September 2009 to August 2017. Data of all adult patients managed for renal tumours was retrieved and analyzed using SPSS 20.0 version for windows. The results were presented in percentages and mean ± SD as well as charts. Results: Twenty (20) patients were managed for renal tumours during the review period. The mean age of patients was 39.94 ± 12.19 years with median of 35 years and male to female ratio of 1:2. Nineteen (19) patient (95%) and 1(5%) had malignant and benign renal tumours respectively. Clinical presentations were flank mass seen in 18 patients (90%), flank pain 16 (80%), haematuria 10(50%), cough 2(10%), and pleural effusion 2(10%). Only clinical stages III and IV tumour were seen. 70% were clear cell variety while 5% was angiomyolipoma. Sixteen (80%) of patients had radical nephrectomy and two (10%) with inoperable tumour benefited from targeted molecular therapy preoperatively using Sorafenib. Conclusion: Late presentation of patients with renal tumours to our facility despite the availability of imaging facilities such as ultrasound scanning is still the norm. This makes surgery which offers best chance of survival and quality of life difficult and challenging. Targeted therapy using sorafenib, if available and affordable in our environment will be useful in management of patients with inoperable tumours.

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