scholarly journals Heat stroke during long-term clozapine treatment: should we be concerned about hot weather?

2016 ◽  
Vol 38 (1) ◽  
pp. 56-59 ◽  
Author(s):  
Maurício Scopel Hoffmann ◽  
Lucas Mendes Oliveira ◽  
Maria Inês Rodrigues Lobato ◽  
Paulo Belmonte-de-Abreu
Keyword(s):  
Heat Stroke ◽  
Systemic Infection ◽  
Accurate Diagnosis ◽  
Pharmacological Intervention ◽  
Case Description ◽  
Clozapine Treatment ◽  
Improve Treatment ◽  
Clinical Events ◽  
Hot Weather

Objective To describe the case of a patient with schizophrenia on clozapine treatment who had an episode of heat stroke. Case description During a heat wave in January and February 2014, a patient with schizophrenia who was on treatment with clozapine was initially referred for differential diagnose between systemic infection and neuroleptic malignant syndrome, but was finally diagnosed with heat stroke and treated with control of body temperature and hydration. Comments This report aims to alert clinicians take this condition into consideration among other differential diagnoses, especially nowadays with the rise in global temperatures, and to highlight the need for accurate diagnosis of clinical events during pharmacological intervention, in order to improve treatment decisions and outcomes.

Acute, medium and long-term effects of yellow sand and air pollutants on allergy and biomarker search

Impact ◽  
2020 ◽  
Vol 2020 (3) ◽  
pp. 63-65
Author(s):  
Tomomi Higashi
Keyword(s):  
Air Pollutants ◽  
Genetic Factors ◽  
Long Term Effects ◽  
Emergency Rooms ◽  
Improve Treatment ◽  
Treatment And Prevention ◽  
Chronic Effects ◽  
Difficulty Breathing ◽  
Acute And Chronic Effects

Talk to any allergy sufferer and they will tell you how awful it can be. Runny noses, itchy eyes, coughing and difficulties breathing. For many these symptoms rise only to the level of annoyance and can be avoided by steering clear of the source of their allergy. What many people don't realise though is that allergies can become a far more serious issue for a large segment of the population. Shortness of breath and difficulty breathing due to allergies bring many people to emergency rooms and these are just the acute symptoms. Along with the potential for an allergic attack during a windy or dusty day, researchers and medical professionals are beginning to recognise that there are chronic, long term effects associated with allergies. In order to mitigate both the acute and chronic effects of allergies a better understanding of how genetic factors combine with environmental conditions to produce the ranges of symptoms and effects of allergy suffers is needed. Professor Tomomi Higashi, from the Department of Hygiene at Kanazawa University in Japan, is an expert in this field and is currently working to improve treatment and prevention of allergic disease.

scholarly journals THE IMPACT OF MID-TERM OCT FINDINGS ON LONG-TERM CLINICAL EVENTS AFTER DRUG-ELUTING STENTS IMPLANTATION

2012 ◽  
Vol 59 (13) ◽  
pp. E120
Author(s):  
Hiromasa Otake ◽  
Toshiro Shinke ◽  
Junya Shite ◽  
Ken–ichi Hirata
Keyword(s):  
Drug Eluting Stents ◽  
Clinical Events ◽  
Drug Eluting ◽  
The Impact

scholarly journals High levels of interleukin-6 are associated with final infarct size and adverse clinical events in patients with STEMI

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001869
Author(s):  
Ingvild Maria Tøllefsen ◽  
Christian Shetelig ◽  
Ingebjørg Seljeflot ◽  
Jan Eritsland ◽  
Pavel Hoffmann ◽  
...  
Keyword(s):  
Infarct Size ◽  
Interleukin 6 ◽  
Left Ventricular ◽  
Clinical Event ◽  
Left Ventricular Ejection ◽  
Clinical Events ◽  
Sampling Points ◽  
All Cause Mortality

