Immune-mediated Neuropathies Our Experience over 3 Years

ABSTRACT Introduction: Immune-mediated peripheral neuropathy is the term applied to a spectrum of peripheral nerve disorders where immune dysregulation plays a role. Therefore, they are treatable. We analyzed the cases seen in the past 3 years by us and evaluated the clinical, laboratory, and outcome parameters in these patients. Patients and Methods: Consecutive patients seen by the authors and diagnosed as immune-mediated neuropathy were analyzed for etiology, pathology, and outcome assessed. Results: A total of sixty patients, 31 acute and 29 chronic neuropathies, were identified. Their subtypes treatment and outcome assessed. Males were significantly more in both acute and chronic cases. Miller Fisher 4, AMAN 1, paraplegic type 1, motor dominant type 19, Sensory-motor 1, MADSAM 3, Bifacial 2. Nonsystemic vasculitis was seen in 16 out of 29 chronic neuropathy and HIV, POEMS, and diabetes mellitus one each. Discussion: There is a spectrum of immune-mediated neuropathy which varies in clinical course, response to treatment, etc., Small percentage of uncommon cases are seen. In this group, mortality was nil and morbidity was minimal. Conclusion: Immune-mediated neuropathies are treatable and hence should be diagnosed early for good quality outcome.

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NUMERICAL COEFFICIENT FOR ENDOMETRIAL CANCER INDIVIDUAL RISK EVALUATION IN POSTMENOPAUSAL WOMEN

Problems in oncology ◽

10.37469/0507-3758-2017-63-3-461-465 ◽

2017 ◽

Vol 63 (3) ◽

pp. 461-465

Author(s):

Lev Bershteyn ◽

Dmitriy Vasilev ◽

Tatyana Poroshina ◽

Igor Berlev

Keyword(s):

Breast Cancer ◽

Endometrial Cancer ◽

Risk Evaluation ◽

Tumor Response ◽

Molecular Genetic ◽

Response To Treatment ◽

Individual Risk ◽

The Past ◽

Genetic Landscape ◽

Numerical Coefficient

Increased frequency of endometrial cancer (EC) since the beginning of this century exceeds that of breast cancer and to a large extent can be attributed to dynamics of parameters, which characterize hormonal and metabolic status of ill women and molecular genetic landscape of transforming endometrium. During the past few years there are suggested several options for a personalized assessment of the risk of EC. The aim of this article is to propose and justify own version of this score with the idea of its further not only retrospective but also prospective testing both in relation to the risk of developing endometrial cancer as well as an additional marker helping to predict tumor response to treatment.

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Triangulating abuse liability assessment for flavoured cigar products using physiological, behavioural economic and subjective assessments: a within-subjects clinical laboratory protocol

BMJ Open ◽

10.1136/bmjopen-2018-023850 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023850

Author(s):

Catherine S Wall ◽

Rose S Bono ◽

Rebecca C Lester ◽

Cosima Hoetger ◽

Thokozeni Lipato ◽

...

Keyword(s):

Clinical Laboratory ◽

Subjective Effects ◽

Latin Square ◽

Abuse Liability ◽

Smoke Inhalation ◽

Nicotine Concentration ◽

The Past ◽

The Usa ◽

Behavioural Economic ◽

Scientific Meetings

IntroductionIn the USA, Food and Drug Administration regulations prohibit the sale of flavoured cigarettes, with menthol being the exception. However, the manufacture, advertisement and sale of flavoured cigar products are permitted. Such flavourings influence positive perceptions of tobacco products and are linked to increased use. Flavourings may mask the taste of tobacco and enhance smoke inhalation, influencing toxicant exposure and abuse liability among novice tobacco users. Using clinical laboratory methods, this study investigates how flavour availability affects measures of abuse liability in young adult cigarette smokers. The specific aims are to evaluate the effect of cigar flavours on nicotine exposure, and behavioural and subjective measures of abuse liability.Methods and analysesParticipants (projected n=25) are healthy smokers of five or more cigarettes per day over the past 3 months, 18–25 years old, naive to cigar use (lifetime use of 50 or fewer cigar products and no more than 10 cigars smoked in the past 30 days) and without a desire to quit cigarette smoking in the next 30 days. Participants complete five laboratory sessions in a Latin square design with either their own brand cigarette or a session-specific Black & Mild cigar differing in flavour (apple, cream, original and wine). Participants are single-blinded to cigar flavours. Each session consists of two 10-puff smoking bouts (30 s interpuff interval) separated by 1 hour. Primary outcomes include saliva nicotine concentration, behavioural economic task performance and response to various questionnaire items assessing subjective effects predictive of abuse liability. Differences in outcomes across own brand cigarette and flavoured cigar conditions will be tested using linear mixed models.Ethics and disseminationThe Virginia Commonwealth University Institutional Review Board approved the study (VCU IRB: HM20007848). Dissemination channels for study findings include scientific journals, scientific meetings, and policy briefs.Trial registration numberNCT02937051.

