Certolizumab Pegol in the Treatment of Psoriasis and Psoriatic Arthritis: Preliminary Real-Life Data

Abstract

Introduction

We present the results of real-life tests conducted in adults affected by psoriatic arthritis (PsA) with mild cutaneous involvement to evaluate the efficacy of certolizumab pegol (CZP), an anti-tumor necrosis factor-alpha agent approved in Europe for the treatment of rheumatoid arthritis and PsA.

Methods

Assessments included an evaluation of the Psoriasis Area and Severity Index (PASI) and the Disease Activity Score computed on 44 joints (DAS-44) correlated to the erythrocyte sedimentation rate (ESR) (DAS44-ESR). A total of 41 patients (16 men, 25 women; mean age 59.8 ± 8 years) completed the study. Of these, 36 patients were affected by both PsA and psoriasis, and five patients were affected only by PsA. A total of 32 patients (group A) completed 3 months of treatment (W12), and 12 patients completed 6 months of treatment (W24) (group B).

Results

The clinical efficacy of CZP was consistent on both the cutaneous and rheumatic components of the treatment. The mean PASI score decreased from 4.4 ± 4.7 at baseline (BL) to 2.3 ± 3.7 at W12 (group A), and from 5.1 ± 5.7 at BL to 0.8 ± 1.2 at W24 (group B). The DAS44-ESR decreased from 4.4 ± 0.6 at BL to a mean of 2.2 ± 0.9 at W12 (group A) and from 4.1 ± 0.6 at BL to a mean of 1.9 ± 0.5 at W24 (group B). No adverse events were reported.

Conclusion

Our results demonstrate that CZP can be used safely and effectively to treat both the cutaneous and joint components of PsA. However, long-term data are needed to confirm our preliminary observations.

http://ift.tt/2idpsBZ

Cover Image

The cover image, by Jianjian Qiu et al., is based on the Original Article ¹⁸F-Fluoromisonidazole positron emission tomography/CT-guided volumetric-modulated arc therapy-based dose escalation for hypoxic subvolume in nasopharyngeal carcinomas: A feasibility study, DOI: 10.1002/hed.24925.

http://ift.tt/2mog4Ad

Issue Information - Contents

http://ift.tt/2moWyDu

Novel topical agent containing superoxide dismutase 100 000 IU and 4% of plant extracts as a mono-therapy for atopic dermatitis

Abstract

Introduction

Corticosteroids are the mainstay of treatment for the acute phase of atopic dermatitis (AD), whereas topical emollients are mainly used for maintenance of remission. A topical agent that combines emollient and anti-inflammatory properties would achieve control of all phases of AD, without the need for chronic corticosteroid use.

Aim

To assess the efficacy of a novel topical agent containing superoxide dismutase (SOD) 100 000 IU and 4% of a combination of plant extracts (blackcurrant seed oil, sunflower oil concentrate, balloon vine extract).

Methods

Twenty patients (age range from 8 months to 72 years old) with mild-to-moderate atopic dermatitis were assessed. The product was used as mono-therapy, applied to the affected skin areas twice daily. Patients were evaluated before and after a 30-day course using the SCORAD and the Visual Analog Scale for assessment of pruritus intensity. Primary endpoint was improvement of AD according to SCORAD and clinical assessment. Secondary endpoint was patient satisfaction and improvement of pruritus.

Results

Mean SCORAD on day 0 was 32.61(range = 16.0-46.9) and decreased to 10.55 (range = 0-17.0) on day 30, reflecting a reduction of 67.6%. On day 30, all patients described significant improvement in pruritus and quality of sleep.

Conclusion

The application of the study product cream resulted in significant improvement of AD, as reflected by the objective SCORAD measurement, and the subjective assessment of pruritus and quality of life. This novel anti-inflammatory emollient product may emerge as a safe and effective therapeutic tool for all phases of AD without the adverse effects of chronic use of corticosteroids.

http://ift.tt/2z0A95g

Vaccines We Need But Don't Have

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2AEtn1I

Association of Single-Nucleotide Polymorphisms in Immune-Related Genes with Development of Dengue Hemorrhagic Fever in a Mexican Population

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2id9BDF

Enhanced CD103 Expression and Reduced Frequencies of Virus-Specific CD8+ T Cells Among Airway Lymphocytes After Influenza Vaccination of Mice Deficient in Vitamins A + D

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2AE2V8i

Correction to: Abstracts

Abstract

In Oral Free Paper Sessions, the first-author name was missing from the authorship group originally listed for Abstract OFP-04-012 (page S14), entitled "Differentiating primary pulmonary squamous cell carcinoma from squamous cell carcinoma of the cervix metastatic to the lung: Histological and immunohistochemistry study".

http://ift.tt/2joQqdm

Interaction of zearalenone with bovine serum albumin as determined by fluorescence quenching

Abstract

The major aim of this study was to examine the binding of zearalenone (ZEN) to bovine serum albumin (BSA) by measuring the quenching of the intrinsic fluorescence of the protein under aqueous conditions. The results suggest that ZEN has a strong ability to quench the intrinsic fluorescence of BSA through a static mechanism. The hydrophobicity of the microenvironment around the tyrosine (Tyr) residues in BSA was increased in the presence of ZEN. The quenching constants, ratio of protein with ZEN, and thermodynamic parameters were determined. The collaborative action of hydrophobic and electrostatic interactions was involved in the binding process and the formation of the complex was mainly enthalpy-driven. The average binding distance between ZEN and BSA was calculated to be 2.20 nm. This is much closer in magnitude than the distance reported for the binding of most toxins to HSA and most pharmaceuticals to BSA, indicating a strong affinity.

http://ift.tt/2yxOrX5

ACS NSQIP risk calculator reliability in head and neck oncology: The effect of prior chemoradiation on NSQIP risk estimates following laryngectomy

To determine whether inclusion of chemoradiation history increases estimated risk for complications following total laryngectomy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator.

http://ift.tt/2AH5aZe

Ohrmuschelplastik der Dysplasie Grad I

Laryngo-Rhino-Otol 2017; 96: 797-807
DOI: 10.1055/s-0043-119044

Die Korrektur der Ohrmuscheldysplasie Grad I gehört zu den häufigsten ästhetischen Eingriffen im HNO-Gebiet. In den allermeisten Fällen liegt eine komplexe Pathologie von Anthelix, Cavum conchae und/oder Lobulus vor. Der Operateur muss deshalb nach einer genauen Analyse der Pathologie aus den verschiedenen Korrekturmöglichkeiten nach dem „Baukastenprinzip" die für das spezielle Problem geeignetsten Operationstechniken auswählen können.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2AF59oR

