scholarly journals Case Report: Identifying Andersson-Like Lesions in Diffuse Idiopathic Skeletal Hyperostosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaojiang Sun ◽  
Han Qiao ◽  
Xiaofei Cheng ◽  
Haijun Tian ◽  
Kangping Shen ◽  
...  
Keyword(s):  
Treatment Effectiveness ◽  
Clinical Symptoms ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Treatment Strategies ◽  
Significant Deterioration ◽  
Spinal Immobilization ◽  
Neurologic Sequelae ◽  
The Stability ◽  
Spinal Cord Function ◽  
Skeletal Stability

Andersson lesions (ALs) in ankylosing spondylitis (AS) pose a severe risk to the stability of ankylosed spine, which might result in significant deterioration of spinal cord function after traumatic or inflammatory causes. Herein, erosive discovertebral lesions in diffuse idiopathic skeletal hyperostosis (DISH) presented important clinical similarities to AL in AS, but failed to completely recognize unstable spinal lesions. Therefore, we pioneered to identify spinal discovertebral lesions similar to Andersson-like lesions (ALLs) in DISH, followed by the characterization and summarization of the etiology, radiology, laboratory results, clinical symptoms, and treatment strategies for AL in AS with ALL in DISH. By characterizing the ALL in DISH cases, we showed that the ALL was mainly traumatic and established at the junction of focal stress between two adjacent ossified level arms. Erosive discovertebral ALLs were formed after trivial stress of direct impact and could be subdivided into transdiscal, transvertebral, and discovertebral types radiologically. Patients who presented with ALL frequently suffered from consistent back pain clinically and experienced a decrease in motion ability that could reflect skeletal stability, which received treatment effectiveness after conservative external spinal immobilization or further surgical internal fixation, indicating the significance of recognizing ALL in the ankylosed DISH spine to further maintain spinal stability in order to prevent catastrophic neurologic sequelae. Our work highlighted the clinical relevance of ALL in DISH in comparison with AL in AS, which provided broader insight to identify ALL in DISH, thus facilitating early intervention against DISH deterioration.

scholarly journals 49. Clinical Characteristics of the 2019 Eastern Equine Encephalitis Virus Outbreak in Michigan

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S154-S154
Author(s):  
Adam T Ladzinski ◽  
Matthew T Rumschlag ◽  
Aditya Mehta ◽  
Eric Edewaard ◽  
Pimpawan Boapimp ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
The United States ◽  
Encephalitis Virus ◽  
Eastern Equine Encephalitis Virus ◽  
Radiographic Images ◽  
Eastern Equine Encephalitis ◽  
Male Predominance ◽  
Equine Encephalitis Virus ◽  
Neuroinvasive Disease ◽  
Neurologic Sequelae

Abstract Background Eastern Equine Encephalitis Virus (EEEV) is a mosquito-borne alphavirus responsible for unpredictable outbreaks of severe neurologic disease in humans. While the vast majority of human EEEV infections are either asymptomatic or clinically nonspecific, a minority of patients develops neuroinvasive disease (EEE), which is a devastating illness with a mortality of at least 30%. No treatments are known to be effective. EEEV infection is relatively rare in the United States, with an annual average nationwide incidence of 7 cases between 2009 and 2018. However, 2019 was an exceptionally active year for human EEEV disease, yielding 38 nationwide confirmed cases, including 10 in Michigan, comprising the state’s largest outbreak to date. Methods EEE cases were identified by a regional network of physicians. Cases were defined by presentation with clinical symptoms of encephalitis, and by identification of EEEV IgM antibodies or RNA in cerebrospinal fluid (CSF), or EEEV-specific IgM in serum as confirmed by plaque reduction neutralization test. Radiographic images were evaluated and clinical data abstracted through chart review and clinical follow-up where possible. Results Records from 7 patients were identified and reviewed. The median age was 64, with a male predominance, and all presented in August. Notably, commercial arboviral CSF serology was uniformly negative on the initial CSF sample, and diagnosis was not made until a mean of 23 days (range: 12–38 days) after presentation. Testing in public health laboratories yielded the diagnosis in 5 out of 7 cases. Imaging findings were heterogeneous, but most patients exhibited abnormal findings in the thalamus and/or basal ganglia, and one patient displayed prominent pons and midbrain abnormalities. 4 patients died, while 2 patients survived with severe neurologic sequelae, and 1 patient recovered without sequelae. One patient underwent a limited postmortem examination, which revealed diffuse meningoencephalitis and focal vascular necrosis. Conclusion EEE is a frequently fatal condition whose diagnosis is often delayed, and for which no effective treatments are known. Improved diagnostics are needed to facilitate further clinical studies of EEE and encourage the development of potential therapies. Disclosures All Authors: No reported disclosures

