scholarly journals Main metabolic and toxic polyneuropathies in clinical practice

2021 ◽  
pp. 134-146
Author(s):  
N. V. Pizova
Keyword(s):  
Clinical Symptoms ◽  
Diabetic Polyneuropathy ◽  
Pathological Process ◽  
Clinical Settings ◽  
Therapeutic Approaches ◽  
Clinical Form ◽  
Drug Induced ◽  
Diagnosis And Prognosis ◽  
Almost All ◽  
Attending Physicians

Polyneuropathies are diseases of the peripheral nervous system with lesions of motor, sensory or autonomic fibers which are encountered by attending physicians of almost all specialties in outpatient and clinical settings. To date, more than 100 different causes of polyneuropathies have been identified. Metabolic and toxic polyneuropathies are the most common in the group of secondary polyneuropathies. Diabetic, alcoholic, uremic, and drug-induced polyneuropathies take the leading place among these diseases. The main forms of diabetic polyneuropathy are presented. The main clinical form is distal symmetrical polyneuropathy. Clinical symptoms depend on the type of fibers involved in the pathological process - thin or thick. There is an assessment scale in points to determine the severity of diabetic polyneuropathy, which helps in clarifying the diagnosis and prognosis of the disease. The next most frequent among metabolic polyneuropathies is uremic polyneuropathy as the most frequent complication in patients suffering from chronic renal insufficiency. Risk factors of uremic polyneuropathy development, clinical picture, the course of the disease are described. Within the framework of toxic polyneuropathies, the main place is given to alcoholic polyneuropathies, chemotherapy-induced, and drug-induced. For each of these categories, clinical forms and pathophysiology of development are described. For all polyneuropathies, the main diagnostic aspects are presented. The main therapeutic approaches are shown. A separate place is given to the use of alpha-lipoic acid.

AN OBSERVATIONAL STUDY OF THE CLINICAL PROFILE AND OUTCOMES OF PATIENTS WITH MILIARY TUBERCULOSIS (TB).

2021 ◽  
pp. 11-14
Author(s):  
Rajeev Tandon ◽  
Prabhat Kumar ◽  
Pradeep Nirala ◽  
Ansha Sinha
Keyword(s):  
Mortality Rate ◽  
Observational Study ◽  
Clinical Symptoms ◽  
Treatment Success ◽  
Miliary Tuberculosis ◽  
Time Duration ◽  
Drug Induced ◽  
Treatment Regimens ◽  
Standardized Treatment ◽  
Almost All

Objectives: This study aimed to evaluate the clinical prole and outcome of the patients with miliary tuberculosis (TB). Methods: This was a retrospective observational study which involved evaluation of medical records of 44 patients with miliary TB in the department of respiratory medicine and internal medicine from 2016-2019. Miliary TB in these patients had been diagnosed on the basis of clinical symptoms, radiology and microbiology. The clinical prole of the patients in terms of age, gender, clinical presentations were recorded. Time duration for resolution of symptoms was noted. Radiological outcome was also studied. Final outcome was treatment success and mortality. Results: The mean age of the patients were 37.07 years with 27 males. Most common complaints were fever (86.36%), cough (72.73%), expectoration (65.91%) and anorexia (45.45%). Laboratory ndings showed hypertransaminasemia, anemia, and hyponatremia in 75.00%, 70.45%, and 43.18% patients, respectively. Standardized treatment (RHEZ) was given in 70.45% patients, and non-standardized treatment in 29.55% patients. Median duration of fever was relieved in 15 days. Mortality rate was 11.36% and drug induced liver injury (DILI) was seen in 4(9.09%) patients. Radiological resolution was seen in almost all of the patients except in 3 and in majority of patients clearing was seen within the rst two months of initiation of treatment. Among all variables, hyperbilirubinemia showed signicant association with mortality (OR=14.6, 95% CI 1.86 to 114.615, P=0.013). Conclusion: In conclusion, in our series miliary TB presents most commonly in the third decade of life and is predominant among males. The clinical features were similar to pulmonary tuberculosis. There was frequent association with derangements in liver function, electrolyte, and hemoglobin. Hyperbilirubinemia was associated with signicantly increased the odds of mortality. Non-standardized treatment regimens were associated with poorer outcome. Mortality rate in miliary TB was as high as 11.3% in our series.

