scholarly journals Total Dystrophic Onychomycosis Successfully Treated with Efinaconazole Topical Solution in Times of COVID: A Case Study

2021 ◽  
Author(s):  
Matthew G Garoufalis
Keyword(s):  
Treatment Options ◽  
Self Esteem ◽  
Once Daily ◽  
Nail Polish ◽  
Nail Lacquer ◽  
Assessment Period ◽  
Published Report ◽  
Topical Solution

Toenail onychomycosis is a common condition that is equally challenging for podiatrists and patients. This case study documents a 26-year-old woman with bilateral total dystrophic onychomycosis of at least 5 years' duration. She had previously failed to respond to treatment with ciclopirox nail lacquer 8% and despite hiding her condition with nail polish, was suffering from embarrassment, distress and low self-esteem. At initial consult, one hundred percent of both great toenails were affected. After discussion of all treatment options, the patient opted for topical efinaconazole 10% solution, once daily for 48 weeks. Significant improvement was noted at the first (4 week) assessment period. This improvement was maintained through each subsequent virtual consult and complete cure was seen at a 30-week follow-up visit. To the author's knowledge this is the first published report on the use of efinaconazole in total dystrophic onychomycosis. It suggests that the product may be effective in patients with even the most severe and treatment recalcitrant disease, who are unwilling or unable to tolerate systemic antifungal therapy.

Topical Treatment of Onychomycosis as a Realistic Option to Systemic Therapy

2014 ◽  
Vol 104 (1) ◽  
pp. 115-117
Author(s):  
Aditya K. Gupta
Keyword(s):  
Topical Treatment ◽  
Trichophyton Rubrum ◽  
Treatment Success ◽  
Common Disease ◽  
Mycological Cure ◽  
Once Daily ◽  
Realistic Option ◽  
Assessment Period

Onychomycosis is a very common disease, especially in podiatric medical practice. It can be associated with significant patient distress, major disability and pain, and is challenging to treat successfully. This is a case study of a 41-year-old man with distal lateral subungual onychomycosis of 5 years' duration. Forty percent of the great toenail was affected and a total of six toenails were involved. Baseline fungal cultures were positive for Trichophyton rubrum. This patient was treated with efinaconazole 10% solution, a new topical antifungal, once daily for 48 weeks. Mycological cure was noted at the first assessment period (12 weeks), and compete cure was seen at follow-up. This case study alerts physicians to a promising new topical treatment for onychomycosis under development, and to the importance of mycological cure as an early indicator of treatment success.

Effectiveness and safety of edoxaban in patients with atrial fibrillation: data from the Danish Nationwide Cohort

2019 ◽  
Author(s):  
Peter Brønnum Nielsen ◽  
Torben Bjerregaard Larsen ◽  
Flemming Skjøth ◽  
Mette Søgaard ◽  
Gregory Y H Lip
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Treatment Options ◽  
Clinical Effectiveness ◽  
Systemic Embolism ◽  
Antithrombotic Treatment ◽  
Bleeding Events ◽  
Once Daily ◽  
Randomized Controlled

Abstract Aims Edoxaban treatment for stroke prevention in atrial fibrillation (AF) has mainly been investigated in randomized controlled trials, and data reflecting clinical practice are limited. We ascertained the clinical effectiveness and safety of edoxaban 30 and 60 mg once daily among Danish patients with AF. Methods and results This was an observational study based on Danish nationwide registries collecting information for administrative purposes. From June 2016 through November 2018, we identified 3405 patients initiating edoxaban. After exclusions, 2285 AF patients were followed for the effectiveness outcome of thromboembolism (ischaemic stroke and/or systemic embolism) and bleeding outcomes (composite of major bleeding, gastrointestinal bleeding, and intracranial haemorrhage), as well as bleeding requiring hospitalization. Population mean age was 75 years and 43% were female; 643 patients received the 30 mg edoxaban dosage regimen and 1642 initiated 60 mg edoxaban. During follow-up, we observed 41 thromboembolic events and 89 bleeding events of which 40 events required hospitalization. Among patients with 30 mg edoxaban, the rate (per 100 person-years) of thromboembolism was 2.07 vs. 1.62 for 60 mg edoxaban. Rates of bleeding were similar for the two dosages at ∼3.85. Bleeding requiring hospitalization occurred at a rate of 1.74 for 30 mg edoxaban and 1.69 with 60 mg edoxaban. Conclusion In this nationwide cohort of Caucasian AF patients treated with edoxaban for stroke prevention, the clinical effectiveness and safety were in line with data from the ENGAGE AF-TIMI 48 trial. Studies investigating comparative effectiveness and safety for edoxaban in comparison with other choices of antithrombotic treatment options are needed.