scholarly journals Systematic Review of Recurrent Osteosarcoma Systemic Therapy

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1757
Author(s):  
Ioanna Gazouli ◽  
Anastasios Kyriazoglou ◽  
Ioannis Kotsantis ◽  
Maria Anastasiou ◽  
Anastasios Pantazopoulos ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Treatment Effectiveness ◽  
Treatment Strategies ◽  
Bone Cancer ◽  
Predictive Biomarkers ◽  
Mtor Inhibitors ◽  
Cytotoxic Chemotherapy ◽  
Driver Mutations ◽  
Preclinical Research ◽  
Primary Bone

Osteosarcoma is the most frequent primary bone cancer, mainly affecting those of young ages. Although surgery combined with cytotoxic chemotherapy has significantly increased the chances of cure, recurrent and refractory disease still impose a tough therapeutic challenge. We performed a systematic literature review of the available clinical evidence, regarding treatment of recurrent and/or refractory osteosarcoma over the last two decades. Among the 72 eligible studies, there were 56 prospective clinical trials, primarily multicentric, single arm, phase I or II and non-randomized. Evaluated treatment strategies included cytotoxic chemotherapy, tyrosine kinase and mTOR inhibitors and other targeted agents, as well as immunotherapy and combinatorial approaches. Unfortunately, most treatments have failed to induce objective responses, albeit some of them may sustain disease control. No driver mutations have been recognized, to serve as effective treatment targets, and predictive biomarkers of potential treatment effectiveness are lacking. Hopefully, ongoing and future clinical and preclinical research will unlock the underlying biologic mechanisms of recurrent and refractory osteosarcoma, expanding the therapeutic choices available to pre-treated osteosarcoma patients.

scholarly journals From CPAP to tailored therapy for obstructive sleep apnoea

2018 ◽  
Vol 13 ◽  
Author(s):  
Peter A. Cistulli ◽  
Kate Sutherland ◽  
Kristina Kairaitis ◽  
Brendon J. Yee
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Treatment Effectiveness ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Sleep Apnoea ◽  
Patient Acceptance ◽  
Cpap Therapy ◽  
Individual Level ◽  
Obstructive Sleep ◽  
The Individual

Obstructive Sleep Apnoea (OSA) is a common sleep disorder that is associated with daytime symptoms and a range of comorbidity and mortality. Continuous Positive Airway Pressure (CPAP) therapy is highly efficacious at preventing OSA when in use and has long been the standard treatment for newly diagnosed patients. However, CPAP therapy has well recognised limitations in real world effectiveness due to issues with patient acceptance and suboptimal usage. There is a clear need to enhance OSA treatment strategies and options. Although there are a range of alternative treatments (e.g. weight loss, oral appliances, positional devices, surgery, and emerging therapies such as sedatives and oxygen), generally there are individual differences in efficacy and often OSA will not be completely eliminated. There is increasing recognition that OSA is a heterogeneous disorder in terms of risk factors, clinical presentation, pathophysiology and comorbidity. Better characterisation of OSA heterogeneity will enable tailored approaches to therapy to ensure treatment effectiveness. Tools to elucidate individual anatomical and pathophysiological phenotypes in clinical practice are receiving attention. Additionally, recognising patient preferences, treatment enhancement strategies and broader assessment of treatment effectiveness are part of tailoring therapy at the individual level. This review provides a narrative of current treatment approaches and limitations and the future potential for individual tailoring to enhance treatment effectiveness.

