scholarly journals CURRENT THERAPEUTIC OPTIONS FOR CORONAVIRUS DISEASE-2019 – A PHARMACOLOGICAL REVIEW

2020 ◽  
pp. 42-50
Author(s):  
SASMI MB ◽  
MARIA JOSE ◽  
PRAVEENLAL KUTTICHIRA
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Case Series ◽  
Standard Of Care ◽  
Therapeutic Options ◽  
Cochrane Library ◽  
Global Public Health ◽  
Medical Subject Headings ◽  
Published Evidence

Objectives: Coronavirus pandemic is currently a global public health emergency. With expanding knowledge of the virus and the disease, new therapeutic targets are emerging widely. There is limited evidence about the use of different treatment options in coronavirus disease-2019 (COVID-19). This review aims to summarize the available evidence regarding therapeutic options in treating coronavirus infection. Methods: We searched PubMed, Google Scholar, and Cochrane library using pre-specified Medical Subject Headings terms about the role of therapeutic options in COVID-19 patients. Results: The majority of the published evidence is either case reports or small observational studies. Antimalarial like hydroxychloroquine reported equivocal results with five studies got positive results and five without any added benefit compared with standard of care. Lopinavir/ ritonavir monotherapy does not show any significant role except in combination with other antiviral drugs but encouraging results are emerging with remdesivir. Studies with favipiravir are inconclusive with some exhibit benefit and others not. Limited case series have shown that tocilizumab and convalescent plasma to be useful as adjuvant therapy in critically ill patients. Conclusion: There is currently no strong evidence for the efficacy of different therapeutic agents in the treatment of COVID-19. More data from ongoing and future trials will add more insight into the role of various drugs.

scholarly journals Potential of Radiolabeled PSMA PET/CT or PET/MRI Diagnostic Procedures in Gliomas/Glioblastomas

2020 ◽  
Vol 13 (2) ◽  
pp. 94-98 ◽  
Author(s):  
Francesco Bertagna ◽  
Domenico Albano ◽  
Elisabetta Cerudelli ◽  
Maria Gazzilli ◽  
Raffaele Giubbini ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Whole Body ◽  
Cochrane Library ◽  
Whole Body Imaging ◽  
Mri Imaging ◽  
Psma Pet ◽  
Pet Ct ◽  
Diagnostic Role

Background: Radiolabeled prostate-specific membrane antigen PSMA-based PET/CT or PET/MRI is a whole-body imaging technique currently performed for the detection of prostate cancer lesions. PSMA has been also demonstrated to be expressed by the neovasculature of many other solid tumors. Objective: The aim of this review is to evaluate the possible diagnostic role of radiolabeled PSMA PET/CT or PET/MRI in patients with gliomas and glioblastomas, by summarizing the available literature data. Methods: A comprehensive literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was conducted to find relevant published articles about the diagnostic performance of radiolabeled PSMA binding agents in PET/CT or PET/MRI imaging of patients with suspected gliomas or glioblastomas. Results: Seven case reports or case series and 3 studies enrolling more than 10 patients showed that gliomas and glioblastoma are PSMA-avid tumors. Conclusion: Radiolabeled PSMA imaging seems to be useful in analyzing glioma/glioblastoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of radiolabeled PSMA in this setting and its possible position in the diagnostic flow-chart.

scholarly journals Ulipristal acetate (UPA) for fibroids–IVF outcomes following treatment with UPA after IVF failure: series of 2 case reports

2017 ◽  
Vol 6 (7) ◽  
pp. 3177 ◽  
Author(s):  
Ashish R Kale
Keyword(s):  
Case Reports ◽  
Uterine Fibroids ◽  
Case Series ◽  
Standard Of Care ◽  
Infertile Woman ◽  
Ulipristal Acetate ◽  
Uterine Tumors ◽  
Size Number ◽  
Ivf Failure

Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Fibroids are present in 5-10% of infertile patients, and may be the sole cause of infertility in 1-2.4%. The removal of fibroids by hysteroscopy and laparoscopy has now become the standard of care depending upon the size, number and location of fibroids in an infertile woman. Off lately, there is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). Here, we report a case series of 2 women, with fibroids, who were put on UPA prior to IVF. These women had at least one previous IVF failure. The pre and post UPA fibroid characteristics were compared to see the effect of the drug. IVF was done post 3 month UPA therapy. Both the women showed a drastic reduction in the fibroid size, increased distance from endometrial cavity, and successful post UPA IVF cycles. Safety of the drug has been proven in few recent trials, but the role of UPA in infertile women with fibroids, who have had previous IVF failure, has opened new horizons in this field.

scholarly journals The emerging role of laparoscopic nephrectomy in the operative management of renal trauma: is less really more?