scholarly journals TMPRSS2 As an Influential Human Gene for COVID-19

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Sepideh Abdollahi ◽  
Pantea Izadi
Keyword(s):  
Risk Factors ◽  
Clinical Symptoms ◽  
Epidemiological Studies ◽  
Therapeutic Approaches ◽  
Diverse Range ◽  
Angiotensin Converting Enzyme 2 ◽  
Clinical Presentations ◽  
Health System Efficiency ◽  
Almost All

: In December 2019, the new virus, COVID-19, emerged and led to a pandemic respiratory acute disease. Almost all countries have experienced different rates of morbidity and mortality. These differences can be attributed to factors such as a diagnostic test capacity for COVID-19 and the health system efficiency. Besides the differences between countries related to the COVID-19 management, different patients represent a diverse range of clinical symptoms, from outpatient to patients admitted to the intensive care unit (ICU) due to the severity of symptoms. To gain deeper insights into such disparities in the severity of COVID-19 clinical presentations, epidemiological studies have reported risk factors such as old age, male sex, underlying chronic diseases such as diabetes, inflammatory and cardiovascular diseases, which have a bearing on susceptibility to COVID-19. In addition to these risk factors, the molecular mechanism involved in the virus entry process has been under investigation. Apart from a well-known protein called ACE2 (angiotensin-converting enzyme 2), which plays the receptor role for COVID-19, another essential protein in this pathway is TMPRSS2 (transmembrane protease, serine 2). This protease has a crucial role in effective membrane integration between the virus and the target cell. This process can affect the severity of the infection and the mortality rate of the disease. Thus, it seems that understanding the role of TMPRSS2 in COVID-19 infection can help better management by designing TMPRSS2 inhibitors drugs. Given the variants of the TMPRSS2 gene, which are associated with the severity of symptoms, people exposed to severe forms of this disease can be identified before the deterioration of the disease to adopt appropriate therapeutic approaches. Therefore, this study focused on the different levels of the TMPRSS2 interactions with COVID-19 virus and disease severity.

scholarly journals Recent update on the management of anaphylaxis

2021 ◽  
Vol 8 (3) ◽  
pp. 160-172
Author(s):  
Quang Luu Quoc ◽  
Tra Cao Thi Bich ◽  
Jae-Hyuk Jang ◽  
Hae-Sim Park
Keyword(s):  
Clinical Symptoms ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Drug Induced ◽  
Tryptase Level ◽  
Systemic Corticosteroids ◽  
Life Threatening ◽  
New Guidelines ◽  
Almost All ◽  
Physical Findings

Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.

A Hexagonal (II) Phase Phospholipid Neutralization Assay for Lupus Anticoagulant Identification

1993 ◽  
Vol 70 (05) ◽  
pp. 787-793 ◽  
Author(s):  
Douglas A Triplett ◽  
Linda K Barna ◽  
Gail A Unger
Keyword(s):  
Hemophilia A ◽  
Clinical Laboratory ◽  
Neutralization Assay ◽  
Confirmatory Test ◽  
Specific Factor ◽  
Clinical Settings ◽  
Drug Induced ◽  
Variable Screening ◽  
Routine Clinical Laboratory

SummaryLupus anticoagulants (LAs) are immunoglobulins (IgG, IgM, or both) which interfere with in vitro phospholipid (PL) dependent tests of coagulation (e.g. APTT, dilute PT, dilute Russell Viper Venom Time). These antibodies may be identified in a wide variety of clinical settings. With the exception of heparinized patient samples, the presence of LAs is often the most common cause of an unexplained APTT in a routine clinical laboratory. The diagnosis of LAs is difficult due to variable screening reagent sensitivity and intrinsic heterogeneity of LAs. Recently, Rauch and colleagues have shown human monoclonal hybridoma LAs were inhibited by hexagonal (II) phase PLs. In contrast, lamellar phase PLs had no effect. We have evaluated a new assay system, Staclot LA®, which utilizes a hexagonal (II) phase PL (egg phosphatidylethanolamine [EPE]) as a confirmatory test for LAs. Plasma samples from the following patient populations were studied: LA positive, heparinized, oral anticoagulated, hemophilia A and B, and specific factor inhibitors (factors V, VIII, IX). Unlike previous studies, the LA positive patients were a mixed population including: autoimmune diseases, drug-induced, and post-infection. Our findings confirm the specificity of hexagonal (II) phase PL neutralization of LAs.