scholarly journals Two Cases of Anomalous Origin of Left Coronary Artery From The Pulmonary Artery

2021 ◽  
Author(s):  
Zhao Juan ◽  
Zou Chunbo
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Vascular Malformation ◽  
Left Coronary Artery ◽  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Anomalous Origin ◽  
Coronary Cta ◽  
Congenital Vascular Malformation

Abstract Coronary artery originating from pulmonary artery is a rare congenital vascular malformation, which generally presents corresponding clinical symptoms with the growth of patients' age. Coronary CTA and angiography are important methods for diagnosis of this disease, and provide evidence for treatment strategies of patients.

scholarly journals Current and Future Treatments in Alzheimer Disease: An Update

2020 ◽  
Vol 12 ◽  
pp. 117957352090739 ◽  
Author(s):  
Konstantina G Yiannopoulou ◽  
Sokratis G Papageorgiou
Keyword(s):  
Alzheimer Disease ◽  
Clinical Symptoms ◽  
Neurofibrillary Tangle ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Amyloid Β ◽  
Cell Therapies ◽  
Novel Biomarkers ◽  
Disease Modifying ◽  
Underlying Mechanisms

Disease-modifying treatment strategies for Alzheimer disease (AD) are still under extensive research. Nowadays, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance: 3 cholinesterase inhibitors and memantine. To block the progression of the disease, therapeutic agents are supposed to interfere with the pathogenic steps responsible for the clinical symptoms, classically including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation. Other underlying mechanisms are targeted by neuroprotective, anti-inflammatory, growth factor promotive, metabolic efficacious agents and stem cell therapies. Recent therapies have integrated multiple new features such as novel biomarkers, new neuropsychological outcomes, enrollment of earlier populations in the course of the disease, and innovative trial designs. In the near future different specific agents for every patient might be used in a “precision medicine” context, where aberrant biomarkers accompanied with a particular pattern of neuropsychological and neuroimaging findings could determine a specific treatment regimen within a customized therapeutic framework. In this review, we discuss potential disease-modifying therapies that are currently being studied and potential individualized therapeutic frameworks that can be proved beneficial for patients with AD.

scholarly journals Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

2017 ◽  
Vol 7 (3) ◽  
pp. 272-279 ◽  
Author(s):  
Gordon D. Skeoch ◽  
Matthew K. Tobin ◽  
Sajeel Khan ◽  
Andreas A. Linninger ◽  
Ankit I. Mehta
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Treatment Modalities ◽  
High Dose ◽  
Dexamethasone Treatment ◽  
Corticosteroid Administration

Study Design: Narrative review. Objective: Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic. Methods: A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials. Results: Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable. Conclusions: It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug’s efficacy.

Social function, clinical symptoms and personality disturbance

2004 ◽  
Vol 21 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Ula Nur ◽  
Peter Tyrer ◽  
Stephen Merson ◽  
Tony Johnson
Keyword(s):  
Personality Disorder ◽  
Rating Scale ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
Randomised Trial ◽  
Treatment Strategies ◽  
Social Function ◽  
Personality Pathology ◽  
Social Dysfunction ◽  
Personality Disturbance

