scholarly journals Preoperative evaluation and surgical strategy for epileptic spasms in children

2021 ◽  
Vol 7 (1) ◽  
pp. 56-64
Author(s):  
Yiou Liu ◽  
Wenjing Zhou ◽  
Jiuluan Lin ◽  
Jie Shi ◽  
Haixiang Wang
Keyword(s):  
Drug Resistance ◽  
Surgical Treatment ◽  
Adrenocorticotropic Hormone ◽  
Preoperative Evaluation ◽  
Surgical Strategy ◽  
Surgical Indications ◽  
First Line ◽  
Developmental Regression ◽  
Epileptic Spasms ◽  
Surgical Options

Epileptic spasm (ES) is one of the most common types of seizures in children. It is primarily characterized by brief axial contractions lasting less than 2 s and recurring in short clusters. It usually occurs in children of 3 to 12 months of age, although it can also occur after the age of 1 year. In general, children with ES develop other symptoms of epilepsy, such as tonic, tonic‐clonic, or focal seizures, after 3 to 5 years of age. ES in children is often damaging and usually results in developmental regression. First‐line treatments for spasm seizures include adrenocorticotropic hormone (ACTH) and vigabatrin. However, many patients fail to respond to these medications, and continued to have spasms associated with progressive neurodevelopmental degeneration. Therefore, it is important to consider whether children with drug resistance meet surgical indications to consider surgical treatment in such conditions. In this study, we reviewed and summarized the importance of preoperative evaluation in order to provide surgical options for treatment of children with ES.

scholarly journals Deploying triple artemisinin-based combination therapy (TACT) for malaria treatment in Africa: ethical and practical considerations

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Paulina Tindana ◽  
Freek de Haan ◽  
Chanaki Amaratunga ◽  
Mehul Dhorda ◽  
Rob W. van der Pluijm ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Combination Therapy ◽  
Southeast Asia ◽  
Malaria Control ◽  
Lessons Learned ◽  
Line Treatment ◽  
African Continent ◽  
First Line ◽  
First Line Treatment ◽  
Made In

AbstractMalaria remains a major cause of morbidity and mortality in Africa, particularly in children under five years of age. Availability of effective anti-malarial drug treatment is a cornerstone for malaria control and eventual malaria elimination. Artemisinin-based combination therapy (ACT) is worldwide the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail in Southeast Asia because of drug resistance. Resistance to artemisinins and their partner drugs could spread from Southeast Asia to Africa or emerge locally, jeopardizing the progress made in malaria control with the increasing deployment of ACT in Africa. The development of triple artemisinin-based combination therapy (TACT) could contribute to mitigating the risks of artemisinin and partner drug resistance on the African continent. However, there are pertinent ethical and practical issues that ought to be taken into consideration. In this paper, the most important ethical tensions, some implementation practicalities and preliminary thoughts on addressing them are discussed. The discussion draws upon data from randomized clinical studies using TACT combined with ethical principles, published literature and lessons learned from the introduction of artemisinin-based combinations in African markets.

scholarly journals Exploiting vulnerabilities in cancer signalling networks to combat targeted therapy resistance

2018 ◽  
Vol 62 (4) ◽  
pp. 583-593 ◽  
Author(s):  
Peter T. Harrison ◽  
Paul H. Huang
Keyword(s):  
Drug Resistance ◽  
Targeted Therapy ◽  
Kinase Inhibitors ◽  
Effective Means ◽  
Deep Understanding ◽  
Therapy Resistance ◽  
Resistance Mechanisms ◽  
Precision Oncology ◽  
First Line ◽  
Clinical Responses

Drug resistance remains one of the greatest challenges facing precision oncology today. Despite the vast array of resistance mechanisms that cancer cells employ to subvert the effects of targeted therapy, a deep understanding of cancer signalling networks has led to the development of novel strategies to tackle resistance both in the first-line and salvage therapy settings. In this review, we provide a brief overview of the major classes of resistance mechanisms to targeted therapy, including signalling reprogramming and tumour evolution; our discussion also focuses on the use of different forms of polytherapies (such as inhibitor combinations, multi-target kinase inhibitors and HSP90 inhibitors) as a means of combating resistance. The promise and challenges facing each of these polytherapies are elaborated with a perspective on how to effectively deploy such therapies in patients. We highlight efforts to harness computational approaches to predict effective polytherapies and the emerging view that exceptional responders may hold the key to better understanding drug resistance. This review underscores the importance of polytherapies as an effective means of targeting resistance signalling networks and achieving durable clinical responses in the era of personalised cancer medicine.

