scholarly journals Severely ill patients with tuberculosis: the option to reduce mortality and optimize management with the help of step therapy and the usage of infusion forms of anti-tuberculosis drugs

2020 ◽  
pp. 170-171
Author(s):  
N.A. Lytvynenko
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Oral Administration ◽  
Blood Plasma ◽  
Digestive System ◽  
Intravenous Treatment ◽  
Main Disadvantage ◽  
Step Therapy ◽  
In Blood Plasma

Background. A doctor often has to answer the question whether it is sufficient to treat tuberculosis (TB) exclusively with the oral forms of anti-tuberculosis drugs (ATD). In general, the answer is yes, if the absorption of drugs and their delivery to the affected organs is not impaired. However, drug absorption is often impaired due to hypoalbuminemia, TB of the gastrointestinal tract or central nervous system, concomitant diseases of the digestive system, alcoholism, hyperthyroidism, diabetes, or in the elderly patients. Objective. To evaluate the feasibility of using infusion forms of ATD. Materials and methods. Review of current guidelines. Results and discussion. The advantages of exclusively oral administration of ATD include convenience, low cost, the possibility of usage in an outpatient setting, whereas the main disadvantage is that it is not always possible to create the required concentration of ATD in blood plasma. In turn, the advantages of intravenous ATD include the creation of maximal concentrations in blood plasma and foci of infection, fewer side effects in the digestive system, patients’ awareness of the importance of treatment, whereas disadvantages are high cost and low adherence to treatment. The use of part of the ATD as a step therapy (course of intravenous infusions with subsequent transition to oral administration) allows to create the maximal concentration of active substances in blood plasma and affected organs at the beginning of treatment, to provide better cost/effectiveness ratio in comparison to previously listed regimens, and to increase the treatment adherence without compromising the quality of life of patients. The additional cost of intravenous ATD delivery devices is the main disadvantage. Criteria for the transition from the infusions to oral administration are the elimination of bacterial excretion, obtaining a stable positive dynamics of the clinical condition, elimination of the causes of the need for intravenous treatment (normalization of swallowing function, elimination of malabsorption). Indications for step therapy include the severe forms of TB, severe disorders of the central nervous system and gastrointestinal tract, the presence of severe comorbidities, pre- and postoperative periods, mental disorders, side effects of 3rd-4th degree in case of oral ATD intake. The duration of the infusion course is determined individually, but in average it is about 1-2 months. Such drugs as rifampicin, isoniazid, ethambutol, levofloxacin, moxifloxacin, linezolid, and carbapenems exist in the infusion form. Conclusions. 1. Infusion of ATD as a part of step therapy can improve the quality of treatment of TB patients. 2. Criteria for the transition from infusions to oral administration are the elimination of bacterial excretion, obtaining a stable positive dynamics of the clinical condition, elimination of the causes of the need for intravenous treatment. 3. The duration of the infusion course is determined individually (in average – 1-2 months).

scholarly journals QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii438-iii438
Author(s):  
Kathleen Dorris ◽  
Jessica Channell ◽  
Ashley Mettetal ◽  
Molly Hemenway ◽  
Natalie Briones ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Cell Activity ◽  
Cns Tumors ◽  
Low Grade ◽  
Tumor Type ◽  
Central Nervous System Tumor ◽  
The Impact

Abstract BACKGROUND Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population. METHODS A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected. RESULTS Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy. CONCLUSIONS Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.

Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors

2021 ◽  
Author(s):  
A McCauley Massie ◽  
Jonathan Ebelhar ◽  
Kristen E Allen ◽  
Nicholas P DeGroote ◽  
Karen Wasilewski-Masker ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
End Of Life ◽  
Phase 1 ◽  
Marrow Transplant ◽  
Cns Tumors ◽  
Do Not Resuscitate ◽  
Intensive Care Admission ◽  
Repeated Events