AbstractObjectives: To investigate the relationship between psychiatric symptoms, personality disturbance, and social function.Method: Longitudinal study of 100 psychiatric patients presenting as emergencies originally entered to a randomised trial of community and hospital-based treatment strategies. Ratings of social function using the Social Functioning Questionnaire, personality status using the Personality Assessment Schedule, and clinical symptomatology using the Comprehensive Psycho-pathological Rating Scale were recorded at baseline with assessment of social function repeated at two, four and 12 weeks. Correlation, regression, and path analysis were performed to test the hypothesis that personality status had more influence than clinical symptoms on social function.Results: Path and regression analysis showed, that at baseline both psychopathology and personality pathology contributed to social dysfunction equally, but from two weeks onwards personality abnormality contributed to a greater degree than clinical psychopathology. Of the 100, 35 patients had a personality disorder and in these there was a strong correlation between social function scores at baseline and 12 weeks (48% of variation explained) whereas in those with no personality disorder the correlation was much weaker (14%); regression analyses confirmed this conclusion.Conclusions: Psychopathology and personality status contribute to social dysfunction in patients presenting as emergencies but persistent social dysfunction is more likely to reflect personality pathology than other forms of mental disorder.

scholarly journals Successful Treatment of Metastatic Anal Canal Adenocarcinoma with mFOLFOX6 + Bevacizumab

2016 ◽  
Vol 9 (1) ◽  
pp. 249-254 ◽  
Author(s):  
Mototsugu Matsunaga ◽  
Keisuke Miwa ◽  
Yosuke Oka ◽  
Sachiko Nagasu ◽  
Takahiko Sakaue ◽  
...  
Keyword(s):  
Partial Response ◽  
Anal Canal ◽  
Treatment Effectiveness ◽  
Case Reports ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Distant Metastases ◽  
Convincing Evidence ◽  
Response To Treatment ◽  
Peripheral Neurotoxicity

Anal canal adenocarcinoma is a relatively rare malignancy without established diagnostic and treatment criteria. Case reports of chemotherapy for anal canal adenocarcinoma with distant metastasis are limited, and there is no convincing evidence for treatment effectiveness. A 62-year-old man complained of difficulty in defecation, anal pain, and bleeding during bowel movement. He was diagnosed with moderately differentiated primary anal canal adenocarcinoma. A computed tomography scan revealed multiple metastases in the lung and liver. The patient was treated with abdominoperineal resection to control local tumor growth and then with chemotherapy consisting of mFOLFOX6 + bevacizumab. Because he had an activating KRAS mutation, anti-EGFR therapy was not considered. A reduction in the size of lung and liver metastases was observed after 4 courses of mFOLFOX6 + bevacizumab, and after 22 courses, maximum reduction in the metastatic lesions was achieved. The patient demonstrated tolerable levels of oxaliplatin-related peripheral neurotoxicity (grades 1-2) and was considered as having partial response to treatment. He is currently at the partial response state for 1 year. We plan to continue the treatment unless the patient develops progressive disease or intolerable adverse reactions. This case demonstrates that anal canal adenocarcinoma with distant metastases could be successfully treated with mFOLFOX6 + bevacizumab therapy according to the guidelines for rectal carcinoma. However, as anal canal carcinoma has multiple histological subtypes, it is important to establish subtype-specific treatment strategies.

scholarly journals Clinical Characteristics of Patients With Re-admitted of Novel Coronavirus 2019 (nCOVID-19) in Wenzhou, China

2021 ◽  
Vol 9 ◽  
Author(s):  
Xinchun Ye ◽  
Yuping Yuan ◽  
Risheng Huang ◽  
Aiqiong Cheng ◽  
Zhijie Yu ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Ct Imaging ◽  
Negative Results ◽  
Medical Observation ◽  
Primary Focus ◽  
Novel Coronavirus ◽  
Clinical Records ◽  
Test Result ◽  
Pcr Test