Pituitary Adenomas that Produce Adrenocorticotropic Hormone and A-Subunit: Clinicopathological, Immunohistochemical, Ultrastructural, and Immunoelectron Microscopic Studies in Nine Cases

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 397-403 ◽  
Author(s):  
Kathryn K. Berg ◽  
Bernd W. Scheithauer ◽  
Ignacio Felix ◽  
Kalman Kovacs ◽  
Eva Horvath ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Adrenocorticotropic Hormone ◽  
Secretory Granules ◽  
Preoperative Evaluation ◽  
Periodic Acid ◽  
Periodic Acid Schiff ◽  
Double Labeling ◽  
Corticotroph Adenoma ◽  
A Subunit ◽  
Corticotroph Adenomas

Abstract Eight surgical and one autopsy specimen of pituitary adenomas (six cases of Cushing's disease, two of Nelson's syndrome. and one of hypopituitarism) were studied by histochemical, immunohistocytological, and ultrastructural methods. Eight tumors showed the characteristic histochemical profile of corticotroph adenoma—amphophilic to basophilic, and periodic acid-Schiff-positive to some extent. In all tumors, immunohistochemical studies revealed adrenocorticotropic hormone (ACTH) and à-subunit in the cytoplasm of some adenoma cells. By electron microscopy, seven tumors were found to be monomorphous; six were typical corticotroph adenomas and one was a subtype II silent corticotroph adenoma. One unique lesion was bimorphous—i.e., composed of corticotrophs as well as cells resembling glycoprotein cells. Immunoelectron microscopy by the double-labeling immunogold technique, performed on one corticotroph adenoma, demonstrated the presence of ACTH and à-subunit not only within the same adenoma cells but also within the same secretory granules. The cytogenesis of ACTH à-subunit tumors, a rare form of plurihormonal adenoma. remains to be elucidated. The duration of disease associated with these tumors exceeded the duration in patients with ordinary corticotroph adenomas. Given the low frequency with which increases in serum à-subunit are detectable in patients with such tumors—13% in this series—hormone production is not recognized at preoperative evaluation.

scholarly journals Tenofovir-based regimens associated with less drug resistance in HIV-1-infected Nigerians failing first-line antiretroviral therapy

AIDS ◽  
2013 ◽  
Vol 27 (4) ◽  
pp. 553-561 ◽  
Author(s):  
Mary-Ann A. Etiebet ◽  
James Shepherd ◽  
Rebecca G. Nowak ◽  
Man Charurat ◽  
Harry Chang ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
First Line ◽  
Hiv 1

Surgical management of congenital coronary arterial anomalies in adults

2010 ◽  
Vol 20 (S3) ◽  
pp. 68-85 ◽  
Author(s):  
Sameh M. Said ◽  
Joseph A. Dearani ◽  
Harold M. Burkhart ◽  
Hartzell V. Schaff
Keyword(s):  
Surgical Treatment ◽  
Sudden Cardiac Death ◽  
Coronary Arteries ◽  
Myocardial Ischaemia ◽  
Congenital Anomalies ◽  
Cardiac Death ◽  
Indications For Surgery ◽  
Surgical Options ◽  
Cause Of Pain ◽  
Arterial Anomalies

AbstractCongenital anomalies of the coronary arteries are an uncommon, but important, cause of pain in the chest, myocardial ischaemia and even sudden cardiac death, especially in young individuals. This paper focuses on the surgical treatment of congenital anomalies of the coronary arteries in adults; indications for surgery and the different surgical options will be reviewed.

scholarly journals Surgical treatment of pulmonary tuberculosis in patients with concurrent parenteral viral hepatitis

2020 ◽  
Vol 98 (6) ◽  
pp. 22-26
Author(s):  
S. N. Shugаevа ◽  
А. E. Suzdаlnitskiy ◽  
E. D. Sаvilov ◽  
S. I. Mаlov ◽  
I. V. Mаlov
Keyword(s):  
Drug Resistance ◽  
Surgical Treatment ◽  
Viral Hepatitis ◽  
Hepatitis Virus ◽  
Small Scale ◽  
Surgical Interventions ◽  
Tuberculosis Patients ◽  
Continuous Sampling ◽  
Extensive Drug Resistance ◽  
Chronic Course

The objective: to assess the effect of parenteral viral hepatitis on the manifestations of respiratory tuberculosis and the nature of surgical interventions for tuberculosis.Subjects and methods. An ambispective observational study was conducted with a continuous sampling of 475 respiratory tuberculosis patients over 18 years old who underwent surgical interventions. The patients are divided into two groups: the group of RTB+PVH consisted of 92 patients with concurrent respiratory tuberculosis and chronic parenteral viral hepatitis; the group of RTB included 383 patients with respiratory tuberculosis and no parenteral viral hepatitis.Results. It was found that compared with RTB group, in RTB+PVH group (regardless of the type of hepatitis virus), a chronic course of tuberculosis was registered significantly more often (42.4%; p = 0.005; OS = 2.0); more often bacillary excretion was documented (68.5%; p = 0.035; OR = 1.7), including those with multiple and extensive drug resistance (52.4% of cases with positive sputum tests, p = 0.048; OR = 1.8). Radical (69.6%; p = 0.05; OS = 1.7) and small-scale surgical interventions (64.1%; p = 0.037; OS = 1.8) were significantly less frequently performed in RTB+PVH patients; and such patients often developed postoperative complications (8.7%; p = 0.009; OS = 2.9).

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