ObjectiveInflammation has emerged as a new treatment target in patients with coronary artery disease and inflammation seems to play an important role in ischaemia/reperfusion injury that follows ST-elevation myocardial infarction (STEMI). We aimed to explore the role of acute and sustained interleukin 6 (IL-6) signalling, including soluble IL-6 receptor (IL-6R), with regard to infarct size, adverse remodelling and future cardiovascular events in patients with STEMI.MethodsWe included 269 patients with first-time STEMI, symptom duration <6 hours and treated with percutaneous coronary intervention. Blood sampling and cardiac MRI were performed in the acute phase and after 4 months. Clinical events and all-cause mortality were registered during 12-month and 70-month follow-up, respectively.ResultsIL-6 levels above median at all sampling points were significantly associated with increased infarct size and reduced left ventricular ejection fraction (LVEF). IL-6 levels in the highest quartile were at all sampling points associated with an increased risk of having an adverse clinical event during the first 12 months and with long-term all-cause mortality. IL-6R was not associated with infarct size, LVEF, myocardial salvage or long-term all-cause mortality.ConclusionAcute and sustained elevation of IL-6 measured 4 months after STEMI were associated with larger infarct size, reduced LVEF and adverse clinical events including all-cause mortality. The results add important information to the sustained role of inflammation in patients with STEMI and IL-6 as a potential target for long-term intervention.Trial registration numberNCT00922675.

scholarly journals Highly Resistant Salmonella enterica Serovar Typhi with a NovelgyrAMutation Raises Questions about the Long-Term Efficacy of Older Fluoroquinolones for Treating Typhoid Fever

2012 ◽  
Vol 56 (5) ◽  
pp. 2761-2762 ◽  
Author(s):  
Kanika Deshpande Koirala ◽  
Duy Pham Thanh ◽  
Sudeep Dhoj Thapa ◽  
Amit Arjyal ◽  
Abhilasha Karkey ◽  
...  
Keyword(s):  
Multidrug Resistance ◽  
Typhoid Fever ◽  
Treatment Failure ◽  
Salmonella Enterica ◽  
Systemic Infection ◽  
Resistant Isolate ◽  
Content Type ◽  
Salmonella Enterica Serovar Typhi ◽  
Term Efficacy

ABSTRACTAs a consequence of multidrug resistance, clinicians are highly dependent on fluoroquinolones for treating the serious systemic infection typhoid fever. While reduced susceptibility to fluoroquinolones, which lessens clinical efficacy, is becoming ubiquitous, comprehensive resistance is exceptional. Here we report ofloxacin treatment failure in typhoidal patient infected with a novel, highly fluoroquinolone-resistant isolate ofSalmonella entericaserovar Typhi. The isolation of this organism has serious implications for the long-term efficacy of ciprofloxacin and ofloxacin for typhoid treatment.

Outcomes of 33 patients from the wars in Iraq and Afghanistan undergoing bilateral or bicompartmental craniectomy

2011 ◽  
Vol 115 (1) ◽  
pp. 124-129 ◽  
Author(s):  
Robert D. Ecker ◽  
Lisa P. Mulligan ◽  
Michael Dirks ◽  
Randy S. Bell ◽  
Meryl A. Severson ◽  
...  
Keyword(s):  
Medical Center ◽  
Systemic Infection ◽  
Categorical Variables ◽  
Cerebrovascular Injury ◽  
The Us ◽  
Long Term Follow Up ◽  
Initial Injury ◽  
Gcs Score

