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Sample records for asthenia

  1. Asthenia in Children with Chronic Viral Hepatitis

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    I.S. Lembryk

    2016-03-01

    Full Text Available In the article results of own researches concerning peculiarities of the course of asthenic syndrome in school-aged children with chronic hepatitis B, C and mixed forms are provided. It is established that chronic hepatitis C as well as a mixed hepatitis are accompanied by more evident symptoms of deadaptation and somatogenic asthenia than hepatitis B in which psychogenic manifestations prevailed. The degree of endogenous intoxication was also higher at hepatitis C.

  2. [Fever, asthenia, myalgia and murmur due to cardiac myxoma].

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    Giménez Roca, C; Felipe Villalobos, A; Cambra Lasaosa, F J; Prada Martínez, F; Caffarena Calvar, J M; Jou Muñoz, C

    2013-10-01

    Cardiac tumours are rare, especially in children, and most of them are benign. Myxomas are unusual in children, being more common among adults. They are usually located in the left atrium, with 25% appearing in the right. The clinical signs and symptoms depend mainly on where the tumour is located. A feature of these tumours is that they can be accompanied by constitutional symptoms and laboratory abnormalities. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications. We present a case of a 10 year-old girl diagnosed with right atrial myxoma who presented with a fever, myalgia, asthenia and laboratory abnormalities. Diagnosis was made by echocardiography, and the early surgical resection of the tumour ran smoothly and showed a good postoperative recovery. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  3. Marjolin's ulcer in two horses with hereditary equine regional dermal asthenia

    OpenAIRE

    Badial, Peres R. [UNESP; Rashmir-Raven, Ann M.; Cagnini, Didier Q. [UNESP; Oliveira-Filho, José P. [UNESP; Cooley, Avery J.; Cunha, Paulo Henrique J.; Kitchell, Barbara E.; Conceição, Lissandro G.; Mochal, Cathleen A.; Borges, Alexandre Secorun [UNESP

    2013-01-01

    Two Quarter Horse mares with hereditary equine regional dermal asthenia (HERDA) were diagnosed with metastatic squamous cell carcinoma (SCC) associated with chronic nonhealing wounds. The lesions were similar to the development of SCC from chronic nonhealing ulcers, known as Marjolin's ulcers in humans. The horses showed recurrent skin wounds in the saddle and paralumbar regions and were confirmed by molecular techniques as having HERDA. Both horses were maintained as research animals for pro...

  4. Different Perspectives on Asthenia in Astronauts and Cosmonauts: International Research Literature

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    Sandoval, Luis; Shea, Camille; Otto, Christian; Leventon, Lauren

    2010-01-01

    The Behavioral Health and Performance (BHP) Element is one of the six elements within the NASA Human Research Program (HRP) and is responsible for managing four risks: a) The Risk of Performance Decrements due to inadequate Cooperation, Coordination, Communication and Psychological Adaptation within a Team (Team), b) the Risk of Performance Errors due to Sleep Loss, Circadian De-synchronization, Fatigue and Work Overload (Sleep), c) Risk of Behavioral Conditions (BMed), and d) the Risk of Psychiatric Disorders (BMed). The aim of this report is to address some of the recommendations made by the recent NASA HRP Standing Review Panel for the Behavioral Medicine Risk of Psychiatric Disorders. Such recommendations included: a) the inclusion of important national and international literature in English and non-English language materials; including journals, books, magazines, conference reports and b) an extensive literature review of certain types of psychological states to predict, detect, and assess adverse mental states that may negatively affect the psychological well being of the astronauts, specifically asthenia. This report was a collaborative international work effort focused on the evaluation and determination of the importance of continuing research on asthenia as a possible psychological problem that might affect the optimal psychological functioning among crewmembers during long-duration space flight missions. Russian medical personnel (flight surgeons and psychologist) have observed symptoms of asthenia (weakness, increased fatigue, irritability, and attention and memory disorders) in cosmonauts after four months in space (Myasnikov& Zamaleddinov1996; Grigorieve, 1996 ) and believe that asthenia is one of the greater risks that will affect crews? optimal psychological functioning.

  5. Effects of melatonin in the treatment of asthenia in aneurysmal subarachnoid hemorrhage.

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    Gilard, V; Ferracci, F-X; Langlois, O; Derrey, S; Proust, F; Curey, S

    2016-12-01

    Survivors of aneurysmal subarachnoid hemorrhage (aSAH) commonly experience sleep disorders resulting in asthenia. The objective of this prospective study was to determine, in a cohort of patients with treated ruptured intracranial aneurysm (IA), the proportion of asthenia at 2months, in a cohort of patients treated with melatonin and in a control cohort. Twenty consecutive patients admitted for the treatment of ruptured IA and able to answer a standardized questionnaire were included in the study. After evaluation for fatigue at discharge, we divided our population into 2 cohorts of 10 patients: the first cohort was treated with melatonin for a period of 2months; the second cohort had no specific treatment for fatigue. The primary endpoint was the proportion of asthenia at 2months in both groups. Confounding factors, such as depression, autonomy and apathy were evaluated at the same time. At discharge, there was no significant difference observed between both groups in terms of mean age and initial clinical status (WFNS, Rankin Scale and Fatigue Severity Scale). At 2months, the mean FSS score in the control group was of 4.7±1.0 versus 3.8±0.9 in the melatonin group (P=0.03). The mean MADRS score in the control group was of 1.1±1.45 versus 2.7±2.5 in the melatonin group (P=0.10). The mean LARS score in the control group was of -32.5±1.7 versus -31.7±1.9 in the melatonin group (P=0.24). In a prospective evaluation of post-aSAH fatigue, we suggest that melatonin could decrease fatigue. There is no significant impact on depression and apathy. Further studies would be necessary to improve our comprehension of fatigue physiopathology in a context of aSAH. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Ocular dimensions, corneal thickness, and corneal curvature in quarter horses with hereditary equine regional dermal asthenia.

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    Badial, Peres R; Cisneros-Àlvarez, Luis Emiliano; Brandão, Cláudia Valéria S; Ranzani, José Joaquim T; Tomaz, Mayana A R V; Machado, Vania M; Borges, Alexandre S

    2015-09-01

    The aim of this study was to compare ocular dimensions, corneal curvature, and corneal thickness between horses affected with hereditary equine regional dermal asthenia (HERDA) and unaffected horses. Five HERDA-affected quarter horses and five healthy control quarter horses were used. Schirmer's tear test, tonometry, and corneal diameter measurements were performed in both eyes of all horses prior to ophthalmologic examinations. Ultrasonic pachymetry was performed to measure the central, temporal, nasal, dorsal, and ventral corneal thicknesses in all horses. B-mode ultrasound scanning was performed on both eyes of each horse to determine the dimensions of the ocular structures and to calculate the corneal curvature. Each corneal region examined in this study was thinner in the affected group compared with the healthy control group. However, significant differences in corneal thickness were only observed for the central and dorsal regions. HERDA-affected horses exhibited significant increases in corneal curvature and corneal diameter compared with unaffected animals. The ophthalmologic examinations revealed mild corneal opacity in one eye of one affected horse and in both eyes of three affected horses. No significant between-group differences were observed for Schirmer's tear test, intraocular pressure, or ocular dimensions. Hereditary equine regional dermal asthenia-affected horses exhibit decreased corneal thickness in several regions of the cornea, increased corneal curvature, increased corneal diameter, and mild corneal opacity. Additional research is required to determine whether the increased corneal curvature significantly impacts the visual accuracy of horses with HERDA. © 2014 American College of Veterinary Ophthalmologists.

  7. [Effect of electroacupuncture on differentiation and proliferation of hippocampal nerve stem cells in splenic asthenia pedo-rats].

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    Zhuo, Yuan-yuan; Yang, Zhuo-xin; Wu, Jia-man

    2011-10-01

    To observe the effect of electroacupuncture (EA) on the differentiation and proliferation of nerve stem cells in the hippocampal dentate gyrus (DG) in splenic asthenia pedo-rats so as to study its central mechanism. A total of 72 SD male rats were randomly assigned to normal control group (n=24), model group (n=24) and EA group (n=24) which were further divided into 7 d, 14 d, 28 d and 49 d time-points (n=6). Splenic asthenia model was established by intraperitoneal injection of reserpine and gavage of Dahuang (Radix et Rhizoma Rhei) fluid. EA was applied to bilateral "Zusanli" (ST 36) and "Sanyinjiao" (SP 6) for 20 min, once daily for 7, 14, 28 and 49 days respectively. Brdu, Nestin, glial fibrillary acidic protein (GFAP), and neuron-specific enolase (NSE) expression in the DG of hippocampus were detected by immunohistochemistry double staining. Compared with the normal control group, the numbers of Brdu, Brdu/GFAP, Brdu/NSE Immunoreactive (IR) positive cells in the DG of hippocampus on day 7 and 14, and that of Brdu/Nestin IR-positive cells on day 7 were decreased considerably in the model group (P 0.05). EA of ST 36 and SP 6 can effectively suppress splenic asthenia syndrome-induced decrease of the numbers of Brdu, Brdu/GFAP, Brdu/Nestin and Brdu/NSE IR-positive cells in the DG of hippocampus at the early stage in the splenic asthenia rats, which may contribute to its effect in improving splenic asthenia symptoms in clinic by promoting the proliferation and differentiation of some nerve stem cells in the hippocampus.

  8. ASTENIA CUTÂNEA EM GATO (RELATO DE CASO CUTANEOUS ASTHENIA IN CAT (CASE REPORT

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    Silvia Franco Andrade

    2008-07-01

    Full Text Available

    Astenia cutânea é caracterizada por alterações na síntese de colágeno ou na formação de fibras que resulta em perda de elasticidade e fragilidade da pele.Atendeu-se no HV da UNOESTE um felino, sem raça definida, macho, 1 ano, não vacinado e vermifugado, com livre acesso à rua e com queixa de apatia e anorexia fazia uma semana, apresentando hiperextensibilidade e fragilidade cutânea da região da cabeça e do flanco direito, com rompimento da pele e visualização do subcutâneo sem hemorragia. A qualquer toque ou manipulação do animal, o desprendimento da pele aumentava. Foram colhidas amostras da pele para realização de biopsia e os achados histológicos demonstraram atrofia epidermo-dermal com depleção de anexos cutâneos e discretas áreas de hemorragias nos locais de laceração cutânea. Ao tricômico de Masson percebeu-se desorganização das fibras colágenas. Na microscopia eletrônica de transmissão, observou-se intensa variação de diâmetro das fibras colágenas. Com base nos achados físicos e histopatológicos, confirmou-se a suspeita de astenia cutânea, dermatopatia que não possui tratamento específico, somente medidas de manejo que visem minimizar possíveis traumas ou lacerações, como ambientes acolchoados e restrição à saída para rua, além de tratamento das lesões e do desprendimento da pele.

    PALAVRAS-CHAVES: Astenia cutânea, gato, síndrome da fragilidade cutânea.

    Cutaneous asthenia is characterized by alterations in the synthesis of collagen or in the formation of fibers that results in loss of elasticity and fragility of the skin. It was attended in HV of UNOESTE, a crossbred male cat, 1 year, no vaccinated and dewormed, with free access to the street and with apathy and anorexia, presenting hyperextensible and cutaneous fragility of the head’s area and of the right flank, with skin disruption and visualization of the subcutaneous

  9. Influences of AMY1 gene copy number and protein expression on salivary alpha-amylase activity before and after citric acid stimulation in splenic asthenia children.

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    Yang, Zemin; Lin, Jing; Chen, Longhui; Zhang, Min; Yang, Xiaorong; Chen, Weiwen

    2015-06-01

    To compare the correlations between salivary alpha-amylase (sAA) activity and amylase, alpha 1 (salivary) gene (AMYl) copy number or its gene expression between splenic asthenia and healthy children, and investigate the reasons of attenuated sAA activity ratio before and after citric acid stimulation in splenic asthenia children. Saliva samples from 20 splenic asthenia children and 29 healthy children were collected before and after citric acid stimulation. AMYl copy number, sAA activity, and total sAA and glycosylated sAA contents were determined, and their correlations were analyzed. Although splenic asthenia and healthy children had no differences in AMY1 copy number, splenic asthenia children had positive correlations between AMY1 copy number and sAA activity before or after citric acid stimulation. Splenic asthenia children had a higher sAA glycosylated proportion ratio and glycosylated sAA content ratio, while their total sAA content ratio and sAA activity ratio were lower compared with healthy children. The glycosylated sAA content ratio was higher than the total sAA content ratio in both groups. Splenic asthenia and healthy children had positive correlations between total sAA or glycosylated sAA content and sAA activity. However, the role played by glycosylated sAA content in sAA activity in healthy children increased after citric acid stimulation, while it decreased in splenic asthenia children. Genetic factors like AMY1 copy number variations, and more importantly, sAA glycosylation abnormalities leading to attenuated sAA activity after citric acid stimulation, which were the main reasons of the attenuated sAA activity ratio in splenic asthenia children compared with healthy children.

  10. Perspectives on Asthenia in Astronauts and Cosmonauts: Review of the International Research Literature

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    Sandoval, Luis; Keeton, Kathryn; Shea, Camille; Otto, Christian; Patterson, Holly; Leveton, Lauren

    2012-01-01

    The Behavioral Health and Performance Element (BHP) is one of the 6 elements in the NASA Human Research Program (HRP) and is responsible for managing 4 of the identified and named risks to human health and performance from human space exploration: a) Risk of Behavioral Conditions (BMed), b) Risk of Psychiatric Disorders (BMed), c) Risk of Performance Decrements due to inadequate Cooperation, Coordination, Communication and Psychological Adaptation within a Team (Team), and d) Risk of Performance Errors due to Sleep Loss, Circadian De-synchronization, Fatigue and Work Overload (Sleep). Each risk is reviewed by a NASA HRP Standing Review Panel (SRP), and recently the Behavioral Medicine Risk of Psychiatric Disorders was reviewed. The aim of this report is to address one of the recommendations made by that panel, specifically the recommendation that the "literature on asthenia should be evaluated (possibly as a psychological or psychosomatic / psycho-physiological analogue of chronic fatigue syndrome)" (SRP p. 4), in addition to General Recommendation 4, which states that "all reviews must include non-English language materials as well as materials appearing in conferences reports, books, and other non-refereed journal outlets" (SRP p. 2).

  11. Dermatological and morphological findings in quarter horses with hereditary equine regional dermal asthenia.

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    Badial, Peres R; Oliveira-Filho, José P; Pantoja, José Carlos F; Moreira, José C L; Conceição, Lissandro G; Borges, Alexandre S

    2014-12-01

    Hereditary equine regional dermal asthenia (HERDA) is an autosomal recessive disorder affecting quarter horses (QHs); affected horses exhibit characteristic skin abnormalities related to abnormal collagen biosynthesis. To characterize the thickness and morphological abnormalities of the skin of HERDA-affected horses and to determine the interobserver agreement and the diagnostic accuracy of histopathological examination of skin biopsies from horses with HERDA. Six affected QHs, confirmed by DNA testing, from a research herd and five unaffected QHs from a stud farm. The skin thickness in 25 distinct body regions was measured on both sides in all affected and unaffected horses. Histopathological and ultrastructural evaluation of skin biopsies was performed. The average skin thickness in all of the evaluated regions was thinner in the affected horses. A statistically significant difference between skin thickness of the affected and unaffected animals was observed only when the average magnitude of difference was ≥38.7% (P = 0.038). The interobserver agreement for the histopathological evaluation was fair to substantial. The histopathological sensitivity for the diagnosis of HERDA was dependent on the evaluator and ranged from 73 to 88%, whereas the specificity was affected by the region sampled and ranged from 35 to 75%. Despite the regional pattern of the cutaneous signs, skin with decreased thickness was not regionally distributed in the HERDA-affected horses. Histopathological evaluation is informative but not conclusive for establishing the diagnosis. Samples of skin from the neck, croup or back are useful for diagnosis of HERDA. However, the final diagnosis must be confirmed using molecular testing. © 2014 ESVD and ACVD.

  12. Cardiac findings in Quarter Horses with heritable equine regional dermal asthenia.

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    Brinkman, Erin L; Weed, Benjamin C; Patnaik, Sourav S; Brazile, Bryn L; Centini, Ryan M; Wills, Robert W; Olivier, Bari; Sledge, Dodd G; Cooley, Jim; Liao, Jun; Rashmir-Raven, Ann M

    2017-03-01

    OBJECTIVE To compare biomechanical and histologic features of heart valves and echocardiographic findings between Quarter Horses with and without heritable equine regional dermal asthenia (HERDA). DESIGN Prospective case-control study. ANIMALS 41 Quarter Horses. PROCEDURES Ultimate tensile strength (UTS) of aortic and mitral valve leaflets was assessed by biomechanical testing in 5 horses with HERDA and 5 horses without HERDA (controls). Histologic evaluation of aortic and mitral valves was performed for 6 HERDA-affected and 3 control horses. Echocardiography was performed in 14 HERDA-affected and 11 control horses. Biomechanical data and echocardiographic variables of interest were compared between groups by statistical analyses, RESULTS Mean values for mean and maximum UTS of heart valves were significantly lower in HERDA-affected horses than in controls. Blood vessels were identified in aortic valve leaflets of HERDA-affected but not control horses. Most echocardiographic data did not differ between groups. When the statistical model for echocardiographic measures was controlled for body weight, mean and maximum height and width of the aorta at the valve annulus in short-axis images were significantly associated with HERDA status and were smaller for affected horses. CONCLUSIONS AND CLINICAL RELEVANCE Lower UTS of heart valves in HERDA-affected horses, compared with those of control horses, supported that tissues other than skin with high fibrillar collagen content are abnormal in horses with HERDA. Lack of significant differences in most echocardiographic variables between affected and control horses suggested that echocardiography may not be useful to detect a substantial loss of heart valve tensile strength. Further investigation is warranted to confirm these findings. Studies in horses with HERDA may provide insight into cardiac abnormalities in people with collagen disorders.

  13. [Effect of electroacupuncture on cellular structure of hippocampus in splenic asthenia pedo-rats].

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    Yang, Zhuo-xin; Zhuo, Yuan-yuan; Yu, Hai-bo; Wang, Ning

    2010-02-01

    To observe the effect of electroacupuncture (EA) on hippocampal structure in splenic asthenia pedo-rats. A total of 15 SD male rats were randomly assigned to normal control group (n=5), model group (n=5) and EA group (n=5). Splenic asthenic syndrome model was established by intragastric administration of rhubarb and intraperitoneal injection of Reserpine for 14 d. EA (1 mA, 3 Hz/iS Hz) was applied to bilateral "Zusanli" (ST 36) and "Sanyinjiao" (SP 6) for 20 mm, once a day for 14 days. The cellular structure of hippocampus was observed by light microscope and transmission electron microscope. Optical microscopic observation showed that in normal control group, the cellular nucleus was distinct, and the granular cell layer well-arranged and tight. In model group, the intracellular space was widened, and the granular cell layer was out of order in the arrangement. In EA group, the celluldr nucleus and the granular cell layer were nearly normal. Results of the electronic microscope showed that cells in model group had a karyopyknosis with irregular appearance and clear incisure, and some of them presented dissolving and necrotic phenomena; and those in EA group were milder in injury, had nearly-normal nucleus with visible nucleoli and relatively-intact nuclear membrane. Regarding the cellular plasma, in comparison with rich normal organelles of control group, the mitochondria in model group were swelling, with vague, dissolved and broken cristae, while in EA group, majority of the organelles were well-kept, and slightly dissolved mitochondrial cristae found. In regard to the synaptic structure, in comparison with control group, synaptic apomorphosis and swelling mitochondria were found in model group While in EA group, milder swelling and hydropic degeneration were seen. Different from the distinct pre- and post-synaptic membrane and synaptic vesicles of control group, while those in EA group were nearly-normal. electroacupunture can effectively relieve splenasthenic

  14. Evaluation of the evoked brain potentials of patients with asthenia and anxiety symptoms and the partial loss of sight

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    Tsira Abdryakhimova

    2017-03-01

    Full Text Available Background. Loss of sight, even partial, especially in adulthood, is accompanied by emotional, motivational and social consequences that directly affect the psychophysiological state of the individual himself, his communication in society and, often, the social status of the subject.  Methods. From the group of patients-volunteers (n=15 with a partial loss of sight of traumatic genesis two groups were formed for carrying out neurophysiological studies: with predominant asthenia and predominant anxiety. The controle group (CG constisted from patients of the same age (n=20 without psychiatric comorbidity. A study of acoustic event-related potentials of the brain (ERP was carried out in the oddball paradigm with the recording of the time and correctness of a simple sensorimotor reaction. Results. Comparative analysis of the asthenia group with the comparison group revealed a sufficient number of indicators of the ERP, which have significant statistical differences. The correctness of the sensorimotor reaction in this group was 98.3 ± 2.44%, whereas in the CG - 92.5 ± 5.74% (U [15; 20] = 62.5, p <0.01. The values of the amplitude of the early positivity of P1 in the asthenia group were 4.25 ± 3.312 μV, and in the CG -4.15 ± 7.933 μV (U [15, 20] = 50, p <0.001. The early negativity in that group was -2.78 ± 2.377 μV, and in the CG it was 10.55 ± 7.466 μV (U [15; 20] = 75; p <0.05.  Conclusion. In the asthenia group this is the correctness of the sensorimotor reaction and the amplitude of the components: P1, N1, P2, N2. In the anxiety group, such indicators were: latency period P1, intervals P1N1 and N2P3, amplitude swing P1N1. A specific marker of the asthenia group, distinguishing it from the CG, was the more positive values of the amplitude of the components P1, N1, P2, N2. Taking into account the low-frequency nature of the modulation of the amplitudes of these components (circa 2 Hz, it can be assumed that nonspecific brainstem

  15. Evaluation of the evoked brain potentials of patients with asthenia and anxiety symptoms and the partial loss of sight

    Directory of Open Access Journals (Sweden)

    Tsira Abdryakhimova

    2017-03-01

    Full Text Available Background. Vision loss, even partial, especially in adulthood, is accompanied by emotional, motivational and social consequences that directly affect the psychophysiological state of the individual himself, his communication in society and, often, the social status of the subject. Methods. From the group of patients-volunteers (n=15 with a partial loss of sight of traumatic genesis two groups were formed for carrying out neurophysiological evaluation: with predominant asthenia and anxiety. The control group (CG consisted of patients with the same age (n=20 without psychiatric comorbidity. A study of acoustic event-related potentials of the brain (ERP was carried out in the oddball paradigm with the recording of the time and correctness of a simple sensorimotor reaction. Results. Comparative analysis of the asthenia group with the comparison group revealed a sufficient number of ERP's, which have significant statistical differences. The correctness of the sensorimotor reaction in this group was 98.3 ± 2.44%, whereas in the CG - 92.5 ± 5.74% (U = 62.5, p<0.01. The P1 initial positivity amplitude values in the asthenia group were 4.25 ± 3.312 μV and in the CG -4.15 ± 7.933 μV (U = 50, p<0.001. The early negativity in that group was -2.78 ± 2.377 μV, and in the CG it was 10.55 ± 7.466 μV (U = 75; p<0.05. Conclusion. In the anxiety group, significant differences were noted in: P1 latency, P1N1, and N2P3 interval latencies, amplitude swing in P1N1. A specific marker of the asthenia group, distinguishing it from the CG, was the more positive values of the amplitude for the components P1, N1, P2, N2. Taking into account the low-frequency nature of the amplitude modulation in these components (circa 2 Hz, it can be assumed that nonspecific brainstem systems are involved in the process.

  16. Enfoque del síndrome de astenia crónica The chronic asthenia syndrome: A clinical approach

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    Pablo Young

    2010-06-01

    Full Text Available El término astenia deriva del griego (¢sqsneia, a: privación, sin, esthénos: vigor, fuerza, significa ausencia de fortaleza, vigor o fuerza. Es un síntoma difícil de definir, que implica un conjunto de sensaciones vagas, distintas para cada individuo. Es un motivo habitual de consulta representando hasta el 30% de la consulta ambulatoria. A su vez, la fatiga crónica representa del 1 al 10% de estos casos, y el 0.2- 0.7% del total pertenece al síndrome de fatiga crónica. Es importante saber diferenciar la astenia de la debilidad y de la disnea, ya que los pacientes habitualmente le dan el mismo significado. El factor tiempo en la astenia es útil para su caracterización. Se definió a la fatiga como prolongada cuando su duración es mayor a un mes y crónica cuando la misma supera los 6 meses. La sistematización de las entidades capaces de provocar astenia deberá guiar la búsqueda de síntomas y signos físicos, así como la indicación de estudios complementarios. La depresión es la causa más común de fatiga, representando aproximadamente la mitad de los casos. El tratamiento más efectivo de la astenia es solucionar la causa subyacente; no obstante hasta un 20% de los pacientes queda sin diagnóstico. El diagnóstico de síndrome de fatiga crónica es de exclusión y se deben usar los criterios del consenso internacional del año 1994¹. En cuanto a su tratamiento, existe evidencia a favor de utilizar ejercicio físico graduado y terapia cognitiva. La alta frecuencia del síntoma conlleva un enorme costo social y económico consumiendo recursos de manera desmesurada, por lo que es importante que los médicos estén familiarizados con este síntoma.The term asthenia comes from the Greek (¢sqsneia, a: privation, without; esthénos: vigor, force, it means absence of strength, vigor or force. It is a symptom, difficult to define, with a set of vague sensations, different for each patient. It is a frequent cause of consult, almost

  17. Tensile properties in collagen-rich tissues of Quarter Horses with hereditary equine regional dermal asthenia (HERDA).

