scholarly journals Fibroelastolytic Papulosis in a Middle-Age Female: Presentation and Review of Treatment

2019 ◽  
Vol 3 (3) ◽  
pp. 215-218
Author(s):  
Carl Barrick ◽  
An Guo Michael Chin ◽  
Veronica Rutt ◽  
Nektarios Lountzis ◽  
Cynthia Bartus
Keyword(s):  
Treatment Guidelines ◽  
Treatment Options ◽  
Specific Treatment ◽  
Standard Of Care ◽  
Additional Treatment ◽  
Left Shoulder ◽  
Management Options ◽  
Clinical Presentations ◽  
Topical Retinoids ◽  
Previously Treated

Introduction:Fibroelastolytic papulosis (FEP) is a rare, benign, acquired cutaneous disease with a histopathology that shows variable fibrosis and elastolysis of the papillary dermis. FEP clinically presents as white-ivory to yellow papules and plaques commonly occurring on the neck. Prior to this date there have been no specific treatment guidelines for FEP, thus various management options are explored in this case report. Case Report:We present a 62-year-old female with an isolated ivory, cobblestoned plaque with open comedones on the left shoulder since childhood. The histopathology confirmed the diagnosis of FEP. The patient had been previously treated with topical clindamycin, salicylic acid, tretinoin, and tazarotene without success.Conclusion: This case demonstrates the importance of recognizing FEP, as clinical presentations can vary. FEP can be distressing to patients, and it is important to explore additional treatment options. Treatment options including topical retinoids and ablative lasers have been reported, but with limited and inconsistent success. However, due to the rarity of the disease there is currently no standard of care for the treatment of FEP and additional successful treatment options are needed.

scholarly journals GUIDELINES FOR TREATMENT OF DEGENERATIVE LUMBAR SPONDYLOLISTHESIS

2016 ◽  
Vol 15 (3) ◽  
pp. 238-240 ◽  
Author(s):  
CARMEN YOSSALETH BRICEÑO-GONZÁLEZ ◽  
ADRIÁN GARCÍA-SUAREZ ◽  
EULALIO ELIZALDE-MARTÍNEZ ◽  
MARIO ANTONIO DOMÍNGUEZ-DE LA PEÑA ◽  
RUBÉN TORRES-GONZÁLEZ ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Treatment Options ◽  
Cross Sectional ◽  
Practice Guide ◽  
Transpedicular Instrumentation ◽  
Clinical Presentations ◽  
Study Results ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Axial Symptoms ◽  
Lumbar Spondylolisthesis

ABSTRACT Objectives: To determine the standard of treatment of degenerative lumbar spondylolisthesis in its different clinical presentations in UMAE Dr. Victorio de la Fuente Narváez. Methods: Six cases found in the literature were presented to 36 experts in spine surgery, along with treatment options, to thereby obtain a standard prescription for the treatment of degenerative lumbar spondylolisthesis. Analytical observational cross-sectional descriptive study. Results: It was found that the treatment of choice in cases of degenerative lumbar spondylolisthesis with axial symptoms is conservative. The surgical treatment of choice for both stable and unstable patients with radiculopathy and/or claudication is decompression + posterolateral graft + transpedicular instrumentation + discectomy (graft). Conclusions: We managed to define the degenerative lumbar spondylolisthesis treatment guidelines in our unit, which can serve as a basis for the development of a clinical practice guide.

Stroke in children

2018 ◽  
Author(s):  
Bettina Henzi ◽  
Maja Steinlin
Keyword(s):  
Treatment Guidelines ◽  
Treatment Options ◽  
Specific Treatment ◽  
Future Research ◽  
Significant Delay ◽  
Delay In Diagnosis ◽  
The Public ◽  
Arterial Ischaemic Stroke ◽  
Paediatric Stroke ◽  
Socioeconomic Burden