Nasenmuscheloperation: Welche olfaktorischen Leistungen werden eingeschränkt

Laryngo-Rhino-Otol 2017; 96: 753-754
DOI: 10.1055/s-0043-119601

Konstantinidis I et al. Intranasal trigeminal function in patients with empty nose syndrome. Laryngoscope 2017;127: 1263–1267 Das trigeminale System vermittelt die Wahrnehmung des nasalen Luftflusses. Eine griechische Arbeitsgruppe hat nun in einer Studie untersucht, inwieweit bei „Syndrom der leeren Nase"-Patienten (Empty Nose Syndrome, ENS) die geschädigte intranasale Trigeminusfunktion Teil einer paradoxen Nasenatmungsbehinderung ist.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2AGo9mT

Ungewöhnlicher Verlauf eines stumpfen Traumas der Halsregion im Rahmen eines Sportunfalles

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119757

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2yxqu1P

Narrow Band Imaging (NBI) zur Früherkennung von Zweitkarzinomen

Laryngo-Rhino-Otol 2017; 96: 754-755
DOI: 10.1055/s-0043-119566

Tirelli G et al. Follow-up of oral and oropharyngeal cancer using narrow-band imaging and high-definition television with rigid endoscope to obtain an early diagnosis of second primary tumors: a prospective study. Eur Arch Otorhinolaryngol 2017; 274: 2529–2536 Italienische Wissenschaftler testeten, inwieweit nach einer Behandlung von oralen Karzinomen und Tumoren des Oropharynx mit einer starren Endoskopie mit NBI-Licht Zweittumore oder lokale Rezidive besser detektierbar sind als mit Weißlicht-Endoskopie (WLE). Darüber hinaus untersuchten sie inwieweit vorherige Radiotherapie, Läsionsseite und Lernkurve die NBI-Leistung zur Detektion mukosaler Gefäßveränderungen tangiert.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2AHtOsW

Rhinoplastik

Laryngo-Rhino-Otol 2017; 96: 810-813
DOI: 10.1055/s-0043-119386

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2yxqejn

Idiopathische subglottische Stenose: Rezidivwahrscheinlichkeit unverändert

Laryngo-Rhino-Otol 2017; 96: 755-756
DOI: 10.1055/s-0043-119935

Aarnæs MT et al. Idiopathic subglottic stenosis: an epidemiological single-center study. Eur Arch Otorhinolaryngol 2017; 274: 2225–2228 Wissenschaftler der HNO-Klinik der Universität Oslo untersuchten Inzidenz, Management und Behandlungsergebnisse der idiopathischen subglottischen Stenose.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2AEN5Ls

Aus der Gutachtenpraxis: Die Begutachtung der Facialisparese in der österreichischen privaten Unfallversicherung

Laryngo-Rhino-Otol 2017; 96: 792-796
DOI: 10.1055/s-0043-119592

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2yANa1v

Koniotomie

Laryngo-Rhino-Otol 2017; 96: 757-758
DOI: 10.1055/s-0043-119561

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2yybVeG

Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 808-809
DOI: 10.1055/s-0043-119804

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2AGXpCv

Hörverlust und Sprachverstehen im Alter

Laryngo-Rhino-Otol 2017; 96: 759-764
DOI: 10.1055/s-0043-119388

Das Verstehen von Sprache bei Hintergrundgeräuschen bereitet vielen älteren Menschen Probleme. In der klinischen Praxis wird diese Qualität des Hörvermögens durch Sprachtests im Störgeräusch untersucht. Die Studie HÖRSTAT setzte den Göttinger Satztest (GÖSA) im Störgeräusch zusätzlich zur Tonaudiometrie und einer Befragung bei einer Zufallsstichprobe aus der Allgemeinbevölkerung ein. Wie erwartet nahm der Anteil Schwerhörender ab ca. 60 Jahren stark zu. Bei Ausschluss sehr hoher Hörverluste waren im Alter von 60–85 Jahren jedoch 68 % von 553 Probanden nach dem WHO-Kriterium als normalhörend einzustufen. Von diesen erreichte im GÖSA allerdings nur jeder Dritte annähernd das Sprachverstehen im Störgeräusch junger Normalhörender. Die Selbsteinschätzung des Hörvermögens folgte dabei nur eingeschränkt der messbaren Verschlechterung. Ab einem Alter von ca. 70 Jahren wurden die eigenen Hör-Fähigkeiten eher über- und die Defizite unterschätzt.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2yzDuUM

Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2017; 96: 750-751
DOI: 10.1055/s-0043-122090

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2AE5NTn

Tablet-based sublingual immunotherapy for respiratory allergy

Publication date: Available online 13 November 2017
Source:Allergologia et Immunopathologia
Author(s): L. Prieto
Allergic respiratory disease represents a significant and expanding health problem worldwide. The gold standard of therapeutic intervention is still grucocorticosteroids, although they are not effective in all patients and may cause side effects. Allergen Immunotherapy has been administrated as subcutaneous injections for treatment of allergic rhinoconjunctivitis and asthma and has been practiced for the past century. Sublingual immunotherapy (SLIT) tablets are now available for grass- or ragweed-induced rhinoconjunctivitis and will be available in Spain for house dust mite (HDM)-induced rhinoconjunctivitis and asthma in the next months. In this review, new developments in the field of tablet-based SLIT for respiratory allergy are summarized, with special emphasis on HDM-induced allergic rhinitis and asthma. SLIT tablets are the best-documented immunotherapy products on the market and represent a more patient-friendly concept because they can be self-administrated at home.



http://ift.tt/2zImhcY

Und sie bewegt sich doch!

http://ift.tt/2joaCwb

Combined use of high doses of vasopressin and corticosteroids in a patient with Crohn’s disease with refractory septic shock after intestinal perforation: a case report

In this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery.