Background: During the COVID-19 pandemic, many patients admitted to hospital for treatment have recovered and been discharged; however, in some instances, these same patients are re-admitted due to a second fever or a positive COVID-19 PCR test result. To ascertain whether it is necessary to treat these patients in hospitals, especially in asymptomatic cases, we summarize and analyze the clinical and treatment characteristics of patients re-admitted to hospital with a second COVID-19 infection.Methods: Of the 141 COVID-19 cases admitted to the Wenzhou Central Hospital between January 17, 2020, to March 5, 2020, which were followed until March 30, 2020, 12 patients were re-admitted with a second COVID-19 infection. Data was collected and analyzed from their clinical records, lab indexes, commuted tomography (CT), and treatment strategies.Results: Most of the 141 patients had positive outcomes from treatment, with only 12 (8.5%) being re-admitted. In this sub-group: one (8.3%) had a fever, a high white blood cell count (WBC), and progressive CT changes; and one (8.3%) had increased transaminase. The PCR tests of these two patients returned negative results. Another 10 patients were admitted due to a positive PCR test result, seven of which were clinically asymptomatic. Compared to the CT imaging following their initial discharge, the CT imaging of all patients was significantly improved, and none required additional oxygen or mechanical ventilation during their second course of treatment.Conclusions: The prognoses of the re-admitted patients were good with no serious cases. We conclude that home treatment with concentrated medical observation is a safe and feasible course of treatment if the patient returns a positive PCR test result but does not display serious clinical symptoms. During medical observation, patients with underlying conditions should remain a primary focus, but most do not need to be re-admitted to the hospital.

scholarly journals Tear Replacement Therapy in Medical Support of Patients after Femto-LASIK Keratorefractive Surgery

2020 ◽  
Vol 17 (2) ◽  
pp. 274-280
Author(s):  
I. E. Panova ◽  
A. V. Titov ◽  
D. R. Mirsaitova
Keyword(s):  
Treatment Effectiveness ◽  
Tear Film ◽  
Morphometric Parameters ◽  
Control Group ◽  
Medical Support ◽  
Basal Secretion ◽  
Artificial Tear ◽  
Keratorefractive Surgery ◽  
The Stability

Purpose — to analyze the effectiveness of artificial tear drops HYLOPARIN-COMOD® in the complex medical support of the FemtoLASIK operation based on monitoring of clinical, functional and morphometric indicators of the eye surface’s condition. Patients and methods. The study included 25 patients (50 eyes) who underwent a keratorefractive surgery (Femto-LASIK) and were prescribed instillations of artificial tear drops HILOPARIN-COMOD®. To analyze the effectiveness of artificial tear drops HYLOPARIN-COMOD® in the complex medical support of the Femto-LASIK operation based on monitoring of clinical, functional and morphometric indicators of the eye surface’s condition: UCVA, BCVA, Schirmer’s II test, tear break-up time (Norn’s test), OCT pachymetry of the cornea and corneal flap. The treatment effectiveness was evaluated at 1 day, 1 week, 1 and 3 months after the surgery. Results. As a result of the treatment, the following refractive data were obtained: UCVA increased from 0.09 ± 0.02 to 0.94 ± 0.07 on the first day after surgery and to 0.96 ± 0.04 and 0.99 ± 0.07 to 1 and 3 months of follow-up, BCVA respectively, from 0.97 ± 0.04 to 0.94 ± 0.07, 0.97 ± 0.07 and 0.99 ± 0.07 after surgery. A faster restoration of the cornea and corneal valve was revealed, as evidenced by a decrease in their thickness already in the 1st week after surgery in comparison with the control group, where were more pronounced changes occur only by the 1st and 3rd month of observation (p ≤ 0.05). There was a significant increase in the basal secretion of the lacrimal gland (Schirmer’s II test) from 10.16 ± 1.33 to 11.66 ± 1.13 and 12.88 ± 0.96 µm by 1 and 3 months after surgical treatment, respectively (p ≤ 0.05). The Norn’s test increased from 10.89 ± 1.94 to 12.78 ± 1.59 and 13.83 ± 0.5 s to 1 and 3 months of treatment, respectively (p ≤ 0.05). Conclusion. The effectiveness of the HILOPARIN-COMOD® use in the correction of the dry eye syndrome after keratorefractive operations has been proven. The obtained results clearly demonstrate that the HILOPARIN-COMOD® preparation enhances not only the stability of the tear film, but also the restoration of the OCT morphometric parameters of the thickness of the cornea and corneal flap.

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