scholarly journals Chloroquine/Hydroxychloroquine Use and Suicide Risk: Hypotheses for Confluent Etiopathogenetic Mechanisms?

2021 ◽  
Vol 11 (11) ◽  
pp. 154
Author(s):  
Alessandra Costanza ◽  
Valeria Placenti ◽  
Andrea Amerio ◽  
Andrea Aguglia ◽  
Gianluca Serafini ◽  
...  
Keyword(s):  
Suicide Risk ◽  
Attempted Suicide ◽  
Scientific Literature ◽  
Neuropsychiatric Symptoms ◽  
First Line ◽  
Psychiatric Illnesses ◽  
Rheumatologic Diseases ◽  
First Line Therapy ◽  
History Of ◽  
Anti Inflammatory

Chloroquine (CQ) and hydroxychloroquine (HCQ) are classical anti-malarial and anti-inflammatory treatments, which were used as first-line therapy at the beginning of the 2019 coronavirus disease (COVID-19) pandemic. Besides the emerging data on their lack of efficacy against COVID-19 infection, such treatments have been associated with some severe health concerns, including those of neuropsychiatric nature, such as a possible increase in suicide risk. Here we report a case of a patient with no history of psychiatric illnesses, who abruptly developed depression with melancholic features, severe suicidal ideation (SI), and attempted suicide (SA) shortly after receiving HCQ for his COVID-19 infection. The case was followed by a mini-review of the heterogeneous scientific literature on the hypothetical association between neuropsychiatric symptoms, with a focus on SI and suicidal behavior (SB, including SA and death by suicide), when CQ and HCQ are used in COVID-19, rheumatologic diseases, and malaria settings. Considering the anti-inflammatory properties of CQ and HCQ and the implications for neuroinflammation in suicide pathogenesis, the possible increase in suicide risk caused by these medications appears paradoxical and suggests that other underlying pathological trajectories might account for this eventuality. In this regard, some of these latter mechanistic postulates were proposed. Certainly the role and contribution of psycho-social factors that a COVID-19 patient had to face can neither be minimized nor excluded in the attempt to understand his suffering until the development of SI/SB. However, while this case report represents a rare scenario in clinical practice, no consensus exists in the literature on this topic, a psychiatric screening for suicide risk in patients using of CQ and HCQ could be carefully considered.

Nonopioid, Multimodal Analgesia as First-line Therapy After Otolaryngology Operations: Primer on Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

2020 ◽  
pp. 019459982094701
Author(s):  
John D. Cramer ◽  
Michael L. Barnett ◽  
Samantha Anne ◽  
Brian T. Bateman ◽  
Richard M. Rosenfeld ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Multimodal Analgesia ◽  
Cochrane Library ◽  
First Line ◽  
Opioid Prescribing ◽  
First Line Therapy ◽  
Line Therapy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Effective Analgesia

Objective To offer pragmatic, evidence-informed advice on nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy after surgery. This companion to the American Academy of Otolaryngology–Head & Neck Surgery (AAO-HNS) clinical practice guideline (CPG), “Opioid Prescribing for Analgesia After Common Otolaryngology Operations,” presents data on potency, bleeding risk, and adverse effects for ibuprofen, naproxen, ketorolac, meloxicam, and celecoxib. Data Sources National Guidelines Clearinghouse, CMA Infobase, National Library of Guidelines, NICE, SIGN, New Zealand Guidelines Group, Australian National Health and Medical, Research Council, TRIP database, PubMed, Guidelines International Network, Cochrane Library, EMBASE, CINAHL, BIOSIS Previews, ISI Web of Science, AHRQ, and HSTAT. Review Methods AAO-HNS opioid CPG literature search strategy, supplemented by PubMed/MEDLINE searches on NSAIDs, emphasizing systematic reviews and randomized controlled trials. Conclusion NSAIDs provide highly effective analgesia for postoperative pain, particularly when combined with acetaminophen. Inconsistent use of nonopioid regimens arises from common misconceptions that NSAIDs are less potent analgesics than opioids and have an unacceptable risk of bleeding. To the contrary, multimodal analgesia (combining 500 mg acetaminophen and 200 mg ibuprofen) is significantly more effective analgesia than opioid regimens (15 mg oxycodone with acetaminophen). Furthermore, selective cyclooxygenase-2 inhibition reliably circumvents antiplatelet effects. Implications for Practice The combination of NSAIDs and acetaminophen provides more effective postoperative pain control with greater safety than opioid-based regimens. The AAO-HNS opioid prescribing CPG therefore prioritizes multimodal, nonopioid analgesia as first-line therapy, recommending that opioids be reserved for severe or refractory pain. This state-of-the-art review provides strategies for safely incorporating NSAIDs into acute postoperative pain regimens.