http://ift.tt/2yYJHhe

Change over time in the rates of adverse events in patients receiving systemic therapy for psoriasis: a cohort study

http://ift.tt/2zDZSj2

Validity and Accuracy of a Mobile Phone Application for the Assessment of Wounds in Recessive Dystrophic Epidermolysis Bullosa

http://ift.tt/2yYaIkY

The role of T helper 25 (Th25) cells in the immune response to M. leprae

http://ift.tt/2yXb9vT

Rituximab as first line adjuvant in pemphigus: retrospective analysis of the long-term outcomes in a single center

http://ift.tt/2mksIQs

All cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis

There are varying reports of the association of basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (SCC) with all-cause mortality.Patients with a history of SCC have an approximately 25% increased risk of all-cause mortality compared to the general population CC may be a clinical marker of a decline in health

http://ift.tt/2mrdxFx

Effect of implant loading protocols on failure and marginal bone loss with unsplinted two-implant-supported mandibular overdentures: systematic review and meta-analysis

The aim of this study was to compare implant failure and radiographic bone level changes with different loading protocols for unsplinted two-implant-supported mandibular overdentures. An electronic search of two databases (PubMed, Cochrane Library) was performed, without language restriction, to identify randomized controlled trials (RCTs) comparing immediate or early versus conventional dental implant loading protocols for unsplinted two-implant-supported mandibular overdentures. Data were extracted independently by two reviewers.

http://ift.tt/2AFKtgd

Correlation between intraoperative proximal segment rotation and post-sagittal split ramus osteotomy relapse: a three-dimensional cone beam computed tomography study

This study evaluated the effects of proximal segment rotation and the extent of mandibular setback on post-sagittal split ramus osteotomy (SSRO) relapse using three-dimensional (3D) analysis. Thirty-one patients diagnosed with a skeletal class III malocclusion who underwent SSRO alone were enrolled in this study. The movements of the mandibular condyles were assessed using cone beam computed tomography (CBCT) and a 3D imaging program at ≤1 month before the operation (T0), 1 week after the operation (T1), and 6 months (T2) and 1year (T3) postoperative.

http://ift.tt/2yzgXY2

Soft palate reconstruction after radionecrosis: Combined anterolateral thigh adipofascial and nasoseptal flaps

Although radiation-based treatment for nasopharyngeal cancer may achieve excellent long term oncologic results, late effects of therapy may lead to soft tissue radionecrosis and velopharyngeal insufficiency (VPI). Repair of these oro- and nasopharyngeal defects presents a complex reconstructive challenge. We present a case of a long-term survivor treated with chemoradiotherapy for nasopharyngeal cancer who developed progressive dysphagia, velopharyngeal insufficiency, and radionecrosis of the nasopharynx and soft palate, leading to tracheostomy and gastrostomy tube dependence.

http://ift.tt/2mns70y

Ki67 labeling index: assessment and prognostic role in gastroenteropancreatic neuroendocrine neoplasms

Abstract

In 1983, a monoclonal antibody, Ki67, was generated, that labeled the nuclei of proliferating non-neoplastic and neoplastic cells. The name Ki67 derived from the city of Kiel (Ki) where the antibody was produced in the university department of pathology and refers to the number of the original clone (67). Systematic assessment of the proliferative activity of tumors using Ki67 started in the 1990s, when Ki67, which only worked on frozen tissue, was complemented by the antibody MIB-1 that also worked in formalin-fixed tissues. Pancreatic neuroendocrine neoplasms (PanNENs) were the first endocrine tumors whose proliferative activity was assessed with Ki67. This approach was so successful that Ki67 was included as prognostic marker in the 2000 and 2004 WHO classifications of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). In 2010, the WHO classification of GEP-NENs introduced a three-tiered grading, originally proposed by ENETS in 2006 that was mainly based on the Ki67 index. As it has subsequently been shown that the Ki67 index is the most reliable factor in the prognostic evaluation of GEP-NENs, especially of PanNENs, the 2017 WHO classification of PanNENs requires its use and strongly recommends exact assessment of the proportion Ki67-labeled cells as basis for the calculation of the Ki67 index. Problems in assessing the Ki67 index include intertumoral and intratumoral staining heterogeneity and counting methods. Despite such problems, the Ki67 index has emerged as indispensable for the prognostic and therapeutic stratification of the majority of GEP-NENs and can barely be replaced by counting mitoses. In future, however, it can be anticipated that the Ki67 cut-offs experience refinement in relation to the type of tumor, its location, and its response to therapy. It is also possible that the prognostic risk of an individual tumor is calculated for each Ki67 unit and not for an "a priori" fixed Ki67 class.

http://ift.tt/2mqpMCe

Selected Literature Watch

Violence and Gender , Vol. 0, No. 0.


http://ift.tt/2mnQpaz

Trump Picks Ex-Pharma Exec Alex Azar to Head HHS

Azar, who served in HHS before, will be Trump's point person for reducing the cost of prescription drugs.
Medscape Medical News

http://ift.tt/2zTugHp

How Trump's Tax Plan Could Affect Doctors

The impending tax overhaul may still change, but here's how the elements of the proposed plans could affect physicians.
Medscape Business of Medicine

http://ift.tt/2zG1XsQ

Synchronized Spontaneous Otoacoustic Emissions Provide a Signal-to-Noise Ratio Advantage in Medial-Olivocochlear Reflex Assays

Abstract

Detection of medial olivocochlear-induced (MOC) changes to transient-evoked otoacoustic emissions (TEOAE) requires high signal-to-noise ratios (SNR). TEOAEs associated with synchronized spontaneous (SS) OAEs exhibit higher SNRs than TEOAEs in the absence of SSOAEs, potentially making the former well suited for MOC assays. Although SSOAEs may complicate interpretation of MOC-induced changes to TEOAE latency, recent work suggests SSOAEs are not a problem in non-latency-dependent MOC assays. The current work examined the potential benefit of SSOAEs in TEOAE-based assays of the MOC efferents. It was hypothesized that the higher SNR afforded by SSOAEs would permit detection of smaller changes to the TEOAE upon activation of the MOC reflex. TEOAEs were measured in 24 female subjects in the presence and absence of contralateral broadband noise. Frequency bands with and without SSOAEs were identified for each subject. The prevalence of TEOAEs and statistically significant MOC effects were highest in frequency bands that also contained SSOAEs. The median TEOAE SNR in frequency bands with SSOAEs was approximately 8 dB higher than the SNR in frequency bands lacking SSOAEs. After normalizing by TEOAE amplitude, MOC-induced changes to the TEOAE were similar between frequency bands with and without SSOAEs. Smaller MOC effects were detectable across a subset of the frequency bands with SSOAEs, presumably due to a higher TEOAE SNR. These findings demonstrate that SSOAEs are advantageous in assays of the MOC reflex.