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Autoimmunity and Genetic Syndromes: A Focus on Down Syndrome

Genes ◽

10.3390/genes12020268 ◽

2021 ◽

Vol 12 (2) ◽

pp. 268

Author(s):

Marta Ferrari ◽

Stefano Stagi

Keyword(s):

Down Syndrome ◽

Autoimmune Diseases ◽

Normal Population ◽

Underlying Mechanism ◽

Short Review ◽

Immune Dysregulation ◽

Infectious Complications ◽

Genetic Syndromes ◽

Genetic Syndrome

Within immune system-related diseases, autoimmunity has always represented a field of great interest, although many aspects remain poorly understood even today. Genetic syndromes associated with immunity disorders are common and represent an interesting model for a better understanding of the underlying mechanism of autoimmunity predisposition. Among these conditions, Down syndrome (DS) certainly deserves special attention as it represents the most common genetic syndrome associated with immune dysregulation, involving both innate and adaptive immunity. Autoimmunity represents a well-known complication of DS: it is estimated that people affected by this disease present a risk four to six times higher than the normal population to develop autoimmune diseases such as celiac disease, type 1 diabetes mellitus, and hypo- or hyperthyroidism. Several factors have been considered as possible etiology, including genetic and epigenetic modifications and immune dysregulation. In times in which the life expectancy of people with DS has been extremely prolonged, thanks to improvements in the diagnosis and treatment of congenital heart disease and infectious complications, knowledge of the mechanisms and proper management of autoimmune diseases within this syndrome has become essential. In this short review, we aim to report the current literature regarding the genetic, immune, and environmental factors that have been proposed as the possible underlying mechanism of autoimmunity in individuals with DS, with the intent to provide insight for a comprehensive understanding of these diseases in genetic syndromes.

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Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia

Journal of Clinical Medicine ◽

10.3390/jcm10061154 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1154

Author(s):

Eun Lee ◽

Yun Young Lee

Keyword(s):

Pleural Effusion ◽

Mycoplasma Pneumoniae ◽

Predictive Factors ◽

Respiratory Virus ◽

Clinical Laboratory ◽

Poor Response ◽

Response To Treatment ◽

Slow Response ◽

Response Group ◽

Time Of Admission

The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303−48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000–1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404–18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374–13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002–1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095–1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.

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AB1119 U9: A NOVEL CLINICALLY ORIENTED ULTRASONOGRAPHIC SCALE AS A USEFUL MARKER FOR MONITORING THERAPEUTIC RESPONSE IN RHEUMATOID ARTHRITIS (MULTI CENTERS STUDY)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2733 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1848.2-1849

Author(s):