Stroke in children is a rare, but terrifying disease and its lifelong sequelae weigh heavy on patients and families. It is also increasingly recognized as a socioeconomic burden, ongoing for many years after the acute manifestation. There is a significant delay in diagnosis of childhood stroke. This is caused by several factors: lack of awareness among the public and professionals, childhood-specific manifestations, numerous stroke mimics, and last but not least, limited access to emergency neuroimaging for children. Fast stroke recognition tools need adaption to the special needs in children. Childhood arterial ischaemic stroke differs in aetiology from adult stroke with cerebral vasculopathies being the leading cause and cardioembolic aetiology ranking second. However, treatment guidelines are largely based on adult guidelines and expert consensus. Future research has to put emphasis on understanding pathophysiology, defining specific treatment options, and providing evidence for treatment guidelines in paediatric stroke.

scholarly journals The interaction between equipoise and logistics in clinical trials: A case study

2017 ◽  
Vol 14 (3) ◽  
pp. 314-318 ◽  
Author(s):  
Meredith G Warshaw ◽  
Vincent J Carey ◽  
Elizabeth J McFarland ◽  
Liza Dawson ◽  
Elaine Abrams ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Treatment Options ◽  
Specific Treatment ◽  
Standard Of Care ◽  
Design Stage ◽  
Ethical Review ◽  
Clinical Equipoise ◽  
Expert Clinician ◽  
Barriers To Enrollment

Introduction: Equipoise is usually discussed as an ethical issue in clinical trials. However, it also has practical implications. Background: Clinical equipoise is usually construed to mean uncertainty or disagreement among the expert clinician community. However, an individual physician’s sense of equipoise may vary by location, based on the local standard of care or availability of specific treatment options, and these differences can affect providers’ willingness to enroll participants into clinical trials. There are also logistical barriers to enrollment in international trials due to prolonged timelines for approvals by government agencies and ethical review boards. Case Study: A multinational clinical trial of bridging strategies for treatment of non-adherent HIV-infected youth, experienced differing perceptions of equipoise due to disparities in availability of treatment options by country. Unfortunately, the countries with most demand for the trial were those where the approval process was most delayed, and the study was closed early due to slow accrual. Discussion: When planning multicenter clinical trials, it is important to take into account heterogeneity among research sites and try to anticipate differences in equipoise and logistical factors between sites, in order to plan to address these issues at the design stage.

Comparison of the Treatment Guidelines for Actinic Keratosis: A Critical Appraisal and Review

2017 ◽  
Vol 21 (5) ◽  
pp. 408-417 ◽  
Author(s):  
Patrick Fleming ◽  
Stephanie Zhou ◽  
Robert Bobotsis ◽  
Charles Lynde
Keyword(s):  
United Kingdom ◽  
Actinic Keratosis ◽  
Critical Appraisal ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Expert Consensus ◽  
The United Kingdom ◽  
Clinical Presentations

There are currently several reputable guidelines on the treatment of actinic keratosis (AK) from groups in Canada, the United Kingdom, and Europe. These recommendations, based on evidence or expert consensus, offer clinicians a variety of treatment options for the different clinical presentations of AKs. Although the guidelines are similar in some regards, variations exist in treatment options, duration, and strength of recommendation. Some guidelines also lack input on specific therapies and certain types of AK, such as hypertrophic or thin presentations. The purpose of this article is to review and compare guidelines published by Canadian, UK, and European groups for the management of AKs in patients.

scholarly journals Once-Daily Nevirapine XR

2012 ◽  
Vol 11 (6) ◽  
pp. 369-373 ◽  
Author(s):  
Laveeza Bhatti ◽  
Jay Gladstein
Keyword(s):  
Clinical Trials ◽  
Serum Lipids ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Transcriptase Inhibitor ◽  
Current Treatment ◽  
Additional Treatment ◽  
Controlled Clinical Trials ◽  
Once Daily ◽  
Randomized Controlled Clinical Trials

Nevirapine (NVP) was the first nonnucleoside reverse transcriptase inhibitor (NNRTI) approved by the US Food and Drug Administration (FDA) in 1996, for the treatment of HIV infection. Current treatment guidelines include NVP as a component of a recommended alternative NNRTI regimen, which may be the preferred regimen for patients with established cardiovascular risk factors since NVP has minimal untoward effects on serum lipids. Two randomized and controlled clinical trials established the noninferior virologic efficacy of twice-daily NVP versus ritonavir-boosted atazanavir (ATV/r), a protease inhibitor with limited effects on serum lipids, each drug on a background regimen of once-daily (QD) tenofovir (TDF)/emtricitabine (FTC). An extended-release (XR) formulation of NVP was developed since QD dosing and reduced pill burdens have been shown to improve regimen adherence. This formulation (Viramune XR 400 mg) was recently FDA approved based on the results of 2 randomized, controlled clinical trials. The XR formulation will provide additional treatment options for patients who may benefit from NVP-based regimens.