http://ift.tt/2ic6wDA

Aminoglycoside Damage and Hair Cell Regeneration in the Chicken Utricle

Abstract

In this study, we present a systematic characterization of hair cell loss and regeneration in the chicken utricle in vivo. A single unilateral surgical delivery of streptomycin caused robust decline of hair cell numbers in striolar as well as extrastriolar regions, which in the striola was detected very early, 6 h post-insult. During the initial 12 h of damage response, we observed global repression of DNA replication, in contrast to the natural, mitotic hair cell production in undamaged control utricles. Regeneration of hair cells in striolar and extrastriolar regions occurred via high rates of asymmetric supporting cell divisions, accompanied by delayed replenishment by symmetric division. While asymmetric division of supporting cells is the main regenerative response to aminoglycoside damage, the detection of symmetric divisions supports the concept of direct transdifferentiation where supporting cells need to be replenished after their phenotypic conversion into new hair cells. Supporting cell divisions appear to be well coordinated because total supporting cell numbers throughout the regenerative process were invariant, despite the initial large-scale loss of hair cells. We conclude that a single ototoxic drug application provides an experimental framework to study the precise onset and timing of utricle hair cell regeneration in vivo. Our findings indicate that initial triggers and signaling events occur already within a few hours after aminoglycoside exposure. Direct transdifferentiation and asymmetric division of supporting cells to generate new hair cells subsequently happen largely in parallel and persist for several days.

http://ift.tt/2zVZEVA

Editorial Board

Publication date: November 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 9





http://ift.tt/2id7bVn

Training Groups

Publication date: November 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 9





http://ift.tt/2AD7hN4

Safety Outcomes Following Spine and Cranial Neurosurgery: Evidence From the National Surgical Quality Improvement Program.

Background: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was used to establish predictors for 30-day postoperative complications following spine and cranial neurosurgery. Materials and Methods: The ACS-NSQIP participant use files were queried for neurosurgical cases between 2005 and 2015. Prevalence of postoperative complications following neurosurgery was determined. Nested multivariable logistic regression analysis was used to identify demographic, comorbidity, and perioperative characteristics associated with any complication and mortality for spine and cranial surgery. Results: There were 175,313 neurosurgical cases (137,029 spine, 38,284 cranial) identified. A total of 23,723 (13.5%) patients developed a complication and 2588 (1.5%) patients died. Compared with spine surgery, cranial surgery had higher likelihood of any complication (22.2% vs. 11.1%; P

http://ift.tt/2zHYKJw

Phenytoin-induced Excessive Sedation During Awake Craniotomy: An Unusual Observation.

No abstract available

http://ift.tt/2iRKvtD

Complement in the pathogenesis of Alzheimer’s disease

Abstract

The emergence of complement as an important player in normal brain development and pathological remodelling has come as a major surprise to most scientists working in neuroscience and almost all those working in complement. That a system, evolved to protect the host against infection, should have these unanticipated roles has forced a rethink about what complement might be doing in the brain in health and disease, where it is coming from, and whether we can, or indeed should, manipulate complement in the brain to improve function or restore homeostasis. Complement has been implicated in diverse neurological and neuropsychiatric diseases well reviewed elsewhere, from depression through epilepsy to demyelination and dementia, in most complement drives inflammation to exacerbate the disease. Here, I will focus on just one disease, the most common cause of dementia, Alzheimer's disease. I will briefly review the current understanding of what complement does in the normal brain, noting, in particular, the many gaps in understanding, then describe how complement may influence the genesis and progression of pathology in Alzheimer's disease. Finally, I will discuss the problems and pitfalls of therapeutic inhibition of complement in the Alzheimer brain.

http://ift.tt/2zDU75g

Synchronized Spontaneous Otoacoustic Emissions Provide a Signal-to-Noise Ratio Advantage in Medial-Olivocochlear Reflex Assays

Abstract

Detection of medial olivocochlear-induced (MOC) changes to transient-evoked otoacoustic emissions (TEOAE) requires high signal-to-noise ratios (SNR). TEOAEs associated with synchronized spontaneous (SS) OAEs exhibit higher SNRs than TEOAEs in the absence of SSOAEs, potentially making the former well suited for MOC assays. Although SSOAEs may complicate interpretation of MOC-induced changes to TEOAE latency, recent work suggests SSOAEs are not a problem in non-latency-dependent MOC assays. The current work examined the potential benefit of SSOAEs in TEOAE-based assays of the MOC efferents. It was hypothesized that the higher SNR afforded by SSOAEs would permit detection of smaller changes to the TEOAE upon activation of the MOC reflex. TEOAEs were measured in 24 female subjects in the presence and absence of contralateral broadband noise. Frequency bands with and without SSOAEs were identified for each subject. The prevalence of TEOAEs and statistically significant MOC effects were highest in frequency bands that also contained SSOAEs. The median TEOAE SNR in frequency bands with SSOAEs was approximately 8 dB higher than the SNR in frequency bands lacking SSOAEs. After normalizing by TEOAE amplitude, MOC-induced changes to the TEOAE were similar between frequency bands with and without SSOAEs. Smaller MOC effects were detectable across a subset of the frequency bands with SSOAEs, presumably due to a higher TEOAE SNR. These findings demonstrate that SSOAEs are advantageous in assays of the MOC reflex.

http://ift.tt/2ic6wDA

Aminoglycoside Damage and Hair Cell Regeneration in the Chicken Utricle

Abstract

In this study, we present a systematic characterization of hair cell loss and regeneration in the chicken utricle in vivo. A single unilateral surgical delivery of streptomycin caused robust decline of hair cell numbers in striolar as well as extrastriolar regions, which in the striola was detected very early, 6 h post-insult. During the initial 12 h of damage response, we observed global repression of DNA replication, in contrast to the natural, mitotic hair cell production in undamaged control utricles. Regeneration of hair cells in striolar and extrastriolar regions occurred via high rates of asymmetric supporting cell divisions, accompanied by delayed replenishment by symmetric division. While asymmetric division of supporting cells is the main regenerative response to aminoglycoside damage, the detection of symmetric divisions supports the concept of direct transdifferentiation where supporting cells need to be replenished after their phenotypic conversion into new hair cells. Supporting cell divisions appear to be well coordinated because total supporting cell numbers throughout the regenerative process were invariant, despite the initial large-scale loss of hair cells. We conclude that a single ototoxic drug application provides an experimental framework to study the precise onset and timing of utricle hair cell regeneration in vivo. Our findings indicate that initial triggers and signaling events occur already within a few hours after aminoglycoside exposure. Direct transdifferentiation and asymmetric division of supporting cells to generate new hair cells subsequently happen largely in parallel and persist for several days.

