Clinical Features of Mycetoma and the Appropriate Treatment Options

Fungal endocarditis, specifically from Candida species, is a rare but serious infection with a high mortality rate. Most cases occur in bioprosthetic or mechanical valves and are uncommon in native, structurally normal valves. When Candida endocarditis is detected and appropriate treatment is initiated earlier, there is an improvement in mortality. While the recommendation is usually to treat with a combination of surgery and antifungal medications, patient comorbidities may limit treatment options.

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The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-021-01257-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masayoshi Koike ◽

Mie Yoshimura ◽

Yasushi Mio ◽

Shoichi Uezono

Keyword(s):

Patient Safety ◽

Retrospective Study ◽

High Risk ◽

Treatment Plan ◽

Treatment Options ◽

High Risk Patients ◽

Appropriate Treatment ◽

Risk Patients ◽

Treatment Plans ◽

Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

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Psoas Abscess: Diagnosis and Treatment

Acute Medicine Journal ◽

10.52964/amja.0118 ◽

2006 ◽

Vol 5 (1) ◽

pp. 13-16

Author(s):

Raj Kandasamy ◽

◽

Asha Srikanth ◽

SM Rutter ◽

CJ Butcher ◽

...

Keyword(s):

Clinical Features ◽

Case History ◽

Diagnostic Tests ◽

Psoas Abscess ◽

Diagnosis And Treatment ◽

Uncommon Presentation ◽

Appropriate Treatment ◽

History Of

Psoas abscess is an uncommon presentation on the acute medical take. However recognition and appropriate treatment is essential. This review is designed to highlight the clinical features, microbiology, diagnostic tests and treatment for this condition. In order to illustrate some of the pitfalls and complexities in the management of psoas abscess we have included a case history of a patient who was recently treated in our department.

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Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

Clinical Microbiology Reviews ◽

10.1128/cmr.12.2.224 ◽

1999 ◽

Vol 12 (2) ◽

pp. 224-242 ◽

Cited By ~ 183

Author(s):

Shamez Ladhani ◽

Christopher L. Joannou ◽

Denise P. Lochrie ◽

Robert W. Evans ◽

Susan M. Poston

Keyword(s):

Clinical Features ◽

Treatment Options ◽

Entire Body ◽

Secondary Complications ◽

Staphylococcal Scalded Skin Syndrome ◽

Treatment And Prevention ◽

Causative Agents ◽

Underlying Diseases ◽

Disease Understanding ◽

Significant Mortality

SUMMARY The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.

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Updates in insomnia diagnosis and treatment

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217419860716 ◽

2019 ◽

Vol 54 (4-5) ◽

pp. 275-289 ◽

Cited By ~ 1

Author(s):

Scott Bragg ◽

JJ Benich ◽

Natalie Christian ◽

Josh Visserman ◽

John Freedy

Keyword(s):

Drug Therapy ◽

Behavioral Therapy ◽

Treatment Plan ◽

Treatment Options ◽

First Line ◽

Safety Concerns ◽

Diagnostic And Statistical Manual ◽

First Line Therapy ◽

Appropriate Treatment ◽

Central Nervous System Depression

Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.

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A Brief Review of Severe Asthma

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v6i2.14942 ◽

2021 ◽

Vol 6 (2) ◽

pp. 4-12

Author(s):

Muhammad Amin Ibrahim ◽

Ahmad Izuanuddin Ismail ◽

Mohammed Fauzi Abdul Rani

Keyword(s):

Severe Asthma ◽

Treatment Options ◽

Oral Steroid ◽

Inhaler Technique ◽

Inhaled Corticosteroid ◽

Asthma Care ◽

Asthmatic Patients ◽

Appropriate Treatment ◽

Considerable Morbidity ◽

The Cost

Severe asthma describes an asthma condition that requires a substantial amount of inhaled corticosteroid and bronchodilators to keep it under control including the frequent additional need for oral steroid to avoid exacerbations. The incidence of severe asthma in Malaysia is unknown but data elsewhere shows that it is around 5 to 10 % of asthmatics. This category of asthmatic patients has considerable morbidity, is disproportionate cost-wise to the number of sufferers and requires specialised and focused care. The management of severe asthma should be undertaken at a severe asthma clinic led by a physician with a special interest in its management. The diagnosis needs confirmation, comorbidities identified and triggering factors addressed. Inhaler technique and compliance are major contributing issues and must be addressed at all consultation opportunities. Once the diagnosis of severe asthma is confirmed, the disease needs phenotyping to plan for the most appropriate treatment, termed as a personalised approach to severe asthma care. The advances in biologics have changed the landscape of treatment of this disease but in Malaysia especially, there are many limitations namely the cost. This article briefly explores the current understanding of severe asthma, the assessment including phenotyping and possible treatment options.