Everolimus for postmenopausal women with advanced breast cancer: Updated results of the BOLERO-2 phase III trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 559-559 ◽  
Author(s):  
Martine J. Piccart-Gebhart ◽  
Shinzaburo Noguchi ◽  
Kathleen I. Pritchard ◽  
Howard A. Burris ◽  
Hope S. Rugo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Aromatase Inhibitor ◽  
Postmenopausal Women ◽  
Survival Data ◽  
Treatment Options ◽  
Safety Data ◽  
Phase Iii ◽  
Double Blind ◽  
Once Daily

559 Background: Current treatment options for postmenopausal patients with estrogen-receptor–positive (ER+) breast cancer (BC) who relapse or progress on a nonsteroidal aromatase inhibitor (NSAI) are limited. The BOLERO-2 trial supports the activity of everolimus (EVE; an oral mammalian target of rapamycin [mTOR] inhibitor) added to the steroidal aromatase inhibitor exemestane (EXE) to prolong progression-free survival (PFS) in this patient population. Long-term PFS and survival data are awaited. Methods: BOLERO-2 is a phase III double-blind, randomized, international trial comparing EVE (10 mg once daily) plus EXE (25 mg once daily) versus placebo (PBO) plus EXE in postmenopausal women with advanced ER+ BC progressing or recurring after NSAIs (letrozole or anastrozole). Patients were randomized (2:1) to EVE + EXE or PBO + EXE. The primary endpoint was PFS by local investigator assessment. Main secondary endpoints included centrally assessed PFS, overall survival (OS), safety, bone turnover, and overall response rate (ORR). Results: Baseline disease characteristics including tumor burden and prior cancer therapy were well balanced between treatment arms (N = 724). Median PFS was doubled and response rates were consistently improved with EVE + EXE (n = 485) vs PBO + EXE (n = 239) in interim analyses. Median PFS by local assessment was ~3 mo with PBO + EXE vs 6.9 mo (hazard ratio [HR] = 0.43; P < .0001) and 7.4 mo (HR = 0.44; P < .0001) with EVE + EXE at 7.5 mo and 12.5 mo follow-up, respectively. Fewer deaths were reported with EVE + EXE (17.2%) vs PBO + EXE (22.7%) at 12.5 mo follow-up. Safety profiles were consistent with previous reports for mTOR inhibitors. PFS data including 528 events (protocol-specified final analysis), and updated OS and safety data will be presented. Conclusions: Adding EVE to EXE markedly prolonged PFS in patients with NSAI-refractory advanced ER+ BC. There were fewer deaths among patients receiving EVE, and further follow-up will evaluate the effect of EVE on OS.

Psycholinguistic Analysis of Emotional Disclosure: A Case Study in Sport Injury

2009 ◽  
Vol 3 (2) ◽  
pp. 182-196 ◽  
Author(s):  
Aditi Mankad ◽  
Sandy Gordon ◽  
Karen Wallman
Keyword(s):  
Cruciate Ligament ◽  
Self Esteem ◽  
Emotional Disclosure ◽  
Mood Disturbance ◽  
Cognitive Integration ◽  
Linguistic Markers ◽  
Anterior Cruciate ◽  
Reducing Stress

The present study features a psycholinguistic analysis, using Pennebaker’s (1989) emotional disclosure paradigm, of an athlete’s experience in recovering from injury. “GL,” a male athlete rehabilitating from anterior cruciate ligament reconstruction, participated in a 9-week testing protocol. A 3-day intervention was used, consisting of three 20-minute writing sessions, which promoted disclosure of negative emotions associated with injury and rehabilitation. In addition, measures of stress, mood disturbance, and self-esteem were administered from pre- to postintervention and at follow-up. Results revealed decreases in stress and mood disturbance, as well as an increase in self-esteem. Analysis of writing samples revealed increased use of linguistic markers indicating affective awareness. Findings also highlighted the importance of emotional disclosure and cognitive integration in reducing stress and enhancing understanding of injury.