2021 ◽  
Vol 8 (7) ◽  
pp. 2140
Author(s):  
Akram A. Bokhari ◽  
Jared McDowall ◽  
Zakiyah Gaibie ◽  
Sunil Sinha ◽  
Maeyane S. Moeng ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Case Reports ◽  
Case Series ◽  
Laparoscopic Nephrectomy ◽  
Renal Trauma ◽  
Cochrane Library ◽  
Trauma Patients ◽  
Renal Surgery ◽  
Select Group

The role of laparoscopic nephrectomy (LN) is well established in the operative armamentarium of renal surgery and has also extended to the resection of benign and malignant renal neoplasms. Despite growing evidence advocating conservative management of renal trauma, the role of LN in the management of renal trauma is not well defined. Thus, a systematic review was conducted to better define the role of LN in the subgroup of renal trauma patients requiring operative nephrectomy. In accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive literature search was performed (March 2020), using the following databases: Cochrane library of systematic reviews, EMBASE, PubMed, Scopus, and web of science. Included studies were further assessed for relevance and quality using the Oxford 2010 critical appraisal skills program (CASP). A total of 620 studies were identified, non-relevant and non-English articles were excluded which resulted in 4 relevant articles being included. Due to a relative lack of data, case reports and case series were also included. The role of LN is a viable option in a select group of cases when operative intervention is already planned for advanced renal injury. The special considerations and relative contraindications to laparoscopy must be adhered to when selecting this modality in the setting of renal trauma. Future prospective studies are required to better define this relationship.

scholarly journals Struggling with recurrent Clostridium difficile infections: is donor faeces the solution?

2009 ◽  
Vol 14 (34) ◽  
Author(s):  
E van Nood ◽  
P Speelman ◽  
E J Kuijper ◽  
J J Keller
Keyword(s):  
Clostridium Difficile ◽  
Case Reports ◽  
Treatment Options ◽  
Intestinal Flora ◽  
Treatment Strategies ◽  
Case Series ◽  
Oral Vancomycin ◽  
Vancomycin Therapy ◽  
Evidence Based Treatment

Patients with recurrent Clostridium difficile infections (CDI) in hospitals and the community constitute an increasing treatment problem. While most patients with a first infection respond to either metronidazole or oral vancomycin, therapy in recurrent C. difficile infections tends to fail repeatedly. Lack of alternative treatment options can be a tremendous burden, both to patients and their treating physicians. Most guidelines recommend prolonged oral vancomycin pulse and or tapering schedules, but evidence-based treatment strategies are lacking. The role of immunoglobulins, whey prepared from vaccinated cows, probiotics or other antibiotics is unclear. Since 1958 several case series and case reports describe a treatment strategy where faecal infusions are successfully given for the treatment of recurrent CDI. Restoring intestinal flora has been historically thought of as the mechanism responsible for cure in these patients. In the literature, more than 150 patients have received faeces from a healthy donor, either infused through an enema, or through a nasoduodenal or nasogastric tube. We summarise the literature regarding treatment with donor faeces for recurrent CDI, and introduce the FECAL trial, currently open for inclusion.

scholarly journals Total Ankle Replacement in Hemophilia

2020 ◽  
Vol 20 (2) ◽  
pp. 88-92
Author(s):  
Emerito C. Rodriguez-Merchan
Keyword(s):  
Adverse Events ◽  
Daily Living ◽  
Case Reports ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Cochrane Library ◽  
Hemophilic Arthropathy ◽  
Accessible Information ◽  
Ankle Replacement