scholarly journals Characteristics and Clinical Application of Extracellular Vesicle-Derived DNA

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3827
Author(s):  
Jae Young Hur ◽  
Kye Young Lee
Keyword(s):  
Therapeutic Potential ◽  
Extracellular Vesicle ◽  
Clinical Settings ◽  
Biomarker Detection ◽  
Diagnosis And Prognosis ◽  
Double Stranded Dna ◽  
Fundamental Research ◽  
The Stability ◽  
Next Generation Sequencing Ngs ◽  
Generation Sequencing

Extracellular vesicles (EVs) carry RNA, proteins, lipids, and diverse biomolecules for intercellular communication. Recent studies have reported that EVs contain double-stranded DNA (dsDNA) and oncogenic mutant DNA. The advantage of EV-derived DNA (EV DNA) over cell-free DNA (cfDNA) is the stability achieved through the encapsulation in the lipid bilayer of EVs, which protects EV DNA from degradation by external factors. The existence of DNA and its stability make EVs a useful source of biomarkers. However, fundamental research on EV DNA remains limited, and many aspects of EV DNA are poorly understood. This review examines the known characteristics of EV DNA, biogenesis of DNA-containing EVs, methylation, and next-generation sequencing (NGS) analysis using EV DNA for biomarker detection. On the basis of this knowledge, this review explores how EV DNA can be incorporated into diagnosis and prognosis in clinical settings, as well as gene transfer of EV DNA and its therapeutic potential.

scholarly journals Targeting RB1 Loss in Cancers

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3737
Author(s):  
Paing Linn ◽  
Susumu Kohno ◽  
Jindan Sheng ◽  
Nilakshi Kulathunga ◽  
Hai Yu ◽  
...  
Keyword(s):  
Cell Cycle Progression ◽  
Suppressor Gene ◽  
Therapeutic Approaches ◽  
Neighboring Gene ◽  
Genomic Aberration ◽  
Cycle Progression ◽  
Synthetic Lethal ◽  
Mitotic Kinases ◽  
Promote Cell Cycle Progression ◽  
Almost All

Retinoblastoma protein 1 (RB1) is encoded by a tumor suppressor gene that was discovered more than 30 years ago. Almost all mitogenic signals promote cell cycle progression by braking on the function of RB1 protein through mono- and subsequent hyper-phosphorylation mediated by cyclin-CDK complexes. The loss of RB1 function drives tumorigenesis in limited types of malignancies including retinoblastoma and small cell lung cancer. In a majority of human cancers, RB1 function is suppressed during tumor progression through various mechanisms. The latter gives rise to the acquisition of various phenotypes that confer malignant progression. The RB1-targeted molecules involved in such phenotypic changes are good quarries for cancer therapy. Indeed, a variety of novel therapies have been proposed to target RB1 loss. In particular, the inhibition of a number of mitotic kinases appeared to be synthetic lethal with RB1 deficiency. A recent study focusing on a neighboring gene that is often collaterally deleted together with RB1 revealed a pharmacologically targetable vulnerability in RB1-deficient cancers. Here we summarize current understanding on possible therapeutic approaches targeting functional or genomic aberration of RB1 in cancers.

scholarly journals Drug-Induced Photosensitivity—From Light and Chemistry to Biological Reactions and Clinical Symptoms

2021 ◽  
Vol 14 (8) ◽  
pp. 723
Author(s):  
Justyna Kowalska ◽  
Jakub Rok ◽  
Zuzanna Rzepka ◽  
Dorota Wrześniok
Keyword(s):  
Defense Mechanisms ◽  
Clinical Symptoms ◽  
Chemical Properties ◽  
Additional Treatment ◽  
Cosmetic Products ◽  
Aesthetic Value ◽  
Drug Usage ◽  
Drug Induced ◽  
Biochemical Level ◽  
The Aesthetic