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    Bowser, J E; Elder, S H; Pasquali, M; Grady, J G; Rashmir-Raven, A M; Wills, R; Swiderski, C E

    2014-03-01

    Hereditary equine regional dermal asthenia (HERDA) is an autosomal recessive disorder of Quarter Horses characterised by skin fragility. Horses with HERDA have a missense mutation in peptidyl-prolyl cis-trans isomerase B (PPIB), which encodes cyclophilin B and alters folding and post translational modifications of fibrillar collagen. The study aimed to test the hypothesis that tendons, ligaments and great vessels, which, like skin, are rich in fibrillar collagen, will also have abnormal biomechanical properties in horses with HERDA. Ex vivo biomechanical study comparing horses with and without a diagnosis of HERDA. Forelimb suspensory ligament, superficial and deep digital flexor tendons; withers, forelimb and abdominal skin; the main pulmonary artery and the aortic arch were harvested from 6 horses with HERDA and 6 control horses without the HERDA allele. Tissues were distracted to failure. Tensile strength (TS), elastic modulus (EM) and energy to failure (ETF) were compared. Horses with HERDA had significantly lower TS and EM in tendinoligamentous tissues and great vessels, respectively. The TS, EM and ETF were significantly lower in skin from horses with HERDA. Differences in TS and ETF were more extreme at the withers than at the forelimb or abdomen. Tendinoligamentous tissue, great vessels and skin are significantly weaker in horses with HERDA than in horses lacking the PPIB mutation, substantiating that diverse tissues with high fibrillar collagen content are abnormal in HERDA and that the HERDA phenotype is not limited to the integument. © 2013 EVJ Ltd.

  18. Increased susceptibility of skin from HERDA (Hereditary Equine Regional Dermal Asthenia)-affected horses to bacterial collagenase degradation: a potential contributing factor to the clinical signs of HERDA.

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    Rashmir-Raven, Ann; Lavagnino, Michael; Sedlak, Aleksa; Gardner, Keri; Arnoczky, Steven

    2015-12-01

    Hereditary equine regional dermal asthenia (HERDA) is a genetic disorder of collagen resulting in fragile, hyper-extensible skin and ulcerative lesions. The predominance of skin lesions have been shown to occur on the dorsum of HERDA-affected horses. While this has been postulated to be due to increased exposure to sunlight of these areas, the precise pathological mechanism which causes this to occur is unclear. We hypothesized that an increase in collagenase activity, that has been associated with the exposure of dermal fibroblasts to sunlight, will significantly degrade the material properties of skin from HERDA-affected horses when compared to unaffected controls. Six unaffected and seven HERDA-affected horses, all euthanized for other reasons. Full-thickness skin samples from similar locations on each horse were collected and cut into uniform strips and their material properties (tensile modulus) determined by mechanical testing before (n = 12 samples/horse) or after (n = 12 samples/horse) incubation in bacterial collagenase at 37°C for 6 h. The change in modulus following treatment was then compared between HERDA-affected and unaffected horses using a Student's t-test. The modulus of skin from HERDA-affected horses decreased significantly more than that from unaffected horses following collagenase treatment (54 ± 7% versus 30 ± 16%, P = 0.004). The significant decrease in the modulus of skin from HERDA-affected horses following collagenase exposure suggests that their altered collagen microarchitecture is more susceptible to enzymatic degradation and may explain the localization of skin lesions in HERDA-affected horses to those areas of the body most exposed to sunlight. These findings appear to support the previously reported benefits of sunlight restriction in HERDA-affected horses. © 2015 ESVD and ACVD.

  19. [Gene chip study on cerebral gene of effect of Jinkui Shenqiwan and Youguiwan on mouse model of kidney-yang asthenia with syndrome disproved according to therapeutic efficacy of drugs used].

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    Yang, Yuhua; Li, Zhen; Sun, Jing

    2009-05-01

    To inquire into the cerebral gene change of effect of Jingui Shenqiwan and Youguiwan for animal model of kidney-yang asthenia caused by excessive physical and sexual activities, which may study the effect mechanism of the medicine with syndrome disproved therapeutic efficacy of drugs used. Male mice of Kunming species, weight 35-40 g, and female weight 28-35 g were randomly divided into four groups: control group, model group and treatment groups of Jigui Shenqiwan and Youguiwan in which there were ten male mice, fifteen ones, ten ones and ten ones, respectively. All of them were fed normally, and poured into their stomach with 0.5 mL of distill water for each mouse in the control group and model group, and with 0.5 mL suspension of the drugs (including 1.1 g x kg(-1) drug) for each one in the treatment groups every day. The mice in the model group and treatment groups were kept by means of each male mouse with six female mice in the same cage, and all male mice swam until they gradully submerged and were scooped up from water once everyday for lasting four weeks to induce the kidney-yang asthenia with excessive physical and sexual activities. Animals' manifestation such as fearing cold, activity and responses, mouse' fur and so on were observed. The brain gene were detected with the mouse brain gene chip of 36K Mouse genome array made by Capital Bio Corp. Beijing, China, and the differential expression gene were screened according to the ratio equal to or above 2 and equal to or below 0.5 with the related fluorescent intensity comparing the two groups, which could be further verified in the light of partly differential expression gene with qRT-PCR. The mouse model of kidney-yang asthenia in the model group was successfully induced by way of excessive physical and sexual activities. There were twenty-three genes among up-regulated genes in the model group versus control group but down-regulated genes in the treatment groups versus model group, chiefly including the

  20. Enfoque del síndrome de astenia crónica The chronic asthenia syndrome: A clinical approach

    OpenAIRE

    Pablo Young; Finn,Bárbara C; Bruetman,Julio E; Débora Pellegrini; Armando Kremer

    2010-01-01

    El término astenia deriva del griego (¢sqsneia, a: privación, sin, esthénos: vigor, fuerza), significa ausencia de fortaleza, vigor o fuerza. Es un síntoma difícil de definir, que implica un conjunto de sensaciones vagas, distintas para cada individuo. Es un motivo habitual de consulta representando hasta el 30% de la consulta ambulatoria. A su vez, la fatiga crónica representa del 1 al 10% de estos casos, y el 0.2- 0.7% del total pertenece al síndrome de fatiga crónica. Es importante saber d...

  1. THE USAGE OF ORIGINAL COMPUTER PROGRAM FOR SCREENING OF SENILE ASTHENIA IN PRE- AND POST GRADUATE MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Svetlana G. Gorelik

    2014-02-01

    Full Text Available The results of introduction of information technologies in educational process of medical students and students of postgraduate education were shown in the article. The actuality of material, which was outlined in the article, was caused by problems, which prevailed in the system of high education and by necessity of cooperation between practical health care and theoretical knowledge. For this aim the original «Computer program of optimization of care in geriatrics in dependence from degree of senile asthenia” was proposed. This program solved not only problems of qualitative alteration of informative environment of educational system but it contributed to increasing of effectiveness of knowledge’s mastering for increasing the quality of medical and social help to population.

  2. Obesity decreases both whole muscle and fascicle strength in young females but only exacerbates the aging-related whole muscle level asthenia.

    Science.gov (United States)

    Tomlinson, David J; Erskine, Robert M; Winwood, Keith; Morse, Christopher Ian; Onambélé, Gladys L

    2014-06-24

    Obesity has previously been associated with greater muscle strength. Aging, on the other hand, reduces muscle specific force (the force per unit physiological cross-sectional area [PCSA] of muscle). However, neither the effect of obesity on skeletal muscle specific force nor the combined effects of aging and obesity on this parameter are known. This study aimed to describe the interplay between body mass index (BMI)/adiposity, aging, and skeletal muscle specific force. Ninety-four untrained healthy women categorized by age into young (Y; mean ± SD: 25.5 ± 9.0 years) versus old (O; 64.8 ± 7.2 years) were assessed for body composition, gastrocnemius medialis (GM) muscle volume (V), net maximum voluntary contraction (nMVC), and specific force (SF). The young obese, while demonstrating 71% and 29% (P V and nMVC compared to normal BMI individuals, were in fact 26% (P = 0.007) weaker than these, where V was used to scale nMVC (i.e., nMVC/V). The weakness associated with obesity was further exemplified in the 34% (P P V and nMVC, but 11% and 25% (P V and SF than V (-2 cm(3)/year P P 40% adiposity. Interestingly, however, obesity appeared advantageous to the aging-related changes in nMVC/V (P P young sedentary obese, are substantially weaker, where the volume of skeletal muscle is used to scale the maximal torque output, or forces are quantified at the fascicular level. The seemingly positive impact of obesity on rate of aging, however, is complex and warrants further investigations. © 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  3. ASTHENIC DISORDERS IN ELDERLY PATIENTS WITH ARTERIAL HYPERTENSION: MANAGEMENT POTENTIAL OF MELDONIUM

    Directory of Open Access Journals (Sweden)

    M. E. Statsenko

    2015-09-01

    Full Text Available Aim. To assess the effect of meldonium (in combination with antihypertensive therapy on the severity of asthenic syndrome (AS in elderly patients with arterial hypertension (HT.Material and methods. Patients (n=180, >65 years old with HT (grade 1–2 and secondary somatogenic AS (assessed by the MFI-20 scale. The patients were randomized into 3 groups according to the scheme of treatment. Group 1 — intermittent treatment with meldonium (500 mg once daily for 3 months followed by a break 3 months; 2 courses. Group 2 — continuous treatment with meldonium (500 mg once daily for 12 months. Group 3 — control (receive only antihypertensive drugs. Evaluation of AS was assessed by MFI-20 scales at baseline and at week 52 of treatment.Results. AS signs attenuation was found in groups 1 and2. In group1 a number of patients with general asthenia decreased on 70.5% (p<0.05, with physical asthenia — on 47.7% (p<0.05, with reduced activity — on 33.3%, reduced motivation — on 25%. In group2 a number of patients with general asthenia decreased on 60% (p<0.05, physical asthenia — on 39.7%, reduced activity — on 79.9% (p<0.05, reduced motivation — on 12.2%, mental asthenia — on 77.7% (p<0.05. In group 3 no significant changes in these parameters were found. Moreover a number of patients with mental asthenia increased on 45.4% (p<0.05.Conclusion. Meldonium included into antihypertensive therapy can reduce the symptoms of secondary somatogenic AS. More pronounced antiasthenic effect can be achieved with meldonium taking regime 500 mg daily continuously for 52 weeks.

  4. Phytochemical screening, antimicrobial and cytotoxicity studies of ...

    African Journals Online (AJOL)

    Background: Aphania senegalensis (Sapindaceae) is commonly used in Senegalese traditional medicine to treat pain, inflammation, asthenia, bacterial and fungal infections. The aim of this study was to determine the type of phytochemical constituents present in the ethanol leaf extract and its antimicrobial activity against ...

  5. Research

    African Journals Online (AJOL)

    ebutamanya

    2016-03-03

    Mar 3, 2016 ... Symptoms at presentation: asthenia (57%), anorexia. (55%), loin pain (37%), vomiting (28%), oedema (20%), and anuria (15%). Urinary tract infection was present in 33 patients. Main aetiologies of obstruction: urolithiasis (35%), begnin prostatic hypertrophy (27%), prostatic cancer (12%), cervical cancer ...

  6. The profile of patients with obstructive uropathy in Cameroon: case ...

    African Journals Online (AJOL)

    Associated comorbidities were hypertension, diabetes, and HIV. Mean haemoglobin 8,40±2,4g/dl, mean GFR 10,3 ±10ml/min, 94 (41%) patients needed emergency dialysis. Symptoms at presentation: asthenia (57%), anorexia (55%), loin pain (37%), vomiting (28%), oedema (20%), and anuria (15%). Urinary tract infection ...

  7. Temperament trait Harm Avoidance associates with μ-opioid receptor availability in frontal cortex

    DEFF Research Database (Denmark)

    Tuominen, Lauri; Salo, Johanna; Hirvonen, Jussi

    2012-01-01

    . These associations were driven by two subscales of Harm Avoidance; Shyness with Strangers and Fatigability and Asthenia. In conclusion, higher Harm Avoidance score in healthy subjects is associated with higher μ-opioid availability in regions involved in the regulation of anxiety as well as in the control...

  8. Addison’s Disease: A rare case report

    OpenAIRE

    Agrawal, Sanjay N; Yogeshree R. Deshmukh; Subodhkumar D. Jane; Rawal, Anuprita A.

    2015-01-01

    A female patient presented with progressive weakness, asthenia and generalized hyperpigmentation. The characteristic hyperpimentation pointed towards possibility of Addison’s disease which was proved by markedly decreased plasma cortisol levels, hyponatremia and hyperkalemia. This could be one of the very few cases of Addison’s Disease reported.

  9. A Review on the Incidence, Interaction, and Future Perspective on ...

    African Journals Online (AJOL)

    Zika virus (ZIKV) belongs to the family Flaviviridae and genus Flavivirus. It is a single‑stranded positive‑sense ribonucleic acid (RNA) virus, has its origin traced to Zika forest in Uganda. Its infection leads to ZIKV fever, characterized by arthralgia, myalgia, rash, conjunctivitis, and asthenia. Clinical presentation of the infection ...

  10. Périartérite noueuse en relation avec une hépatite B

    OpenAIRE

    Demolin, G.; Delwaide, Jean; Van Severen, M.; Demolin, H.; Cornet, G.; Belaiche, Jacques

    1999-01-01

    A 66-year-old man was hospitalized for asthenia, weight loss, fever and chills. A polyarteritis nodosa associated with hepatitis B virus infection in a replicative phase was diagnosed. Etiology, physiopathology, and clinical characteristics of hepatitis B virus-related polyarteritis nodosa will be reviewed, as well as the effectiveness of therapy combining corticosteroids, interferon alpha and plasma exchanges. Peer reviewed

  11. Peginterferon plus ribavirin versus interferon plus ribavirin for chronic hepatitis C

    DEFF Research Database (Denmark)

    Hauser, Goran; Awad, Tahany; Brok, Jesper

    2014-01-01

    .96 to 1.07; 12 trials). No significant differences were reported between the two treatment groups regarding anaemia, headache, rigours, myalgia, pyrexia, weight loss, asthenia, depression, insomnia, irritability, alopecia, pruritus, skin rash, thyroid malfunction, decreased appetite, or diarrhoea. We were...

  12. Eribulin Mesylate: A New Therapeutic Option for Metastatic Breast ...

    African Journals Online (AJOL)

    Asthenia, fatigue, neutropenia, alopecia, nausea, anorexia, and neuropathy are the most frequent adverse effects associated with this drug. The aim of this review was to highlight the importance of this drug in the management of breast cancer. Medline, Excerpta Medica database, cochrane database, medscape, Elsevier ...

  13. Self-Esteem, Locus of Control and Various Aspects of Psychopathology of Adults with Visual Impairments

    Science.gov (United States)

    Papadopoulos, Konstantinos; Paralikas, Theodosis; Barouti, Marialena; Chronopoulou, Elena

    2014-01-01

    The exploratory study presented in this article looks into the possible differences in psychosocial aspects (self-esteem and locus of control) and aspects of psychopathology (depression, anxiety, melancholia, asthenia, and mania) amongst sighted adults and adults with visual impairments. Moreover, the study aims to examine the possible…

  14. Addison’s Disease: A rare case report

    Directory of Open Access Journals (Sweden)

    Sanjay N. Agrawal

    2015-04-01

    Full Text Available A female patient presented with progressive weakness, asthenia and generalized hyperpigmentation. The characteristic hyperpimentation pointed towards possibility of Addison’s disease which was proved by markedly decreased plasma cortisol levels, hyponatremia and hyperkalemia. This could be one of the very few cases of Addison’s Disease reported.

  15. Is desvenlafaxine effective and safe in the treatment of menopausal ...

    African Journals Online (AJOL)

    However, the rate of desvenlafaxine treatment discontinuation because of adverse events was a significantly higher than placebo treated women and the risk ratios of adverse events like asthenia, hypertension, anorexia, constipation, diarrhea, dry mouth, nausea, dizziness, insomnia, somnolence and mydriasis were very ...

  16. Efficacy of melflufen, a peptidase targeted therapy, and dexamethasone in an ongoing open-label phase 2a study in patients with relapsed and relapsed-refractory multiple myeloma (RRMM) including an initial report on progression free survival

    DEFF Research Database (Denmark)

    Voorhees, P. M.; Magarotto, V.; Sonneveld, P.

    2015-01-01

    in >10% of patients, regardless of relationship to study drug were thrombocytopenia (94%), anemia (84%), neutropenia (61%), leukopenia (42%), pyrexia (36%), asthenia (32%), fatigue and nausea (26%), bone pain (19%), cough, diarrhea, dyspnea, mucosal inflammation and upper respiratory infection (16......%) and constipation and epistaxis (13%). Treatment-related Grade 3 or 4 AEs were reported in 27 patients (87%). Those occurring in >5% of patients were thrombocytopenia (68%), neutropenia (55%), anemia (42%), leukopenia (32%) and febrile neutropenia, fatigue, pyrexia, asthenia and hyperglycemia each occurred in 6......% of patients. Serious AEs occurred in 9 patients (29%), but were only assessed as related to study drug in 5 patients (16%) including 3 febrile neutropenia, 1 fever and 1 pneumonia. Cycle length has recently been increased to 28 days to improve tolerability with respect to hematologic toxicity. Conclusion...

  17. Hepatitis por citomegalovirus: Presentación de dos casos

    Directory of Open Access Journals (Sweden)

    Carlos Tori

    1995-04-01

    Full Text Available Two cases of hepatitis by cytomegalovirus are described, one in a child and the other in a young adult, presenting with a history of fever, general malaise, hepatomegaly and no jaundice. Their blood test showed atypical lymphocytes, normal bilirubin, elevated liver enzymes, and IgG antibodies against cytomegalovirus. Their course was un was unremarkable except for asthenia which persisted in spite of clinical and laboratory improvement. This course was unremarkable except for asthenia which persisted in spite of clinical and laboratory improvement. This presentation is done because of the low prevalence or infrequent diagnosis of anicteric hepatitis due to cytomegalovirus in normal individuals. Most of the literature refers to congenital cases, premature babies, or patients with debilitating or immunocompromising diseases.

  18. Postinfectious syndrome of convalescentsixodes tick-borne borreliosis

    Directory of Open Access Journals (Sweden)

    O. N. Sumlivaya

    2014-01-01

    Full Text Available The aim: to study the psycho-vegetative status of the quantitative contents of serotonin in blood platelets in patients after the Ixodes tick-borne borreliosis, to evaluate the clinical efficiency treatment by adamantilfenilamin of postinfection asthenia.Materials and methods: there was clinical supervision and inspection conducted of 118 convalescents borreliosis after a course of inpatient treatment. All patients were examined using psychovegetative tests. Platelet serotonin concentration levels were measured by enzyme immunoassay. For the treatment of postinfectious asthenia 36 convalescents received adamantilbromfenilamin in a dose of 100 mg for 25 days.Results: when tested convalescents marked change in indicators of emotional and personality disorders. Quantitative study of blood platelet serotonin content revealed a significant decrease in this indicator relative to control values. Study the correlations between obtained when testing the psycho-emotional parameters and platelet serotonin levels showed a negative correlation between serotonin and an indicator of reactive anxiety (R = -0,81, p <0,05. To correct these violations convalescents with severe asthenia postinfection were treated adamantilfenilamin. Established clinical efficacy contributing to the improvement of the quality of life.Conclusion: the research of neurotransmitter serotonin in patients during the convalescence period after borreliosis possible to evaluate the extent of potential damage to the nervous tissue in the inflammatory process and its involvement in the formation of anxiety and depressive symptoms. adamantilbromfenilamin can be recommended for rehabilitation patients with residual effects in the form of postinfectious asthenia.

  19. A case of suspect “cyanosis”

    OpenAIRE

    Elisabetta Antonucci; Matteo Conte; Michele Di Pumpo; Giuseppe Antonucci

    2013-01-01

    CLINICAL CASE A 70-year old woman was admitted to our hospital because of fever, asthenia and a suspected stroke. Her medical history showed a congenital cardiopathy (Patent Foramen Ovale, PFO). Skin and oral mucosa pigmentation, orthostatic hypotension, hypoglycemia and hyponatriemia arose the suspect of Addison’s disease. The diagnosis was confirmed by the evaluation of basal levels of plasma ACTH and serum cortisol, and serum cortisol levels after ACTH stimulation. Abdominal CT scan showed...

  20. Primitive Tumour of the Pulmonary Valve: Discussion of the Differential Diagnosis

    Directory of Open Access Journals (Sweden)

    A. Hannecart

    2017-01-01

    Full Text Available There is a paucity of information concerning cardiac tumours of the pulmonary valve due to their rarity at this location. We report a case of a 47-year-old patient suffering from haemoptysis, asthenia, and acute kidney injury (AKI. A transthoracic echocardiography (TTE revealed a mass on the pulmonary valve. Further diagnostic investigation was completed until he exhibited worsening hemodynamic instability. This case emphasizes the lack of information regarding the management of a pulmonary valve tumour.

  1. Primitive Tumour of the Pulmonary Valve: Discussion of the Differential Diagnosis.

    Science.gov (United States)

    Hannecart, A; Ndjekembo-Shango, D; Vallot, F; Simonet, O; De Kock, M

    2017-01-01

    There is a paucity of information concerning cardiac tumours of the pulmonary valve due to their rarity at this location. We report a case of a 47-year-old patient suffering from haemoptysis, asthenia, and acute kidney injury (AKI). A transthoracic echocardiography (TTE) revealed a mass on the pulmonary valve. Further diagnostic investigation was completed until he exhibited worsening hemodynamic instability. This case emphasizes the lack of information regarding the management of a pulmonary valve tumour.

  2. A Case of Dyspnea in Pancreatic cancer Treated through Herbal Acupunture Treatment

    OpenAIRE

    Park Sang-Eun; Seo Sang-Ho; Hong Su-hyun; Kim Jae-Yeon; Shin Won-Tak; Youn Hyoun-Min; Hong Sang-Hoon

    2006-01-01

    Objective : This study planed to evaluate effect of oriental medicine therapy treatment method of dyspnea that happen from cancer of the pancreas patient who accompany Multiple metasis Methods : Patient complained dyspnoea during admission into dept . Of internal medicine, college of oriental medicine, Dong-eui Univ ,was appealed patient treated by Oriental medicine therapy that is of use Herb Medication and Herbal -acupuncture Treatment being diagnosed in lung asthenia including deficienc...

  3. IS EVERY RESPIRATORY FAILURE A MYASTHENIC CRISIS?

    OpenAIRE

    Özakın, Engin; Özdemir, Atilla; Aslan, Ebubekir; Acar, Nurdan; Kaya, Filiz

    2018-01-01

    Abstract: Myasthenic crisis is respiratory failure from myasthenic weakness. Due to the involvement of respiratory muscles, hypoventilation can occur and subsequently lead to hypoxia and hypercapnia. This paper presents a 82-year-old patient with a past medical history of myasthenia gravis who presented to the emergency department with complaints of asthenia and shortness of breath. Why should an emergency physician be aware of this: In patients presenting to a hospital due to shortness of br...

  4. [Fibromyalgia syndrome].

    Science.gov (United States)

    Naranjo Hernández, A; Rodríguez Lozano, C; Ojeda Bruno, S

    1992-02-01

    The Fibromialgia Syndrome (FS) is a common clinical entity which may produce symtoms and signs related to multiple fields of Medicine. Typical clinical characteristics of FS include extensive pain, presence of sensitive points during exploration, morning stiffness, asthenia and non-refresing sleep. Frequently, associated rheumatologic diseases are observed, as rheumatoid arthritis, osteoarthrosis and vertebral disorders. In FS, complementary tests are usually normal. The most widely accepted hypothesis suggests that this is a disorder affecting modulation of pain sensitivity.

  5. Chronic pain syndrome at tunnel neuropathies of peripheral nerves. integrative approaches to therapy

    Directory of Open Access Journals (Sweden)

    Yemelyanov A. Y.

    2012-06-01

    Full Text Available

    Painful chronic tunnel syndrome is almost always connected with asthenia and a various degree of anxiety and depressive syndrome. The goal of the research is to investigate prevalence and expressiveness of depressive and astheniс disorders in patients with chronic tunnel pain syndrome and to fnd accommodation of choice. 54 patients with chronic painful tunnel syndrome (35 (64,8 % male, 19 (35,2 % female, mean age 39,7+10,9 years have been examined and treated. Different acupuncture methods in complex treatment were accompanied by a positive dynamics of both subjective and objective clinical neurological and psychological symptoms. Anxiety have been revealed in 79,6 % of patients, depressive syndrome — in 57,3 % of patients, asthenia — in 85,2 % of patients. Acupuncture is tolerable, compare and have not got backside effects. Inclusion of acupuncture in complex treatment chronic tunnel pain syndrome allows to reduce a pain syndrome and asthenia, to normalize psychological condition of the patient.

  6. Diagnosis of smear-negative pulmonary tuberculosis based on clinical signs in the Republic of Congo.

    Science.gov (United States)

    Linguissi, Laure Stella Ghoma; Vouvoungui, Christevy Jeannhey; Poulain, Pierre; Essassa, Gaston Bango; Kwedi, Sylvie; Ntoumi, Francine

    2015-12-18

    The diagnosis of pulmonary tuberculosis (PTB) and smear-negative pulmonary tuberculosis (SNPT) in resource-limited countries is often solely based on clinical signs, chest X-ray radiography and sputum smear microscopy. We investigated currently used methods for the routine diagnosis of SNPT in the Republic of Congo (RoC) among TB suspected patients. The specific case of HIV positive patients was also studied. A cross-sectional study was conducted at the anti-tuberculosis center (CAT) of Brazzaville, RoC. Tuberculosis suspects were examined for physical signs of TB. Clinical signs, results from sputum smear microscopy, tuberculin skin test (TST) and chest X-ray were recorded. Of the 772 enrolled participants, 372 were diagnosed PTB. Cough was a common symptom for PTB and no PTB patients. Pale skin, positive TST, weight loss and chest X-ray with abnormalities compatible with PTB (PTB-CXR) were significant indicators of PTB. Thirty-six percent of PTB patients were diagnosed SNPT. This category of patients presented less persistent cough and less PTB-CXR. Anorexia and asthenia were significant indicators of SNPT. In the case of HIV+ patients, 57% were SNPT with anorexia, asthenia and shorter cough being strong indicators of SNPT. Chest X-ray abnormalities, weight loss, pale skin and positive TST were significant indicators of PTB. Anorexia and asthenia showed good diagnostic performance for SNPT, which deserve to be recommended as index indicators of SNPT diagnosis. Duration of cough is also a relevant indicator, especially for HIV+ patients.