scholarly journals Progress and Challenges of Integrated Drug Efficacy Surveillance for Uncomplicated Malaria in Thailand

2021 ◽  
Author(s):  
Prayuth Sudathip ◽  
Aungkana Saejeng ◽  
Nardlada Khantikul ◽  
Thannikar Thongrad ◽  
Suravadee Kitchakarn ◽  
...  
Keyword(s):  
System Integration ◽  
Treatment Guidelines ◽  
Drug Efficacy ◽  
Fiscal Year ◽  
Efficacy Rate ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Kaplan Meier ◽  
History Of

Abstract BackgroundIntegrated drug efficacy surveillance (iDES) was formally introduced nationally across Thailand in fiscal year 2018 (FY2018), building on a history of drug efficacy monitoring and interventions. According to the National Malaria Elimination Strategy for Thailand 2017–2026, diagnosis is microscopically confirmed, treatment is prescribed, and patients are followed up four times to ensure cure.MethodsRoutine patient data were extracted from the malaria information system for FY2018–FY2020. Treatment failure of first-line therapy was defined as confirmed parasite reappearance within 42 days for Plasmodium falciparum and 28 days for Plasmodium vivax. The primary outcome was the crude drug efficacy rate, estimated using Kaplan–Meier methods, at day 42 for P. falciparum treated with dihydroartemisinin-piperaquine plus primaquine, and day 28 for P. vivax treated with chloroquine plus primaquine; day 60 and day 90 efficacy were secondary outcomes for P. vivax.ResultsThe proportion of patients with outcomes recorded at day 42 for P. falciparum malaria and at day 28 for P. vivax malaria has been increasing, with FY2020 follow-up rates of 61.5% and 57.2%, respectively. For P. falciparum malaria, day 42 efficacy in FY2018 was 92.4% (n = 249), in FY2019 93.3% (n = 379), and in FY2020 98.0% (n = 167). P. falciparum recurrences occurred disproportionally in Sisaket Province, with day 42 efficacy rates of 75.9% in FY2018 (n = 59) and 49.4% in FY2019 (n = 49), leading to an update in first-line therapy to pyronaridine-artesunate at the provincial level, rolled out in FY2020. For P. vivax malaria, day 28 efficacy was 98.5% in FY2018 (n = 2,048), 99.1% in FY2019 (n = 2,206), and 99.9% in FY2020 (n = 2,448), and day 90 efficacy was 94.8%, 96.3%, and 97.1%, respectively.ConclusionsIn Thailand, iDES provided operationally relevant data on drug efficacy, enabling the rapid amendment of treatment guidelines to improve patient outcomes and reduce the potential for the spread of drug-resistant parasites. A strong case-based surveillance system, integration with other health system processes, supporting biomarker collection and molecular analyses, and cross-border collaboration may maximize the potential of iDES in countries moving towards elimination.

Greek Registry Of Essential Thrombocythemia: Baseline Characteristics and Therapeutic Strategy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4084-4084
Author(s):  
Damianos Sotiropoulos ◽  
Argiris Symeonidis ◽  
Vassilios K Papadopoulos ◽  
Panagiotis Tsirigotis ◽  
Maria Pagoni ◽  
...  
Keyword(s):  
Risk Factor ◽  
Significant Risk ◽  
Jak2 V617f ◽  
Significant Risk Factor ◽  
First Line ◽  
Platelet Counts ◽  
First Line Therapy ◽  
Line Therapy ◽  
History Of