http://ift.tt/2zVZEVA

Rhumatisme psoriasique en France, du nourrisson à la personne âgée : données de deux études transversales multicentriques

Publication date: Available online 13 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Galezowski, F. Maccari, S. Hadj-Rabia, M.-L. Sigal, A. Phan, M. Lahfa, A.-C. Bursztejn, H. Barthélémy, F. Boralévi, Z. Reguiai, C. Chiavérini, E. Estève, E. Bourrat, M. Ruer-Mulard, A. Beauchet, E. Mahé
IntroductionLe rhumatisme psoriasique touche 20 à 30 % des patients atteints de psoriasis cutané. Peu de données épidémiologiques sont disponibles en France sur sa prévalence, ses associations avec l'atteinte dermatologique et ses comorbidités.ObjectifsÉvaluer les aspects épidémiologiques et associations cliniques et épidémiologiques du rhumatisme psoriasique chez les enfants et les adultes, en France.MéthodesDeux études transversales, multicentriques ont été menées en France chez les enfants (χ-Psocar, 23 centres de dermatologie pédiatrique membres du GR SFDP, 1 an) et les adultes (Resopsocar, 29 centres de dermatologie membres du GEM RESOPSO, 4 mois) pour étudier les comorbidités cardiovasculaires et métaboliques du psoriasis.RésultatsParmi les 313 enfants (garçons : 47,6 % ; âge moyen, 9,4 ans) et 1954 adultes (hommes : 56,0 % ; âge moyen : 48,5 ans) atteints de psoriasis, 4,2 % des enfants et 21,0 % des adultes souffraient de rhumatisme psoriasique. La prévalence augmentait avec l'âge : 2,2 % des enfants, 14,2 % des adolescents et plus de 20 % après 40 ans. Elle diminuait après 70 ans (19,4 %). Quel que soit l'âge, le sexe n'était pas associé au rhumatisme psoriasique. Chez les enfants, le rhumatisme était associé à l'atteinte unguéale (p=0,04) et à la sévérité de la maladie (p=0,0004). Chez les adultes il était associé au psoriasis en plaques (p=0,002), à la sévérité de la maladie (p<0,0001) et à l'obésité (p<0,0001). Le psoriasis en plaques localisé (cuir chevelu, psoriasis palmo-plantaire par exemple) était moins souvent associé au rhumatisme psoriasique (p<0,05).ConclusionsCes deux études transversales menées en France sur 2267 patients, principalement hospitaliers, donnent une idée de la prévalence du rhumatisme psoriasique tout au long de la vie. La prévalence augmente progressivement avec l'âge, sans différence de genre, avant de diminuer chez les personnes âgées. Nous confirmons l'association avec l'onychopathie psoriasique dès l'enfance et avec l'obésité chez les adultes.BackgroundPsoriatic arthritis affects 20–30% of patients with psoriasis. Few epidemiological data are available in France about its prevalence and its association with skin lesions and comorbidities.ObjectivesTo assess the epidemiological aspects and the risk factors for psoriatic arthritis in children and adults in France.MethodsTwo cross-sectional studies were conducted in France in children (χ-Psocar, 23 pediatric dermatology centers belonging to the SFDP, 1 year) and adults (Resopsocar, 29 dermatology centers belonging to GEM RESOPSO, 4 months) to study the link between psoriasis and cardiovascular and metabolic comorbidities.ResultsThree hundred and thirteen children (males: 47.6%; mean age: 9.4 yrs) and 1,954 adults (males: 56.0%; mean age: 48.5 yrs) with psoriasis were included, with 4.2% of the children and 21.0% of the adults presenting psoriatic arthritis. Prevalence increased with age: 2.2% of children, 14.2% of adolescents, and over 20% after 40 years. It decreased after the age of 70 years (19.4%). Regardless of age, arthritis was not associated with gender. In the children's group, rheumatism was associated with nail involvement (P=0.04) and disease severity (P=0.0004). Adult rheumatism was associated with generalized plaque psoriasis (P=0.002), disease severity (P<0.0001), and obesity (P<0.0001). Localized plaque psoriasis was less often associated with arthritis (P<0.05).ConclusionsThese two cross-sectional studies conducted in 2267 patients in France yielded information on the prevalence of joint involvement from infants to elderly subjects. It is the first study conducted in a single population to provide data for the whole population. Prevalence gradually increases with age, without gender difference, before decreasing in old age. We confirm the association of nail involvement in the first years of life, and of obesity in adults.



http://ift.tt/2ABX7wf

Use of a Non-ICU Specialty Ward For Immediate Post-operative Management of Head and Neck Free Flap

Conditions:   Head and Neck Cancer;   Head and Neck Squamous Cell Carcinoma;   Head and Neck Carcinoma;   Trauma
Intervention:   Other: Non-ICU Specialty ward
Sponsor:   Arnaud Bewley
Recruiting

http://ift.tt/2zEBs9l

Multiorgan Metabolic Imaging Response Assessment of Abemaciclib

Conditions:   Esophageal Adenocarcinoma;   Esophagus SCC;   Cholangiocarcinoma;   Urothelial/Bladder Cancer, Nos;   Endometrial Cancer
Intervention:   Drug: Abemaciclib
Sponsors:   Jules Bordet Institute;   Eli Lilly and Company
Not yet recruiting

http://ift.tt/2hqarfs

Melanoma tumors exhibit a variable but distinct metabolic signature

http://ift.tt/2ic7Ru9

Molecular photoprotection of human keratinocytes in vitro by the naturally occurring mycosporine-like amino acid (MAA) palythine

Summary

Background

Solar ultraviolet radiation (UVR) induces molecular and genetic changes in the skin, which result in skin cancer, photoageing and photosensitivity disorders. The use of sunscreens is advocated to prevent such photodamage, however most formulations contain synthetic UVR filters that are non-biodegradable and can damage fragile marine ecosystems. Mycosporine-like amino acids (MAA) are natural UVR-absorbing compounds that have evolved in marine species for protection against chronic UVR exposure in shallow-water habitats.