The burden of illness in metastatic renal cell carcinoma (mRCC) patients after two targeted therapies: A review of the literature.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15043-e15043
Author(s):  
Giuseppe Di Lorenzo ◽  
John Coombs ◽  
Roman Casciano ◽  
Lee Stern
Keyword(s):  
Targeted Therapies ◽  
Negative Impact ◽  
Burden Of Illness ◽  
Data Extraction ◽  
Treatment Options ◽  
Unmet Need ◽  
Specific Treatment ◽  
Additional Treatment ◽  
Line Treatment ◽  
Medical Needs

e15043 Background: MRCC poses a substantial burden in terms of morbidity, mortality, impaired quality of life (QoL), and costs. Despite the emergence of targeted therapies (VEGF-TKIs and mTORs) in this setting, considerable unmet medical needs remain. Methods: A comprehensive literature search was performed to systematically review available data on the burden of mRCC. Included articles focused on the efficacy, toxicity, guidelines, therapy sequencing, and overall disease burden of mRCC patients who have failed multiple targeted therapies. Of the 933 articles mRCC articles identified, 83 met the criteria for data extraction. Results: An extensive amount of literature is published on targeted therapies in the treatment of patients with mRCC. Recently approved therapies report improved outcomes in 1st and 2nd line treatment; however, there are minimal data on the efficacy and safety of treatments following failure of 2 sequential targeted therapies. Specifically, two studies report OS in 2nd line failures: one prospective study of capecitabine as 3rd line treatment (OS: 7.2 months [CI: 4.6-8.8]) and one retrospective single arm study of 3rd line sorafenib use after failure of both VEGF-TKIs and mTORs (OS: 7 months [range: 6-10]). Consequently, of the six current practice guidelines, none recommend a specific treatment for patients who fail 2 targeted therapies. As highlighted in over 20 articles on therapy sequencing, the treatment population failing 2 targeted therapies represents an extremely heterogeneous group with a variety of prior therapies, for whom data are lacking. QoL and economic data focusing on patients in this setting were not identified. However, based upon evaluations in 1st and 2nd line patients, treatment toxicity and disease progression are expected to have a negative impact on QoL while increasing costs due to the associated need for additional treatment, hospitalizations, and other management. Conclusions: Despite significant advances in the treatment options for patients with mRCC, many patients inevitably progress and are left with few options. There is substantial unmet need for safe and effective 3rd line treatment options that can provide clinical benefit.

scholarly journals Management Options of Sacrococcygeal Pilonidal Disease.

2018 ◽  
Vol 24 (S) ◽  
pp. 859-862
Author(s):  
Zakariya Rashid ◽  
Abdur Rashid Ti (M) ◽  
Ghulam Mustafa
Keyword(s):  
Pilonidal Disease ◽  
Severe Disease ◽  
Treatment Options ◽  
Specific Treatment ◽  
Staging System ◽  
Management Options ◽  
Hospitalization Period ◽  
Group 2 ◽  
Methods Analytical ◽  
Incision Drainage

Objective: To Assess the outcome of different treatment options we used in our 310 Cases of Sacro Coccygeal Pilonidal Disease in 12 Years. Methods: Analytical case study. 310 Patients were divided in 4 groups according to the stage of disease. Ist group, sinuses with occasional discharge (110 Cases) had eccentric excision closed with advancing flap. (Karydakis Flap). 2nd group, limited disease with dryed up occasionally bleeding track excised and closed under local anaesthesia (17 Case). Third group, very extensive, severe disease with multiple sinuses (161 cases). Treated with Lim berg flap. 4th group of acute abscess treated with incision drainage and debridement, (22 Cases). Results: Hospitalization period 3.5 days in all groups. Mean period for healing 3.8 wreaks. Late recurrences after one year follow up were; In group 1, karydakis flap, 1.85%, Group 2, Local excision Nil, Group 3, Limbergs flap Nil, Group 4, incision drainage of abscess 18.3%. Conclusion: For best results we need to define a staging system consistent with varied clinical presentation of the disease resulting in a stage specific treatment approach.