Abstract Background Children with brain and central nervous system (CNS) tumors experience substantial challenges to their quality of life during their disease course. These challenges are opportunities for increased subspecialty palliative care (PC) involvement. Palliative opportunities have been defined in the pediatric oncology population, but the frequency, timing, and factors associated with palliative opportunities in pediatric patients with CNS tumors are unknown. Methods A single-institution retrospective review was performed on children ages 0-18 diagnosed with a CNS tumor who died between 01/01/2012-11/30/2017. Nine palliative opportunities were defined prior to data collection (progression; relapse; admission for severe symptoms; intensive care admission; bone marrow transplant; phase 1 trial; hospice; do-not-resuscitate (DNR) order). Demographic, disease, treatment, palliative opportunity, and end-of-life data were collected. Opportunities were evaluated over quartiles from diagnosis to death. Results Amongst 101 patients with a median age at death of eight years (Interquartile range, IQR=8.0, range 0-22), there was a median of seven (IQR=6) palliative opportunities per patient, which increased closer to death. PC consultation occurred in 34 (33.7%) patients, at a median of 2.2 months before death, and was associated with having a DNR order (p=0.0028). Hospice was involved for 72 (71.3%) patients. Conclusion Children with CNS tumors suffered repeated events warranting PC yet received PC support only one-third of the time. Mapping palliative opportunities over the cancer course promotes earlier timing of PC consultation which can decrease suffering and resuscitation attempts at the end-of-life.

Behandeling van spasticiteit met enkele overwegingen naar sport toe

2021 ◽  
Author(s):  
K. DECLERCK ◽  
F. HEISTERCAMP ◽  
K. SLABBYNCK ◽  
A. BOSMANS
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Multidisciplinary Approach ◽  
Healthy Lifestyle ◽  
Crucial Aspect ◽  
Limited Function ◽  
Sporting Activities ◽  
Interventional Therapies

Treatment of spasticity with some considerations regarding sport Spasticity is a possible side effect in patients with a central nervous system pathology and it affects more than 12 million people worldwide. Spasticity can have an important impact on the quality of life and sporting activities. Spasticity only needs to be treated if there is spasticity associated pain and/or (expected) limited function. Primarily triggering factors of spasticity must be treated. A multidisciplinary approach containing a combination of medication and physical therapy is recommended in the treatment of spasticity. If this approach remains insufficient, interventional therapies can be taken into consideration, although they should always be combined with rehabilitation to reduce (the) spastic tone/spasticity. Sports and exercising should not be merely seen in the context of therapy and/or rehabilitation but also as a crucial aspect of a healthy lifestyle, in particular for people ‘at risk’ for inactivity. Therefore, it is important to fill the gap between rehabilitation and sustainable sports practice for the rehabilitator.

scholarly journals Diagnosis and treatment of Multiple sclerosis: Brazilian and global overview

2021 ◽  
Author(s):  
Lorrane de Moura Moreira ◽  
Bruna Stefany Alves Françozo ◽  
Bruno Barcelos Pereira ◽  
Camila Almeida Sardinha ◽  
Débora Pimenta Alves ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Research Result ◽  
Motor Action ◽  
The Central Nervous System ◽  
Nutritional Monitoring ◽  
Diagnosis Therapy ◽  
Inflammatory Character

Introduction: Multiple sclerosis (MS) is a neurodegenerative autoimmune disease of the central nervous system with a chronic, progressive and inflammatory character. In addition, it presents itself in a heterogeneous way, and can be as an isolated syndrome or as a recurrent remitter, in the first stage, or as progressive, in the second stage. The present work was developed with the objective of determining which is the best form of diagnosis and therapy for multiple sclerosis in Brazil. Methods: The review was performed in PubMed platform, with the descriptors: “multiple sclerosis”, “diagnosis”, “therapy” and “research”. Results: The research result in 148 articles. After a criterious reading and the application of the used criteria, was selected 20 articles. Conclusion: For the diagnosis of this chronic neurological disease, magnetic resonance imaging is used to assess myelination of the different regions of the central nervous system, which is the most suitable for the diagnosis of MS. Μoreover, as a complement, cerebrospinal fluid extraction and blood tests are performed in order to ascertain the concentration of B cells. Regarding therapeutics, this is diversified, including drugs, diets and therapies that stimulate cognition and motor action, such as the use of virtual reality programs and motor images. In relation to drugs, it is of importance that SUS makes natalizumab and ocrelizumab available because they are more efficient and enable users to have a better quality of life. Finally, nutritional monitoring is also suggested to establish a ketogenic or fasting diet in a balanced way

scholarly journals Quality of Life in Carotid Atherosclerosis: The Role of Co-morbid Mood Disorders