  7. Equine diseases caused by known genetic mutations.

    Science.gov (United States)

    Finno, Carrie J; Spier, Sharon J; Valberg, Stephanie J

    2009-03-01

    The recent development of equine genome maps by the equine genome community and the complete sequencing of the horse genome performed at the Broad Institute have accelerated the pace of genetic discovery. This review focuses on genetic diseases in the horse for which a mutation is currently known, including hyperkalemic periodic paralysis, severe combined immunodeficiency, overo lethal white syndrome, junctional epidermolysis bullosa, glycogen branching enzyme deficiency, malignant hyperthermia, hereditary equine regional dermal asthenia, and polysaccharide storage myopathy. Emphasis is placed on the prevalence, clinical signs, etiology, diagnosis, treatment and prognosis for each disease.

  8. [Asthenic syndrome in patients with burnout syndrome].

    Science.gov (United States)

    Chutko, L S; Surushkina, S Iu; Rozhkova, A V; Nikishena, I S; Iakovenko, E A

    2013-01-01

    The authors present the results of a survey of 103 patients aged 25 to 45 years with burnout syndrom. The results showed that most patients with the syndrome of burnout have clinical manifestations of asthenia, varying degrees of severity. According to psychological and psychophysiological examination in this group of patients were found attention and memory dysfunction. This study evaluated the efficacy of memoplant in the treatment of this pathology. The high efficiency of memoplant (improvement in 69.7% of cases) was detected, confirmed by the data of the clinical, psychological and neuropsychological research.

  9. Pituitary apoplexy presenting as an intraventricular hemorrhage: An infrequent neurovascular emergency

    Directory of Open Access Journals (Sweden)

    Gabriel Torrealba-Acosta, MD

    2017-12-01

    Full Text Available Pituitary macroadenomas may present with a pituitary apoplexy, commonly with associated hemorrhage, but rarely large enough to show an intraventricular bleeding. This is a case report of a 66-year-old woman with a 3-month history of headache, hyporexia, asthenia and altered consciousness. First evaluations showed a large intraventricular hemorrhage on CT scan that was initially misdiagnosed for an aneurysmal rupture etiology but later confirmed to be a pituitary apoplexy from a large pituitary adenoma. Intraventricular hemorrhage due to a pituitary apoplexy could be mistaken for an aneurysmal origin thus warranting for a careful evaluation of the sellar region.

  10. Fibromyalgia syndrome: definition and diagnostic aspects

    Directory of Open Access Journals (Sweden)

    A. Alciati

    2011-09-01

    Full Text Available Although the term “fibromyalgia” (FM is relatively new, the condition characterised by chronic musculoskeletal pain that is accompanied by numerous extra-skeletal symptoms has been described in the medical literature for many years under different names. The term “fibrositis,” which was originally used in 1904 by Sir William Gowers to define a type of lumbalgia, became a synonym for diffuse musculoskeletal pain until 1976 (1. In the mid-1970s, Smythe and Moldofsky used the term “fibrositic syndrome” to describe the presence of tender points (TPs, sleep disturbances and other accompanying symptoms such as asthenia...

  11. [Gambling addiction: the psychopathological structure of game-circle].

    Science.gov (United States)

    Malygin, V L; Chugaevskaia, E V; Khvostikov, G S

    2010-01-01

    Thirty-two pathological gamblers were examined. The SCL-90-R, the LSI (Life Style Index) and the CSW questionnaires were used to evaluate psychopathological disorders. Based on the data obtained and the analysis of the development of pathological behavior, authors singled out 6 periods of the game-circle: 1) distress that directly followed the game (anxiety-depressive, obsessive-compulsive and paranoia disorders); 2) moderate anxiety-depressive disorders; 3) subdepressive disorders with predominance of asthenia and apathy; 4) anxiety and dysphoria comorbid with subdepression; 5) the narrow state of consciousness (game trans) preceding the relapse; 6) the return to game.

  12. Severe Statin-induced Rhabdomyolysis following Cholestatic Hepatitis induced by Amoxicillin-clavulanate

    Directory of Open Access Journals (Sweden)

    Rachele Rapetti

    2014-05-01

    Full Text Available We report the case of an 86-year-old man with a past history of coronary disease admitted to our internal medicine department for severe asthenia and weakness due to rhabdomyolysis. Three days earlier, he had been discharged from a gastroenterology unit with a diagnosis of amoxicillin–clavulanate-induced acute cholestatic hepatitis. A review of his drugs revealed that he had taken atorvastatin 10 mg daily in the previous six years, without clinical or laboratory signs of myopathy. Atorvastatin was therefore stopped, with gradual improvement of the rhabdomyolysis. All concomitant drug therapy needs to be reassessed in elderly patients, especially when they become acutely ill.

  13. [Personality and psychic deadaptation of airline pilots with neurocirculatory dystonia].

    Science.gov (United States)

    Krapivnitskaia, T A

    2006-01-01

    In-depth clinical psychological investigation of airline pilots with neurocirculatory dystonia (n=194, mean age 38.57 +/- 0.85) and essentially healthy control pilots (n=183, mean age 38.4+/-0.92) revealed distinctive features in NCD pilots' mentality and behavior including personality, interpersonal communication, type of thinking, stress reaction, protection tactics, and mental dysfunctions. Psychic deadaptation such as symptoms of psychic asthenia, paranoia, depression, schizophrenia, and impulsive behavior had a negative effect on the clinical course and led to medical disqualification of 15% of NCD pilots.

  14. Progressively invalidating orthostatic hypotension: A common symptom for a challenging diagnosis

    Directory of Open Access Journals (Sweden)

    Serena Pelusi

    2016-01-01

    Full Text Available We discuss here an uncommon condition of neurogenic hypotension in the context of immunoglobulin light chain (amyloid light-chain amyloidosis. The most serious feature was autonomic nervous system impairment, mainly characterized by severe refractory orthostatic hypotension, which became progressively invalidating, forcing the patient to bed. Moreover, since the systemic involvement of the disease, the patient presented also diarrhea, dysphagia, asthenia, peripheral edema because of gastrointestinal, and kidney dysfunction. Eventually, the massive myocardial depression and infiltration led to a fatal outcome.

  15. A case of suspect “cyanosis”

    Directory of Open Access Journals (Sweden)

    Elisabetta Antonucci

    2013-05-01

    Full Text Available CLINICAL CASE A 70-year old woman was admitted to our hospital because of fever, asthenia and a suspected stroke. Her medical history showed a congenital cardiopathy (Patent Foramen Ovale, PFO. Skin and oral mucosa pigmentation, orthostatic hypotension, hypoglycemia and hyponatriemia arose the suspect of Addison’s disease. The diagnosis was confirmed by the evaluation of basal levels of plasma ACTH and serum cortisol, and serum cortisol levels after ACTH stimulation. Abdominal CT scan showed atrophy and calcification of adrenal glands. CONCLUSIONS In most cases, Addison’s disease is provoked by autoimmune destruction of the adrenal cortex; however, in our reported patient, tuberculosis could be a possible cause.

  16. Trichloroethylene occupational exposure: elements for better prevention.

    Science.gov (United States)

    Barret, L; Faure, J; Guilland, B; Chomat, D; Didier, B; Debru, J L

    1984-01-01

    One hundred and eighty-eight workers occupationally exposed to trichloroethylene (TRI) were studied by physical examination, exposure parameters (measure of atmospheric TRI and urinary trichloroacetic acid (CA) and evaluation of personal factors (age, alcoholic and tobacco consumption). A statistical comparison (chi 2 test) of the frequency of the symptoms observed in the high- and low-exposure populations with an analysis of nonprofessional factors allowed us to distinguish different classes of symptoms. Those more likely linked with TRI exposure are trigeminal and optic nerve impairment, asthenia, headache and dizziness. An interaction between TRI exposure and alcohol intake on the occurrence of clinical liver impairment and degreaser flush is suggested.

  17. Giant left atrial myxoma in an elderly patient: natural history over a 7-year period.

    Science.gov (United States)

    Bajraktari, Gani; Emini, Merita; Berisha, Venera; Gashi, Fitnete; Beqiri, Arton; Zahiti, Bedri; Selmani, Hamza; Shatri, Faik; Manaj, Rexhep

    2006-01-01

    We present the case of a 71-year-old woman with a 7-year history of a giant left atrial myxoma. The myxoma was attached to the atrial septum and occupied almost the entire left atrial cavity. The patient was hospitalized 4 times because of dyspnea on exertion, palpitations, fatigue, general asthenia, and weight loss. During prior hospitalizations, the patient had refused cardiac surgery. She developed several complications, including atrial fibrillation, mitral and tricuspid regurgitation, mesenteric embolism, pulmonary edema, and thrombotic stroke. We herein describe the natural history of left atrial myxoma in an elderly patient over a 7-year period. Copyright 2006 Wiley Periodicals, Inc.

  18. Scurvy in a patient with AIDS: case report

    Directory of Open Access Journals (Sweden)

    André Luiz Maltos

    2011-02-01

    Full Text Available We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

  19. Outbreak of acute Chagas disease associated with oral transmission in the Rio Negro region, Brazilian Amazon.

    Science.gov (United States)

    Souza-Lima, Rita de Cássia de; Barbosa, Maria das Graças Vale; Coura, José Rodrigues; Arcanjo, Ana Ruth Lima; Nascimento, Adelaide da Silva; Ferreira, João Marcos Bemfica Barbosa; Magalhães, Laylah Kelre; Albuquerque, Bernardino Cláudio de; Araújo, Guilherme Alfredo Novelino; Guerra, Jorge Augusto de Oliveira

    2013-01-01

    Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. There were 15 males (average age, 31.3 years), all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.

  20. Residual tissue post splenectomy detected by splenic scintillography with erythrocytes damaged by heat; Tejido residual postesplenectomia detectado por centellografia esplenica con eritrocitos danados por calor

    Energy Technology Data Exchange (ETDEWEB)

    Rivera B, B.; Garcia C, E.S.; Garcia O, J.R. [Centro Medico ABC, Departamento de Medicina Nuclear, Mexico, D.F. (Mexico)

    2005-07-01

    Feminine of 26 years old with diagnostic of purple thrombocytopenic idiopathic to those 4 years of age, tried with steroids and splenectomy at 11 years old. Pathway practically asymptomatic until 4 months ago she had presented asthenia, adynamia and general uneasiness, with platelet figures of 40,000 plat/microliter. It was carried out scintillographic study with damaged erythrocytes for post surgical remainder search. Its were took two-dimensional images and tomography by single photon emission (SPECT), being knitted splenic residual in area of anatomical projection of the spleen. (Author)

  1. Parálisis periódica hiperpotasémica Hyperpotassemia periodic paralysis

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    Albia Pozo Alonso

    2011-03-01

    Full Text Available La parálisis periódica hiperpotasémica es una canalopatía del músculo esquelético que se caracteriza por episodios recurrentes de debilidad muscular que pueden ser desencadenados por el ejercicio, el frío, el reposo poco después del ejercicio y el aporte de potasio. Se presenta el caso de una paciente de 13 años de edad, con diagnóstico de parálisis periódica hiperpotasémica, sin antecedentes familiares de esta entidad y sin miotonía asociada. Los ataques de debilidad muscular sucedían en ocasiones diariamente y cada 2 o 3 días, con duración variable desde media hora hasta 24 a 48 h. Durante un episodio de debilidad muscular se constataron concentraciones de potasio en sangre de 7,14 mmol/L y el electromiograma mostró un patrón miopático. Se observó una disminución de la frecuencia de los episodios de debilidad muscular a los 2 meses de iniciado el tratamiento con acetazolamida por vía oral.The periodic hyperpotassemia paralysis is a striated muscle channelopathy characterized by recurrent episodes of muscular asthenia that may to be triggered by exercise, cold, not rest after exercise and potassium support. This the case of a female patient aged 13 diagnosed with hyperpotassemia periodic paralysis without family backgrounds of this entity and also without associated myotonia. The seizures of muscular asthenia occurred almost daily and each 2 or 3 days with a variable length from a half hour to 24 to 48 hours. During a episode of muscular asthenia there were blood potassium concentrations of 7,14 mmol/L and the electromyogram showed a myopathic pattern. There was a frequency decrease of episodes of muscular asthenia at 2 months of treatment onset with oral acetazolamide.

  2. Wuji Baifeng Wan White Phoenix Bolus of Black-Bone Chicken 乌鸡白凤丸

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@*Source It is a modified recipe from "Shoushi Baoyuan" (Preserving Essence to Extending Life-span) by Gong Tingxian of Ming Dynasty in beginning of 17th century, the imperial hospital listed as specific drug for royal palace. Carried in Pharmacopoeia of P.R.China (1995 Edition) *Chief Ingredients Black-bone chicken, Antler glue, Turtle shell, Oyster shell, Mantis egg-case, Ginseng root, Milkvetch root, Chinese angelica root, White peony root, Nutgrass flatsedge rhizome, Lucid asparagus root, Licorice root, Rehmannia root, Prepared rehmannia root, Chuanxiong rhizome, Stellaria root, Red sage root, Chinese yam, Gordon euryale seed, Deglued antler powder. *Explanation The black-bone chicken can replenish Liver and Kidney, Qi and blood, serve as principal drug; Antler glue, Mantis warm Kidney Yang while Turtle and Oyster shell, Asparagus, Stellaria nourish Yin to clear asthenia heat, Ginseng, Milkvetch, Yam, Licorice, Euryale tonify Spleen Qi, and Chinese angelica, Chuanxiong, Peony, Rehmannia, Red sage replenish blood and regulate menstruation. *Function Replenishing Qi and nourishing blood, regulating menstruation and arresting vaginal discharge *Indication Deficiency of both Qi and blood, pathological wasting and asthenia, aching and weak loins and knees, irregular menstruation, metrorrhagia metrostaxis, leukorrhagia

  3. Wuji Baifeng Wan White Phoenix Bolus of Black-Bone Chicken

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    *Source It is a modified recipe from "Shoushi Baoyuan" (Preserving Essence to Extending Life-span) by Gong Tingxian of Ming Dynasty in beginning of 17th century, the imperial hospital listed as specific drug for royal palace. Carried in Pharmacopoeia of P.R.China (1995 Edition)  *Chief Ingredients Black-bone chicken, Antler glue, Turtle shell, Oyster shell, Mantis egg-case, Ginseng root, Milkvetch root, Chinese angelica root, White peony root, Nutgrass flatsedge rhizome, Lucid asparagus root, Licorice root, Rehmannia root, Prepared rehmannia root, Chuanxiong rhizome, Stellaria root, Red sage root, Chinese yam, Gordon euryale seed, Deglued antler powder.  *Explanation The black-bone chicken can replenish Liver and Kidney, Qi and blood, serve as principal drug; Antler glue, Mantis warm Kidney Yang while Turtle and Oyster shell, Asparagus, Stellaria nourish Yin to clear asthenia heat, Ginseng, Milkvetch, Yam, Licorice, Euryale tonify Spleen Qi, and Chinese angelica, Chuanxiong, Peony, Rehmannia, Red sage replenish blood and regulate menstruation.  *Function Replenishing Qi and nourishing blood, regulating menstruation and arresting vaginal discharge  *Indication Deficiency of both Qi and blood, pathological wasting and asthenia, aching and weak loins and knees, irregular menstruation, metrorrhagia metrostaxis, leukorrhagia……

  4. Clinical residual symptomatology and associated factors in multiple organ failure survivors: A long-term mortgage.

    Science.gov (United States)

    Rodríguez-Villar, S; Rodríguez-García, J L; Arévalo-Serrano, J; Sánchez-Casado, M; Fletcher, H

    2017-12-01

    To evaluate which residual clinical symptoms multi-organ failure (MOF) patients may exhibit post discharge from Intensive Care Units (ICU) and to identify the associated factors that cause such symptoms. A total of 545 adult patients admitted to a medical & surgical ICU in Spain diagnosed with MOF on admission were included in the study. Follow up in the form of a telephone survey regarding the patients clinical symptoms were conducted at 6 and 12 months after discharge from ICU. A total of 266 patients were followed up at both 6 and 12 months post ICU discharge; 62.2% were male; age 60±18 years; 67.8% medical patients. The most common symptoms to appear following hospital discharge included: asthenia (173; 76%), sleep disturbances (112; 50%) and depression (109; 48%). The study revealed frequent residual clinical symptoms persisting for almost a year post ICU discharge, most notably arthromyalgia and asthenia. Depression symptoms during the first 6 months post-hospital discharge were also common among multiple organ failure survivors. The presence of symptomatology over time was found to be related to a poor functional situation at 6 and12 months post ICU discharge, length of hospital stay and severity of illness score on ICU admission. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. All rights reserved.

  5. Clinical management of carbamazepine intoxication during anti-tubercular treatment: a case report

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    Massimo Calderazzo

    2015-06-01

    Full Text Available We describe a 67-year-old man with medical history of focal post-stroke seizure and type 2 diabetes mellitus treated with carbamazepine, clobazam, gliclazide, insulin glargine, and omeprazole we visited for the onset in the last 7 days of asthenia, cough with mucus, breathing difficulty, chest pain, and weight loss. After clinical and laboratory tests, pulmonary tuberculosis was diagnosed, and a treatment with isoniazid, ethambutol, pyrazinamide rifampicin, and pyridoxine was started. Therapeutic drug monitoring of tuberculosis treatment documented that all drugs were in normal therapeutic range. Four days after the beginning of the treatment, we documented the improvement of fever, and three days later the patient showed sleepiness, visual disorder and asthenia. Clinical and pharmacological evaluation suggested a carbamazepine toxicity probably related to a drug interaction (Drug Interaction Probability Scale score = 6. The impossibility to switch carbamazepine for another antiepileptic drug, due to a resistant form of seizure, induced the discontinuation of tuberculosis treatment, resulting in the normalization of serum carbamazepine levels in one day (10 µg/ml and in the worsening of fever, requiring a new clinical and pharmacological evaluation. The titration dosage of carbamazepine and its therapeutic drug monitoring allowed to continue the treatment with both antitubercular drugs and carbamazepine, without the development of adverse drug reactions. To date, tuberculosis treatment was stopped and clinical evaluation, radiology and microbiology assays documented the absence of tubercular infection and no seizures appeared (carbamazepine dosage 800 mg/bid; serum levels 9.5 µg/ml.

  6. Clinical and epidemiological aspects of a hepatitis E outbreak in Bangui, Central African Republic

    Directory of Open Access Journals (Sweden)

    Komas Narcisse P

    2011-04-01

    Full Text Available Abstract Background Outbreaks of hepatitis E frequently occur in tropical developing countries during the rainy season due to overflowing drains, short-circuiting of networks of clean water and use of contaminated water from wells. Hepatitis E virus (HEV infections are usually accompanied by general symptoms of acute liver disease. This study was conducted to define the clinical and epidemiological aspects of the HEV outbreak that occurred in May 2004 in Bangui. Methods Blood samples were collected from 411 patients aged 1-87 years, most of whom presented with jaundice, asthenia or signs of uncomplicated malaria, for a transversal study from June 2004 to September 2005. Patients were recruited at 11 health care centres, including two referral hospitals, after they had given informed consent. The diagnosis of HEV was made with a commercial ELISA test to detect IgM and/or IgG antibodies. HEV RNA was amplified by RT-PCR to confirm the presence of the viral genome. Results The most frequent clinical signs found were jaundice (93.4%, vomiting (50.7%, hepatalgia (47.4%, hepatomegaly (30.9% and asthenia (26.8%, which are the general clinical signs of hepatic disease. Acute hepatitis E was found in 213 patients (51.8% who were positive for HEV IgM antibodies. The IgG anti-HEV seroprevalence during this outbreak was high (79.5%. The age group 18-34 years was more frequently infected (91.2% than those aged 1-17 (78.0% or over 34 (64.9% (p -6. RT-PCR performed on 127 sera from the 213 IgM-HEV-positive patients was amplified, and the presence of the viral genome was found in 65 samples. Conclusion Although no specific clinical signs exist for hepatitis E infection, people presenting with jaundice, vomiting, hepatalgia, asthenia, hepatomegaly or distended abdomen with no signs of uncomplicated malaria in tropical developing countries should be sent to a laboratory for testing for hepatitis E.

  7. [Hepatotoxicity and pancreatitis associated with gold salts: case report].

    Science.gov (United States)

    Díaz, Javier; Dávalos, Milagros; Román, Rossana; Bustíos, Carla; Zumaeta, Eduardo

    2004-01-01

    The case of a patient, 37 years old, born and resident of Lima, suffering rheumatoid arthritis who underwent treatment with prednisone, methotrexate, and chloroquine is reported. This therapy was substituted for gold salts one month before her admission. After the third dose she presented symptoms of abdominal pain and diarrhea, itching, and jaundice, associated with asthenia and a feverish sensation. Liver biochemistry demonstrated elevated transaminase, bilirubin, alkaline phosphatase, eosinophilia, inversion of the rate albumin/globulin, higher titer of immunoglobulin G, as well as an elevation of amylase and lipase. The anatomopathological study showed cholestasis, hepatocyte ballooning, spotty necrosis, predominantly in zone 3 of the acinus. These findings where found consistent with a toxic reaction.

  8. [Myasthenia gravis with the electrographic response of a myasthenic syndrome. Report of a case].

    Science.gov (United States)

    Werneck, L C; Bittencourt, P C; Nóvak, E M

    1985-06-01

    It is reported a case of a 61 years-old man with progressive asthenia, disfagia, disphonia and diplopia, of variable intensity during the day, who had a very good response to anticolinesterasic drugs and corticosteroids. The repetitive stimulation tests at low frequency, resulted in large increment (maximum 275%) of the basal voltage after exercise. At high frequency he also had a large increment. Radiological and laboratory investigation three times in a seven-year period was normal, without evidence of any neoplasia. Muscle biopsy showed a type II muscle fiber atrophy. The repetitive stimulation tests repeated three times, was typical of myasthenia gravis in one occasion and in the other two, typical of myasthenic syndrome (increment of 418%). A discussion about other cases with similar findings is made after a review of the literature.

  9. Toxocara canis infection: Unusual trigger of systemic lupus erythematosus.

    Science.gov (United States)

    Levy, Michaël; Bourrat, Emmanuelle; Baudouin, Véronique; Guillem, Colette; Peuchmaur, Michel; Deschênes, Georges; Fila, Marc

    2015-08-01

    Infection by Toxocara canis can cause systemic vasculitis. We report here a unique case of systemic lupus erythematosus (SLE) triggered by T. canis infection. An 8-year-old girl was treated with albendazole therapy for common toxocariasis, but she developed two weeks later, asthenia, fever, infiltrated maculopapular eruption of the face, peripheral vascular disease with necrosis of the fingers and inflammatory anemia with proteinuria. Anti-nuclear, anti-DNA and anti-Sm antibodies positivity, together with minimal change nephritis with mesangial exclusive IgM deposit on renal biopsy and clinical relapse after initially successful steroid therapy, led to the diagnosis of SLE. T. canis infection can trigger systemic lupus but must also be ruled out of the differential diagnosis given its association with autoimmunity. © 2015 Japan Pediatric Society.

  10. Folk medicine used to heal malaria in Calabria (southern Italy).

    Science.gov (United States)

    Tagarelli, Giuseppe; Tagarelli, Antonio; Piro, Anna

    2010-09-18

    In Italy, malaria was an endemic disease that was eradicated by the mid-20th century. This paper evaluates the prophylactic and therapeutic remedies used by folk medicine to cure malaria in Calabria (southern Italy).The data has been collected by analysing works of physicians, ethnographers, folklorists and specialists of the study of Calabrian history between the end of the 19th century and the 20th century. The data collected have allowed us to describe the most common cures used by the Calabrian people to treat malaria and the most evident symptoms of this disease, such as intermittent fever, hepato-spleenomegaly, asthenia and dropsy. This approach uncovered a heterogeneous corpus of empirical, magical and religious remedies, which the authors have investigated as evidences of past "expert medicine" and to verify their real effectiveness in the treatment of malaria.

  11. Portal hypertensive biliopathy: review of pathophysiology and management.

    Science.gov (United States)

    Khan, Muhammad Rizwan; Tariq, Jibran; Raza, Rushna; Effendi, Muhammad Shahrukh

    2012-01-01

    Portal hypertensive biliopathy is described as abnormalities of the walls of the biliary tree secondary to portal hypertension. In literature it has also been named as "Cholangiopathy associated with portal hypertension", "Portal biliopathy" and "Portal cavernoma associated cholangiopathy". It is usually asymptomatic and found incidentally, but rarely patients do present with symptoms of abdominal pain, jaundice, asthenia and fever. Treatment is warranted in symptomatic cases only, and is dictated by the clinical manifestations and complications of the disease process. Due to presence of underlying severe portal hypertension, endoscopic biliary intervention is usually the first line of management, and is relatively safe and often sufficient. When surgery is resorted to, a porto-systemic shunt prior to biliary bypass procedure provides early relief of obstructive biliary symptoms and often precludes the need for a biliary bypass surgery. This review describes the pathophysiology, presentation, progression and management approaches to portal biliopathy.