Abstract The Greek Registry of Essential Thrombocythemia (ET) is implemented under the auspices of the Acute Leukemias and Myeloproliferative Neoplasms Study Group of the Hellenic Society of Haematology. Hereby, we present results after four years of retrospective data collection. The total number of patients included is 1078, from 14 Greek sites; ET was diagnosed between 1982 and 2012. The male to female ratio is 1:1.19. Median age at diagnosis is 63 years, median platelet counts (PLT) 826x109/L, hemoglobin (Hb) 13.6 g/dL, white blood cell counts (WBC) 9.4x109/L. The presenting symptoms were a thrombotic event in 6.8%, a hemorrhagic event in 1.5% of patients. In 79.8% of the patients the diagnosis was made after incidental finding of elevated platelet counts on routine laboratory investigation. Molecular studies were performed in 677 patients and 42.8% of them were positive for the JAK2-V617F mutation. The presence of JAK2-V617F mutation (mutant vs wild type allele) was associated with baseline platelet counts (757.5 vs 882 x109/L) and hemoglobin levels (14.4 vs 13.4 g/dL), p<0.001 (Mann-Whitney U-test). A history of thrombosis or hemorrhage was present in 18.6% and 6.6% of patients respectively. Chi-square test was performed to assess whether platelet counts at diagnosis (<600, 600-800, >800 x109/L), Hb<13.8g/dL, WBC>9.5x109/L, or splenomegaly are associated with thrombotic or hemorrhagic events in the past medical history or during the follow-up of ET patients. The only statistically significant difference was observed in the occurrence of thrombosis during the follow up: 10.1% of those with PLT between 600-800 x109/L, 4.5% in PLT<600 and 5.6% in PLT>800 x109/L. To assess for possible confounders the multivariable logistic regression model was used, with independent variables the PLT at diagnosis, age >60 years, history of thrombosis and first line therapy. The history of thrombosis was the only statistically significant risk factor with odds ratio (OR) 3.9 (p=0.0005), while PLT was not a statistically significant risk factor (OR=2.5, p=0.074). Antiplatelet therapy was offered in 80% of patients (aspirin in 59.1%, clopidogrel in 4.7%, and combination therapy in 6.5%); anticoagulants (low molecular weight heparin or warfarin) were given in 2.3%, while the remaining 17.8% of patients did not receive any antithrombotic therapy. During the first six months post diagnosis, 31.6% of patients did not need any cytoreductive therapy. The rest 68.4% of the patients received first line therapy (hydroxyurea 80.6%, anagrelide 11.4% and interferon 5.4%). The response rates were 89.9%, 82.1% and 85.7%, respectively. Second-line therapy was received by 25.8% of the patients (hydroxyurea 23%, anagrelide 44.6%, interferon 9.5%), while the off-label combination of hydroxyurea and anagrelide was administered to 21.2% of the patients. Of the 852 patients treated with hydroxyurea as first line therapy, 12.1% switched to anagrelide and 1.2% to interferon. Of those initially treated with anagrelide, 27.6% switched to hydroxyurea and 8.2% to interferon. During the follow up phase, secondary solid tumor occurred in 4% and hematological malignancy in 2.7% of the patients. The aim of the registry and the subsequent data analysis is to convey the practice of managing the disease. Moreover, useful conclusions can be reached regarding to the patients’ responsiveness to therapy and the minimization of thrombotic and hemorrhagic adverse events. Disclosures: Spanoudakis: Genesis Hellas: Honoraria. Kotsianidis:Genesis Hellas: Honoraria, Research Funding.

scholarly journals Treatment of Blepharospasm and Oromandibular Dystonia with Botulinum Toxins

Toxins ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 269 ◽  
Author(s):  
Travis J.W. Hassell ◽  
David Charles
Keyword(s):  
Site Selection ◽  
Botulinum Neurotoxin ◽  
Clinical Evidence ◽  
Standard Of Care ◽  
Oromandibular Dystonia ◽  
Botulinum Toxins ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
History Of

Blepharospasm and oromandibular dystonia are focal dystonias characterized by involuntary and often patterned, repetitive muscle contractions. There is a long history of medical and surgical therapies, with the current first-line therapy, botulinum neurotoxin (BoNT), becoming standard of care in 1989. This comprehensive review utilized MEDLINE and PubMed and provides an overview of the history of these focal dystonias, BoNT, and the use of toxin to treat them. We present the levels of clinical evidence for each toxin for both, focal dystonias and offer guidance for muscle and site selection as well as dosing.