Objectives

To determine if palythine, a photostable model MAA, could offer protection against a range of UVR-induced damage biomarkers that are important in skin cancer and photoageing.

Methods

HaCaT human keratinocytes were used to assess the photoprotective potential of palythine using a number of endpoints including cell viability, DNA damage (non-specific, cyclobutane pyrimidine dimers and oxidatively generated damage), gene expression changes (linked to inflammation, photoageing and oxidative stress) and oxidative stress. The anti-oxidant mechanism was investigated using chemical quenching and Nrf2 pathway activation assays.

Results

Palythine offered statistically significant protection (p<0.005) against all endpoints tested even at extremely low concentrations (0.3% w/v). Additionally, palythine was found to be a potent antioxidant, reducing oxidatively generated stress, even when added post exposure.

Conclusions

Palythine is an extremely effective multifunctional photoprotective molecule in vitro that has potential to be developed as a natural and biocompatible alternative to synthetic UVR filters.

This article is protected by copyright. All rights reserved.

http://ift.tt/2AAYpY6

How to get rid of a nose piercing bump

Even with the best aftercare, a bump may form around a nose piercing. In this article, learn how to treat and prevent a nose piercing bump.

http://ift.tt/2iRdYDL

Gluten sensitivities and the allergist: Threshing the grain from the husks

Abstract

"Gluten sensitivity" has become commonplace among the public. Wheat allergy (WA) and celiac disease (CD) are well-defined entities, but are becoming a fraction of individuals following a gluten-free diet. WA has a prevalence of <0.5%. Wheat, specifically its omega-5 gliadin fraction, is the most common allergen implicated in food-dependent, exercise-induced anaphylaxis. CD is a non-IgE hypersensitivity to certain cereal proteins: gluten in wheat, secalin in rye, hordein in barley, and to a lesser extent avenin in oat. It is a rare disease, with an estimated prevalence that varied widely geographically, being higher in Northern Europe and the African Saharawi region than in Southeast Asia. In addition to suggestive symptoms, serologic testing has high diagnostic reliability and biopsy is a confirmatory procedure. CD patients have extra-intestinal autoimmune comorbid conditions more frequently than expected. A third entity is non-celiac gluten sensitivity, which has been created because of the increasing number of subjects who claim a better quality of life or improvement of their variety of symptoms on switching to a gluten-free diet. The phenomenon is being fueled by the media and exploited by the industry. The lack of a specific objective test has been raising substantial controversy about this entity. Allergists and gastroenterologists need to pay attention to the multitudes of individuals who elect to follow a gluten-free diet. Many such subjects might have WA, CD, or another illness. Providing them with appropriate evaluation and specific management would be of great advantages, medically and economically.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hvzocY

Quality of life is significantly impaired in non-allergic rhinitis patients

Abstract

Background

In contrast to the well-known significant impairment of quality of life (QoL) in allergic rhinitis (AR), the degree of impairment in QoL in non-allergic rhinitis (NAR) remained unknown for a long time, due to a lack of a validated questionnaire to assess QoL in the NAR patient group.

In this study a validation for the mini-RQLQ questionnaire in NAR patients was performed, followed by an assessment of QoL in NAR patients compared to AR and healthy controls.

Secondly, use of medication and treatment satisfaction in AR and NAR was assessed.

Methods

The study was an observational cohort study in 287 AR and 160 NAR patients.

Patients with symptoms of rhinitis were recruited from a tertiary care outpatient clinic of the Otorhinolaryngology Department. AR was defined as one or more positive results on skin prick testing and clinically relevant symptoms of rhinitis related to their sensitization. NAR was defined as clinically relevant symptoms of rhinitis but without positive results on skin prick testing.

The mini-RQLQ was successfully validated in this study for NAR patients.

Results

QoL in NAR patients was equally -and for some aspects even more- impaired compared to AR. More than half of both AR and NAR patients were unsatisfied with treatment.

Conclusion

These results demonstrate a significant impairment in both AR and NAR patients in their QoL combined with a low treatment satisfaction, emphasizing the need for adequate treatment, especially in the NAR patient group.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jndol2

Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

http://ift.tt/2AG8ggm

Diabetes und Krebs – den Zusammenhängen auf der Spur

http://ift.tt/2zFF6xD

Extragenitale, disseminierte Infektion mit humanen Papillomaviren

Zusammenfassung

Bei einem 50-jährigen Patienten mit seit 5 Jahren bestehender großflächiger Warzenmanifestation und extremem Pruritus kamen wir zur Diagnose einer reaktivierten HPV (humane Papillomaviren)-Infektion durch 3 molekulargenetisch gesicherte Virustypen (6, 16, 18), die im Impfstoff Gardasil® enthalten sind. Nachdem konventionelle Therapieverfahren keinen Erfolg erbrachten, zeigte sich nach Gardasil®-Immunisierung rasch ein signifikanter Rückgang der Hautmanifestation. Inwieweit therapieresistente HPV-Infektionen mittels einer aktiven HPV-Impfung zu beeinflussen sind, sollte in weiteren Studien untersucht werden.

http://ift.tt/2zTV4Hj

Equivalence in outcomes between Draf 2B vs Draf 3 frontal sinusotomy for refractory chronic frontal rhinosinusitis

Background

Endoscopic Draf 2B and Draf 3 frontal sinusotomies are frequently performed for chronic refractory frontal rhinosinusitis. The purpose of this study was to compare outcomes between Draf 2B and Draf 3 procedures.

Methods

A retrospective cohort study was conducted comparing patients undergoing bilateral Draf 2B vs Draf 3 procedures from 2000 to 2016. Patients with neoplasia, dysplasia, mucocele, cystic fibrosis, or ciliary dyskinesia were excluded. Preoperative disease parameters included number of prior surgeries, presence of polyps, preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) score, frontal Lund-Mackay score, anterior-posterior diameter of the frontal ostium, and Global Osteitis Scoring Scale (GOSS). Postoperative outcomes included SNOT-22 score, neo-ostium patency, surgical revision rates, and complications.