  12. Sunitinib-associated hypertension and neutropenia as efficacy biomarkers in metastatic renal cell carcinoma patients

    DEFF Research Database (Denmark)

    Donskov, Frede; Michaelson, M Dror; Puzanov, Igor

    2015-01-01

    ), neutropenia (grade ⩾2), thrombocytopenia (grade ⩾2), hand-foot syndrome (grade >0), and asthenia/fatigue (grade >0)) were analysed in multivariate analyses of progression-free survival (PFS) and overall survival (OS) end points. RESULTS: On-treatment neutropenia and hypertension were associated with longer...... PFS (P=0.0276 and Pneutropenia was significantly associated...... with longer PFS and OS (P=0.013 and P=0.0122, respectively) and hypertension or hand-foot syndrome with longer OS (P=0.0036 and P=0.0218, respectively). The concordance index was 0.65 (95% CI: 0.63-0.67) for IMDC classification alone and 0.72 (95% CI: 0.70-0.74) when combined with hypertension and neutropenia...

  13. [Cryptogenic organising pneumonia].

    Science.gov (United States)

    Lazor, Romain

    2005-06-01

    Organising Pneumonia (formerly called Bronchiolitis Obliterans with Organising Pneumonia) is a particular form of inflammatory and fibroproliferative lung disease. Its idiopathic form called Cryptogenic Organising Pneumonia, was recently defined by an ATS/ERS consensus conference. The disease onset is subacute with cough, dyspnea, fever, asthenia, weight loss, crackles, and elevation of biological inflammatory markers. Bronchoalveolar lavage reveals a mixed alveolitis with elevated lymphocyte, neutrophil, and eosinophil counts. Chest imaging usually shows multifocal alveolar opacities predominating in the subpleural regions, often with a migratory pattern. Lung biopsy reveals budding connective tissue filling the distal airspaces. Diagnosis is established by combining clinical, radiological and histological criteria. Similarities with other disease processes can lead to delayed or erroneous diagnosis. Most patients respond well to corticosteroid therapy. Relapses are frequent but can generally be controlled with moderate doses of prednisone and do not worsen the prognosis. The therapeutic strategy aims at reducing the steroid doses while maintaining an optimal disease control.

  14. [Atypical presentation of an induced hyperthyroidism].

    Science.gov (United States)

    Duque, María Del Pilar Velásquez; Miranda, Jaime Bernal

    2013-03-01

    We present the case of a person with baseline Bipolar Affective Disorder, who starts receiving medical treatment for subclinical Hypothyroidism, during this time the patient develops Hyperthyroidism. During the course of the latter, the patient started to exhibit depressed mood symptoms and worsening of her baseline disorder. Typically there are depressive symptoms in hypothyroidism and manic symptoms in hyperthyroidism, there have been a few cases of depressive symptoms (depressed mood, asthenia and apathy) reported in patients with hyperthyroidism. Up till now it's a fact that Hyperthyroidism constitutes itself as a risk factor for developing or precipitating depressive states, thus increasing hospital readmissions, and another important fact is that of manifesting or worsening affective symptoms due to the influence of thyroid hormones. We also present the well-known relationship between thyroid malfunction and affective disorders. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  15. A case of possible Kounis syndrome as a complication of scombroid syndrome

    Directory of Open Access Journals (Sweden)

    Stefano Rusconi

    2017-11-01

    Full Text Available Kounis syndrome is defined as the concurrence of acute coronary syndromes such as coronary spasm or acute myocardial infarction with conditions associated with activation of inflammatory mediators such histamine, arachidonic acid and various cytokines and chemokines. Recently, a variety of unusual etiologies have been reported, including scombroid syndrome. We present a case of a woman without previous history of cardiac diseases or cardiovascular risk factors, who presented to emergency department after the onset of flushing, asthenia, palpitations, burning sensation in the mouth having just eaten tuna. The electrocardiogram revealed a sinus tachycardia with diffuse ST segment depression. After therapy, in a short time symptoms recovered and a second electrocardiogram no longer showed any ST changes. These electrocardiographic changes observed in our case were probably due to transitory coronary vasospasm as described in type I variant of Kounis syndrome.

  16. Folk medicine used to heal malaria in Calabria (southern Italy

    Directory of Open Access Journals (Sweden)

    Tagarelli Antonio

    2010-09-01

    Full Text Available Abstract In Italy, malaria was an endemic disease that was eradicated by the mid-20th century. This paper evaluates the prophylactic and therapeutic remedies used by folk medicine to cure malaria in Calabria (southern Italy. The data has been collected by analysing works of physicians, ethnographers, folklorists and specialists of the study of Calabrian history between the end of the 19th century and the 20th century. The data collected have allowed us to describe the most common cures used by the Calabrian people to treat malaria and the most evident symptoms of this disease, such as intermittent fever, hepato-spleenomegaly, asthenia and dropsy. This approach uncovered a heterogeneous corpus of empirical, magical and religious remedies, which the authors have investigated as evidences of past "expert medicine" and to verify their real effectiveness in the treatment of malaria.

  17. [Primary diffuse leptomeningeal gliomatosis. Presentation of one case].

    Science.gov (United States)

    Olivera-Leal, I R; Gómez-Viera, N; Gónzalez-Espinosa, L; Borrajero-Martínez, I; Alvarez-Santana, R; Cubero-Rego, D

    1997-09-01

    A twenty-four-year-old woman presented with asthenia, anorexia and weight los associated with headache, neck ache, lumbo-sacral pain, flaccid quadriparous, bilaterally diminished vision and sphincter disorders. On computerized axial tomography of the skull, only slight signs of ventricular dilatation were seen. Cytochemical study of the cerebro-spinal fluid showed a marked increase in protein and there was a raised erythrocyte sedimentation rate. The patient was treated with steroids in view of the possibility of vasculitis or a demyelinating disorder. However the disease worsened and she died four months after onset of the disorder. Neuro-pathological study showed tumour infiltration of the leptomeninges of the base of both cerebral hemispheres, cerebellum and spinal medulla. The optic nerves, chiasma and spinal nerve roots were also infiltrated with neoplastic cells. No intraparenchymatous tumour was found. The neuropathological findings were compatible with primary diffuse leptomeningeal gliomatosis.

  18. Outbreak of acute Chagas disease associated with oral transmission in the Rio Negro region, Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Rita de Cássia de Souza-Lima

    2013-10-01

    Full Text Available Introduction Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. Methods We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. Results There were 15 males (average age, 31.3 years, all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. Conclusions All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.

  19. Outbreak of acute Chagas disease associated with oral transmission in the Rio Negro region, Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Rita de Cassia de Souza-Lima

    2013-07-01

    Full Text Available Introduction Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. Methods We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. Results There were 15 males (average age, 31.3 years, all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. Conclusions All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.

  20. A Case of Dyspnea in Pancreatic cancer Treated through Herbal Acupunture Treatment

    Directory of Open Access Journals (Sweden)

    Park Sang-Eun

    2006-02-01

    Full Text Available Objective : This study planed to evaluate effect of oriental medicine therapy treatment method of dyspnea that happen from cancer of the pancreas patient who accompany Multiple metasis Methods : Patient complained dyspnoea during admission into dept . Of internal medicine, college of oriental medicine, Dong-eui Univ ,was appealed patient treated by Oriental medicine therapy that is of use Herb Medication and Herbal -acupuncture Treatment being diagnosed in lung asthenia including deficiency of Eum and insufficiency of Gi of the lung(폐허(肺虛, the fire due to deficiency(허화(虛火, and loving warfare of symptoms evaluated through VAS (visual analog scales. Results & Conclusion : Patient's difficulty in breathing symptoms took a favorable turn after treatment. This study means that Oriental medicine therapy that is difficulty in breathing symptoms that happen from patient surely has effectiveness.

  1. Syndrome of Inappropriate Antidiuretic Hormone Secretion Due to Amantadine: 3 Cases in the Literature

    Directory of Open Access Journals (Sweden)

    Akif Acay

    2014-02-01

    Full Text Available To report a patient who developed a syndrome of inappropriate antidiuretic hormone secretion (SIADH related with amantadine. A 62 year-old male, who has been followed for Parkinson%u2019s disease for 16 years. Three months ago, amantadine added to his existing treatment. About 4 weeks after the initiation of treatment, confusion, constant sleepiness, lethargy, asthenia, fatigue and muscle weakness appeared. The blood anlysis showed hyponatremia, so he was diagnosed as SIADH and amantadine treatment was stopped. Then his symptoms gradually improved and the sodium levels was turned into the normal ranges. Amantadine may cause SIADH should be used with caution in patients with Parkinson%u2019s disease.

  2. Epidemiologic approach to human toxocariasis in western France.

    Science.gov (United States)

    Gueglio, B; de Gentile, L; Nguyen, J M; Achard, J; Chabasse, D; Marjolet, M

    1994-01-01

    Toxocara canis is a common parasite in puppies. The danger to human health has not been properly established. We estimated the current incidence of this pathogen in two western districts of France, Loire-Atlantique and Maine et Loire. Blood samples from 1836 eosino-philic patients were collected and tested by an enzyme-linked immunosorbent assay (ELISA) excretory-secretory Toxocara antigen test. We obtained positive results in 22% of the cases and highly positive results in 7%. The ELISA data seemed to be age-dependent, with older patients having more positive results (P < 0.0001). The interlaboratory distribution of positive test results was statistically significantly different (P < 0.0001), suggesting regional sources. The main clinical expressions of toxocariasis were: asthenia, gastric pain, and pulmonary disease. Individual and collective surveys of this zoonotic disease need to be carried out.

  3. [Infectious myocarditis--clinical and morphological diagnosis (a literature review)].

    Science.gov (United States)

    Bobin, A N

    2001-04-01

    For comparative evaluation of patient life quality we selected 3 groups depending on methods of surgical treatment of prostate benign hyperplasia. The groups of comparison included the patients who underwent prostate transurethral resection (n = 36), postpubic extravesical adenomectomy (n = 31) and transvesical adenomectomy (n = 35). It was established that informative clinical indices in evaluation of life quality were urination maximal rate, time of urination delay, urination time. Informative psychodiagnostical methods for evaluation of life quality in patients with benign hyperplasia of prostate are "MCF scale", "Asthenia scale", Test for differential self-appraisal of functional state, "Scale of reactive and personal anxiety", "Risk of coronary behavior" and Izenk's questionnaire. Total algorithm was developed permitting to predict the patient life quality with rather high accuracy.

  4. Non-celiac gluten sensitivity and rheumatic diseases.

    Science.gov (United States)

    Isasi, Carlos; Tejerina, Eva; Morán, Luz M

    2016-01-01

    Celiac disease is an autoimmune systemic disease having among its clinical manifestations frequent symptoms common to rheumatologic diseases such as musculoskeletal pain, asthenia, and cognitive fatigue. It is associated with other autoimmune diseases like Sjögren disease. It is a well-characterized disease with specific diagnostic tests. Non-celiac gluten sensitivity is an emerging entity with symptoms similar to celiac disease, but without specific diagnostic tests. The concept of non-celiac gluten sensitivity and its diagnostic problems are reviewed, and the hypothesis of its association with fibromyalgia, spondyloarthritis, and autoimmune conditions is proposed. Clinical observations supporting the hypothesis are described, highlighting the benefit of treating non-celiac gluten sensitivity. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  5. Reversible Pulmonary Hypertension Associated with Whipple’s Disease

    Directory of Open Access Journals (Sweden)

    A. Villa

    2012-01-01

    Full Text Available We describe a case of Whipple’s disease with pulmonary hypertension in a 72-year-old woman in whom the pulmonary hypertension resolved completely after antibiotic therapy. She was admitted to study with a 2-months history of weight loss, diarrhoea, abdominal pain, asthenia, inappetence, and fever. She did not have dyspnoea or respiratory symptoms. A casual echocardiogram showed a pulmonary artery systolic pressure of 95 mmHg. Forty days after starting antibiotic therapy, an echocardiogram showed a complete normalisation of right ventricular involvement. Whipple’s disease is a rare and multisystemic disorder in which pulmonary involvement is not a well-known finding. Although Whipple’s disease is not generally considered as a possible cause of pulmonary hypertension, such awareness is important because it may be potentially resolved with antibiotic therapy.

  6. OUTBREAK OF ZIKA VIRUS DISEASE AND ITS COMPLICATIONS

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    Gabriela S. Tsankova

    2016-07-01

    Full Text Available Zika virus (ZIKV is an arbovirus from Flaviviridae family, genus Flavivirus. Like most of the viruses which belong to the Flavivirus genus, it replicates in and is transmitted by mosquitoes. Unlike other arbovirus infections including dengue and chikungunya, Zika virus causes a relatively mild disease. The most common symptoms of ZIKV are mild fever, arthralgia, myalgia, headache, asthenia, abdominal pain, oedema, lymphadenopathy, retro-orbital pain, conjunctivitis, and cutaneous maculopapular rash, which last for several days to a week. Although 80% of the cases with ZIKV are asymptomatic, severe complications such as microcephalia and GBS may be observed. This explains why ZIKV is more dangerous that it was thought to be and why it rapidly evolves in unexpected challenge for the international and national public health authorities.

  7. Unusual motor and non-motor symptoms and signs in the early stage of Parkinson’s disease

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    Hélio A. G. Teive

    Full Text Available ABSTRACT Objective Patients with Parkinson’s disease (PD may present with unusual motor and non-motor symptoms and signs in the early stage of the disease. Methods Cases were collected over a five-year period at two tertiary movement disorders clinics. All had a diagnosis of PD with unusual presentations defined retrospectively as the presence of complaints not objectively related to any of the classic cardinal signs of parkinsonism or the typical early non-motor features of PD. Results A total of 15 early PD patients fulfilled the proposed criteria, presenting with symptoms such as atypical tremors, shoulder pain, signs related to the rigid akinetic syndrome, as well as cases of asthenia, rhinorrhea, parosmia, dysgeusia, nocturnal sialorrhea, and color discrimination disorders. Conclusions Unusual motor and non-motor symptoms and signs in the early stage of PD can be difficult to interpret. Specialists should be aware of these conditions as clues to a potential diagnosis.

  8. An Evaluation of Significance of Herbal Acupuncture on Treating Limb Impediment Among the Children with Development Disabilities

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    Huh Young-Jin

    2004-02-01

    Full Text Available Objectives : This study was conducted to establish a standard and classify suitability in the treatment of limb impediment among the children with development disabilities using bee venom and eight principles herbal acupuncture. Methods : 10 patients with pediatric development disabilities with limb impediment as the main symptoms were chosen in this study. Bee venom herbal acupuncture and eight principles herbal acupuncture treatments were rendered and evaluated responses as well as pursuing most proper treatment methods. Results : 1. Bee venom herbal acupuncture showed a significant effects when used as supplement treatment technique for the children with partial movement, but insignificant for the children whom were unable to move. 2. Bee venom was effective for severe limb impediment and limb asthenia, whileas eight principles herbal acupuncture effective for mild limb impediment and spasticity. 3. Bee venom herbal acupuncture used in conjunction with eight principles herbal acupuncture for treating limb impediment among the children with development disabilities showed general improvement by intensifying muscular strength.

  9. Chronic myeloid leukemia in children and adolescents: A single center experience from Eastern India.

    Science.gov (United States)

    Raut, Lalit; Bohara, Vinay V; Ray, Siddhartha S; Chakrabarti, Prantar; Chaudhuri, Utpal

    2013-10-01

    Chronic Myeloid Leukemia (CML) constitutes around 3% of leukemia in the children and adolescent age group. The aim of the study was to evaluate the characteristics at presentation and the treatment outcome of CML in the children and adolescent age group. Retrospective analysis was carried out at a single center in India. Thirteen patients (≤17 years) attending CML outdoor from April 2008 to August 2012 were included in the analysis. The mean and median of various parameters were calculated using a Microsoft excel sheet. SPSS 16.0 version software was used to calculate OS and PFS. CML-CP was the most common phase at presentation. Maximum patients belonged to the 14 - 17 year old age group. Disease was common in the male sex. Splenic discomfort and asthenia were the most common symptoms and splenomegaly was the most common sign. The treatment with Imatinib was effective and well-tolerated.

  10. Churg-Strauss syndrome and hemorragic vasculitis

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    Rui Moreira Marques

    2011-12-01

    Full Text Available Churg-Strauss syndrome (CSS is a rare syndrome characterized by sinusitis, asthma and peripheral eosinophilia. This vasculitic syndrome affects medium and small-sized vessels, the lung being the most commonly affected organ, followed by the skin. The authors report a case of a 59-year-old male with a past history of asthma and allergic rhinitis. He presented necrohemorragic lesions in the distal phalanx of the 2nd, 3rd and 4th fingers of the lefthand and petechial lesions in the plant of both feet, accompanied by asthenia, anorexia and weight loss. The analytical study revealed leukocytosis with eosinophilia, elevated inflammatory parameters and p-ANCA positive antibodies. The diagnosis of CSS was established based on clinical and histopathological data. Cutaneous manifestations of hemorragic vasculitis are rare in CSS syndrome but can be the first manifestation of the disease. The recognition of this presentation is important for the early diagnosis and treatment of this syndrome.

  11. Autoimmune Thyroiditis Presenting as Palmoplantar Keratoderma

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    Sara Lestre

    2010-01-01

    Full Text Available Palmoplantar keratoderma is a heterogeneous group of hereditary and acquired disorders characterized by abnormal thickening of palms and soles. Hypothyroidism is an unusual cause of palmoplantar keratoderma, rarely reported in the literature. We report a case of a 43-year-old woman presented with a 3-month history of a diffuse palmoplantar hyperkeratosis unresponsive to topical keratolytics and corticosteroids. Her past medical and family histories were unremarkable. She complained of recent asthenia, mood changes and constipation. Laboratory evaluation revealed an autoimmune thyroiditis with hypothyroidism. Other causes of acquired palmoplantar keratoderma were excluded. After hormonal replacement therapy institution, a gradual improvement of skin condition was observed. The diagnosis of underlying causes for acquired palmoplantar keratoderma can be a difficult task; however its recognition is essential for successful treatment results. Although a very rare association, hypothyroidism must be suspected in patients with acquired palmoplantar keratoderma, particularly when it occurs in association with systemic symptoms.

  12. Simultaneous Hodgkin′s disease and kaposi sarcoma in a renal transplant recipient

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    Yaich S

    2010-01-01

    Full Text Available A 38-year-old women underwent first cadaver kidney transplantation. Her panel re-active antibody was 0%, and she had never previously been transfused nor pregnant. She received induction therapy with antithymoglobulin (ATG as standard protocol and maintained on immuno-suppressive treatment of cyclosporine A, mycophenolate mofetil (MMF, and prednisone. Nine months after transplantation, she presented with anorexia, asthenia and weight loss. Cutaneous Ka-posi′s sarcoma and a Hodgkin disease were diagnosed. MMF was discontinued and cyclosporin A was switched to sirolimus. She also received a poly-chemotherapy associated with 4 courses of rituximab. Twelve months later, the patient had normal graft function and both malignancies were in complete remission.

  13. Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population.

    Science.gov (United States)

    Moore, Jaime; Greenberg, Caprice; Thibeault, Susan L

    2017-01-01

    To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI). Prospective, survey study. Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database with voice, concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study. The VHI was sent to patients 6 months post clinic visit to determine change in voice handicap from baseline. General health was screened using the 12-item Short Form Health Survey, using physical component summary and mental component summary scores. Predictor variables included treatment (medical and/or behavioral); dysphonia sub-diagnosis; grade, roughness, breathiness, asthenia, and strain rating; age; sex; socioeconomic factors; smoking history; and comorbidity score. Two hundred thirty-seven patients met study criteria and were followed longitudinally. Eighty-two patients returned 6-month surveys. The VHI was significantly correlated with mental component summary scores. Patients with a higher grade in baseline grade, roughness, breathiness, asthenia, and strain score were more likely to receive voice intervention (P = 0.04). Six-month improvement in VHI score was associated with both higher initial VHI score and higher educational level in both univariate (P < 0.01, P = 0.04) and multivariate analyses (P < 0.01, P = 0.02). Voice treatment (medical and/or behavioral) was not a significant factor for improvement in VHI score. Our results suggest that it is important to consider baseline self-perceived voice impact measures and educational level in setting expectations for voice treatment. Future studies examining the relationship between treatment patterns and voice-related patient outcomes are warranted. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  14. Imaged-guided liver stereotactic body radiotherapy using VMAT and real-time adaptive tumor gating. Concerns about technique and preliminary clinical results.

    Science.gov (United States)

    Llacer-Moscardo, Carmen; Riou, Olivier; Azria, David; Bedos, Ludovic; Ailleres, Norbert; Quenet, Francois; Rouanet, Philippe; Ychou, Marc; Fenoglietto, Pascal

    2017-01-01

    Motion management is a major challenge in abdominal SBRT. We present our study of SBRT for liver tumors using intrafraction motion review (IMR) allowing simultaneous KV information and MV delivery to synchronize the beam during gated RapidArc treatment. Between May 2012 and March 2015, 41 patients were treated by liver SBRT using gated RapidArc technique in a Varian Novalis Truebeam STx linear accelerator. PTV was created by expanding 5 mm from the ITV. Dose prescription ranged from 40 to 50 Gy in 5-10 fractions. The prescribed dose and fractionation were chosen depending on hepatic function and dosimetric results. Thirty-four patients with a minimal follow-up of six months were analyzed for local control and toxicity. Accuracy for tumor repositioning was evaluated for the first ten patients. With a median follow-up of 13 months, the treatment was well tolerated and no patient presented RILD, perforation or gastrointestinal bleeding. Acute toxicity was found in 3 patients with G1 abdominal pain, 2 with G1 nausea, 10 with G1 asthenia and 1 with G2 asthenia. 6 patients presented asymptomatic transitory perturbation of liver enzymes. In-field local control was 90.3% with 7 complete responses, 14 partial responses and 7 stabilisations. 3 patients evolved "in field". 12 patients had an intrahepatic progression "out of field". Mean intrafraction deviation of fiducials in the craneo-caudal direction was 0.91 mm (0-6 mm). The clinical tolerance and oncological outcomes were favorable when using image-guided liver SBRT with real-time adaptive tumor gating.

  15. Primary adrenal insufficiency in adult population: a Portuguese Multicentre Study by the Adrenal Tumours Study Group.

    Science.gov (United States)

    Ferreira, Lia; Silva, João; Garrido, Susana; Bello, Carlos; Oliveira, Diana; Simões, Hélder; Paiva, Isabel; Guimarães, Joana; Ferreira, Marta; Pereira, Teresa; Bettencourt-Silva, Rita; Martins, Ana Filipa; Silva, Tiago; Fernandes, Vera; Pereira, Maria Lopes

    2017-11-01

    Primary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. No previous studies have characterized Portuguese patients with PAI. To characterize the clinical presentation, diagnostic workup, treatment and follow-up of Portuguese patients with confirmed PAI. This multicentre retrospective study examined PAI patients in 12 Portuguese hospitals. We investigated 278 patients with PAI (55.8% were females), with a mean age of 33.6 ± 19.3 years at diagnosis. The most frequent presenting clinical features were asthenia (60.1%), mucocutaneous hyperpigmentation (55.0%) and weight loss (43.2%); 29.1% of the patients presented with adrenal crisis. Diagnosis was established by high plasma ACTH and low serum cortisol in most patients (43.9%). The most common aetiology of PAI was autoimmune adrenalitis (61.0%). There were 38 idiopathic cases. Autoimmune comorbidities were found in 70% of the patients, the most frequent being autoimmune thyroiditis (60.7%) and type 1 diabetes mellitus (17.3%). Seventy-nine percent were treated with hydrocortisone (mean dose 26.3 ± 8.3 mg/day) mostly in three (57.5%) or two (37.4%) daily doses. The remaining patients were treated with prednisolone (10.1%), dexamethasone (6.2%) and methylprednisolone (0.7%); 66.2% were also on fludrocortisone (median dose of 100 µg/day). Since diagnosis, 33.5% of patients were hospitalized for disease decompensation. In the last appointment, 17.2% of patients had complaints (7.6% asthenia and 6.5% depression) and 9.7% had electrolyte disturbances. This is the first multicentre Portuguese study regarding PAI. The results emphasize the need for standardization in diagnostic tests and etiological investigation and provide a framework for improving treatment. © 2017 The authors.

  16. Consistency of eletriptan in treating migraine: Results of a randomized, within-patient multiple-dose study.

    Science.gov (United States)

    Almas, Mary; Tepper, Stewart J; Landy, Stephen; Schweizer, Edward; Ramos, Elodie

    2014-02-01

    The current study evaluated the consistency of eletriptan response. Using a within-patient crossover design, patients with migraine completed a three-attack, open-label, lead-in period, before being treated, double-blind for four attacks, with either eletriptan 40 mg (ELE-40; N = 539) or eletriptan 80 mg (ELE-80; N = 432); placebo was randomly substituted for the treatment of one attack. On an A PRIORI analysis of within-patient consistency, double-blind treatment was associated with similar 2 hour headache response rates using a ≥2/3 response criterion for ELE-40 (77%) and ELE-80 (73%), and using a 3/3 response criterion for ELE-40 (46%) and ELE-80 (47%). Within-patient consistency in achieving pain-free status at 2 hours using a ≥2/3 criterion was slightly higher on ELE-40 (42%) compared with ELE-80 (38%), and was similar using the 3/3 criterion (18% on ELE-40, 17% on ELE-80). On a repeated measures logistic regression analysis across all treated attacks, the probability of achieving a headache response at 2 hours ranged from 71% to 74% on ELE-40 vs. 17% to 28% on placebo ( P ELE-80 vs. 21% to 27% on placebo ( P ELE-40 and ELE-80. Few adverse events occurred with incidence ≥10% on ELE-40 (asthenia, 5.0%) or ELE-80 (asthenia, 10%; nausea, 5.8%). Discontinuations because of adverse events were 0.2% on ELE-40, and 1.6% on ELE-80 CONCLUSION: In this multiple attack study, eletriptan was well-tolerated and demonstrated consistent and significant efficacy in the treatment of migraine.