2016 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Maria Lecca ◽  
Luca Saba ◽  
Roberto Sanfilippo ◽  
Elisa Pintus ◽  
Michela Cadoni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Mood Disorders ◽  
Carotid Atherosclerosis ◽  
Short Form ◽  
The Central Nervous System ◽  
Dsm Iv

Introduction/Objective: To study in severe carotid atherosclerosis (CA): the frequency of mood disorders (MD); the impairment of quality of life (QoL); the role of co-morbid MD in such impairment. Methods: Case-control study. Cases: consecutive in-patients with CA (stenosis ≥ 50%). Controls: subjects with no diagnosis of CA randomized from a database of a community survey. Psychiatric diagnosis according to DSM-IV made by clinicians and semi-structured interview, QoL measured by the Short Form Health Survey (SF-12). Results: This is the first study on comorbidity on CA disease and MD in which psychiatric diagnoses are conducted by clinicians according to DSM-IV diagnostic criteria. Major Depressive Disorder (MDD) (17.4% vs 2.72%, P <0.0001) but not Bipolar Disorders (BD) (4.3% vs 0.5%, P = 0.99) was higher in cases (N=46) than in controls (N= 184). SF-12 scores in cases were lower than in controls (30.56±8.12 vs 36.81±6:40; p <0.001) with QoL comparable to serious chronic diseases of the central nervous system. The burden of a concomitant MDD or BD amplifies QoL impairment. Conclusion: Comorbid MD aggravates the impairment of QoL in CA. Unlike autoimmune diseases or degenerative diseases of the Central Nervous System, CA shows a strong risk of MDD than BD.

Effect of amobarbital on the course of human dark adaptation

1961 ◽  
Vol 16 (2) ◽  
pp. 361-366 ◽  
Author(s):  
G. W. Granger
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Oral Administration ◽  
White Light ◽  
Dark Adaptation ◽  
Light Adaptation ◽  
Visual Adaptation ◽  
Test Field ◽  
The Central Nervous System ◽  
The Stability

Following light adaptation to a luminance of 120 mL for 5 minutes, absolute thresholds for a centrally fixated, 7-degree test field in 'white' light were measured during the course of 30 minutes' dark adaptation. Viewing was monocular and the measuring light was exposed in 0.018-second flashes. The resulting curves, defining the relation between log threshold luminance and time in the dark, displayed the typical features of 'rod' dark adaptation and were found to be highly reproducible in three experienced observers. Neither the shape of the curves nor their position along the log luminance axis was affected by the oral administration of a sedative dose (0.30 gm/70 kg) of amobarbital. It was concluded that the results supported the views of Hecht and other photochemical theorists concerning the stability of human dark adaptation and its resistance to fluctuations in the state of the central nervous system, but were not necessarily incompatible, as was sometimes supposed, with the hypothesis of a neural component in visual adaptation. Submitted on May 23, 1960

Clinical study of fetal neurobehavior by the KANET test

2018 ◽  
Vol 46 (6) ◽  
pp. 631-639
Author(s):  
Raul Moreira Neto ◽  
Selma Porovic
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Prenatal Diagnosis ◽  
Behavior Pattern ◽  
Review Of Literature ◽  
Fetal Medicine ◽  
Morphological Studies ◽  
4D Ultrasound ◽  
Spontaneous Movements

AbstractFetal neurology is evolving as an area of great interest in prenatal diagnosis and fetal medicine. The identification and diagnosis of brain damage prenatally has been a great challenge in obstetrics for many years. Investigations of fetal behavior in comparison with morphological studies led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of the fetal central nervous system (CNS). Four-dimensional (4D) ultrasound has greatly improved the assessment of the quality of the fetal spontaneous movements, and enabled a better evaluation of fetal behavior. The assessment of normal neurobehavioral development by 4D ultrasound provided the opportunity to investigate functional characteristics of the fetus that could predict neurological developmental dysfunction. Some studies have already been carried out to evaluate this new methodology in the observation of fetal behavior during different stages of gestation, in an attempt to better understand the relationships between the maturation of the CNS of the fetus and its implications on its behavior pattern. We present a review of literature on fetal behavior by 4D ultrasound.

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