Results

A total of 21 patients with bilateral Draf 2B and 17 patients with Draf 3 surgeries were compared. Mean follow-up time was 15.6 months. No significant differences were seen between groups for any preoperative disease parameter. Both cohorts showed statistically significant (p = 0.0001 [Draf 2B]; p = 0.0001 [Draf 3]) and clinically meaningful (Δ = 24.1; Δ = 24.9) improvements in SNOT-22 at last follow-up vs preoperatively. The Draf 2B group had greater improvement in SNOT-22 score than the Draf 3 group at 1 to 3 months (p = 0.003), but the magnitude of improvement equalized at 5 to 9 months (p = 0.66) and last follow-up (p = 0.90). No significant differences were noted between groups regarding patency, revision rates, or complications.

Conclusion

Both Draf 2B and Draf 3 procedures offer durable symptomatic improvement for patients with refractory frontal CRS. The Draf 2B is associated with earlier postoperative symptom improvement and overall shows comparable long-term outcomes to the Draf 3 sinusotomy.

http://ift.tt/2ho4gsg

Behandlungsalgorithmus CUP

http://ift.tt/2huSj82

Treatment-related survival associations of claudin-2 expression in fibroblasts of colorectal cancer

Abstract

Claudin-2 is a trans-membrane protein—component of tight junctions in epithelial cells. Elevated claudin-2 expression has been reported in colorectal cancer (CRC). The aim of this study was to investigate the expression patterns of claudin-2 in human CRC samples and analyze its association with clinical characteristics and treatment outcome. TMAs of primary tumors from two cohorts of metastatic CRC (mCRC) were used. Claudin-2 IHC staining was evaluated in a semi-quantitative manner in different regions and cell types. Claudin-2 expression was also analyzed by immunofluorescence in primary cultures of human CRC cancer-associated fibroblasts (CAFs). Initial analyses identified previously unrecognized expression patterns of claudin-2 in CAFs of human CRC. Claudin-2 expression in CAFs of the invasive margin was associated with shorter progression-free survival. Subgroup analyses demonstrated that the survival associations occurred among cases that received 5-FU+oxaliplatin combination treatment, but not in patients receiving 5-FU±irinotecan. The finding was validated by analyses of the independent cohort. In summary, previously unreported stromal expression of claudin-2 in CAFs of human CRC was detected together with significant association between high claudin-2 expression in CAFs and shorter survival in 5-FU+oxaliplatin-treated mCRC patients.

http://ift.tt/2iQvoAD

DFD-01 Reduces Transepidermal Water Loss and Improves Skin Hydration and Flexibility

Abstract

Introduction

In plaque psoriasis, the benefit of topical steroids is well established. The vehicle formulation of topical steroids may also provide benefit in addition to the effects of the steroid itself. DFD-01 (betamethasone dipropionate spray, 0.05%) is a formulation composed of a topical steroid in an emollient-like vehicle that enhances penetration to the target site of inflammation in the skin. The aim of this study was to assess the effect of DFD-01 and its vehicle on skin hydration and barrier function in compromised skin and to evaluate its effect on flexibility in healthy skin.

Methods

Eighteen healthy white volunteers were enrolled in each of two studies. In Study 1, dry shaving of volar forearms created a compromised skin barrier, through which transepidermal water loss (TEWL) was measured using an evaporimeter. Capacitance, a measure of epidermal hydration, was also measured at baseline and at 1, 2 and 4 h after application of DFD-01 or its vehicle formulation. In Study 2, intact skin flexibility was tested with a cutometer before and at 1, 2 and 4 h after application of DFD-01 or vehicle.

Results

In Study 1, both DFD-01 and its vehicle were effective at reducing TEWL through the compromised stratum corneum. Capacitance measurements confirmed this finding; razor-chafed skin treated with either DFD-01 or vehicle exhibited levels of skin hydration similar to unshaved control skin. Study 2 found softening and greater flexibility of normal skin treated with either DFD-01 or vehicle compared with nontreated control skin samples.

Conclusions

These tests suggest that the DFD-01 formulation and its vehicle are each effective at retaining moisture within a damaged skin barrier and for softening and increasing the flexibility of intact skin.

Funding

Dr. Reddy's Laboratories.

http://ift.tt/2ACNFbL

Post-traumatic untreated chronic osteomyelitis: an extreme presentation with severe complications

Description

An 89-year-old man presented to the hospital complaining of several episodes of lipotimia and non-specific malaise. Comorbidities included a right lower limb chronic osteomyelitis, as consequence of a trauma at the age of 12 years, with occasional bleeding, and which has never been medical or surgically treated before. He was haemodynamically stable with normal cardiac and pulmonary auscultation during the physical examination. The right lower limb revealed an extensive extremely putrefied and suppurative wound with bone exposition in which fragments could easily be removed (figure 1A,B). Considering the patient's complaints, a 12-lead ECG was performed and showed normal sinus rhythm with 2:1 atrioventricular block, ST-segment elevation in the inferior leads and V6 and ST-segment depression in V1, V2, aVL and aVR. Patient denied chest pain. The laboratory investigation revealed a microcytic and hypochromic anaemia with an Hb of 4.2 g/dL (reference range 13.5–17.0 g/dL) and...

http://ift.tt/2zwAkFb

Tubular sigmoid duplication in an adult man: an interesting incidental finding

A 61-year-old man attended an outpatient colorectal clinic for a chronic, non-specific abdominal pain, associated with rectal bleeding. He underwent a number of investigations including a CT pneumocolon, which revealed an incidental finding of 20 cm of additional sigmoid colon. This case is interesting because tubular sigmoid duplication is an extremely unusual condition, rarely diagnosed in adults; only a few cases have been reported of this condition in the adult population. Our team chose to treat this patient conservatively, in order to avoid putting the patient at risk of an unnecessary surgery.

http://ift.tt/2zSeVH0

Urachal sinus leading to pyourachus presenting as recurrent periumbilical sepsis in an infant

Description

A 5-month-old female infant presented with an 8 days duration of fever and irritability. In the previous 48 hours, she developed a rash around her umbilicus with reduced feeding and wet nappies (figure 1). She was born at 38+3/40 weeks gestation by caesarean section for breech presentation. At 4 months of age, she had gastro-oesophageal reflux. She initially presented to the general practitioner (GP) at 3 months of age with redness around the umbilicus and dried clots in the centre without any swelling. She had no fever and was otherwise well. Initial treatment given by GP included a 1-week course of oral flucloxacillin for provisional diagnosis of infected umbilical granuloma. This seemed to have resolved her symptoms.

Figure 1

Clinical photograph showing a diffuse periumbilical erythema.