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A Rare Prostate Pathology: Mantle Cell Lymphoma: A Case Report and Literature Review

Grand Journal of Urology ◽

10.5222/gju.2021.22931 ◽

2021 ◽

Author(s):

Selman Ünal ◽

Halil Uzundal ◽

Turker Soydaş ◽

Asım Özayar ◽

Arslan Ardıçoğlu ◽

...

Keyword(s):

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Treatment Options ◽

Specific Antigen ◽

Rare Condition ◽

Additional Treatment ◽

Appropriate Treatment ◽

Histopathologic Diagnosis ◽

Mantle Cell ◽

Secondary Lymphoma

Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.

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Molecular Diagnostics and Biological Safety 2021. COVID-19: Epidemiology, Diagnosis and Prophylaxis: Conference Abstracts

10.36233/978-5-6045286-2-4 ◽

2021 ◽

Keyword(s):

Clinical Features ◽

Molecular Diagnostics ◽

Distress Syndrome ◽

Treatment Options ◽

Educational Institutions ◽

Diagnostic Tools ◽

Post Vaccination ◽

Medical Practitioners ◽

Coronavirus Infection ◽

Post Infectious

The pandemic of the new coronavirus infection has spread to more than 200 countries. To date, over 130 million people have been affected and over 2.8 million have died. COVID-19 infection has a number of specific epidemiological and clinical features. In severe cases of the disease, acute respiratory distress syndrome develops, which is often fatal. The SARS-CoV-2 virus is susceptible to mutations, which alarms the scientific community all over the world. Therefore, scientific research in the field of COVID-19, the search for new diagnostic tools, methods for nonspecific and specific prevention and treatment are central topics today.This collection contains abstracts submitted by leading experts in the field of epidemiology, clinics of infectious diseases, molecular diagnostics, young researchers and medical practitioners. Published materials contain data on the methods of molecular diagnostics of COVID-19, se-quencing of the SARS-CoV-2 genome, epidemiology of new coronavirus infection, immuno-pathogenesis of COVID-19, clinical features of infection and treatment options, as well as the study of post-infectious and post-vaccination immunity and examples of complex measures for nonspecific prevention of COVID-19.The materials of the Congress are of interest to doctors and researchers of all specialties, teachers of secondary and higher educational institutions.

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Diagnosis and treatment of calcific tendinitis of the shoulder

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00318 ◽

2020 ◽

Vol 23 (4) ◽

pp. 203-209

Author(s):

Min-Su Kim ◽

In-Woo Kim ◽

Sanghyeon Lee ◽

Sang-Jin Shin

Keyword(s):

Conservative Treatment ◽

Shoulder Pain ◽

Treatment Options ◽

Review Article ◽

Calcific Tendinitis ◽

Diagnosis And Treatment ◽

Appropriate Treatment ◽

Acute Calcific Tendinitis ◽

Calcific Deposits ◽

Pain Patients

Calcific tendinitis is the leading cause of shoulder pain. Among patients with calcific tendinitis, 2.7%–20% are asymptomatic, and 35%–45% of patients whose calcific deposits are inadvertently discovered develop shoulder pain. If symptoms are present, complications such as decreased range of motion of the shoulder joint should be minimized while managing pain. Patients with acute calcific tendinitis respond well to conservative treatment and rarely require surgery. In contrast, patients with chronic calcific tendinitis often do not respond to conservative treatment and do require surgery. Clinical improvement takes time, even after surgical treatment. This review article summarizes the processes related to the diagnosis and treatment of calcific tendinitis with the aim of helping clinicians choose appropriate treatment options for their patients.

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