  17. Skin malformations in a neonatal foal tested homozygous positive for Warmblood Fragile Foal Syndrome.

    Science.gov (United States)

    Monthoux, Chloé; de Brot, Simone; Jackson, Michelle; Bleul, Ulrich; Walter, Jasmin

    2015-01-31

    Skin malformations that resembled manifestations of Ehlers-Danlos-Syndrome were described in a variety of domestic animals during the last century as cutis hyperelastica, hyperelastosis cutis, dermatosparaxis, dermal/collagen dysplasia, dermal/cutaneous asthenia or Ehlers-Danlos-like syndrome/s. In 2007, the mutation responsible for Hereditary Equine Regional Dermal Asthenia (HERDA) in Quarter Horses was discovered. Several case reports are available for similar malformations in other breeds than Quarter Horses (Draught Horses, Arabians, and Thoroughbreds) including four case reports for Warmblood horses. Since 2013, a genetic test for the Warmblood Fragile Foal Syndrome Type 1 (WFFS), interrogating the causative point mutation in the equine procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 (PLOD1, or lysyl hydroxylase 1) gene, has become available. Only limited data are available on the occurrence rate and clinical characteristics of this newly detected genetic disease in horses. In humans mutations in this gene are associated with Ehlers-Danlos Syndrome Type VI (kyphoscoliotic form). This is the first report describing the clinical and histopathological findings in a foal confirmed to be homozygous positive for WFFS. The Warmblood filly was born with very thin, friable skin, skin lesions on the legs and the head, and an open abdomen. These abnormalities required euthanasia just after delivery. Histologic examination revealed abnormally thin dermis, markedly reduced amounts of dermal collagen bundles, with loosely orientation and abnormally large spaces between deep dermal fibers. WFFS is a novel genetic disease in horses and should be considered in cases of abortion, stillbirth, skin lesions and malformations of the skin in neonatal foals. Genetic testing of suspicious cases will contribute to evaluate the frequency of occurrence of clinical WFFS cases and its relevance for the horse population.

  18. Clinical evaluation of Gabitril and Lamictal for drug-resistant epilepsy in adults.

    Science.gov (United States)

    Chmielewska, B; Stelmasiak, Z

    2001-01-01

    Second generation antiepileptics lamotrigine (LTG) and tiagabine (TGB) were primarily licensed for adjunctive treatment of simple and complex partial seizures with/without secondary generalisation as similarly effective drugs. Reduction of seizures frequency is the most important index of drug efficacy, but overall therapeutic benefit estimated as a quality of life is nowadays the target goal of management. In this study efficacy and tolerability of LTG or TGB as short-term add-on treatment in patients with refractory complex partial seizures were assessed by the use of both physician-rated measures (mean monthly seizure frequency, responders rate, adverse events, clinical biochemistry) and patients perceived change in their own quality of life estimation (descriptive scale and visual analogue scale-VAS). Comparable efficacy of LTG (n-22, 378 mg/day) and TGB (n-26, 43 mg/g) was assessed as 41 and 35% of responders and above half of patients with noticeable improvement. 25% of patients in both groups reported reduction of seizures severity in 4-points descriptive scale. Biochemistry values did not show clinically significant changes after treatment. 13% of patients on LTG reported adverse events (headache, asthenia, irritability, insomnia). This coefficient was greater for TGB-35% (asthenia, headache, sleepiness, vertigo). However, no case of discontinuation as a result of adverse events was reported for either of the tested drugs. Even if efficacy of LTG and TGB was comparable in objective measurements, only patients on LTG reported a significant quality of life improvement in VAS. This might be the consequence of more frequent adverse events and treatment schedule of TGB (triple dosing/day). This trial confirmed that VAS might be used as an easy additional test in evaluation of antiepileptic drug for individual patient in everyday clinical practice.

  19. Infección por Citomegalovarius con compromiso hepático en adultos inmunocompetentes Cytomegalovirus infection with hepatic involvement in immunocompetent adults

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    Claudia Vujacich

    2006-06-01

    presented fever and asthenia, mild to moderate increase of transaminases and serological findings compatible with recent cytomegalovirus infection. We excluded patients with a history of transfusions, drug abuse, immunodeficiencies, preexistent hepatic impairment or serological findings compatible with acute hepatitis A, B and C (HAV, HBV, HCV and Epstein Barr virus (EBV. The laboratory diagnosis of recent cytomegalovirus infection was made by especific IgM detection (ELISA or a significant increase of specific IgG. The most frequent symptoms were fever (85% and asthenia (83%, followed by cephalea (25%, splenomegaly (20%, adenomegalies (22%, pharyngitis (25%, myalgias (25% and hepatomegaly (19%. All the patients showed moderate increase of transaminases and lymphomonocytosis (73/73. In average, ALT was increased by 6 fold and AST by 3.5 fold. The clinical characteristics that differentiate CMV infection from Epstein-Barr infection are the lesser frequency of adenomegalies and pharyngitis in the former. The differential diagnosis of CMV infection with hepatic involvement from acute hepatitis A and B, is based on the absence of jaundice, the lower elevation of transaminases, the intense lymphomonocytosis and the presence of specific IgM against CMV that are characteristic of CMV infection. In conclusion, in previously healthy young adults with fever, intense asthenia, lymphomonocytosis and moderate increase in transaminases levels, cytomegalovirus infection should be investigated.

  20. Safety and efficacy of sunitinib in patients from Latin America: subanalysis of an expanded access trial in metastatic renal cell carcinoma.

    Science.gov (United States)

    Barrios, Carlos H; Herchenhorn, Daniel; Chacón, Matías; Cabrera-Galeana, Paula; Sajben, Peter; Zhang, Ke

    2016-01-01

    Sunitinib is an approved treatment for metastatic renal cell carcinoma (mRCC). The safety profile and efficacy of sunitinib were confirmed in a global expanded access trial (ClinicalTrials.gov identifier: NCT00130897). This report presents a subanalysis of the final trial data from patients in Latin America. Treatment-naïve or previously treated mRCC patients aged ≥18 years received oral sunitinib at a starting dose of 50 mg/day on a 4-weeks-on/2-weeks-off schedule. Treatment continued until disease progression, unacceptable toxicity, or withdrawal of consent. Safety was assessed regularly, and tumor measurements were scheduled per local practice (using Response Evaluation Criteria in Solid Tumors). In total, 348 patients from Latin America received sunitinib. Overall, 75% of patients had two or more sites of metastatic disease, 28% were aged ≥65 years, 14% had an Eastern Cooperative Oncology Group performance status ≥2, 9% had brain metastases, 9% had no prior nephrectomy, and 5% had non-clear cell RCC. Median treatment duration was 8 months, and median follow-up was 15.1 months. In total, 326 patients (94%) discontinued treatment, primarily due to death (41%) or lack of efficacy (22%). Most treatment-related adverse events were of mild to moderate severity (grade 1/2). Mucosal inflammation (reported in 54% of patients), diarrhea (53%), and asthenia (41%) were the most common any-grade treatment-related adverse events. Asthenia (12%), neutropenia (10%), and fatigue and thrombocytopenia (both 9%) were the most common grade 3/4 treatment-related adverse events. In total, 311 patients were included for tumor response, of whom eight (3%) had a complete response and 46 (15%) a partial response, yielding an objective response rate of 17%. Median duration of response, progression-free survival, and overall survival were 26.7, 12.1, and 16.9 months, respectively. The efficacy and safety profile of sunitinib in patients with mRCC from Latin America was comparable to

  1. Psychosocial value of space simulation for extended spaceflight

    Science.gov (United States)

    Kanas, N.

    1997-01-01

    There have been over 60 studies of Earth-bound activities that can be viewed as simulations of manned spaceflight. These analogs have involved Antarctic and Arctic expeditions, submarines and submersible simulators, land-based simulators, and hypodynamia environments. None of these analogs has accounted for all the variables related to extended spaceflight (e.g., microgravity, long-duration, heterogeneous crews), and some of the stimulation conditions have been found to be more representative of space conditions than others. A number of psychosocial factors have emerged from the simulation literature that correspond to important issues that have been reported from space. Psychological factors include sleep disorders, alterations in time sense, transcendent experiences, demographic issues, career motivation, homesickness, and increased perceptual sensitivities. Psychiatric factors include anxiety, depression, psychosis, psychosomatic symptoms, emotional reactions related to mission stage, asthenia, and postflight personality, and marital problems. Finally, interpersonal factors include tension resulting from crew heterogeneity, decreased cohesion over time, need for privacy, and issues involving leadership roles and lines of authority. Since future space missions will usually involve heterogeneous crews working on complicated objectives over long periods of time, these features require further study. Socio-cultural factors affecting confined crews (e.g., language and dialect, cultural differences, gender biases) should be explored in order to minimize tension and sustain performance. Career motivation also needs to be examined for the purpose of improving crew cohesion and preventing subgrouping, scapegoating, and territorial behavior. Periods of monotony and reduced activity should be addressed in order to maintain morale, provide meaningful use of leisure time, and prevent negative consequences of low stimulation, such as asthenia and crew member withdrawal

  2. The Influence of Native Language on Auditory-Perceptual Evaluation of Vocal Samples Completed by Brazilian and Canadian SLPs.

    Science.gov (United States)

    Chaves, Cristiane Ribeiro; Campbell, Melanie; Côrtes Gama, Ana Cristina

    2017-03-01

    This study aimed to determine the influence of native language on the auditory-perceptual assessment of voice, as completed by Brazilian and Anglo-Canadian listeners using Brazilian vocal samples and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. This is an analytical, observational, comparative, and transversal study conducted at the Speech Language Pathology Department of the Federal University of Minas Gerais in Brazil, and at the Communication Sciences and Disorders Department of the University of Alberta in Canada. The GRBAS scale, connected speech, and a sustained vowel were used in this study. The vocal samples were drawn randomly from a database of recorded speech of Brazilian adults, some with healthy voices and some with voice disorders. The database is housed at the Federal University of Minas Gerais. Forty-six samples of connected speech (recitation of days of the week), produced by 35 women and 11 men, and 46 samples of the sustained vowel /a/, produced by 37 women and 9 men, were used in this study. The listeners were divided into two groups of three speech therapists, according to nationality: Brazilian or Anglo-Canadian. The groups were matched according to the years of professional experience of participants. The weighted kappa was used to calculate the intra- and inter-rater agreements, with 95% confidence intervals, respectively. An analysis of the intra-rater agreement showed that Brazilians and Canadians had similar results in auditory-perceptual evaluation of sustained vowel and connected speech. The results of the inter-rater agreement of connected speech and sustained vowel indicated that Brazilians and Canadians had, respectively, moderate agreement on the overall severity (0.57 and 0.50), breathiness (0.45 and 0.45), and asthenia (0.50 and 0.46); poor correlation on roughness (0.19 and 0.007); and weak correlation on strain to connected speech (0.22), and moderate correlation to sustained vowel (0.50). In general

  3. The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (a multicentre study).

    Science.gov (United States)

    Dobru, Daniela; Pascu, Oliviu; Tanţă, Marcel; Gheorghe, Cristina; Goldiş, Adrian; Bălan, Gheorghe; Olteanu, Ilie; Fraticiu, Alexandru; Dumitru, Eugen; Miuţescu, Eftimie; Mulder, Chris; Podoleanu, Simona

    2003-06-01

    The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum, as distally as possible, which were submitted to histopathological examination and scored according to the modified UEGW Marsh criteria (2001). A database was set up to include all the patients with data regarding sex, age, urban or rural background, full clinical diagnosis, clinical symptoms, history of the coeliac disease. Of the 2436 patients studied, 54 (2.22%) were diagnosed with coeliac disease. Their demographic features: 48.15% men, 51.85% women, 68.52% living in urban areas, 31.48% in rural ones, mean age 42 +/-17.0 years. The most frequent reasons for performing upper digestive endoscopy were: dyspeptic syndrome - 15.93%, anemia - 24.07%, and chronic diarrhoea - 22.22%. The most frequently recorded clinical manifestations were: chronic diarrhoea in 46.3%, asthenia in 29.63%, anemia in 24.07%, aphthae in 24.07%. Histopathological results according to Marsh classification were: Marsh III- 64.81 %, Marsh II-35.19%. The prevalence of the coeliac disease in Romania is 2.22%: its

  4. Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials.

    Directory of Open Access Journals (Sweden)

    Minjie Gao

    Full Text Available Whether patients with smoldering multiple myeloma (SMM needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM.MEDLINE and Cochrane Library were searched to May 2014 for randomized controlled trials (RCTs that assessed the effect of early treatment over deferred treatment. Primary outcome measure was mortality, and secondary outcome measures were progression, response rate, and adverse events.Overall, 5 trials including 449 patients were identified. There was a markedly reduced risk of disease progression with early treatment (Odds Ratio [OR] = 0.13, 95% confidence interval [CI] = 0.07 to 0.24. There were no significant differences in mortality and response rate (OR = 0.85, 95% CI = 0.45 to 1.60, and OR = 0.63, 95% CI = 0.32 to 1.23, respectively. More patients in the early treatment arm experienced gastrointestinal toxicities (OR = 10.02, 95%CI = 4.32 to 23.23, constipation (OR = 8.58, 95%CI = 3.20 to 23.00 and fatigue or asthenia (OR = 2.72, 95%CI = 1.30 to 5.67. No significant differences were seen with the development of acute leukemia (OR = 2.80, 95%CI = 0.42 to 18.81, hematologic cancer (OR = 2.07, 95%CI = 0.43 to 10.01, second primary tumors (OR = 3.45, 95%CI = 0.81 to 14.68, nor vertebral compression (OR = 0.18, 95%CI = 0.02 to 1.59.Early treatment delayed disease progression but increased the risk of gastrointestinal toxicities, constipation and fatigue or asthenia. The differences on vertebral compression, acute leukemia, hematological cancer and second primary tumors were not statistically significant. Based on the current evidence, early treatment didn't significantly affect mortality and response rate. However, further much larger trials were needed to provide more evidence.

  5. Pramipexole. A review of its use in the management of early and advanced Parkinson's disease.

    Science.gov (United States)

    Dooley, M; Markham, A

    1998-06-01

    Pramipexole is an orally active non-ergoline dopamine agonist with selective activity at dopamine receptors belonging to the D2 receptor subfamily (D2, D3, D4 receptor subtypes) and with preferential affinity for the D3 receptor subtype. It is approved as monotherapy in early Parkinson's disease and as adjunctive therapy to levodopa in patients with advanced disease experiencing motor effects because of diminished response to levodopa. The potential neuroprotective effects of pramipexole have been shown in animal and in vitro studies. Data from relatively long term (10- or 31-week) studies suggest that pramipexole monotherapy (0.375 to 6.0 mg/day) can improve activities of daily living and motor symptoms in patients with early Parkinson's disease. Pramipexole (0.375 to 4.5 mg/day for 31 or 36 weeks), as an adjunct to levodopa in advanced disease, improved activities of daily living and motor symptoms, reduced the duration and severity of 'off' periods and allowed a reduction in levodopa dosage. Mentation, behaviour and mood [Unified Parkinson's Disease Rating Scale (UPDRS) part I], and timed walking test were not significantly improved. The extent of disability improved according to the UPDRS parts II and III but, when assessed by secondary efficacy parameters, it is unclear whether disability or the severity of disease improved. No significant differences were observed in patients randomised to pramipexole or bromocriptine according to a secondary hypothesis in a prospective study in which both drugs were better than placebo. Some quality-of-life measures improved with active treatment relative to placebo. Further studies comparing pramipexole with other dopamine agonists and levodopa in patients with early and advanced Parkinson's disease would be useful. In pramipexole recipients with early disease, the most commonly experienced adverse events were nausea, dizziness, somnolence, insomnia, constipation, asthenia and hallucinations. The most commonly reported

  6. Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001-2013: a Clinical Practice Research Datalink study.

    Science.gov (United States)

    Collin, Simon M; Bakken, Inger J; Nazareth, Irwin; Crawley, Esther; White, Peter D

    2017-06-01

    Objective Trends in recorded diagnoses of chronic fatigue syndrome (CFS, also known as 'myalgic encephalomyelitis' (ME)) and fibromyalgia (FM) in the UK were last reported more than ten years ago, for the period 1990-2001. Our aim was to analyse trends in incident diagnoses of CFS/ME and FM for the period 2001-2013, and to investigate whether incidence might vary by index of multiple deprivation (IMD) score. Design Electronic health records cohort study. Setting NHS primary care practices in the UK. Participants Participants: Patients registered with general practices linked to the Clinical Practice Research Datalink (CPRD) primary care database from January 2001 to December 2013. Main outcome measure Incidence of CFS/ME, FM, post-viral fatigue syndrome (PVFS), and asthenia/debility. Results The overall annual incidence of recorded cases of CFS/ME was 14.8 (95% CI 14.5, 15.1) per 100,000 people. Overall annual incidence per 100,000 people for FM was 33.3 (32.8-33.8), for PVFS 12.2 (11.9, 12.5), and for asthenia/debility 7.0 (6.8, 7.2). Annual incidence rates for CFS/ME diagnoses decreased from 17.5 (16.1, 18.9) in 2001 to 12.6 (11.5, 13.8) in 2013 (annual percent change -2.8% (-3.6%, -2.0%)). Annual incidence rates for FM diagnoses decreased from 32.3 (30.4, 34.3) to 27.1 (25.5, 28.6) in 2007, then increased to 38.2 (36.3, 40.1) per 100,000 people in 2013. Overall annual incidence of recorded fatigue symptoms was 2246 (2242, 2250) per 100,000 people. Compared with the least deprived IMD quintile, incidence of CFS/ME in the most deprived quintile was 39% lower (incidence rate ratio (IRR) 0.61 (0.50, 0.75)), whereas rates of FM were 40% higher (IRR 1.40 (0.95, 2.06)). Conclusion These analyses suggest a gradual decline in recorded diagnoses of CFS/ME since 2001, and an increase in diagnoses of fibromyalgia, with opposing socioeconomic patterns of lower rates of CFS/ME diagnoses in the poorest areas compared with higher rates of FM diagnoses.

  7. Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials.

    Science.gov (United States)

    Gao, Minjie; Yang, Guang; Tompkins, Van S; Gao, Lu; Wu, Xiaosong; Tao, Yi; Hu, Xiaojing; Hou, Jun; Han, Ying; Xu, Hongwei; Zhan, Fenghuang; Shi, Jumei

    2014-01-01

    Whether patients with smoldering multiple myeloma (SMM) needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM. MEDLINE and Cochrane Library were searched to May 2014 for randomized controlled trials (RCTs) that assessed the effect of early treatment over deferred treatment. Primary outcome measure was mortality, and secondary outcome measures were progression, response rate, and adverse events. Overall, 5 trials including 449 patients were identified. There was a markedly reduced risk of disease progression with early treatment (Odds Ratio [OR] = 0.13, 95% confidence interval [CI] = 0.07 to 0.24). There were no significant differences in mortality and response rate (OR = 0.85, 95% CI = 0.45 to 1.60, and OR = 0.63, 95% CI = 0.32 to 1.23, respectively). More patients in the early treatment arm experienced gastrointestinal toxicities (OR = 10.02, 95%CI = 4.32 to 23.23), constipation (OR = 8.58, 95%CI = 3.20 to 23.00) and fatigue or asthenia (OR = 2.72, 95%CI = 1.30 to 5.67). No significant differences were seen with the development of acute leukemia (OR = 2.80, 95%CI = 0.42 to 18.81), hematologic cancer (OR = 2.07, 95%CI = 0.43 to 10.01), second primary tumors (OR = 3.45, 95%CI = 0.81 to 14.68), nor vertebral compression (OR = 0.18, 95%CI = 0.02 to 1.59). Early treatment delayed disease progression but increased the risk of gastrointestinal toxicities, constipation and fatigue or asthenia. The differences on vertebral compression, acute leukemia, hematological cancer and second primary tumors were not statistically significant. Based on the current evidence, early treatment didn't significantly affect mortality and response rate. However, further much larger trials were needed to provide more evidence.

  8. A unique association of arrhythmogenic right ventricular dysplasia and acute myocarditis, as assessed by cardiac MRI: a case report.

    Science.gov (United States)

    Ponsiglione, Andrea; Puglia, Marta; Morisco, Carmine; Barbuto, Luigi; Rapacciuolo, Antonio; Santoro, Mario; Spinelli, Letizia; Trimarco, Bruno; Cuocolo, Alberto; Imbriaco, Massimo

    2016-11-21

    Arrhythmogenic right ventricular dysplasia (ARVD), is a genetic disorder of the heart, which mainly involves the right ventricle. It is characterized by hypokinetic areas at the free wall of the right ventricle (RV) or both ventricles, where myocardium is replaced by fibrous or fatty tissue. ARVD is an important cause of ventricular arrhythmias in children and young adults. Although the transmission of the disease is based on hereditary, in young adults it may not show any symptoms. The main differential diagnoses with other frequent etiological causes of sudden arrhythmia are: idiopathic outflow tract ventricular tachycardia of the RV, myocarditis, dilated cardiomyopathy and sarcoidosis. We describe an unusual case of a 44-year-old woman who was hospitalized for ventricular tachycardia, deep asthenia and dyspnoea with no previous history of cardiac disease. The patient had a ten-year history of palpitations, which started immediately after her last pregnancy. She was diagnosed with both acute/subacute viral myocarditis and arrhythmogenic right ventricular dysplasia, based on established clinical and cardiac MRI criteria. After the diagnosis the patient received an automatic implantable cardioverter defibrillator. Currently, she is on clinical follow-up with no apparent further complications. Analyzing this rare case, we have shown the link between myocarditis and arrhythmogenic right ventricular dysplasia, and how important is to perform a cardiac MRI, in the context of acute myocarditis and ventricular arrhythmia.

  9. Psychosocial issues in space: results from Shuttle/Mir.

    Science.gov (United States)

    Kanas, N; Salnitskiy, V; Grund, E M; Weiss, D S; Gushin, V; Bostrom, A; Kozerenko, O; Sled, A; Marmar, C R

    2001-06-01

    Important psychosocial issues involving tension, cohesion, leader support, and displacement of negative emotions were evaluated in a 4 1/2-year study involving five U.S. and four Russian Shuttle/Mir space missions. Weekly mood and group climate questionnaires were completed by five U.S. astronauts, eight Russian cosmonauts, and 42 U.S. and 16 Russian mission control subjects. There were few findings that supported our hypothesized changes in tension, cohesion, and leader support in crew and ground subjects using various time models, although crewmembers reported decreasing leader support in the 2nd half of the missions, and astronauts showed some evidence of a novelty effect in the first few weeks. There was no evidence suggesting a 3rd quarter effect among crewmembers on any of the 21 subscales evaluated. In contrast, there was strong evidence to support the hypothesized displacement of tension and negative emotions from crewmembers to mission control personnel and from mission control personnel to management. There were several significant differences in response between Americans vs. Russians, crewmembers vs. mission control personnel, and subjects in this study vs. people in comparable groups on Earth. Subject responses before, during, and after the missions were similar, and we did not find evidence for asthenia in space. Critical incidents that were reported generally dealt with events on-board the Mir and interpersonal conflicts, although most of the responses were from a relatively small number of subjects. Our findings have implications for future training and lead to a number of countermeasures.

  10. Factores asociados a la experiencia de sufrimiento en pacientes con cáncer avanzado

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    Alicia Krikorian

    2015-08-01

    Full Text Available Objective: To examine the experience of suffering and its relation with physical, psychological, social and spiritual problems in advanced cancer patients. Methods: Ninety-eight patients attending the palliative care unit of an oncologic institution participated in the study. The level of suffering and the intensity and threat perceived from symptoms and a series of physical, psychological, social and spiritual problems were examined, as well as adjustment levels, illness awareness and coping strategies. Descriptive and comparative statistics were obtained. Results: Nearly 50% of participants manifested moderate suffering. The most frequent problems encountered were: general distress, asthenia, emotional distress, loss of autonomy, sadness, concern for the family´s future and suffering. Severe suffering was associated to adjustment problems and use of wishful thinking. Lower levels of suffering were associated with cognitive restructuring and avoidance strategies. Conclusions: Results indicate the importance of focusing on the subjective aspects of the illness experience. Any symptom or problem has the potential to become a source of suffering when perceived as threatening and when the person´s regulatory processes are insufficient for adaptation.

  11. Evaluation of granulocytes reposition and appearance of the adverse effects produced by the stimulating factors of granulocytic colonies.

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    Gracia Solera Camarasa

    2017-08-01

    Full Text Available Objective: To evaluate the most frequent adverse effects produced by colony stimulating factors available at the University Hospital San Juan de Alicante (filgrastim and pegfilgrastim. Materials and methods: Observational, retrospective study, developed at the Pharmaceutical Care Unit for External Patients (UFPE of the Hospital Universitario de San Juan de Alicante, between February 8 and 26, 2016 (inclusive. Variables collected: Sex, age, diagnosis, chemotherapy scheme, start date chemotherapy treatment, stimulating factor and prescribed dose, cycles received, start date treatment with stimulant factor and adverse effects. Results: Of the 15 patients treated with colony stimulating factor only the 13.3% were being treated with lower doses than the ones according to their weight. In 100% the medication was correctly prescribed. The main chemotherapy regimen where primary prophylaxis was used was AC for breast cancer. The main side effects were musculoskeletal pain, asthenia / fatigue, and gastrointestinal disorders such as constipation and diarrhea. Conclusions: Preventive use with granulocytic colony stimulating factor has been shown to reduce the risk and duration of neutropenia. The adverse effects obtained are within the normal range for the use of said medicament.