Object There are no published long-term data for patients with penetrating head injury treated with bilateral supratentorial craniectomy, or supra- and infratentorial craniectomy. The authors report their experience with 33 patients treated with bilateral or bicompartmental craniectomy from the ongoing conflicts in Iraq and Afghanistan. Methods An exploratory analysis of Glasgow Outcome Scale (GOS) scores at 6 months in 33 patients was performed. Follow-up lasting a median of more than 2 years was performed in 30 (91%) of these patients. The association of GOS score with categorical variables was explored using the Wilcoxon rank-sum test or Kruskal-Wallis analysis of variance. The Spearman correlation coefficient was used for ordinal/continuous data. To provide a clinically meaningful format to present GOS scores with categorical variables, patients with GOS scores of 1–3 were categorized as having a poor outcome and those with scores of 4 and 5 as having a good outcome. This analysis does not include the patients who died in theater or in Germany who underwent bilateral decompressive craniectomy because those figures have not been released due to security concerns. Results All patients were men with a median age of 24 years (range 19–46 years) and a median initial Glasgow Coma Scale (GCS) score of 5 (range 3–14). At 6 months, 9 characteristics were statistically significant: focus of the initial injury, systemic infection, initial GCS score, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, GCS score on dismissal from the medical center, Injury Severity Score, and patients with cerebrovascular injury. Six factors were significant at long-term follow-up: focus of initial injury, systemic infection, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, and GCS score on dismissal from the medical center. At long-term follow-up, 7 (23%) of 30 patients had died, 5 (17%) of 30 had a GOS score of 2 or 3, and 18 (60%) of 30 had a GOS score of 4 or 5. Conclusions In this selected group of patients who underwent bilateral or bicompartmental craniectomy, 60% are independent at long-term follow-up. Patients with bifrontal injury fared best. Systemic infection and cerebrovascular injury corresponded with a worse outcome.

Recurrent Solitary Fibrous Tumor of the Pleura With Malignant Transformation

2004 ◽  
Vol 128 (4) ◽  
pp. 460-462
Author(s):  
Rani Kanthan ◽  
Bahman Torkian
Keyword(s):  
Malignant Transformation ◽  
Solitary Fibrous Tumor ◽  
Immunohistochemical Staining ◽  
White Woman ◽  
Accurate Diagnosis ◽  
Malignant Progression ◽  
Biological Behavior ◽  
Fibrous Tumor

Abstract Recurrent solitary fibrous tumor of the pleura with malignant progression occurs rarely. We report a case of solitary fibrous tumor of the pleura in an 85-year-old white woman that recurred 4 times during a span of 10 years and subsequently underwent malignant transformation. The accurate diagnosis of solitary fibrous tumor is aided by ancillary techniques, such as immunohistochemical staining; however, with malignant transformation, such tools may be of limited value. Long-term clinical follow-up is recommended for all patients with solitary fibrous tumor because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation.

Multiple Isolated Extramedullary Relapse and Long-term Survival of One AML Patient

2020 ◽  
Author(s):  
Jiman Li ◽  
Yang Liu ◽  
Yunzhu Li ◽  
liu weiping
Keyword(s):  
Complete Remission ◽  
Poor Prognosis ◽  
Unusual Case ◽  
Granulocytic Sarcoma ◽  
Accurate Diagnosis ◽  
Physical Damage ◽  
Term Survival ◽  
Case Presentation ◽  
Extramedullary Relapse

Abstract Background: Granulocytic sarcomas (GS) are very rare. If it occurs after complete remission of acute myeloblastic leukemia（AML）, it indicates a recurrence of AML and a poor prognosis. In such cases, relapse of leukemia occurs within a mean of 10 months following granulocytic sarcoma.Case presentation: Here we present an unusual case of 78-year-old male who presented with AML-M1 38 years ago. After complete remission from AML-M1 6 years later, he developed unusual multiple isolated extramedullary relapses. And the extramedullary relapse occurred 7 times and involved 8 anatomic sites during 15 years. Despite repeated relapses, treatment and physical damage, the patient managed to survive into 2016.However, we did not detect any signs of leukemia after 1992 and his bone marrow and peripheral blood remained normal Until his death. Immunohistochemical results of our case are all the same, suggesting that they were all derived from the recurrence of the same tumor.Conclusions: Extramedullary relapses may occur in AML patients after complete relieve and without the blood count and BM involvement. Accurate diagnosis of GS is important so the patient could to be treated timely. It is a challenge for the pathologist to make the diagnosis, and without immunohistochemistry (IHC), it may be misdiagnosed as another tumor.