Introduction: Severe ankle hemophilic arthropathy can be a calamitous sign of severe hemophilia with important inferences for activities of daily living. Aims: To summarize the contemporary, accessible information on Total Ankle Replacement (TAR) for ankle hemophilic arthropathy. Methods: A search of Cochrane Library and PubMed (MEDLINE) regarding the role of TAR in ankle hemophilic arthropathy. Results: The insufficient information regarding the results of TAR for hemophilic arthropathy is confined to scanty case series and case reports. An evaluation of the accessible literature reveals encouraging but inconstant outcomes. The reported rate of adverse events is 33%. The reported anticipated survival of TAR is 94% at 5 years, 85% at 10 years and 70% at 15 years. Conclusion: Whereas people with advanced hemophilic arthropathy of the ankle are prone to ameliorate pain and range of motion following TAR, there is deficient knowledge to regularly recommend its use. Adverse events and infection percentages are disturbing. Moreover, the lack of survival analysis knowledge makes it difficult to assess the benefit to people with hemophilia. TAR is a demanding surgical procedure and its survival is not comparable to that after hip or knee replacement.

scholarly journals Neoadjuvant Systemic Treatment of Primary Angiosarcoma

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2251
Author(s):  
Kimberley M. Heinhuis ◽  
Nikki S. IJzerman ◽  
Winette T. A. van der Graaf ◽  
Jan Martijn Kerst ◽  
Yvonne Schrage ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Systemic Therapy ◽  
Case Reports ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Resection Margins ◽  
Term Survival ◽  
Primary Angiosarcoma ◽  
Neoadjuvant Systemic Therapy

Angiosarcoma is an extremely rare and aggressive malignancy. Standard of care of localized tumors includes surgery ± radiation. Despite this multimodal treatment, >50% of the angiosarcoma patients develop local or distant recurrent disease. The role of neoadjuvant systemic therapy is still controversial and we therefore performed a systematic review of the literature to define the role of neoadjuvant systemic therapy based on available evidence. We focused on the effects of neoadjuvant systemic therapy on: 1. The success of surgical resection and 2. the long-term survival. All articles published before October 2019 on Ovid Medline, Ovid Embase, Cochrane library and Scopus were evaluated. Eighteen case reports and six retrospective cohort studies were included. There were no randomized controlled trials. This literature showed a beneficial role of neoadjuvant chemotherapy on downsizing of the tumor resulting in an improvement of the resection margins, especially in patients with cardiac or cutaneous angiosarcoma. However, no definitive conclusions on survival can be drawn based on the available literature lacking any prospective randomized studies in this setting. We advise that neoadjuvant chemotherapy should be considered, since this could lead to less mutilating resections and a higher rate of free resection margins. An international angiosarcoma registry could help to develop guidelines for this rare disease.

scholarly journals Current Treatment Options for Cervical Leiomyomas: A Systematic Review of Literature

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 92
Author(s):  
Federico Ferrari ◽  
Sara Forte ◽  
Gaetano Valenti ◽  
Laura Ardighieri ◽  
Fabio Barra ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Surgical Complications ◽  
Case Reports ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Case Series ◽  
Weighted Average ◽  
Cochrane Library ◽  
Systematic Research ◽  
Treatment Type

Background and objectives: Cervical leiomyomas are a rare benign disease. Although they are mainly treated surgically, currently, there is not a standardized treatment for cervical leiomyomas. This study aims to summarize current literature evidence about treatment options for cervical leiomyomas. Materials and methods: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to treatment options for cervical leiomyomas, evaluating the following aspects: study design, population, treatment type, rate of surgical complications, and fertility outcome. Results: According to literature research, 38 articles were included. Among 214 patients, the weighted average age was 39.4 years-old; 23 patients were pregnant. Most of the leiomyomas (78%) were extracervical; in 22% of cases (29 patients) were intracervical; 188 patients (88%) received surgical treatment, 6 (3%) received exclusive conservative management and 21 (10%) underwent interventional radiology treatment. One hundred twenty-seven patients (67.5%) underwent myomectomy, while 54 (28.7%) and 7 (3.7%) hysterectomy and trachelectomy, respectively. Cervical myomectomy was performed by open surgery in 21 out of 127 cases (16.5%), while in 92 (72.4%) and 6 (4.7%) patients the surgical approach was performed by traditional and robot-assisted laparoscopy, respectively. The total rate of surgical complications was 5.6%. Conclusion: Surgery is the primary therapeutic option for cervical leiomyomas with a low rate of surgical complications. Interventional radiology techniques have reported promising but still limited results.