Obsessional Slowness: A Case Study

2008 ◽  
Vol 75 (4) ◽  
pp. 249-254 ◽  
Author(s):  
Wendy Lam ◽  
Karen W. Wong ◽  
Mary-Ann Fulks ◽  
Liisa Holsti
Keyword(s):  
Treatment Options ◽  
Treatment Phase ◽  
Post Treatment ◽  
Behavioural Intervention ◽  
Single Subject ◽  
Baseline Phase ◽  
Carry Over ◽  
Withdrawal Design

Background. Obsessional slowness is a rare psychiatric disorder with few treatment options and limited research to date. Some suggest that targeted behavioural interventions may reduce the time taken for functional daily activities. Purpose. To examine whether a behavioural intervention would reduce the amount of time taken for an adolescent with obsessional slowness to walk to class. Methods. A single-subject A-B-A withdrawal design was incorporated into this case study. The treatment involved one-to-one pacing and prompting during the subject's walk to gym class. Walking times to gym class were measured during a baseline phase, during a one-month treatment phase, and during a post-treatment follow-up phase. Findings. The subject's walking times decreased during the treatment phase. Post-treatment walking times suggested a carry-over effect. Implications. This study adds to the sparse evidence on treatments for obsessional slowness and suggests occupation-based treatment options.

scholarly journals Comparison of efficacy of mirabegron and darifenacin in overactive bladder- a prospective study

2020 ◽  
Vol 8 (1) ◽  
pp. 196
Author(s):  
Gurpreet Singh Bhangu ◽  
Kamal Preet Kaur ◽  
Darpan Bansal ◽  
Ritansh Bansal
Keyword(s):  
Overactive Bladder ◽  
Drug Treatment ◽  
Comparative Study ◽  
Prospective Study ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Medical Sciences ◽  
Once Daily ◽  
A Prospective Study

Background: Overactive bladder (OAB) is under reported yet distressing symptoms which can be managed effectively by the drugs available. Aim was to study and compare the efficacy of two drugs, mirabegron and darifenacin in controlling the symptoms of overactive bladder.Methods: This prospective study included a total of 120 cases of overactive bladder reported at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar from January 2018 to December 2019. This comparative study was done by giving Mirabegron to first five patients and next five patients were given darifenacin up to 120 patients. The drug treatment with once daily administration of 25 mg mirabegron and 7.5 mg of darifenacin was given for a total of 12 weeks. The signs and symptoms were noted at the beginning of the therapy and then follow up was done at 4, 8, 10 and 12 weeks.Results: Total 54 out of 60 patients (90%) on miragaberon and 59 of 60 patients (98.33%) on darifenacin were relieved of symptom of increased frequency of micturition. 53 of 60 pateints (88.33%) on miragaberon and 59 of 60 patients (98.33%) on darifenacin were relieved of symptom of decreased average voiding volume. 28 of 60 pateints (46.67 %) on miragaberon showed nocturia as compared to 25 of 60 patients (41.67%) on darifenacin.Conclusions: It has been concluded that both mirabegron as well as darifenacin are highly efficacious newer treatment options for the management of OAB. Our study found Darifenacin to be relatively more efficacious in the treatment of OAB at a lesser dose and statistically significant differences were observed between the two drugs. 

scholarly journals Amelogenesis Imperfecta: Rehabilitation and Brainstorming on the Treatment Outcome after the First Year

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Ayça Deniz İzgi ◽  
Ediz Kale ◽  
Remzi Niğiz
Keyword(s):  
Treatment Outcome ◽  
Oral Hygiene ◽  
Treatment Options ◽  
Self Esteem ◽  
Open Bite ◽  
Amelogenesis Imperfecta ◽  
First Year ◽  
Gingival Inflammation ◽  
Anterior Open Bite