M. A. Mortada ◽

H. Eitta ◽

R. Elmallah ◽

A. Radwan ◽

A. Elsaman

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Laboratory ◽

Pearson Correlation ◽

Response To Treatment ◽

P Value ◽

Clinical Parameters ◽

Biologic Dmards ◽

Das 28 ◽

Significant Difference

Background:Musculoskeletal Ultrasonography (MSUS) is now a widely used tool for monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA, which affects many joints and tendons in different presentations. In previous study (1) U9 score was proven to be correlated with disease activity parameters.Objectives:To determine whether US assessment using U9 score is useful for monitoring response to treatment for RA or not?Methods:A prospective, multicenter study were conducted in period from July 2019 to December 2019. All recruited RA patients were subjected to: Disease activity assessment by clinical disease activity indices (CDAI and DAS28 ESR). Functional status assessment by (HAQ) and ultrasonographic assessment using U9 score which include 8 joints (bilateral wrists,2ndMCP,3RDMCP and knees) plus most clinically affected joint or tendon (one joint or one tendon). Most clinically affected joints from 48 joints. Any affected tendons could be choosing. All targeted joints were evaluated according to EULAR guidlines and by EULAR/ OMERACT combined score (0-3). Targeted tendons were scored (0-3).All patients received their treatment (biologic and non biologic DMARDs) according to the decision of the treating physicians. No specific therapy is needed. CDAI and DAS28 ESR, HAQ and U9 score were repeated after 3 months to detect the response to change after receiving the therapy.Results:One hundred and forty patients (23.6% were male) with mean age 39.26±11.30 were recruited from 4 tertiary referral university hospitals.There was a significant difference (<0.001) between the first and second visits as regards clinical, laboratory and ultrasonographic parameters. DAS 28 decreased form (5.29±1.21) to (3.95±0.99), ESR decreased from (42.12±15.24) to (26.84±12.32), HAQ2 improved from (0.652±0.350) to (0.510±0.237) and U9 total US score decreased from (13.56±5.18) to (8.02±4.28).There was significant correlation between U9 ultrasonographic score and clinical parameters at both visits (table 1).Table 1.correlation between U9 ultrasonographic score and clinical parameters.U9 at 1stvisitU9 at 2ndvisitDAS-28Pearson Correlation(P value)0.806<0.0010.790<0.001CDAIPearson Correlation(P value)0.787<0.0010.773<0.001HAQPearson Correlation(P value)0.431<0.0010.317<0.001We found that the most suitable cut-off value of U9 score to predict high disease activity was 11.5 (sensitivity 85.7% and specificity 80.6%), cut off value for moderate disease activity was 5.5(sensitivity 83.2% and specificity 88%) and cut off value for low disease activity was 3.5 (sensitivity of 83.3% and specificity 57.1%). These results are summarized in the following table:Conclusion:U9 ultrasonographic score is very useful method for evaluating the monitoring the response of treatment.References:[1]Mortada, et al. Annals of the Rheumatic Diseases 2019;78:1009.Disclosure of Interests:None declared

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Myopic foveal detachment associated with pachychoroid characteristics

BMC Ophthalmology ◽

10.1186/s12886-021-02040-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yong Kyun Shin ◽

Sun Hyup Han ◽

Se Woong Kang ◽

Sang Jin Kim ◽

A Young Kim

Keyword(s):

Vascular Endothelial Growth Factor ◽

Multimodal Imaging ◽

High Myopia ◽

Complete Response ◽

Response To Treatment ◽

Vascular Endothelial ◽

Foveal Detachment ◽

Endothelial Growth Factor ◽

Choroidal Vascular Hyperpermeability

Abstract Purpose To describe myopic nontractional foveal detachment associated with pachychoroid diseases. Methods This retrospective study included 15 myopic eyes which had nontractional serous foveal detachment. The eyes were divided into myopic central serous chorioretinopathy (CSC) group (n = 8) and a myopic pachychoroid neovascularization (PNV) group (n = 7) according to the presence of type 1 choroidal neovascularization on multimodal imaging. The findings of multimodal imaging and treatment response were described. Results In myopic CSC group, pachychoroid features such as pachyvessels, choroidal vascular hyperpermeability and punctate hyperfluorescent spots were noted in 8 eyes (100%), 8 eyes (100%), 5 eyes (62.5%) respectively. The above features were noted in 7 eyes (100%), 5 eyes (83.3%), 5 eyes (83.3%), respectively, in the myopic PNV group. Five of 8 eyes in myopic CSC and all 7 eyes received treatment including anti-vascular endothelial growth factor injection and/or photodynamic therapy. However, only five eyes had a complete response. Conclusions The pachychoroid phenotype may coexist with high myopia and lead to myopic nontractional serous foveal detachment. Our series suggest that the response to treatment for these conditions would be limited.

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Infliximab: A Review of its use in the Treatment of Pediatric Crohn's Disease

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s2840 ◽

2010 ◽

Vol 2 ◽

pp. CMT.S2840

Author(s):

Arkady Broder ◽

Joel R. Rosh

Keyword(s):

Monoclonal Antibodies ◽

Crohn’S Disease ◽

Chronic Disease ◽

Crohn's Disease ◽

Tumor Necrosis ◽

Immune Dysregulation ◽

Necrosis Factor Alpha ◽

The Past ◽

Factor Alpha ◽

Necrosis Factor

The past decade has brought great change to the treatment of pediatric Crohn's disease. The majority of affected patients now receive therapy directed at the underlying immune dysregulation that is associated with this chronic disease. The monoclonal antibodies directed against tumor necrosis factor alpha play an increasing role in such therapy. Infliximab is the prototype of this class of biologic based therapy. This review covers the basic pharmacokinetics of infliximab while reviewing the data on its efficacy in pediatric Crohn's disease patients. Current issues related to infliximab dosing and safety are also reviewed.