scholarly journals Update on the role of pembrolizumab in patients with unresectable or metastatic colorectal cancer

2021 ◽  
Vol 14 ◽  
pp. 175628482110244
Author(s):  
Vanessa Wookey ◽  
Axel Grothey
Keyword(s):  
Colorectal Cancer ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Standard Of Care ◽  
Cancer Type ◽  
Cancer Therapies ◽  
Multiple Cancer ◽  
Multiple Treatment

Colorectal cancer (CRC) is the third most common cancer type in both men and women in the USA. Most patients with CRC are diagnosed as local or regional disease. However, the survival rate for those diagnosed with metastatic disease remains disappointing, despite multiple treatment options. Cancer therapies for patients with unresectable or metastatic CRC are increasingly being driven by particular biomarkers. The development of various immune checkpoint inhibitors has revolutionized cancer therapy over the last decade by harnessing the immune system in the treatment of cancer, and the role of immunotherapy continues to expand and evolve. Pembrolizumab is an anti-programmed cell death protein 1 immune checkpoint inhibitor and has become an essential part of the standard of care in the treatment regimens for multiple cancer types. This paper reviews the increasing evidence supporting and defining the role of pembrolizumab in the treatment of patients with unresectable or metastatic CRC.

scholarly journals Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Nikita Mohan ◽  
Muhammad Ali Fayyaz ◽  
Christopher del Rio ◽  
Navpreet Kaur Rajinder Singh Khurana ◽  
Sampada Sandip Vaidya ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Case Reports ◽  
Healthcare Providers ◽  
Case Series ◽  
Altered Mental Status ◽  
Common Finding ◽  
Cochrane Library ◽  
Neurological Manifestations ◽  
The Cochrane Library ◽  
Ct And Mri

Abstract Background The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. Objective To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2. To identify neuro-invasive pathways of COVID infection. Methods Relevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. Results Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. Conclusion The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

Neurological associations of SARS-CoV-2 infection: A Systematic Review

2021 ◽  
Vol 20 ◽  
Author(s):  
Amaan Javed
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Case Series ◽  
Severe Infection ◽  
Cerebrovascular Diseases ◽  
Controlled Vocabulary ◽  
Cochrane Central Register ◽  
Post Traumatic Stress ◽  
Medical Subject Headings ◽  
Reported Data

Background: The current ongoing COVID-19 pandemic has compelled us to scrutinize major outbreaks in the past two decades, severe acute respiratory syndrome (SARS), in 2002, and Middle East respiratory syndrome (MERS), in 2012. We aimed to assess the associated neurological manifestations with SARS CoV-2 infection. Methods: In this systematic review, a search was carried out by key-electronic databases, controlled vocabulary, and indexing of trials to evaluate the available pertinent studies which included both medical subject headings (MeSH) and advance electronic databases comprising of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL). Peer-reviewed studies published in English and Spanish were considered which reported data on the neurological associations of individuals with suspected or laboratory-confirmed SARS-CoV-2 infection. Outcomes were nervous signs or symptoms; symptom severity; and diagnoses. Findings: Our search identified 45 relevant studies, with 21 case reports, 3 case series, 9 observational studies, 1 retrospective study, 9 retrospective reviews, and 2 prospective reviews. This systematic review revealed that most commonly reported neuronal presentations involved headache, nausea, vomiting and muscular symptoms like fibromyalgia. Anosmia and ageusia, defects in clarity or sharpness of vision (error in visual acuity), and pain may occur in parallel. Notable afflictions in the form of anxiety, anger, confusion, post-traumatic stress symptoms, and post-intensive care syndrome were observed in individuals who were kept in quarantine and those with long-stay admissions in healthcare settings. SARS CoV-2 infection may result in cognitive impairment. Patients with more severe infection exhibited uncommon manifestations, such as acute cerebrovascular diseases (intracerebral haemorrhage, stroke), rhabdomyolysis, encephalopathy, Guillain-Barré syndrome. Interpretation: SARS-CoV-2 patients experience neuronal presentations varying with the progression of the infection. Healthcare professionals should be acquainted with the divergent neurological symptoms and to curb misdiagnosis and limit long term sequelae. Health-care planners and policymakers must prepare for this eventuality, while the ongoing studies increase our knowledge base on acute and chronic neurological associations of this pathogen.

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