  12. An overview of the brucellosis epidemic conditions in Iran

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    fallah rostami Fatemeh

    2016-01-01

    Full Text Available Brucellosis is as one of the most important infection common disease between human and cattle, which nowadays considered as one of serious health systems dilemma specifically in developing countries.Among brucellosis different species are the cause of infection, 4 species namely B.melitensis, BSuis, B.abortus , B.canis are the most major cause of disease in human(1.Indeed, in Iran that is considered as an endemic area of hygienic organization, B. melitensis is as the most prevalent cause of infection in human. This bacterium generally will transfer to human from contact with contaminated animals or the consumption of cattle production such as unpasteurized dairy (raw milk, soft cheese, cream or even via breathe can transfer to human. But the transfer of infection from person to person is very infrequent.Of course there is some evidence of transfer in a bone marrow transplanting. The most prevalent clinical symptoms of this disease are fever, night sweat, asthenia and anorexia (2.Naturally this infection involved different systems and organs in human body and the one of most major part of body can be mentioned to nervous system, muscuskeletal and also some organs like joints, heart and liver.Diagnosis of this infection can be made by some various laboratory tests like SAT, 2ME. But some misdiagnosis instances are very common. Thus, World Health Organization (WHO exposed in its report that the number of infected cases are maybe ten folds more than scale which stated by health organizations.

  13. [Quick and early diagnostic outpatient unit: an effective and efficient assistential model. Five years experience].

    Science.gov (United States)

    Capell, Santiago; Comas, Pere; Piella, Teresa; Rigau, Joaquim; Pruna, Xavier; Martínez, Francesc; Montull, Santiago

    2004-09-04

    To analyze the applicability of an out-patient Quick and Early Diagnostic Unit (QEDU) to evaluate patients with a potential life-threatening disorder on an out-patient basis. We analyzed prospectively all patients attended in the unit for five years (1997-2001). We compared patients with lung cancer and colorectal cancer admitted to hospital for conventional study versus patients studied at the unit. We attended 2,748 patients in total Main reasons for consultation were abdominal pain, asthenia-anorexia, neurologic symptoms, anemia and palpable tumors. The most frequent diagnostic category corresponded to gastroenterological diseases and neoplastic diseases. The mean interval (standard error) for the first visit was 4.9 (3.4) days and for diagnosis it was 5.7 (6.5) days. Some 95% patients displayed a high degree of satisfaction by the questionnaire. In patients with cancer of the colon studied at the QEDU, we observed a reduction in the average interval for diagnosis which was highly significant (p = 0.03). The overall costs of final diagnosis were also lower for the QEDU model. The QEDU unit represents an alternative to in hospital admission for diagnostic workouts, which is fully feasible in our setting. It can result in the same efficacy and a higher efficiency than hospital admission.

  14. Differences in acoustic and perceptual parameters of the voice between elderly and young women at habitual and high intensity.

    Science.gov (United States)

    Mazzetto de Menezes, Keyla S; Master, Suely; Guzman, Marco; Bortnem, Cori; Ramos, Luiz Roberto

    2014-01-01

    The present study aimed to compare elderly and young female voices in habitual and high intensity. The effect of increased intensity on the acoustic and perceptual parameters was assessed. Sound pressure level, fundamental frequency, jitter, shimmer, and harmonic to noise ratio were obtained at habitual and high intensity voice in a group of 30 elderly women and 30 young women. Perceptual assessment was also performed. Both groups demonstrated an increase in sound pressure level and fundamental frequency from habitual voice to high intensity voice. No differences were found between groups in any acoustic variables on samples recorded with habitual intensity level. No significant differences between groups were found in habitual intensity level for pitch, hoarseness, roughness, and breathiness. Asthenia and instability obtained significant higher values in elderly than young participants, whereas, the elderly demonstrated lower values for perceived tension and loudness than young subjects. Acoustic and perceptual measures do not demonstrate evident differences between elderly and young speakers in habitual intensity level. The parameters analyzed may lack the sensitivity necessary to detect differences in subjects with normal voices. Phonation with high intensity highlights differences between groups, especially in perceptual parameters. Therefore, high intensity should be included to compare elderly and young voice. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  15. An Unusual Presentation of Plasma Cells – Castleman Disease: A Case Report

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    Mihăilă Mariana

    2016-06-01

    Full Text Available We present the case of a 76 year old female patient admitted in the Department of Cardiology for physical asthenia, profuse sweating and dyspnea with orthopnea for about one month. Clinical and paraclinical assessments performed at admission confirmed the diagnosis of cardiac tamponade. Surgical intervention was performed and 400 mL of clear effusion were drained. Post-operative evolution was marked by recurrence of symptoms, requiring after 3 weeks a new drainage of 600 mL of clear effusion, and biopsy of the pericardium was performed. Pathological exam described serous pericarditis with chronic inflammatory infiltrate, xanthogranulomatous reaction intricated in the pericardium and mesothelial hyperplasia. The patient was subsequently transferred to the Department of Internal Medicine for further investigations. Physical examination showed a patient with altered general status, pallor, vesicular murmur absent in both bases, presenting cutaneous hyperpigmentation at the level of the right hemi-abdomen and hip with posterior extension, and a peripheral indurated erythematous plaque. The patient presented nodular masses of 3 cm in the right latero-cervical and bilateral axillary regions, non-adherent to the superficial structures, as well as adenopathic blocks in both inguinal regions. CT scan of the thorax and abdomen showed moderate bilateral pleuresia, minimal pericardial effusion (15 mm and multiple adenopathies on both sides of the diaphragm. Skin biopsy was performed, as well as bone marrow aspirate and excision of a right axillary lymph node. Pathological exams and immunohistochemistry tests confirmed the diagnosis of Plasma Cells Castleman disease.

  16. Effect of performance time of the high-pitched blowing vocal exercise in the voice of women.

    Science.gov (United States)

    Moreira, Fabíola Santos; Gama, Ana Cristina Côrtes

    2017-02-16

    To analyze the results of the runtimes of one, three, five, and seven minutes of the high-pitched blowing vocal exercise in women without voice complaints and with dysphonia and vocal nodules. This is an experimental study with a consecutive and convenience sample of 60 women divided into two groups: 30 participants with dysphonia caused by vocal fold nodules (study group - SG) and 30 participants without vocal complaints (control group - CG). All participants performed the high-pitched blowing vocal exercise for one, three, five, and seven minutes. Sustained vowels /a/ and counting from one to ten were recorded before and after each exercise runtime. The recordings were randomized and evaluated by comparison task by four speech-language pathologists using the parameters grade of vocal deviation, roughness, breathiness, asthenia, strain and instability (GRBASI). The acoustic parameters analyzed were fundamental frequency, jitter, shimmer, period perturbation quotient, amplitude perturbation quotient, and harmonics-to-noise ratio. After each vocal exercise runtime, the participants responded whether they had felt vocal discomfort using a visual analogue scale. Auditory-perceptual analysis in the SG showed improved overall severity of dysphonia and breathiness after three minutes and worsening of these acoustic parameters after seven minutes of exercise performance. Participants in the SG reported self-perception of vocal discomfort after seven minutes of exercise performance. The ideal prescription time for the high-pitched blowing vocal exercise in dysphonic women is three minutes; worsening of voice quality and perception of vocal discomfort occurs after seven minutes.

  17. [Clinical profiles of patients with uncomplicated Plasmodum falciparum malaria in northwestern Colombia].

    Science.gov (United States)

    Knudson, Angélica; Nicholls, Rubén Santiago; Guerra, Angela Patricia; Sánchez, Ricardo

    2007-12-01

    Few studies describe the clinical presentations of uncomplicated Plasmodium falciparum malaria in the province of Córdoba in an endemic area of northwestern Colombia. Profiles of patients with uncomplicated Plasmodium falciparum malaria were described from two twons of Córdoba, Tierrata and Puerto Libertador, based on clinical, epidemiological and laboratory variables. Patients were examined according to standard WHO/PAHO protocols for assessment of antimalarial drug efficacy. Clinical data and parasitological information was collected as well. A multiple correspondence multivariate analysis was used to compare the profiles of 127 patients with uncomplicated Plasmodium falciparum malaria. Of the 127 patients,105 completed the 14-day follow-up and 7 had adequate clinical response. Between 80% and 98% of patients exhibited at least one of the most frequent symptoms of uncomplicated malaria, and 80.3% had asthenia as the most frequent symptom. The multivariate analysis grouped the variables into five distinguishable clusters of clinical profiles. These groups showed similarities with the classical clinical descriptions of uncomplicated malaria encountered in the literature. The low frequency of patients with adequate clinical response hampered the association analysis. In Córdoba, therapeutic failure to chloroquine treatment is high in treating uncomplicated Plasmodium falciparum malaria. Multivariate analysis summarized variables related to epidemiological and clinical aspects and permitted a more objective approach to the interpretation of the findings.

  18. [Professor Ling Changquan's experience in treating primary liver cancer: an analysis of herbal medication].

    Science.gov (United States)

    Sun, Zhen; Su, Yong-hua; Yue, Xiao-qiang

    2008-12-01

    On the basis of outpatients' medical records concerning primary liver cancer (PLC), data of 552 patients (with 2020 effective prescriptions) from the Outpatient Department of Changhai Hospital treated by Professor Ling Changquan were collected. The nature, flavor and meridian distribution of the herbs used in the prescriptions were summarized by frequency method, and the features of the herbs used according to syndrome differentiation were analyzed by logistic regression. The couple herbs used were analyzed by cluster analysis. All the data were analyzed in combination with the experience of the specialist. It showed that most of the frequently used herbs were herbs for invigorating the spleen to promote appetite, removing toxic materials to inhibit tumor growth, and activating blood circulation to dissipate blood stasis. These herbs are mostly of plain or cool nature, and mainly of sweet, bitter, or acrid taste. It also showed that the most frequently used herbs for qi deficiency were Astragalus membranaceus, Atractylodes macrocephala, and Pseudostellariae; Caulis Spatholobi and Chinese jujube for blood asthenia; Fructus Corni and Ophiopogon japonicus for yin deficiency; Agastache rugosa, Semen Plantaginis and Poria for water-dampness; cape jasmine fruit and baikal skullcap root for heat excess; peach seed and Radix Paeoniae Rubra for blood stasis; Curcuma wenyujin, Akebia trifoliata and Bupleurum chinese for qi stagnation. A total of 19 pairs of couple herbs were summarized by the cluster analysis.

  19. Phase I study of afatinib combined with nintedanib in patients with advanced solid tumours.

    Science.gov (United States)

    Bahleda, Rastislav; Hollebecque, Antoine; Varga, Andrea; Gazzah, Anas; Massard, Christophe; Deutsch, Eric; Amellal, Nadia; Farace, Françoise; Ould-Kaci, Mahmoud; Roux, Flavien; Marzin, Kristell; Soria, Jean-Charles

    2015-11-17

    This Phase I study evaluated continuous- and intermittent-dosing (every other week) of afatinib plus nintedanib in patients with advanced solid tumours. In the dose-escalation phase (n=45), maximum tolerated doses (MTDs) were determined for continuous/intermittent afatinib 10, 20, 30 or 40 mg once daily plus continuous nintedanib 150 or 200 mg twice daily. Secondary objectives included safety and efficacy. Clinical activity of continuous afatinib plus nintedanib at the MTD was further evaluated in an expansion phase (n=25). The most frequent dose-limiting toxicities were diarrhoea (11%) and transaminase elevations (7%). Maximum tolerated doses were afatinib 30 mg continuously plus nintedanib 150 mg, and afatinib 40 mg intermittently plus nintedanib 150 mg. Treatment-related adverse events (mostly Grade⩽3) included diarrhoea (98%), asthenia (64%), nausea (62%) and vomiting (60%). In the dose-escalation phase, two patients had partial responses (PRs) and 27 (60%) had stable disease (SD). In the expansion phase, one complete response and three PRs were observed (all non-small cell lung cancer), with SD in 13 (52%) patients. No pharmacokinetic interactions were observed. MTDs of continuous or intermittent afatinib plus nintedanib demonstrated a manageable safety profile with proactive management of diarrhoea. Antitumour activity was observed in patients with solid tumours.

  20. Tiagabine: efficacy and safety in partial seizures – current status

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    Jürgen Bauer

    2008-09-01

    Full Text Available Jürgen Bauer, Déirdre Cooper-MahkornDepartment of Epileptology, Bonn University Hospital, GermanyAbstract: Tiagabine hydrochloride (TGB is a selective gamma-aminobutyric acid (GABA reuptake inhibitor. TGB is effective as an add-on medication in adults and children 12 years and older in the treatment of partial seizures. Results of nonrandomized add-on trials with TGB show treatment success with seizure reduction of at least 50% in 33% to 46% of patients. In newly diagnosed patients with partial epilepsy, TGB monotherapy was as effective as carbamazepine. Comedication with TGB elevates the risk of nonconvulsive status (7.8% vs 2.7% without TGB. The most common side effects include dizziness/lightheadedness, asthenia/lack of energy and somnolence. TGB has no negative effects on cognition; it does not increase the risk of fractures or rash. TGB may interfere with color perception. TGB presents an intermediate risk for depression in patients with epilepsy (approximately 4%. Regarding the risk of overdose, 96–680 mg TGB (mean 224 mg caused seizures or coma. TGB is an antiepileptic drug exhibiting a specific anticonvulsive mechanism of action, the efficacy of which is relatively low when used in comedication. Critical side effects, such as the induction of nonconvulsive status epilepticus, further limit its use.Keywords: epilepsy, tiagabine, antiepileptic drugs, status epilepticus, pharmacotherapy

  1. Rare case of Cushing's disease due to double ACTH-producing adenomas, one located in the pituitary gland and one into the stalk.

    Science.gov (United States)

    Mendola, Marco; Dolci, Alessia; Piscopello, Lanfranco; Tomei, Giustino; Bauer, Dario; Corbetta, Sabrina; Ambrosi, Bruno

    2014-01-01

    We describe a patient affected by Cushing's disease due to the presence of double pituitary adenomas, one located within the anterior pituitary and the other in the infundibulum associated with a remnant of Rakthe's pouch. Cure was achieved only after the infundibulum lesion was surgically removed. A 38-year-old female presented with unexplained weight gain, hirsutism, amenorrhea, asthenia, recurrent cutaneous micotic infections and alopecia. Hormonal studies indicated Cushing's disease and MRI showed an enlarged pituitary gland with a marked and homogeneous enhancement after injection of gadolinium and an enlarged infundibulum with a maximum diameter of 8 mm. As a venous sampling of the inferior petrosal sinus after 10 μg iv desmopressin stimulation revealed a central to peripheral ACTH ratio consistent with a pituitary ACTH-secreting tumor, transphenoidal explorative surgery was performed and a 4-mm pituitary adenoma immunopositive for ACTH was disclosed and removed. Since postoperative hormonal evaluation showed persistent hypercortisolism, confirmed by dynamic tests, the patient again underwent surgery by transcranial access and the infundibulum mass was removed. Histology and immunochemistry were consistent with an ACTH-secreting adenoma. A few months after the second operation, cushingoid features were significantly reverted and symptoms improved. Although Cushing's patients bearing multiple adenomas have already been documented, the presence of two adenomas both immunohistochemically positive for ACTH is a very rare cause of Cushing's disease and this is the first report of a case of double ACTH-producing adenomas, one located in the pituitary gland and one attached to the stalk.

  2. [The sick building syndrome (SBS)].

    Science.gov (United States)

    Ezratty, Véronique

    2003-10-11

    AN INCREASINGLY COMMON ENVIRONMENTAL HEALTH PROBLEM: Complaints related to indoor environment represent one of the most frequent problems that environmental health practitioners are confronted with. Hence the incidence of the Sick Building Syndrome (SBS) has been increasing since the Seventies. DIFFERING DEFINITIONS AND CLINICAL PRESENTATIONS: The WHO defines SBS as an excess of complaints and symptoms occurring in certain occupants of non-industrial buildings. The syndrome can only be evoked after elimination in the person concerned of a disease related to the building, the aetiological agent of which is identifiable. The symptoms described during SBS (headaches, concentration problems, asthenia, irritation of the skin or nasal mucosa, of the eyes and upper respiratory tract.) are non specific and frequently observed in the general population. AN UNKNOWN CASE, BUT NUMEROUS AETIOLOGICAL FACTORS SUSPECTED: There is no unanimously accepted definition nor physio-pathological theory to explain the occurrence of SBS in a particular building. Many favouring factors, including the type and rate of ventilation, volatile organic compounds, particles and humidity have been suspected. TECHNICAL, SOCIAL, AND MEDICAL MANAGEMENT IS REQUIRED: Although the symptoms are benign, they can be uncomfortable or even handicapping and prevent the functioning of workplaces. The SBS, the social and economical costs of which are high, requires multidisciplinary management.

  3. [Ulcerative colitis initial presentation with multiple extra-intestinal manifestations].

    Science.gov (United States)

    Marques, M Raquel; Oliveira, Susana; Gorjão Clara, J P

    2010-01-01

    Multiple extraintestinal diseases are present in 0.3- 4.5 % of inflammatory bowel disease patients. A 39-year-old woman was admitted with a 3 months history of cervicalgia with functional incapacity, asthenia, tibio-tarsal bilateral arthritis and bloody diarrhoea. She had ferropenic anemia, SR-120 mm, creatinine clearance-42 mL/min, proteinuria-1.2 g/24h. Colonoscopy with biopsy showed active ulcerative rectossigmoiditis. She had bilateral sacroileitis more pronounced at the right side which was suggestive of ankylosing spondylitis. HLA B27 was positive. Because of colestasis, colangio-MRI and CPRE were done and were suggestive of primary sclerosing colangitis. Renal disease was interpreted as an analgesic nephropathy versus glomerulonephritis associated with ulcerative colitis. Cardiac ecodoppler showed pericardial thickening with a thin pericardial effusion. Full improvement of gastrointestinal complaints was observed with 5-ASA topic enemas, sulfassalazine, corticosteroids and azathioprine and full remission of ankylosing spondylitis with adalimumab. This case illustrates extraintestinal wide involvement as the initial presentation of ulcerative colitis, remarking its systemic nature.

  4. Effect of Sipjeondaebo-Tang on Cancer-Induced Anorexia and Cachexia in CT-26 Tumor-Bearing Mice

    Science.gov (United States)

    Jung, Ki Yong; Woo, Sang-Mi; Jun, Chan-Yong; Park, Jong Hyeong; Shin, Yong Cheol; Ko, Seong-Gyu

    2014-01-01

    Cancer-associated anorexia and cachexia are a multifactorial condition described by a loss of body weight and muscle with anorexia, asthenia, and anemia. Moreover, they correlate with a high mortality rate, poor response to chemotherapy, poor performance status, and poor quality of life. Cancer cachexia is regulated by proinflammatory cytokines such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-α (TNF-α). In addition, glucagon like peptide-1 (GIP-1), peptide YY (PYY), ghrelin, and leptin plays a crucial role in food intake. In this study, we investigated the therapeutic effects of one of the traditional herbal medicines, Sipjeondaebo-tang (Juzen-taiho-to in Japanese; SJDBT), on cancer anorexia and cachexia in a fundamental mouse cancer anorexia/cachexia model, CT-26 tumor-bearing mice. SJDBT was more significantly effective in a treatment model where it was treated after anorexia and cachexia than in a prevention model where it was treated before anorexia and cachexia on the basis of parameters such as weights of muscles and whole body and food intakes. Moreover, SJDBT inhibited a production of IL-6, MCP-1, PYY, and GLP-1 and ameliorated cancer-induced anemia. Therefore, our in vivo studies provide evidence on the role of SJDBT in cancer-associated anorexia and cachexia, thereby suggesting that SJDBT may be useful for treating cancer-associated anorexia and cachexia. PMID:24963216

  5. Cardiovascular system indexes and heart rate in Magadan young male residents with different body constitution types

    Directory of Open Access Journals (Sweden)

    Inessa V. Averyanova

    2017-09-01

    Full Text Available Introduction: The aim of the study is to explore interrelation and contingency between somatometric characteristics and heart rate variability in male students having resided in Magadan region area. Materials and Methods: Pursuing from the study aim we examined basic somatometric, cardiovascular and heart rate variability parameters in 558 young males of different somatotypes: asthenia, normosthenia and hypersthenia. Results: Main results testify that the values of the heart rate were within the range of normotonia through the three examined groups (with small prevailing of parasympathetic link in the heart rate regulation. The hypersthenic subjects demonstrated a sounder parasympathetic link in their heart rate regulation, while asthenic subjects – sympathetic one. The asthenic subjects demonstrated reliably higher heart beats values being thus considered as having less efficient cardiovascular system functioning. The analysis of the percent ratio of the examined subjects accounting for initial autonomic tone in each body constitution group has shown that no difference had been found between the percentage in each somatotype group and the percentage in the whole sample. Discussion and Conclusions: The autonomic regulation types do not directly depend on somatometric characteristics and, particularly, on any type of the body constitution.

  6. Doctor, my son is so tired... about a case of hereditary fructose intolerance.

    Science.gov (United States)

    Guery, M J; Douillard, C; Marcelli-Tourvieille, S; Dobbelaere, D; Wemeau, J L; Vantyghem, M C

    2007-12-01

    We present the case of a 17-year-old male who was diagnosed at birth with hereditary fructose intolerance (HFI). The patient complained of morning-time asthenia and post-prandial drowsiness despite a correct sleep pattern. The physical examination and biological check-up only showed severe vitamin C deficiency (supplementation in vitamin C was advised, with an increase in vegetable intake, principally avoiding carrots, onions, leaks and tinned sweet-corn. This case offers the opportunity for a review of this rare disease. Two kinds of fructose metabolism disorders (both autosomal recessive) are recognized: 1) essential fructosuria caused by a deficiency of fructokinase, which has no clinical consequence and requires no dietary treatment; 2) HFI, linked to three main mutations identified in aldolase B gene that may be confirmed by fructose breath test, intravenous fructose tolerance test, and genetic testing. In HFI, fructose ingestion generally induces gastro-intestinal (nausea and vomiting, abdominal pain, meteorism) and hypoglycemic symptoms. Fasting is well tolerated. If the condition remains undiagnosed, it leads to liver disease with hepatomegaly, proximal tubular dysfunction, and slow growth and weight gain. In conclusion, endocrinologists should be aware of this rare metabolic disease in order to provide careful follow-up, particularly important when the patient reaches adulthood. Moreover, hypoglycemia induced by fructose absorption, unexplained liver disease, irritable bowel syndrome or familial gout in an adult is suggestive of the diagnosis.

  7. Mood Disorders in Uncontrolled Hypertension Despite Multiple Anti-Hypertensive Medications: Searching for a Link.

    Science.gov (United States)

    Mazza, Alberto; Ravenni, Roberta; Armigliato, Michela; Rossetti, Ciro; Schiavon, Laura; Fiorini, Fulvio; Rigatelli, Gianluca; Ramazzina, Emilio; Casiglia, Edoardo

    2016-03-01

    Resistant hypertension is a clinical condition in which blood pressure (BP) control is not achieved under a pharmacological therapy including a diuretic and at least two additional antihypertensive drug classes. To discuss an unusual presentation of uncontrolled hypertension despite multiple anti-hypertensive medications. A 46-year-old woman presented with resistant hypertension (HT) and with a long history of polydipsia, polyuria, weight loss and psychiatric symptoms (sudden onset of personality disorder with free anxiety, negativism and asthenia) unsuccessfully treated with antidepressant drugs. Tests for secondary HT showed a marked increase of serum renin and aldosterone both in clinostatic (342 pg/ml and 907 pmol/l, respectively) and orthostatic posture (351 pg/ml and 2845 pmol/l, respectively), hypokalemia (2.9 mmol/l) and macroalbuminuria (431 mg/day). Diagnostic examinations also revealed a focal stenosis of approximately 70 % of the proximal right renal artery with post-stenotic dilation. After percutaneous balloon angioplasty and stent implantation, BP was normalized with 5 mg/day amlodipine and psychiatric symptoms suddenly disappeared. Psychopathological symptoms are rare at the onset of hyperaldosteronism, and their aetiology is not well defined. A proper diagnostic and therapeutic process is mandatory in order to get the recommended therapeutic targets in short-midterm improving long-term prognosis. We also suggest not considering depressed or treat with antidepressant agents a young hypertensive subject with uncontrolled hypertension despite multiple anti-hypertensive medications without having ruled out a secondary form of hypertension.

  8. Subcutaneous Administration of Bortezomib in Combination with Thalidomide and Dexamethasone for Treatment of Newly Diagnosed Multiple Myeloma Patients

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    Shenghao Wu

    2015-01-01

    Full Text Available Objective. To investigate the efficacy and safety of the treatment of the newly diagnosed multiple myeloma (MM patients with the therapy of subcutaneous (subQ administration of bortezomib and dexamethasone plus thalidomide (VTD regimen. Methods. A total of 60 newly diagnosed MM patients were analyzed. 30 patients received improved VTD regimen (improved VTD group with the subQ injection of bortezomib and the other 30 patients received conventional VTD regimen (VTD group.The efficacy and safety of two groups were analyzed retrospectively. Results. The overall remission (OR after eight cycles of treatment was 73.3% in the VTD group and 76.7% in the improved VTD group (P>0.05. No significant differences in time to 1-year estimate of overall survival (72% versus 75%, P=0.848 and progression-free survival (median 22 months versus 25 months; P=0.725 between two groups. The main toxicities related to therapy were leukopenia, neutropenia, thrombocytopenia, asthenia, fatigue, and renal and urinary disorders. Grade 3 and higher adverse events were significantly less common in the improved VTD group (50% than VTD group (80%, P=0.015. Conclusions. The improved VTD regimen by changing bortezomib from intravenous administration to subcutaneous injection has noninferior efficacy to standard VTD regimen, with an improved safety profile and reduced adverse events.