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Challenge of diabetes mellitus and researchers’ contributions to its control

Open Chemistry ◽

10.1515/chem-2020-0153 ◽

2021 ◽

Vol 19 (1) ◽

pp. 614-634

Author(s):

Ayodele T. Odularu ◽

Peter A. Ajibade

Keyword(s):

Diabetes Mellitus ◽

Medical Records ◽

Diabetes Type ◽

Future Studies ◽

The Past ◽

Significant Events ◽

Review Study ◽

Type 3

Abstract The aim of this review study was to assess the past significant events on diabetes mellitus, transformations that took place over the years in the medical records of treatment, countries involved, and the researchers who brought about the revolutions. This study used the content analysis to report the existence of diabetes mellitus and the treatments provided by researchers to control it. The focus was mainly on three main types of diabetes (type 1, type 2, and type 3 diabetes). Ethical consideration has also helped to boost diabetic studies globally. The research has a history path from pharmaceuticals of organic-based drugs to metal-based drugs with their nanoparticles in addition to the impacts of nanomedicine, biosensors, and telemedicine. Ongoing and future studies in alternative medicine such as vanadium nanoparticles (metal nanoparticles) are promising.

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321P Clinical course comparison between patients with type 1 and type 2 uterine endometrial cancers

Annals of Oncology ◽

10.1093/annonc/mdw585.025 ◽

2016 ◽

Vol 27 (suppl_9) ◽

Author(s):

Y. Takehara ◽

M. Yunokawa ◽

S. Sasada ◽

E. Noguchi ◽

A. Shimomura ◽

...

Keyword(s):

Clinical Course ◽

Endometrial Cancers

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Longterm Outcomes and Damage Accrual in Patients with Childhood Systemic Lupus Erythematosus with Psychosis and Severe Cognitive Dysfunction

The Journal of Rheumatology ◽

10.3899/jrheum.121096 ◽

2013 ◽

Vol 40 (4) ◽

pp. 513-519 ◽

Cited By ~ 20

Author(s):

Lily Siok Hoon Lim ◽

Arlette Lefebvre ◽

Susanne Benseler ◽

Earl D. Silverman

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Cognitive Dysfunction ◽

Lupus Erythematosus ◽

Clinical Course ◽

Immunosuppressive Treatment ◽

Damage Index ◽

Response To Treatment ◽

Systemic Lupus ◽

Damage Accrual

Objective.(1) To describe the clinical course and response to treatment; and (2) to evaluate and compare damage accrual of distinct phenotypic subgroups of patients with clinically important psychiatric illness of pediatric systemic lupus erythematosus (pSLE).Methods.A single-center cohort study of patients with pSLE followed at a pediatric lupus clinic from 1985 to July 2009. Clinical course and response to treatment were studied. Remission was defined by absence of psychiatric/cognitive symptoms while receiving minimal doses of prednisone. Disease activity and damage were measured using SLE Disease Activity Index and SLE Damage Index.Results.Fifty-three children were included: 40 with psychosis and cognitive dysfunction (PSYC group) and 13 with isolated cognitive dysfunction (COG group). All received immunosuppressive treatment. Eighteen of 32 treated with azathioprine required a change to cyclophosphamide for poor response but none on cyclophosphamide required a change. The median times to remission were 72 weeks (PSYC) and 70 weeks (COG). Eight patients (7 PSYC, 1 COG) experienced flare following response/remission. New damage was noted in 50% of children at a median of 11 months: 57% of PSYC group, 31% of COG group. Persistent cognitive dysfunction was seen in 16% of PSYC patients and 15% of COG patients.Conclusion.Most patients responded to immunosuppressive treatment, although median time to remission was > 1 year. Roughly half the patients acquired a new damage item, most of which did not interfere with functional abilities. Fewer than 20% of patients developed neuropsychiatric damage. Both phenotypes of psychiatric pSLE responded equally well to current treatment.

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