Photosensitivity is one of the most common cutaneous adverse drug reactions. There are two types of drug-induced photosensitivity: photoallergy and phototoxicity. Currently, the number of photosensitization cases is constantly increasing due to excessive exposure to sunlight, the aesthetic value of a tan, and the increasing number of photosensitizing substances in food, dietary supplements, and pharmaceutical and cosmetic products. The risk of photosensitivity reactions relates to several hundred externally and systemically administered drugs, including nonsteroidal anti-inflammatory, cardiovascular, psychotropic, antimicrobial, antihyperlipidemic, and antineoplastic drugs. Photosensitivity reactions often lead to hospitalization, additional treatment, medical management, decrease in patient’s comfort, and the limitations of drug usage. Mechanisms of drug-induced photosensitivity are complex and are observed at a cellular, molecular, and biochemical level. Photoexcitation and photoconversion of drugs trigger multidirectional biological reactions, including oxidative stress, inflammation, and changes in melanin synthesis. These effects contribute to the appearance of the following symptoms: erythema, swelling, blisters, exudation, peeling, burning, itching, and hyperpigmentation of the skin. This article reviews in detail the chemical and biological basis of drug-induced photosensitivity. The following factors are considered: the chemical properties, the influence of individual ranges of sunlight, the presence of melanin biopolymers, and the defense mechanisms of particular types of tested cells.

A case of statin-induced liver injury with positive rechallenge with a second statin. Is there a class effect?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Giovanna Onfiani ◽  
Fabio Nascimbeni ◽  
Francesca Carubbi
Keyword(s):  
Liver Injury ◽  
Clinical Symptoms ◽  
High Risk Population ◽  
Drug Induced ◽  
Case Presentation ◽  
Drug Induced Liver Injury ◽  
Aged Woman ◽  
Cardiovascular Morbidity And Mortality ◽  
Middle Aged Woman

Abstract Objectives Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported. Case presentation We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI. Conclusions In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.

Regional anesthesia and acute compartment syndrome: principles for practice

2021 ◽  
pp. rapm-2021-102735
Author(s):  
Tim Dwyer ◽  
David Burns ◽  
Aaron Nauth ◽  
Kaitlin Kawam ◽  
Richard Brull
Keyword(s):  
Compartment Syndrome ◽  
Regional Anesthesia ◽  
Clinical Symptoms ◽  
Motor Nerve ◽  
Acute Compartment Syndrome ◽  
Clinical Settings ◽  
Tissue Ischemia ◽  
Orthopedic Surgical Procedures ◽  
Cardinal Symptom ◽  
Symptoms And Signs

Acute compartment syndrome (ACS) is a potentially reversible orthopedic surgical emergency leading to tissue ischemia and ultimately cell death. Diagnosis of ACS can be challenging, as neither clinical symptoms nor signs are sufficiently sensitive. The cardinal symptom associated with ACS is pain reported in excess of what would otherwise be expected for the underlying injury, and not reasonably managed by opioid-based analgesia. Regional anesthesia (RA) techniques are traditionally discouraged in clinical settings where the development of ACS is a concern as sensory and motor nerve blockade may mask symptoms and signs of ACS. This Education article addresses the most common trauma and elective orthopedic surgical procedures in adults with a view towards assessing their respective risk of ACS and offering suggestions regarding the suitability of RA for each type of surgery.

scholarly journals Therapeutic Effects of Hydrogen in Animal Models of Parkinson's Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Kyota Fujita ◽  
Yusaku Nakabeppu ◽  
Mami Noda
Keyword(s):  
Oxidative Stress ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Animal Models ◽  
Animal Studies ◽  
Clinical Symptoms ◽  
Therapeutic Effects ◽  
Therapeutic Approaches ◽  
Cellular Apoptosis ◽  
6 Hydroxydopamine

Since the first description of Parkinson's disease (PD) nearly two centuries ago, a number of studies have revealed the clinical symptoms, pathology, and therapeutic approaches to overcome this intractable neurodegenerative disease. 1-methy-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 6-hydroxydopamine (6-OHDA) are neurotoxins which produce Parkinsonian pathology. From the animal studies using these neurotoxins, it has become well established that oxidative stress is a primary cause of, and essential for, cellular apoptosis in dopaminergic neurons. Here, we describe the mechanism whereby oxidative stress evokes irreversible cell death, and propose a novel therapeutic strategy for PD using molecular hydrogen. Hydrogen has an ability to reduce oxidative damage and ameliorate the loss of nigrostriatal dopaminergic neuronal pathway in two experimental animal models. Thus, it is strongly suggested that hydrogen might provide a great advantage to prevent or minimize the onset and progression of PD.

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