Delirium

2020 ◽  
pp. 425-436
Author(s):  
David Meagher ◽  
Cara Daly ◽  
Dimitrios Adamis
Keyword(s):  
Antipsychotic Agents ◽  
Careful Consideration ◽  
Cognitive Testing ◽  
Everyday Practice ◽  
Pharmacological Intervention ◽  
Careful Attention ◽  
Healthcare Outcomes ◽  
Underlying Causes ◽  
The Relationship

Delirium is a common, complex neuropsychiatric syndrome that occurs in approximately one in five hospitalized patients. It is associated with a range of adverse healthcare outcomes that are independently predicted by the severity and duration of delirium. Typically 50% or more of cases of delirium are missed, misdiagnosed, or diagnosed late in everyday practice. However, routine systematic cognitive testing aligned to formal screening for delirium in high-risk cases can improve detection in everyday practice. The relationship between delirium and dementia is complex; dementia is a potent risk factor for delirium and 50% of delirium occurs in the context of a pre-existing dementia, but evidence also indicates that the occurrence of delirium can accelerate the course of dementia and that many cases of delirium are followed by long-term cognitive impairment. Delirium is highly preventable, with a third of cases avoidable by addressing a variety of patient, illness, and treatment factors. Treatment of incident delirium requires careful consideration of underlying causes, aggravating environmental factors, and prudent use of pharmacological strategies, with antipsychotic agents the preferred pharmacological intervention. Careful attention to post-delirium care can minimize functional loss, address any psychological sequelae, and reduce the risk of further episodes.

Musculoskeletal system

2011 ◽  
pp. 411-414
Author(s):  
Dr Mark Harrison
Keyword(s):  
Musculoskeletal System ◽  
Early Mobilization ◽  
Musculoskeletal Injuries ◽  
Pharmacological Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
System P ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

8.1 Nonpharmacological measures, 412 8.2 Nonsteroidal anti-inflammatory drugs (NSAIDs), 412 8.3 Corticosteroids, 414 8.4 Drugs used in gout and hyperuricaemia, 414 • Management of musculoskeletal injuries and diseases involves more than just pharmacological intervention. • Consideration of splinting, physiotherapy, and early mobilization can be the most effective way to ease pain and improve long-term outcome....

scholarly journals Genotype-Related Clinical Characteristics and Myocardial Fibrosis and Their Association with Prognosis in Hypertrophic Cardiomyopathy

2020 ◽  
Vol 9 (6) ◽  
pp. 1671 ◽  
Author(s):  
Hyung Yoon Kim ◽  
Jong Eun Park ◽  
Sang-Chol Lee ◽  
Eun-Seok Jeon ◽  
Young Keun On ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
Genetic Variants ◽  
Asian Patients ◽  
Pathogenic Variants ◽  
Clinical Events ◽  
Cerebrovascular Events ◽  
Genotypic Analysis ◽  
Uncertain Significance

Background: The spectrum of genetic variants and their clinical significance of Hypertrophic cardiomyopathy (HCM) have been poorly studied in Asian patients. The objectives of this study were to assess the spectrum of genetic variants and genotype–phenotype relationships within a Korean HCM population. Methods: Eighty-nine consecutive unrelated HCM patients were included. All patients underwent genotypic analysis for 23 HCM-associated genes. Clinical parameters including echocardiographic and cardiac magnetic resonance (CMR) parameters were evaluated. A composite of major adverse cardiac and cerebrovascular events was assessed. Results: Genetic variants were detected in 55 of 89 subjects. Pathogenic variants or likely pathogenic variants were identified in 27 of HCM patients in MYBPC3, TNNI3, MYH7, and MYL7. Variants of uncertain significance were identified in 28 patients. There were significant differences in the presence of non-sustained ventricular tachycardia (p = 0.030) and myocardial fibrosis on CMR (p = 0.029) in the detected compared to the not-detected groups. Event-free survival was superior in the not-detected group (p = 0.006). Conclusion: Genetic variants in patients with HCM are relatively common and are associated with adverse clinical events and myocardial fibrosis on CMR. Genotypic analysis may add important information to clinical variables in the assessment of long-term risk for HCM patients.

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