scholarly journals Prolapsed Hemorrhoids Treatment Options

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Kamal Ahmad Saeed ◽  
Faruq Hassan Faraj ◽  
Hardi Mohammed Dhahir
Keyword(s):  
Topical Application ◽  
Treatment Options ◽  
Specific Treatment ◽  
Case Series ◽  
Anal Pain ◽  
Clinical Presentations ◽  
Case Series Study ◽  
Study Case ◽  
A Prospective Study ◽  
Series Study

Objectives: Hemorrhoids are among the most common complaints worldwide, ranging from painless rectal bleeding to prolapsed hemorrhoids. Hemorrhoids can be classified into external and internal types. External hemorrhoids do not need any specific treatment unless they are cause pain, bleed or become thrombosed. Methods: This study is a prospective study (case series study), approved by ethical committee, conducted on Fifty patients with prolapsed pile, 46 of whom were males and 4 were females and were collected in the span of 2 years from Sulaymaniyah Teaching hospital and Shar hospital. Topical application of mannitol included a gauze soaked with mannitol solution and applied to the prolapsed hemorrhoids. Results: All the patients presented with prolapsed hemorrhoids, 46 of them were males and 4 of them were females. Most of patients were heavy workers (46%), while students made up (18%), employee (22%), retired (8%) and free workers (6%). The most common clinical presentations were constipation (72%), anal pain (68%), bleeding (50%), itching (14%), discharge (4%) and  prolapse only (6%). Conclusions: Prolapsed hemorrhoid can be managed conservatively by topical application of mannitol as it decreases edema, causing the hemorrhoidal tissue to retract to its position.

A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review

2016 ◽  
Vol 33 (S1) ◽  
pp. S544-S544
Author(s):  
K. Kulkarni ◽  
R. Arasappa ◽  
K. Prasad ◽  
A. Zutshi ◽  
P. Chand ◽  
...  
Keyword(s):  
Chart Review ◽  
Second Generation ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Specific Treatment ◽  
Retrospective Chart Review ◽  
Delusional Disorder ◽  
Response To Treatment ◽  
Second Generation Antipsychotics ◽  
Competing Interest

IntroductionThere is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.Objectives and aimsWe aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.ResultsA total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).ConclusionOur study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Strategies for Continued Successful Treatment in Patients with Alzheimer’s Disease: An Overview of Switching Between Pharmacological Agents

2018 ◽  
Vol 15 (10) ◽  
pp. 964-974 ◽  
Author(s):  
Rafael Blesa ◽  
Kazuhiro Toriyama ◽  
Kengo Ueda ◽  
Sean Knox ◽  
George Grossberg
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Successful Treatment ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Standard Of Care ◽  
Current Treatment ◽  
Pharmacological Agents ◽  
First Line Therapy ◽  
Clinical Benefits

Introduction: Alzheimer’s disease (AD) is the most common cause of dementia, characterized by a progressive decline in cognition and function. Current treatment options for AD include the cholinesterase inhibitors (ChEIs) donepezil, galantamine, and rivastigmine, as well as the N-methyl-Daspartate receptor antagonist memantine. Treatment guidelines recommend the use of ChEIs as the standard of care first-line therapy. Several randomized clinical studies have demonstrated the benefits of ChEIs on cognition, global function, behavior and activities of daily living. However, patients may fail to achieve sustained clinical benefits from ChEIs due to lack/loss of efficacy and/or safety, tolerability issues, and poor adherence to the treatment. The purpose of this review is to explore the strategies for continued successful treatment in patients with AD. Methods: Literature search was performed for articles published in PubMed and MEDLINE, using prespecified search terms. Articles were critically evaluated for inclusion based on their titles, abstracts, and full text of the publication. Results and Conclusion: The findings of this review indicate that dose up-titration and switching between ChEIs may help to improve response to ChEI treatment and also address issues such as lack/loss of efficacy or safety/tolerability in patients with AD. However, well-designed studies are needed to provide robust evidence.

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