  9. Management of specific symptom complexes in patients receiving palliative care

    Science.gov (United States)

    Bruera, E; Neumann, C M

    1998-01-01

    During the past 10 years there have been major changes in the management of the most common symptoms of terminal cancer. Opioid agonists remain the mainstay in the management of cancer pain. Slow-release preparations are currently available for several of these agents. The increased use of opioids has led to the recognition of opioid-induced neurotoxic effects and to the development of effective adjuvant drugs and other strategies to counteract these side effects. A number of drugs are available for the management of symptoms of cachexia, including corticosteroids and progestational drugs. Prokinetic drugs, either alone or in combination with other agents such as corticosteroids, are highly effective in the treatment of chronic nausea. For patients with asthenia, it should first be determined whether there are any reversible causes; if not, corticosteroids and psychostimulants may diminish the symptoms. Haloperidol, other neuroleptics and benzodiazepines may be required to manage hyperactive delirium. Oxygen and opioids are effective in treating dyspnea, whereas there is limited evidence that benzodiazepines provide any relief of this symptom. More research on the assessment and management of these devastating clinical symptoms of cancer is badly needed. PMID:9676549

  10. COMPARATIVE STUDY OF EMOTIONAL DISORDERS STRUCTURE IN PATIENTS BEFORE AND AFTER ORTHOTOPIC LIVER TRANSPLANTATION

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    T. G. Mikhaylichenko

    2011-01-01

    Full Text Available Being based on a private experience, authors considered necessary to study features of emotional disorders that will allow understanding the mechanism of mental adaptation to disease at patients before and after OLT. In comparative research of structure of emotional frustration at the patients making the most numerous groups of patients before transplantation of a liver (viral hepatitis and autoimmune liver diseases, 129 persons, from them 75 before OLT are included at entering into a waiting list and 54 to through 22 ± 9 days after OLT. Distinctions in structure of emotional frustration are revealed: at patients with autoimmune liver diseases be- fore OLT and viral hepatitis after OLT the semiology combined with disturbing-depressive experiences and hypochondriac fixings is brightly expressed neurotic, them distinguishes high level of personal uneasiness. For patients with autoimmune liver diseases after OLT and viral hepatitis before OLT are characteristic moderately expressed neurotic frustration of an asthenia circle and low level of personal and situational anxiety. 

  11. Resolution of statin-induced myalgia by correcting vitamin D deficiency: a case report

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    Luca Gallelli

    2015-03-01

    Full Text Available The onset of myalgia is a well-known side effect of cholesterol-lowering statins. Recent studiesa dvanced the hypothesis that reduced vitamin D levels may play a role in the onset of myalgia in statin users and potentially a vitamin D supplementation may be useful in these cases, as suggested by the present case report.A 52-year-old man with a history of smoke and successfully controlled hypertension presented with chest pain and asthenia. He was diagnosed with stable angina pectoris and discharged on atorvastatin. Due to the onset of myalgia, the dosage of atorvastatin was reduced (from 40 mg daily to 20 mg daily and then atorvastatin was switched to rosuvastatin without symptoms improvement. Switching from rosuvastatin to ezetimibe resulted in pain improvement, but also in plasma lipids increase beyond the normal range. Ezetimibe was switched to rosuvastatin+ analgesic; in the meanwhile a high-performance liquid chromatography (HPLC analysis showed low levels of 25-hydroxy-vitamin D and 1-25-dihydroxy-vitamin D. Therefore, vitamin D3 was added to rosuvastatin, resulting in pain improvement, decrease of plasma lipids and progressive discontinuation of analgesics. During the follow-up, rosuvastatin was switched to atorvastatin + vitamin D3, with a good control of plasma lipid levels and without the onset of myalgia.http://dx.doi.org/10.7175/cmi.v9i1.978

  12. Voice Improvement in Patients with Functional Dysphonia Treated with the Proprioceptive-Elastic (PROEL) Method.

    Science.gov (United States)

    Lucchini, E; Ricci Maccarini, A; Bissoni, E; Borragan, M; Agudo, M; González, M J; Romizi, V; Schindler, A; Behlau, M; Murry, T; Borragan, A

    2017-07-18

    The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  13. [Prevalence of pica in iron deficiency anemia in Marrakech (Morocco)].

    Science.gov (United States)

    Nafil, H; Tazi, I; Mahmal, L

    2015-01-01

    Pica is an eating disorder, defined by long-term ingestion of non-nutritive substances. To determine the frequency of pica in patients with iron deficiency anemia and to describe the population with both iron deficiency anemia and pica. This retrospective study examined records from the department of hematology at the Mohammed VI University Hospital Center in Marrakech of all adult patients seen from January 1, 2005, through December 31, 2010 who met both criteria. Results: During the 6-year study period, 320 patients with iron deficiency anemia were seen: 256 women and 64 men (sex-ratio F/M: 4). The prevalence of pica among the patients with iron deficiency anemia was 17.5% (56/320). All the patients with pica were women, for a prevalence of 21.8% (56/256); their average age was 23 years; 40 were white (71.4%) and 16 black (28.6%). The clinical signs were primarily pallor (100%) and asthenia (100%). The mean level of hemoglobin was 7.6 g/dL and of ferritin, 6.4 mg/L. Geophagia was the most common form of pica (75%). Iron supplementation induced regression of pica in 64.3% of patients. Our study shows a high prevalence of pica in patients with iron deficiency anemia.

  14. A Phase-1b study of tivantinib (ARQ 197) in adult patients with hepatocellular carcinoma and cirrhosis.

    Science.gov (United States)

    Santoro, A; Simonelli, M; Rodriguez-Lope, C; Zucali, P; Camacho, L H; Granito, A; Senzer, N; Rimassa, L; Abbadessa, G; Schwartz, B; Lamar, M; Savage, R E; Bruix, J

    2013-01-15

    The mesenchymal-epithelial transition factor (MET) receptor is dysregulated in hepatocellular carcinoma (HCC), and tivantinib (ARQ 197) is an oral, selective, MET inhibitor. This Phase-1b study assessed tivantinib safety as primary objective in patients with previously treated HCC and Child-Pugh A or B liver cirrhosis. Patients received oral tivantinib 360 mg twice daily until disease progression or unacceptable toxicity. Among 21 HCC patients, common drug-related adverse events (AEs) were neutropaenia, anaemia, asthenia, leucopaenia, anorexia, diarrhoea, and fatigue. No drug-related worsening of liver function or performance status occurred, but one Child-Pugh B patient experienced drug-related bilirubin increase. Four patients had drug-related serious AEs, including one neutropaenia-related death. Haematologic toxicities were more frequent than in previous tivantinib studies but were manageable with prompt therapy. Best response was stable disease (median, 5.3 months) in 9 of 16 evaluable patients (56%). Median time to progression was 3.3 months. Tivantinib demonstrated a manageable safety profile and preliminary antitumour activity in patients with HCC and Child-Pugh A or B cirrhosis.

  15. ACCENTUATION OF PERSONALITY TRAITS IN THE PATIENTS WITH GRANULOMATOUS LESIONS OF RESPIRATORY ORGANS IN CASE OF SARCOIDOSIS AND TUBERCULOSIS

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    A. Yu. Chernikov

    2017-01-01

    Full Text Available 404 sarcoidosis and 404 tuberculosis patients were examined in order to detect correlations between clinical manifestations, psychological adaptation and accentuation of personality traits and granulomatous lesions of respiratory organs in case of sarcoidosis and tuberculosis. All patients had subjective and objective examinations and answered the following questionnaires: Schmieschek questionnaire to identify accentuation of personality traits, clinical questionnaire to detect and evaluate neurotic disorders, Taylor Manifest Anxiety Scale to detect the level of anxiety. It has been found out that sarcoidosis patients are characterized both by asymptomatic course of the disease as well as diverse clinical manifestations: pain syndrome, nodal fever, intoxication with expressed general fatigue, respiratory insufficiency. It is combined with stuck, pedant, cycloid, exalted, emotive accentuations of personality traits, with psychological maladaptation as per the scores of autonomic imbalance, neurotic depression, asthenia, with average high level of anxiety. The following is typical of tuberculosis patients: syndrome of bronchial tree lesions and respiratory insufficiency; distymny, demonstrative, excitable, exalted, anxiety-hypochondriac accentuations of personality traits, with psychological maladaptation as per the scores of autonomic imbalance, obsessive-phobic disorders and hysteria; average high level of anxiety. The strong correlation has been found between the degree of symptoms expression, level of anxiety and psychological maladaptation and the type of patient's accentuation of personality traits.

  16. Multiple-System Atrophy with Cerebellar Predominance Presenting as Respiratory Insufficiency and Vocal Cords Paralysis

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    Ramon Andrade Bezerra de Mello

    2010-01-01

    Full Text Available Background. MSA (Multiple System Atrophy may be associated either with Parkinsonism or with cerebellar ataxia (MSA-c subtype. It is considered a rare disease, but many patients are misdiagnosed as suffering from idiopathic Parkinson's disease. In this paper, we report a case of a patient admitted with respiratory failure and vocal cords paralysis due to MSA-c. Case Report. A 79-year-old Caucasian woman was admitted in March 2010 with dyspnea, asthenia, stridor, and respiratory failure needing noninvasive ventilation. She had orthostatic blood pressure decline, constipation, insomnia, daytime sleepiness, and snoring. The neurologic examination revealed cerebellar ataxia. A laryngoscopy revealed vocal cord paralysis in midline position and tracheostomy was performed. The Brain Magnetic Resonance Imaging revealed atrophy of middle cerebellar peduncles and pons with the “hot cross bun sign.” Conclusion. Although Multiple-system atrophy is a rare disease, unexplained respiratory failure, bilateral vocal cord paralysis, or stridor should lead to consider MSA as diagnosis.

  17. Idiopathic Parkinson's disease: vocal and quality of life analysis

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    Luiza Furtado e Silva

    2012-09-01

    Full Text Available OBJECTIVE: To compare voice and life quality of male patients with idiopathic Parkinson's disease, with individuals without disease (Control Group. METHODS: A cross-sectional study that evaluated the voice of individuals with Parkinson's disease, the group was composed of 27 subjects, aged from 39 to 79 years-old (average 59.96. The Control Group was matched on sex and age. Participants underwent voice recording. Perceptual evaluation was made using GRBASI scale, which considers G as the overall degree of dysphonia, R as roughness, B as breathiness, A as asthenia, S as strain and I as instability. The acoustic parameters analyzed were: fundamental frequency, jitter, shimmer, and harmonic to noise ratio (NHR. For vocal self-perception analysis, we used the Voice Related Quality of Life protocol. RESULTS: Fundamental frequency and jitter presented higher values in the Parkinson's group. NHR values were higher in the Control Group. Perceptual analysis showed a deviation ranging. The vocal disorder self-perception demonstrated a worse impact on quality of life. CONCLUSIONS: Individuals with Parkinson's disease have an altered voice quality and a negative impact on quality of life.

  18. [Cutaneous filariasis Loa Loa: 26 moroccan cases of importation].

    Science.gov (United States)

    El Haouri, M; Erragragui, Y; Sbai, M; Alioua, Z; Louzi; El Mellouki, W; Sedrati, O

    2001-09-01

    Loa Loa filariasis or loiasis is a subcutaneous and bloody vectorial parasitosis. It is endemic in forest and swamp areas of west and central Africa. We reviewed 26 moroccan cases of importation. All patients had visited Equatorial Guinea. Transient and migratory edema with pruritus were described in all cases and seen in 5 cases. A history of eyeworm was reported in 13 patients and subcutaneous migration of adult Loa Loa in 19 patients. Other features including fever and asthenia were reported in 11 patients. Microfilaremia was positive in 8 patients and eosinophilia was present in 22 patients. Fifteen patients were treated with diethylcarbamazine alone and 9 patients with ivermectin and diethylcarbamazine. Two patients were treated with ivermectin alone. Relapses were noted in 8 cases. No visceral complications were noted excepting one case of terminal hematury. Loiasis is a filarial infection of man that occurs exclusively in central and West Africa. The most common symptoms being pruritus with temporary, localised edema, subcutaneous and subconjonctival eye passage of the adult worm, fever and fatigue. The biologic diagnosis of loaisis is made on peripheral microfilariae, filarial serology and eosinophil count. Travel and visits endemic areas were at the origin of the emergence of this pathology in Morocco. Filarial Loa Loa infection should be treated with diethylcarbamazine and/or ivermectin.

  19. PATIENTS’ PSYCHOSOMATIC STATUS BEFORE AND AFTER ORTHOPEDIC CORRECTION OF MAXILLOFACIAL DEFECTS

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    A. A. Kulakov

    2012-01-01

    Full Text Available A medicopsychological study of the time course of psychic changes was conducted in 88 cancer patients with defects of facial soft tissues (n = 38 and maxilla (n = 50. Since the patients’ visit to an oncologist, the diagnostic-stage depth of mental disorders was rather various: from mild asthenia to depression. Thus, 88 (100 % patients were found to have an anxious feeling, 16 (18.2 % had affective-shock reactions; 7 (7.9 % had reactive depression. In the postoperative period, anxiety-depressive syndrome gave way to astheno-depressive one. After hospital discharge, the reactive state became less tense during psychosocial readaptation, the characteriological personality changes were increasingly more pronounced in the forefront in the patients. They became anxious, suspicious, unconfident about themselves, sensitive, tried to avoid difficult situations in life. The circle of interests was limited to thoughts on their own health. Combination therapy with psychotropic drugs was used to correct the mental status of patients with acquired maxillary defects in the study group. The dosage of the drugs was individually adjusted according to the degree of psychopathological manifestations. 

  20. [Therapeutic effect of 138 imported falciparum malaria patients].

    Science.gov (United States)

    Yu, Zhen-Hua; Wang, Fu-Yong; Wei, Dong-Dong; Yin, Bin; Wei, Yan-Bin; Zhao, Gui-Hua; Zhang, Ben-Gang; Wang, Yong-Bin

    2014-12-01

    To summarize the clinical characteristics of imported falciparum malaria patients and the treatment, so as to provide the evidences for improving the diagnosis and treatment of the disease. A total of 138 imported falciparum malaria patients who received the treatment in Shandong Institute of Parasitic Diseases from January 2007 to February 2013 were adopted as the observation subjects, and their clinical data were collected and analyzed. All the 138 patients were back from African countries. The main manifestations were fever, headache, asthenia, and hepatosplenomegaly, and most of them were with decreased RBC, PLT levels and increased LDH levels, and 36.96% of them were misdiagnosed as respiratory diseases, nephritis, hepatitis and so on. Through antimalarial treatment of artemether or artesunate or dihydroartemisinin and primaquine, or dihydroartemisinin and piperaquine, and symptomatic treatment, the short-term and long-term cure rates were 98.55% and 94.93% respectively, with 1 case unrecovered and 1 died. Artemisinins are still the most effective antimalarial drugs for falciparum malaria. However, some patients recrudesce as the Plasmodium in their body is resistant or insensitive to these drugs. We should pay more attention to the antimalarial and symptomatic treatments in the early stage of severe malaria so as to improve the cure rate.

  1. Development of countermeasures for medical problems encountered in space flight

    Science.gov (United States)

    Nicogossian, Arnauld E.; Rummel, John D.; Leveton, Lauren; Teeter, Ron

    1992-08-01

    By the turn of this century, long-duration space missions, either in low Earth orbit or for got early planetary missions, will become commonplace. From the physiological standpoint, exposure to the weightless environment results in changes in body function, some of which are adaptive in nature and some of which can be life threatening. Important issues such as environmental health, radiation protection, physical deconditioning, and bone and muscle loss are of concern to life scientists and mission designers. Physical conditioning techniques such as exercise are not sufficient to protect future space travellers. A review of past experience with piloted missions has shown that gradual breakdown in bone and muscle tissue, together with fluid losses, despite a vigorous exercise regimen can ultimately lead to increased evidence of renal stones, musculoskeletal injuries, and bone fractures. Biological effects of radiation can, over long periods of time increase the risk of cancer development. Today, a vigorous program of study on the means to provide a complex exercise regimen to the antigravity muscles and skeleton is under study. Additional evaluation of artificial gravity as a mechanism to counteract bone and muscle deconditioning and cardiovascular asthenia is under study. New radiation methods are being developed. This paper will deal with the results of these studies.

  2. Analysis of Temporal Change in Voice Quality After Thyroidectomy: Single-institution Prospective Study.

    Science.gov (United States)

    Lee, Doh Young; Lee, Ki Jeong; Hwang, Soo Min; Oh, Kyoung Ho; Cho, Jae-Gu; Baek, Seung-Kuk; Kwon, Soon-Young; Woo, Jeong-Soo; Jung, Kwang-Yoon

    2017-03-01

    This study analyzed the temporal changes of voice quality after thyroidectomy and assessed the predictive perioperative parameters of postthyroidectomy voice disorder (PTVD). This is a prospective cohort study. From March 2011 to July 2014, 559 patients who underwent thyroidectomy with or without central neck dissection were prospectively enrolled. All patients underwent prospective voice evaluation using the subjective and objective comprehensive battery of assessments, preoperatively and postoperatively at 1 week, 1 month, 3 months, 6 months, and 12 months. Fundamental frequency (F0) was not significantly decreased during the postoperative follow-up. Maximal vocal pitch (MVP) and maximal intensity were not recovered, even at 1 year postoperatively, whereas the Grade, Roughness, Breathiness, Asthenia, Strain scale reached preoperative value at postoperative 3-6 months and voice handicap index at 1 year. Postoperative 1-month MVP was the best predictor for PTVD, and the cut-off value was 80% of preoperative value. Wide surgical extent and high preoperative F0 were the parameters that significantly correlated with PTVD (P = 0.021 and P voice parameters should be considered in preoperative counseling. Intensive voice therapy may be needed for patients with the ability to produce higher pitch than normal preoperatively and wide surgical extent. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  3. Unresponsiveness of Experimental Canine Leishmaniosis to a New Amphotericin B Formulation

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    Leticia Hernández

    2015-01-01

    Full Text Available This study was designed to evaluate the efficacy and safety of a novel free polyaggregated amphotericin B (FPA formulation used to treat experimental canine leishmaniosis (CanL caused by Leishmania infantum. Eight healthy beagles were intravenously challenged with 5×107 promastigotes per mL of L. infantum. One year after infection, they received an intravenous dose of FPA (5 mg/kg every 2 weeks three times. Dogs were assessed monthly for clinical signs, serology, and parasite detection during a follow-up period of 6 months. Transient adverse effects (i.e., hypotension, diarrhea, bodyweight loss, fever, and asthenia were observed within 24–48 hours after treatment in 4 animals. In three dogs mean clinical signs scores were reduced. Antibody titers measured by immunofluorescence antibody test (IFAT had significantly diminished at the end of the study, although according to bone marrow smears and cultures a high percentage of dogs tested positive for the parasite at 6 months posttreatment (PT6. Real-time quantitative PCR (rtQ-PCR on blood, bone marrow, and urine samples revealed the presence of parasitic DNA in all animals at PT6, although blood loads of the parasite were reduced. These findings indicate that FPA at the dosing regimen used did not achieve clinical or parasitological cure in dogs experimentally infected with L. infantum.

  4. Acute localized exanthem due to Coxsackievirus A4.

    Science.gov (United States)

    Drago, Francesco; Ciccarese, Giulia; Gariazzo, Lodovica; Cioni, Margherita; Parodi, Aurora

    2017-09-01

    Enteroviruses are the leading cause of exanthems in children, especially during summer and autumn. Enterovirus infections may occur in epidemics or small outbreaks. A 30-year-old woman presented with a three-day history of an erythematous maculopapular skin rash with petechiae localized exclusively under the nipple of the right breast. The skin eruption was associated with an erythematous-petechial enanthem. The patient complained of low-grade fever, headache, asthenia, sore throat and arthromyalgias. IgM (1:128) and IgG (1:640) antibodies against Coxsackievirus A4 were detected by the virus neutralization test. Reverse transcriptase real time polymerase chain reaction (PCR) assay detected enterovirus RNA in the patient's plasma and faeces. Diagnosis of an acute localized exanthem due to Coxsachievirus A4 was performed. Skin lesions improved in seven days and completely cleared in two weeks without any systemic or topical treatment. Physicians should be aware of the possibility that enteroviruses may determine localized skin eruptions in addition to hand-foot-mouth disease and atypical exanthems. Viral infections should be considered in the differential diagnosis of localized dermatitis especially when the skin eruption is associated with enanthems and with systemic symptoms.

  5. Prevention of cisplatin-based chemotherapy-induced delayed nausea and vomiting using triple antiemetic regimens: a mixed treatment comparison.

    Science.gov (United States)

    Shi, Qi; Li, Wen; Li, Hongjia; Le, Qiqi; Liu, Shanshan; Zong, Shaoqi; Zheng, Leizhen; Hou, Fenggang

    2016-04-26

    A variety of triple antiemetic regimens are being used to prevent cisplatin-based chemotherapy induced delayed emesis and nausea in cancer patients. We performed a network meta-analysis to compare the efficacies of the different regimens. Electronic searches of the PubMed, Cochrane Library and MEDLINE databases were performed to identify randomized controlled trials, and data were analyzed using JAGS, Stata 14.0 and R project. The primary outcome was a complete response (CR). The secondary outcomes were no vomiting (NV) and no nausea (NN). Among the 398 studies identified, 10 were eligible and included, providing data on nine regimens. In the CR analysis, the absolute rank of netupitant + palonosetron + dexamethasone (NEPA) was 0.8579. In the NV and NN analyses, NEPA's absolute ranks were 0.8631 and 0.7902, respectively. The compliance of patients treated with rolapitant + granisetron + dexamethasone (RGD) was the best due to a low incidence of adverse events, and good compliance was also observed with NEPA. It was difficult to achieve good compliance with aprepitant + granisetron + dexamethasone (AGD). Overall, NEPA was the best regimen, and aprepitant + ondansetron + dexamethasone (AOD) is also worthy of recommendation because of its low cost and good effect. For patients with severe constipation, hiccups, asthenia and/or delayed nausea, RGD is worthy of consideration.

  6. Effect of Sipjeondaebo-tang on cancer-induced anorexia and cachexia in CT-26 tumor-bearing mice.

    Science.gov (United States)

    Choi, Youn Kyung; Jung, Ki Yong; Woo, Sang-Mi; Yun, Yee Jin; Jun, Chan-Yong; Park, Jong Hyeong; Shin, Yong Cheol; Cho, Sung-Gook; Ko, Seong-Gyu

    2014-01-01

    Cancer-associated anorexia and cachexia are a multifactorial condition described by a loss of body weight and muscle with anorexia, asthenia, and anemia. Moreover, they correlate with a high mortality rate, poor response to chemotherapy, poor performance status, and poor quality of life. Cancer cachexia is regulated by proinflammatory cytokines such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor- α (TNF- α). In addition, glucagon like peptide-1 (GIP-1), peptide YY (PYY), ghrelin, and leptin plays a crucial role in food intake. In this study, we investigated the therapeutic effects of one of the traditional herbal medicines, Sipjeondaebo-tang (Juzen-taiho-to in Japanese; SJDBT), on cancer anorexia and cachexia in a fundamental mouse cancer anorexia/cachexia model, CT-26 tumor-bearing mice. SJDBT was more significantly effective in a treatment model where it was treated after anorexia and cachexia than in a prevention model where it was treated before anorexia and cachexia on the basis of parameters such as weights of muscles and whole body and food intakes. Moreover, SJDBT inhibited a production of IL-6, MCP-1, PYY, and GLP-1 and ameliorated cancer-induced anemia. Therefore, our in vivo studies provide evidence on the role of SJDBT in cancer-associated anorexia and cachexia, thereby suggesting that SJDBT may be useful for treating cancer-associated anorexia and cachexia.

  7. Necrotizing fasciitis with group A Streptococci and Eggerthella lenta as a complication of Varicella in a child – case presentation –

    Directory of Open Access Journals (Sweden)

    Claudia Cambrea Simona

    2014-02-01

    Full Text Available Necrotizing fasciitis is a life threatening condition that can be quickly spread through the flesh surrounding the muscle. The disease can be polymicrobial, or caused by group A beta hemolytic Streptococci, or by Clostridium spp. We present a case of a 7 years old girl, which was hospitalized in Children Infectious Diseases Department in a 7th day of chickenpox (hematic crusts all over the body, high fever, asthenia, vomiting, oligoanuria, and tumefaction, pain and functio lessa in the right thigh. In a very short time in the right thigh swelling, edema and congestion have increased gradually, and in the third highest middle thigh the ecchymotic areas appeared evolving towards bubbles and blisters which included the right thigh and calf. After excluding the diagnosis of thrombophlebitis was raised suspicion of necrotizing fasciitis. CT pelvic scan evidenced pelvic asymmetry by maximus and medium right gluteal muscles swelling with important inflammatory infiltrate extended laterally in the subcutaneous adipose tissue. In blood culture was isolated Eggerthella lenta, and from throat swab was isolated group A Streptococci. Treatment consists of a combination of antibiotics associated with intravenous immunoglobulin administration. Despite medical treatment evolution worsened and required transfer in a pediatric surgery department where emergent surgical debridement associated with intensive antibiotic therapy was done. After this intervention evolution was slowly favorable without major limb dysfunction. Polymicrobial necrotizing fasciitis is a severe disease, which if recognized early can have a

  8. [Clinical and electroencephalographic characteristics of specific language impairment in children and an evaluation of the efficacy of cerebrolysin].