The baby was referred for paediatric assessment by her GP with recurrent symptoms mentioned above. On examination,...

http://ift.tt/2zwAhJv

Successful downstaging of locally recurrent penile squamous cell carcinoma with neoadjuvant nanosomal docetaxel lipid suspension (NDLS) based regimen followed by curative surgery

Penile squamous cell carcinoma (pSCC) is a relatively rare disease in Western world but is a significant health problem in developing countries like India. We report here a case of successful multimodality management of recurrent pSCC with pelvic lymphadenopathy in a 56-year-old male patient with poorly controlled diabetes. The patient presented with ulceroproliferative growth over the residual penile stump clinically involving root of penis and with right pelvic lymphadenopathy. The patient had a history of partial penectomy done elsewhere 20 months ago. In view of the comorbidities, locally recurrent disease and presence of right Iliac lymphadenopathy, the patient was treated with nanosomal docetaxel lipid suspension (NDLS), cisplatin and 5-fluorouracil (TPF regimen) in the neoadjuvant setting followed by staged surgical resection. This is the first case report showing successful treatment of recurrent pSCC with NDLS-based TPF regimen in the neoadjuvant setting followed by staged surgery in a patient with poorly controlled diabetes.

http://ift.tt/2zSeRHg

Single coronary artery with high aortic take-off-a rare coronary anomaly

Description

High take-off of coronary arteries refers to the origin of coronary arteries >1 cm above the sinotubular junction.1 Its prevalence in general population is estimated to be 0.20%.1 Some consider it to be benign, while others have reported it to be associated with ischaemia, myocardial infarction, syncope and sudden cardiac death.1 Similarly, single coronary artery is a rare coronary anomaly, where only one coronary artery originates from the single ostium from the aorta and supplies the entire heart. Its incidence varies between 0.0024% and 0.066% in those undergoing coronary angiography.2 It is extremely rare to find a single coronary artery with a high aortic take-off from the aorta, with only a few case reports available previously.3

A 65-year-old man with diabetes presented with a history of chronic stable angina and a positive exercise stress test at low threshold. During his diagnostic...

http://ift.tt/2zwAEDM

Global aphasia in a case of bilateral frontal lobe infarcts involving both caudate nuclei

Description 

We report a 50-year-old man with history of systemic hypertension, nicotine addiction and a folk singer by profession was brought to the hospital with history of abrupt onset of speech arrest at the peak of a high note during his stage performance. His co-performer friend noticed that he was unable to restart his song performance despite back stage prompting. He appeared clueless and unresponsive with expressionless face all of a sudden. His relatives were certain that there was a dramatic change in patient's personality (from an extrovert to an introvert). The patient seemed disinterested in his surroundings. He seemed to have a 'vacant stare'. On examination, his blood pressure was 170/100 mm Hg. He was conscious, alert, but unresponsive to simple verbal commands. There was no speech output. Fundus examination showed grade 1 hypertensive retinopathy, no papilloedema. Motor functions were preserved. MRI of brain with magnetic resonance angiography (MRA) was done in view...

http://ift.tt/2zTDtzr

Asymptomatic contrast medium extravasation

Description

A 72-year-old man was referred for a contrast-enhanced multidetector coronary CT examination. A physician tried to place an angiocatheter (BD Insyte Autoguard Winged, 20G, 1.1x25 mm) into the right median basilic vein; however, the vein could not be punctured correctly because it was difficult to detect owing to the tortuosity of the patient's vascular network. Therefore, the median cephalic vein was punctured. However, when the entire outer plastic tube was placed into the vein, the intravenous infusion failed to drop. When the outer plastic tube was pulled back by about 2 mm, the infusion was able to drop properly and the tube was fixed at that position. Before the infusion of contrast medium (CM), landiolol was injected through this catheter to reduce the patient's heart rate (HR). When the physician injected landiolol by hand, no resistance was felt and the HR of the patient was reduced from 81 to...

http://ift.tt/2zyM5uQ

Use of ketamine for acute suicidal ideation in a patient with chronic pain on prescribed cannabinoids

Ketamine is a standard anaesthetic drug that has been studied as a possible treatment for acute suicidal ideation. Aside to the potential psychotropic effects of ketamine, a Cochrane review reported that available studies suggest a modest effect of ketamine for chronic pain months to years after surgical intervention. We present a patient with acute suicidal ideation who required immediate inpatient psychiatric admission in the setting of concurrent chronic pain on cannabinoids which could not be prescribed within our inpatient hospital setting. This presented a clinical dilemma to rapidly reverse the patient's suicidality while substituting the patient's prescribed cannabinoid products with an alternative pain regimen. Since there is emerging support in the use of ketamine in suicidality and chronic pain, we administered ketamine while withholding cannabinoid products and found evidence to support its use in rapid reversal of suicidal ideation and temporary chronic pain relief.

http://ift.tt/2jl8aq7

Prenatal diagnosis of left isomerism with normal heart

Description

Left isomerism (LI) is characterised by loss of normal asymmetry of the thoracoabdominal organs. Consequently, viscera that normally develop on the left side are found on both sides of the body, whereas right-sided viscera may be absent. This abnormal symmetrical development of organs occurs because in the early embryonic life, there was a disruption of left–right axis orientation.

The most common reported anomalies are bilateral morphological left atria and lungs, cardiac defects, arrhythmias (because the sinus node, located in the right atrium, is absent or incompletely developed), interruption of the inferior vena cava (IVC), multiple spleens and gastrointestinal malformations such as right-sided stomach, midline liver, biliary tract abnormalities and intestinal malrotation.

This rare condition occurs in approximately 1 per 10 000–40 000 live births.1 The outcome of the fetuses with LI varies depending on the association with cardiac defects, dysrhythmias and other significant malformations.

The prenatal diagnosis...

http://ift.tt/2zSMokK

Orlistat-induced oxalate nephropathy: an under-recognised cause of chronic kidney disease

Two patients developed kidney failure due to oxalate deposition in the kidney while taking orlistat. Cessation of orlistat was followed by partial recovery of kidney function. The mechanism by which orlistat causes hyperoxaluria and the management of orlistat-induced oxalate nephropathy is reviewed. We suggest that all patients taking orlistat are at risk of this condition, which may develop insidiously and is easily overlooked. Monitoring of kidney function of patients taking orlistat is warranted.

http://ift.tt/2zzvNl4