scholarly journals Case Report: Post Kala-Azar Dermal Leishmaniasis with History of Visceral Leishmaniasis

2021 ◽  
Vol 8 (5) ◽  
pp. 69-72
Author(s):  
Pavankumar Narapaka ◽  
Kalpana Katikala
Keyword(s):  
Visceral Leishmaniasis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
Kala Azar ◽  
History Of

The complication of visceral leishmaniasis is post-kala-azar dermal leishmaniasis (PKDL). PKDL typically occurs as a result of treatment failure or parasite resistance to treatment regimens, as well as poor patient follow-up. In the treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis, Liposomal Amphotericin B is considering as first-line therapy. We're going to show you a case where Liposomal Amphotericin B was used to treat it. Keywords: visceral leishmaniasis, post-kala-azar dermal leishmaniasis, PKDL, kala-azar

scholarly journals Psoriasis Gutata - Laporan Kasus

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Julieta D. P. Dotulong ◽  
Charly M. M. Korompis ◽  
Herry E. J. Pandaleke
Keyword(s):  
Streptococcal Infection ◽  
Topical Steroid ◽  
The Body ◽  
Trigger Factor ◽  
First Line ◽  
First Line Therapy ◽  
History Of ◽  
Erythematous Plaques ◽  
Guttate Psoriasis ◽  
Case Diagnosis

Abstract: Guttate psoriasis (GP) is a variant of psoriasis with typical drop-shaped lesions sized 0.5-1 cm in diameter, localized especially in the upper part of the body and proximal extremities. It usually occurs in young adult. We reported a female,11 years old, with red, itchy, and scaly patches distributed nearly all over the body. There was a history of sore throat. Dermatologic status showed multiple erythematous plaques which were miliar to numular, discrete, and were covered with layered silvery white scales. The Auspitz sign, wax spot phenomenon, and ASTO were positive. The histopathologic examination showed para-keratosis and Munro microabcesses. The patient treated with topical steroid for 4 weeks made improvement. Conclusion: In this case, diagnosis of guttate psoriasis was based on anamnesis, examination, and supporting examinations. Streptococcal infection was suspected as the trigger factor due to the positive ASTO examination. Topical steroid as the first line therapy for mild to moderate psoriasis made great improvement.Keywords: guttate psoriasis, streptococcal infectionAbstrak: Psoriasis gutata (PG) merupakan varian dari psoriasis. Gambaran khasnya seperti tetesan air dengan diameter 0,5-1 cm, di badan bagian atas dan ekstremitas proksimal. Sering terjadi pada dewasa muda. Kami melaporkan kasus seorang perempuan berusia 11 tahun dengan bercak merah meninggi, bersisik, disertai gatal pada hampir seluruh tubuh. Riwayat nyeri menelan positif. Riwayat pengobatan sebelumnya disangkal. Status dermatologis ditemukan plak eritem, multipel, miliar-numular, diskret, ditutupi skuama berlapis warna putih keperakan. Pemeriksaan tanda Auspitz, fenomena bercak lilin, dan ASTO positif. Pada pemeriksaan histopatologik didapatkan adanya parakeratosis dan mikroabses Munro. Terapi steroid topikal potensi tinggi selama 4 minggu menunjukkan perbaikan. Simpulan: Pada kasus ini diagnosis psoriasis gutata ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang yang khas. Infeksi streptokokus diduga sebagai faktor pencetus berdasarkan hasil pemeriksaan ASTO. Terapi steroid topikal merupakan lini pertama untuk psoriasis ringan sampai sedang memperlihatkan perbaikan yang nyata.Kata kunci: psoriasis gutata, infeksi streptokokus

scholarly journals Dysmenorrhea and endometriosis in teenage girls (review)