Amelogenesis imperfecta (AI) affects enamel on primary and permanent dentition. This hereditary disorder is characterized by loss of enamel, poor esthetics, and hypersensitivity. Functional and cosmetic rehabilitation is challenging with variety of treatment options. This report presents the treatment of an AI patient using conventional fixed dentures and discusses issues related to posttreatment complications and prosthetic treatment outcome after 1 year of follow-up. A 19-year-old male AI patient with impaired self-esteem presented with hypersensitive, discolored, and mutilated teeth. Clinical examination revealed compromised occlusion and anterior open-bite. After hygiene maintenance full-coverage porcelain-fused-to-metal fixed restorations were indicated and applied. At the end of the treatment acceptable functional and esthetic results could be achieved. However, nearly a year after treatment a gingival inflammation in the esthetic zone complicated the outcome. Insufficient oral hygiene was to be blamed. Tooth sensitivity present from early childhood in these patients may prevent oral hygiene from becoming a habit. The relaxation due to relieve of hypersensitivity after treatment makes oral hygiene learning difficult. Continuous oral hygiene maintenance motivation may be crucial for the success of the treatment of AI patients. Treatment of AI patients should be carefully planned and an acceptable risk-benefit balance should be established.

Efinaconazole Topical Solution, 10%

2014 ◽  
Vol 104 (6) ◽  
pp. 568-573 ◽  
Author(s):  
Richard A. Pollak
Keyword(s):  
Topical Therapy ◽  
Treatment Options ◽  
Common Disease ◽  
Nail Lacquer ◽  
Topical Solution ◽  
Mycologic Cure ◽  
Cure Rates ◽  
Patients Experience

Background Toenail onychomycosis is a common disease with limited treatment options; treatment failure and relapse are frequently encountered. Many patients experience long-standing disease affecting multiple toenails, with substantial discomfort and pain. Although some patients might prefer a topical therapy, efficacy with ciclopirox nail lacquer has been disappointing. Methods Efinaconazole topical solution, 10% is the first topical triazole antifungal agent specifically developed for the treatment of onychomycosis. This paper reviews the preclinical and clinical data on efinaconazole topical solution, 10%. Results Efinaconazole has a broad spectrum of antifungal activity in vitro and is more potent than ciclopirox against common onychomycosis pathogens. It has a more optimal keratin affinity than ciclopirox, and it exhibits significantly greater in vivo activity owing to its superior nail penetration. Mycologic cure rates at week 52 were 55.2% (study 1) and 53.4% (study 2) with efinaconazole topical solution, 10% compared with 16.8% and 16.9%, respectively, with vehicle (P&lt;.001 for both). In addition, efinaconazole is well tolerated. Conclusions Efinaconazole topical solution, 10% may likely become a preferred topical agent for the management of mild-to-moderate onychomycosis.

Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

2011 ◽  
Vol 21 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Farzan Irani ◽  
Rodney Gabel
Keyword(s):  
Case Report ◽  
Therapeutic Intervention ◽  
Intensive Therapy ◽  
Positive Outcome ◽  
Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

Counseling Adolescents With Hearing Loss Using a Narrative Therapy Approach

2009 ◽  
Vol 19 (2) ◽  
pp. 72-78
Author(s):  
Rebecca L. Nelson Crowell ◽  
Julie Hanenburg ◽  
Amy Gilbertson
Keyword(s):  
Hearing Loss ◽  
Process Evaluation ◽  
Narrative Therapy ◽  
Daily Life ◽  
Hearing Aid ◽  
Self Esteem ◽  
Therapy Approach ◽  
Self Worth ◽  
Counseling Adolescents

Abstract Audiologists have a responsibility to counsel patients with auditory concerns on methods to manage the inherent challenges associated with hearing loss at every point in the process: evaluation, hearing aid fitting, and follow-up visits. Adolescents with hearing loss struggle with the typical developmental challenges along with communicative challenges that can erode one's self-esteem and self-worth. The feeling of “not being connected” to peers can result in feelings of isolation and depression. This article advocates the use of a Narrative Therapy approach to counseling adolescents with hearing loss. Adolescents with hearing loss often have problem-saturated narratives regarding various components of their daily life, friendships, amplification, academics, etc. Audiologists can work with adolescents with hearing loss to deconstruct the problem-saturated narratives and rebuild the narratives into a more empowering message. As the adolescent retells their positive narrative, they are likely to experience increased self-esteem and self-worth.

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