2021 ◽  
Vol 8 (3) ◽  
pp. 133-138
Author(s):  
Ara L. Unanyan ◽  
Laura G. Pivazyan ◽  
Dzhulietta S. Avetisyan ◽  
Archil A. Siordiya ◽  
Anatoliy I. Ishchenko
Keyword(s):  
Symptomatic Treatment ◽  
Reproductive Period ◽  
First Line ◽  
Transabdominal Ultrasonography ◽  
Teenage Girls ◽  
First Line Therapy ◽  
Future Fertility ◽  
Secondary Dysmenorrhea ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Most adolescents experience discomfort during menstruation. Usually, girls are diagnosed with primary dysmenorrhea in the early reproductive period and respond well to symptomatic treatment with non-steroidal anti-inflammatory or hormonal drugs. If first-line therapy does not improve the symptoms of dysmenorrhea, transabdominal ultrasonography is indicated. Most often, these patients are diagnosed with endometriosis, which is the main cause of secondary dysmenorrhea in adolescents. Endometriosis should be assumed in patients with persistent, clinically pronounced dysmenorrhea that does not respond to treatment with hormonal drugs and non-steroidal anti-inflammatory drugs, especially if no other cause of chronic pelvic pain or secondary dysmenorrhea is detected on the basis of history, physical examination, and ultrasonography of pelvic organs. The aim of the therapy is to relieve symptoms, suppress disease progression, and protect future fertility.

scholarly journals First-line therapy for young patients with CLL

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 146-148
Author(s):  
Nitin Jain ◽  
Susan O’Brien
Keyword(s):  
Prognostic Markers ◽  
Young Patients ◽  
Lymphocytic Leukemia ◽  
Costal Margin ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Night Sweats ◽  
History Of

Abstract A 61-year-old man with a history of chronic lymphocytic leukemia (CLL) presents with complaints of worsening fatigue and night sweats. He was diagnosed with CLL 3 years ago on routine blood count testing. He has no major medical comorbidities. On examination, he has several 2- to 3-cm lymph nodes in the cervical and axillary area. Spleen is palpable 5 cm below the costal margin. Blood counts show lymphocytosis with thrombocytopenia and anemia. Prognostic markers include deletion 13q by fluorescence in situ hybridization analysis and mutated IGHV. You are asked by the hematology fellow you are supervising about the best treatment of this patient.

Parental suicide attempts and offspring's risk of attempting or dying by suicide: does the timing of a parental suicide attempt matter?

2021 ◽  
pp. 1-10
Author(s):  
Ana Ortin-Peralta ◽  
Markus Keski-Säntti ◽  
Mika Gissler ◽  
Juha Veijola ◽  
Andre Sourander ◽  
...  
Keyword(s):  
Young Adulthood ◽  
Suicide Risk ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Suicide Risk Assessment ◽  
Multivariate Models ◽  
Parental History ◽  
Parental Suicide ◽  
History Of ◽  
The Impact

Abstract Background Studies on the transmission of suicide risk have focused on parental history of suicide attempts (SAs), overlooking when the attempt happened. This study examined how the offspring's risk of attempting or dying by suicide varied by the timing of a first parental SA and the sex of the parent who attempted suicide. Methods Participants were 59 469 members of the 1987 Finnish Birth Cohort. The Finnish Hospital Discharge and Cause of Death Registers were the sources for parental and offspring SAs and offspring suicide. Timing of parental SA was coded as before (pre-pregnancy and pregnancy) and after the child's birth [infant/toddler years (0–2 years), childhood (3–11 years), adolescence (12–17 years), and young adulthood (18–26 years)]. Results In the multivariate models, having a parent who attempted suicide increased the offspring's risk of attempting suicide (odds ratio (OR) = 1.77, 95% confidence interval (CI) 1.39–2.25), but not of dying by suicide. Compared to unexposed offspring, those exposed after child's birth were at higher risk of attempting suicide (OR = 1.90, 95% CI 1.46–2.47), specifically when the parent attempted during offspring's childhood, adolescence, and young adulthood. A first maternal SA increased offspring's risk of attempting suicide regardless of the timing. Conclusions The impact of a parental SA on offspring's risk of attempting suicide differed depending on the timing and sex of the parent who attempted suicide, suggesting that the transmission of suicide risk may occur through genetic as well as environmental factors. Our findings call for an intergenerational approach in suicide risk assessment.

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