    Science.gov (United States)

    Chutko, L S; Surushkina, S Yu; Yakovenko, E A; Sergeev, A V; Rozhkova, A V; Anosova, L V; Chistyakova, N P

    2015-01-01

    To study different forms of specific language impairment in children and to evaluate the efficacy of cerebrolysin in clinical and electroencephalographic aspects. Authors examined 60 children, aged 5-7 years, with a specific language impairment (SLI). The study showed the significantly higher severity of speech disorders, a higher degree of asthenia and dyspraxia/dysgnosia in a group of children with a disorder of receptive language (SLI-R) compared to children with a disorder of expressive speech (SLI-E). A comparative analysis of the EEG power spectra showed large values of slow theta-band EEG in children with SLI compared with healthy children. Children with SLI-R were characterized by the increase in theta rhythm power in the occipital region compared with children with SLI-E. The high efficacy of cerebrolysin in the treatment of this disease (an improvement was obtained in 73.3% of cases) was demonstrated, with the best effect in children with SLI-E (80.0% of cases).

  9. Hyperthyroidism caused by acquired immune deficiency syndrome.

    Science.gov (United States)

    Wang, J-J; Zhou, J-J; Yuan, X-L; Li, C-Y; Sheng, H; Su, B; Sheng, C-J; Qu, S; Li, H

    2014-01-01

    Acquired immune deficiency syndrome (AIDS) is an immune deficiency disease. The etiology of hyperthyroidism, which can also be immune-related, is usually divided into six classical categories, including hypophyseal, hypothalamic, thyroid, neoplastic, autoimmune and inflammatory hyperthyroidism. Hyperthyroidism is a rare complication of highly active antimicrobial therapy (HAART) for human immunodeficiency virus (HIV). Hyperthyroidism caused directly by AIDS has not been previously reported. A 29-year-old man who complained of dyspnea and asthenia for 1 month, recurrent fever for more than 20 days, and breathlessness for 1 week was admitted to our hospital. The thyroid function test showed that the level of free thyroxine (FT4) was higher than normal and that the level of thyroid-stimulating hormone (TSH) was below normal. He was diagnosed with hyperthyroidism. Additional investigations revealed a low serum albumin level and chest infection, along with diffuse lung fibrosis. Within 1 month, he experienced significant weight loss, no hand tremors, intolerance of heat, and perspiration proneness. We recommended an HIV examination; subsequently, AIDS was diagnosed based on the laboratory parameters. This is the first reported case of hyperthyroidism caused by AIDS. AIDS may cause hyperthyroidism by immunization regulation with complex, atypical, and easily ignored symptoms. Although hyperthyroidism is rare in patients with AIDS, clinicians should be aware of this potential interaction and should carefully monitor thyroid function in HIV-positive patients.

  10. Clinical and laboratory features at onset of polymyalgia rheumatica (PMR) and elderly onset of rheumatoid arthritis in PMR-like presentation: a comparison of two groups of patients.

    Science.gov (United States)

    Olivo, D; D'Amore, M; Mattace-Raso, F; Mattace, R

    1996-01-01

    The differential diagnosis between polymyalgia rheumatica (PMR) and elderly onset rheumatoid arthritis (EORA) in PMR-like presentation may represent several problems at the beginning of the disease, since the patterns of these pathologies may show largely overlapping areas. In this study we examined clinical and laboratory features of 21 patients with PMR and 22 patients with EORA PMR-like presentation, to identify eventual differences between the 2 diseases. EORA PMR-like presentation occurred more frequently in males (14 men and 8 women) than PMR (6 men and 15 women) (p = 0.046). In EORA PMR-like presentation we observed higher levels of gamma-globulins (p = 0,003), immunoglobulins IgC (p =0.004), IgA (p = 0.002) and IgM (p = 0.014) than in PMR. Fever (p = 0.022), asthenia (p = 0.007) and the contemporary involvement of the shoulder and pelvic girdle (p = 0.0054) were more frequent in PMR patients than EORA PMR-like presentation patients. Moreover, the involvement of the shoulder girdle only (p =0.0054) and arthritis of the peripheral joints (p = 0.045) were more frequent in EORA PMR-like presentation than in PMR patients. The results of this preliminary study revealed different clinical and laboratory features that may offer additional help in differential diagnosis at onset of the 2 diseases.

  11. Macrophagic myofasciitis: an emerging entity. Groupe d'Etudes et Recherche sur les Maladies Musculaires Acquises et Dysimmunitaires (GERMMAD) de l'Association Française contre les Myopathies (AFM).

    Science.gov (United States)

    Gherardi, R K; Coquet, M; Chérin, P; Authier, F J; Laforêt, P; Bélec, L; Figarella-Branger, D; Mussini, J M; Pellissier, J F; Fardeau, M

    1998-08-01

    An unusual inflammatory myopathy characterised by an infiltration of non-epithelioid histiocytic cells has been recorded with increasing frequency in the past 5 years in France. We reassessed some of these cases. We did a retrospective analysis of 18 such cases seen in five myopathology centres between May, 1993, and December, 1997. The myopathological changes were reassessed at a clinopathology seminar. Detailed clinical information was available for 14 patients. The main presumptive diagnoses were polymyositis and polymyalgia rheumatica. Symptoms included myalgias in 12 patients, arthralgias in nine, muscle weakness in six, pronounced asthenia in five, and fever in four. Abnormal laboratory findings were occasionally observed, and included raised creatine kinase concentrations, increased erythrocyte sedimentation rate, and myopathic electromyography. Muscle biopsy showed infiltration of the subcutaneous tissue, epimysium, perimysium, and perifascicular endomysium by sheets of large macrophages, with a finely granular PAS-positive content. Also present were occasional CD8 T cells, and inconspicuous muscle-fibre damage. Epithelioid and giant cells, necrosis, and mitotic figures were not seen. The images were easily distinguishable from sarcoid myopathy and fasciitis-panniculitis syndromes. Whipple's disease, Mycobacterium avium intracellulare infection, and malakoplakia could not be confirmed. Ten patients were treated with various combinations of steroids and antibiotics; symptoms improved in eight patients, and stabilised in two. A new inflammatory muscle disorder of unknown cause, characterised by a distinctive pathological pattern of macrophagic myofasciitis, is emerging in France.

  12. Bilateral adrenal non-Hodgkin lymphoma type B.

    Science.gov (United States)

    Tumino, S; Leotta, M L; Branciforte, G; Mantero, F; Calogero, A E

    2003-11-01

    The adrenal localization of a primary non-Hodgkin lymphoma (NHL) is rare. We report a case of a 66-yr-old woman who had severe asthenia, diffuse skin hitching and abdominal pain. The physical examination revealed poor general conditions, irritability, pallor, dehydration and diffuse skin scratching lesions. The abdomen was painful at left hypochondrium and the Giordano's maneuvre was positive on both sides. A peripheral blood smear showed the presence of big rare lymphocytes with dyshomogeneous chromatin and granulated and hyperbasophil cytoplasm. She underwent abdominal ultrasonography which showed the presence of a hypoechogenic ovoidal mass (major diameter 8.4 cm) within the splenorenal left region. The presence of the suprarenal mass was confirmed by computed tomography (CT) scan which showed an enlarged left adrenal gland (8.1 x 6.2 cm) of solid structure. The right adrenal gland was also enlarged and of round shape (4.5 cm). CT scan-guided fine needle aspiration biopsy was then carried out on the left adrenal mass. It revealed the presence of NHL type B with large cells and modest T-lymphocyte reactive component. The patient was treated with three cycles of cyclophosphamide, adriamycin, vincristine and prednisolone. At the end of the third cycle, there was a transient clinical improvement and the hitching disappeared, but the patient worsened rapidly and she died few weeks later.

  13. Mercury chronic toxicity might be associated to some cases of hydrocephalus in adult humans?

    Science.gov (United States)

    Silva Sieger, Federico A; Díaz Silva, Gustavo A; Ardila, Gustavo Pradilla; García, Ronald G

    2012-07-01

    Mercury accumulates in nervous tissue causing neurological and psychiatric manifestations. Numerous clinical findings have been described in patients that suffered chronic mercury intoxication. Some findings, such as hydrocephalus, have been described only in experimental studies. Following, we present a case of 50 year-old man with a 3-month history of severe frontal headache episodes and vision loss together with a history of asthenia, anorexia, muscle pain, fatigue and neuropsychiatric symptoms. The magnetic resonance imaging showed hydrocephalus and stenosis of aqueduct of Sylvius. This patient reported that he worked as laboratory metallurgic auxiliary for over 30 years. During this time, he had been chronically exposed to elemental mercury. The metals whole blood test was normal, except by his blood mercury level that was 61.5 μg/L (normal ~1 μg/L). In our best knowledge, hydrocephalus and stenosis of aqueduct of Sylvius have been described only in animals exposed to methylmercury during their gestation. We think that this case of hydrocephalus might be associated with the chronic mercury exposure and therefore this etiology must be taken in account in a patient with hydrocephalus of unknown etiology. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Acute kidney injury in visceral leishmaniasis: a cohort of 10 patients admitted to a specialized intensive care unit in northeast of Brazil

    Directory of Open Access Journals (Sweden)

    Elizabeth F. Daher

    2013-02-01

    Full Text Available Objective: To describe co-infections, clinical manifestations, comorbidities and outcome of patients with visceral leishmaniasis and AKI. Methods: This is a case study with ten patients with confirmed diagnosis of VL admitted to the reference ICU of Northeast of Brazil during 6 years, with renal injury. Clinical and laboratory parameters were evaluated in admission, period of hospitalization and outcome. Results: This study found 10 patients with VL in a group of 253 patients admitted to the ICU with AKI. The main signs and symptoms presented at admission were weight loss, fever, splenomegaly, jaundice, anorexia, asthenia, bleeding and vomits. The main co-infections were: AIDS, tuberculosis and leprosy. Patients were classified in RIFLE criteria. RIFLE-F patients were younger and had a longer time between onset of symptoms and hospital admission. Death was observed in 60% of cases. The causes of death were septic shock, respiratory insufficiency and multiple organ dysfunction. Conclusions: AKI is an important complication in VL. The progression of the disease and their complications can achieve high level of severity, even in the absence of comorbidities or co-infections. The high mortality in this group alerts to the importance of adequate management of these patients.

  15. Lead Poisoning at an Indoor Firing Range.

    Science.gov (United States)

    Kang, Kyung Wook; Park, Won Ju

    2017-10-01

    In March 2014, a 39-year-old Korean male presented with a 6-month history of various nonspecific symptoms including dizziness, fatigue, asthenia, irritability, elevated blood pressure, palpitation, eyestrain, and tinnitus. His occupational history revealed that he had been working as an indoor firing range manager for 13 months; therefore, he was subjected to a blood lead level (BLL) test. The test results showed a BLL of 64 μg/dL; hence, he was diagnosed with lead poisoning and immediately withdrawn from work. As evident from the workplace environmental monitoring, the level of lead exposure in the air exceeded its limit (0.015-0.387 mg/m³). He received chelation treatment with calcium-disodium ethylenediaminetetraacetic acid (1 g/day) for 5 days without any adverse effects. In the follow-up results after 2 months, the BLL had decreased to 9.7 μg/dL and the symptoms resolved. This report represents the first occupational case of lead poisoning in firing ranges in Korea, and this necessitates institutional management to prevent the recurrence of poisoning through this route. Workplace environmental monitoring should be implemented for indoor firing ranges, and the workers should undergo regularly scheduled special health examinations. In clinical practice, it is essential to question the patient about his occupational history. © 2017 The Korean Academy of Medical Sciences.

  16. Caprylic triglyceride as a novel therapeutic approach to effectively improve the performance and attenuate the symptoms due to the motor neuron loss in ALS disease.

    Directory of Open Access Journals (Sweden)

    Wei Zhao

    Full Text Available Amyotrophic lateral sclerosis (ALS is a neurodegenerative disorder of motor neurons causing progressive muscle weakness, paralysis, and finally death. ALS patients suffer from asthenia and their progressive weakness negatively impacts quality of life, limiting their daily activities. They have impaired energy balance linked to lower activity of mitochondrial electron transport chain enzymes in ALS spinal cord, suggesting that improving mitochondrial function may present a therapeutic approach for ALS. When fed a ketogenic diet, the G93A ALS mouse shows a significant increase in serum ketones as well as a significantly slower progression of weakness and lower mortality rate. In this study, we treated SOD1-G93A mice with caprylic triglyceride, a medium chain triglyceride that is metabolized into ketone bodies and can serve as an alternate energy substrate for neuronal metabolism. Treatment with caprylic triglyceride attenuated progression of weakness and protected spinal cord motor neuron loss in SOD1-G93A transgenic animals, significantly improving their performance even though there was no significant benefit regarding the survival of the ALS transgenic animals. We found that caprylic triglyceride significantly promoted the mitochondrial oxygen consumption rate in vivo. Our results demonstrated that caprylic triglyceride alleviates ALS-type motor impairment through restoration of energy metabolism in SOD1-G93A ALS mice, especially during the overt stage of the disease. These data indicate the feasibility of using caprylic acid as an easily administered treatment with a high impact on the quality of life of ALS patients.

  17. Herceptin as a single agent in the treatment of patients with metastatic breast cancer.

    Science.gov (United States)

    Zhang, Mingliang; Guo, Wei; Qian, Jun; Wang, Benzhong

    2015-08-01

    The aim of this retrospectively study was to assess the clinical efficacy and toxicity of Herceptin as a single agent in the treatment of patients with metastatic breast cancer (MBC). We retrospectively included and analyzed 31 metastasis breast cancer patients in our patient database. All of the included 31 patients were pathology confirmed of breast carcinoma with remote metastases and treated with Herceptin as a single agent. The clinical efficacy and drug-related toxicity were analyzed. No complete response patients were observed for 31 cases. And 8 (26%) reached partial response 16 (52%) with stable disease. The objective response rate of the 31 patients was 23%. We further divided the 31 cases into three subgroups according to the treatment modality. The objective response rate was 36%, 14%, and 17% for the first-line, second-line, and third-line treatment modality, respectively. The objective response rate was not statistical different among the three subgroups (P > 0.05). The main drug-related adverse event were asthenia, chills, diarrhea, nausea, hypotension and dizziness with their incidence of 68%, 26%, 13%, 10%, 10%, and 6%, respectively, for each patients. Herceptin as a single agent was effective and safe in the treatment of patients with MBC.

  18. Polyglandular autoimmune endocrine insufficiency complicated by severe osteoporosis.

    Science.gov (United States)

    Bassotti, G; Di Sarra, D; Pietrobono, D; Schiaffini, R; Battocletti, T; D'Amico, T; Gargiulo, P

    2006-12-01

    In literature different cases of polyglandular autoimmune type II syndrome (PGA II) are reported, where Addison's disease is associated with gonadal insufficiency. The lack in the production of sexual steroids causes a severe postmenopausal osteoporosis. The case we report is related to a 38-year-old woman we met in 1988 and who was suffering from deep asthenia, cramps, cutaneous hyperpigmentation, nausea, vomiting, abdominal pain, weight loss and hypotension. The biochemical data were indicative for autoimmune adrenal failure. Between 1988 and 1997 the patient developed a progressive insufficiency of other endocrine glands, leading to the classic feature of PGA II. In 1998, this clinical status was complicated by a severe osteoporosis. We thought that the sudden decrease in the bony mineral density was due to the lack of the protective role played by adrenal gland androgens in postmenopausal osteoporosis. They would directly act on the bony tissue, independently from oestrogens peripheral conversion, thus producing a stimulant effect on the bone formation. A new therapeutical approach, in case of osteoporosis, is today represented by DHEA replacement therapy in women showing low hormone levels.

  19. Towards Clinical Application of Neurotrophic Factors to the Auditory Nerve; Assessment of Safety and Efficacy by a Systematic Review of Neurotrophic Treatments in Humans

    Directory of Open Access Journals (Sweden)

    Aren Bezdjian

    2016-11-01

    Full Text Available Animal studies have evidenced protection of the auditory nerve by exogenous neurotrophic factors. In order to assess clinical applicability of neurotrophic treatment of the auditory nerve, the safety and efficacy of neurotrophic therapies in various human disorders were systematically reviewed. Outcomes of our literature search included disorder, neurotrophic factor, administration route, therapeutic outcome, and adverse event. From 2103 articles retrieved, 20 randomized controlled trials including 3974 patients were selected. Amyotrophic lateral sclerosis (53% was the most frequently reported indication for neurotrophic therapy followed by diabetic polyneuropathy (28%. Ciliary neurotrophic factor (50%, nerve growth factor (24% and insulin-like growth factor (21% were most often used. Injection site reaction was a frequently occurring adverse event (61% followed by asthenia (24% and gastrointestinal disturbances (20%. Eighteen out of 20 trials deemed neurotrophic therapy to be safe, and six out of 17 studies concluded the neurotrophic therapy to be effective. Positive outcomes were generally small or contradicted by other studies. Most non-neurodegenerative diseases treated by targeted deliveries of neurotrophic factors were considered safe and effective. Hence, since local delivery to the cochlea is feasible, translation from animal studies to human trials in treating auditory nerve degeneration seems promising.

  20. Longitudinal peripheral blood transcriptional analysis of a patient with severe Ebola virus disease.

    Science.gov (United States)

    Kash, John C; Walters, Kathie-Anne; Kindrachuk, Jason; Baxter, David; Scherler, Kelsey; Janosko, Krisztina B; Adams, Rick D; Herbert, Andrew S; James, Rebekah M; Stonier, Spencer W; Memoli, Matthew J; Dye, John M; Davey, Richard T; Chertow, Daniel S; Taubenberger, Jeffery K

    2017-04-12

    The 2013-2015 outbreak of Ebola virus disease in Guinea, Liberia, and Sierra Leone was unprecedented in the number of documented cases, but there have been few published reports on immune responses in clinical cases and their relationships with the course of illness and severity of Ebola virus disease. Symptoms of Ebola virus disease can include severe headache, myalgia, asthenia, fever, fatigue, diarrhea, vomiting, abdominal pain, and hemorrhage. Although experimental treatments are in development, there are no current U.S. Food and Drug Administration-approved vaccines or therapies. We report a detailed study of host gene expression as measured by microarray in daily peripheral blood samples collected from a patient with severe Ebola virus disease. This individual was provided with supportive care without experimental therapies at the National Institutes of Health Clinical Center from before onset of critical illness to recovery. Pearson analysis of daily gene expression signatures revealed marked gene expression changes in peripheral blood leukocytes that correlated with changes in serum and peripheral blood leukocytes, viral load, antibody responses, coagulopathy, multiple organ dysfunction, and then recovery. This study revealed marked shifts in immune and antiviral responses that preceded changes in medical condition, indicating that clearance of replicating Ebola virus from peripheral blood leukocytes is likely important for systemic viral clearance. Copyright © 2017, American Association for the Advancement of Science.

  1. Somatologic characteristics of biathlon students’ body constitution in predicting of their successfulness

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    S. G. Priymak

    2017-08-01

    Full Text Available Purpose: determination of somatologic characteristics of biathlon students’ body constitution in predicting of their successfulness. Material: in the research the following students participated (n=27, age19-21 years, boys n=17, girls n=10. Quetelet’s, Erisman’s and Piniet’s anthropometric indices were calculated as well as life index. Results: the greatest distinctions between boys and girls were observed by the following absolute indicators: body, trunk and torso lengths; body mass. The least distinctions were by the length of upper and lower limbs, which prevail in boys. In girls we observed noticeable realization of diaphragm breathing. It permits to increase alveolar surface at the cost of lungs’ stretching in longitudinal direction. With it, there was no visible change of chest excursion. Relatively high level of women’s physical fitness conditions asthenia (dolymorphia. It results in approximation of girls’ chest shape to men’s. In boys formation of somatic type is realized at the cost of chest circumferential sizes but directly depends on the strength of hands’ and back’s muscles. Conclusions: for some sport-pedagogic activities (in our case - biathlon certain type of body constitution is intrinsic, which conditions successfulness of professional program realization. Somatic type characterizes compliance and correlation of separated body links. These criteria permit to reduce costly part of future specialist’s training and achieve high results in professional activity.

  2. Hodgkin’s Lymphoma Revealed by Hemophagocytic Lymphohistiocytosis in a Child

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    Sarra Benmiloud

    2014-01-01

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is a severe life-threatening disorder, responsible for extensive phagocytosis of hematopoietic cells and causing a multisystem organ failure. If lymphomas are common causes of HLH, the association with Hodgkin’s lymphoma is rarely described in children. We report a case of a 9-year-old boy presenting with HLH as an initial manifestation of Hodgkin’s lymphoma. He has been suffering from persistent high fever, asthenia, weight loss, and hepatosplenomegaly with no lymphadenopathy. The diagnosis of HLH secondary to infectious disease was initially worn. The patient received high-dose intravenous immunoglobulin with broad-spectrum antibiotics. However, his state got worse with the onset of dry cough and pleural effusion. Histopathologic examination of pleural fluid showed the presence of Reed-Sternberg cells. The outcome was favorable after treatment by corticosteroid and chemotherapy. Hodgkin’s lymphoma revealed by HLH is a source of delayed diagnosis and should be borne in mind in children.

  3. The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence.

    Science.gov (United States)

    Ebersole, Barbara; Soni, Resha S; Moran, Kathleen; Lango, Miriam; Devarajan, Karthik; Jamal, Nausheen

    2017-07-11

    Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P 40 is a significant cutoff point for predicting therapy nonadherence (P Occupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. Fibromyalgia syndrome and temporomandibular disorders with muscular pain. A review.

    Science.gov (United States)

    Moreno-Fernández, Ana Maria; Jiménez-Castellanos, Emilio; Iglesias-Linares, Alejandro; Bueso-Madrid, Débora; Fernández-Rodríguez, Ana; de Miguel, Manuel

    2017-03-01

    Temporomandibular disorders (TMD) refer to a group of clinical picture affecting the masticatory muscles and temporomandibular joint that are characterized by muscular or joint pain, dysfunction (limited or altered functions) and joint noises, as well as other associated symptoms, such as tension headaches, otalgia, dizziness, tinnitus, and others. Fibromyalgia (FM) is a syndrome of unknown etiology involving generalized chronic pain accompanied, in a high percentage of cases, by other symptoms such as asthenia, anxiety, depression, sleep disturbances, and other less frequent symptoms, such as temporomandibular disorders (TMD). Data were compiled by two experienced examiners following a specific form. An electronic search was carried out in the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and SCOPUS electronic databases (up to April 2016, unrestricted by date or language). Comparative clinical studies with patients with both clinical pictures involving the study of pathogenic processes. Fibromyalgia and temporomandibular disorders with muscle pain both have profiles that affect the muscular system and therefore share many epidemiological, clinical, and physiopathological symptoms. Because of this, we are led to think that there is, if not a common etiology, at least a common pathogenesis. This article revises the physiopathological processes of both clinical pictures in an attempt to determine their similarities and likenesses. This would undoubtedly help in providing a better therapeutic approach.

  5. [A pseudotumoral lesion revealing Meckel's diverticulum].

    Science.gov (United States)

    Lemale, J; Boudjemaa, S; Parmentier, B; Ducou Le Pointe, H; Coulomb, A; Dainese, L

    2016-11-01

    Meckel's diverticulum is a common malformation in children, usually asymptomatic, with complications in only 20% of cases. Exceptionally, a tumor can develop in Meckel's diverticulum in children, particularly Burkitt's lymphoma; in adults it can develop into a gastrointestinal stromal tumor, a leiomyosarcoma, or a neuroendocrine tumor such as a carcinoid tumor. The diagnosis of inflammatory pseudotumor following an insidious perforation is rare. We report the case of a 14-month-old boy who presented with fever, asthenia, food refusal, and digestive complaints such as vomiting and tender abdomen suggesting appendicitis. Computed tomography showed an ileal mass of 3cm in diameter, which led to the suspicion of Burkitt's lymphoma. Laparoscopy showed Meckel's diverticulum with a mass of 3×2.8×2cm. Histological examination confirmed the diagnosis of Meckel's diverticulum with gastric heterotopia and showed a proliferation of spindle cells in a myxoid background, with an inflammatory infiltrate made of lymphocytes and plasmocytes. Immunostaining ruled out a malignant tumor. The diagnosis of an inflammatory pseudotumor developing on a Meckel diverticulum with gastric heterotopias was made. The outcome was favorable after surgical resection. While perforation of a Meckel diverticulum with gastric heterotopia is a common finding, the discovery of an inflammatory pseudotumor following a perforation is rare; the differential diagnosis should include Burkitt's lymphoma. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Mental status in pregnant women with brain injury sequels

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    A. A. Volynkin

    2017-01-01

    Full Text Available Objective: to investigate emotional disturbances in pregnant women with sequels of brain injury (BI.Patients and methods. A total of 47 pregnant women with a history of BI, who had been admitted to the Department of Obstetric Physiology, Moscow Regional Research Institute of Obstetrics and Gynecology, in 2013-2015, were examined. All the patients underwent a comprehensive neurological and neuropsychological examination using the Miltidimensional Fatigue Inventory-20 (MFI-20, the Hospital Anxiety and Depression Scale (HADS, and the Spielberg-Hanin Situational and Personal Anxiety Scale.Results. The pregnant women with BI sequels were found to have emotional changes involving asthenic, anxiety, and depressive components. In these women, anxiety symptoms were most common (53.3%; psychoemotional disturbance and asthenic and depressive manifestations were identified in 23.4 and 14.9% of cases. This investigation first verified the structural (situational and personal components of post-traumatic anxiety syndrome in the pregnant women. It revealed that an increased level of situational anxiety and physical symptoms of fatigue was observed in brain concussion sequels; and after brain contusion (BC, alarm acquired personality traits, asthenia was of a mental nature. In the pregnant women with BI sequels, depression was diagnosed only at the subclinical level and more often noted after BC (p=0.0473. 

  7. [Acute renal failure following Chlamydia pneumoniae pneumonia in a child].

    Science.gov (United States)

    Nasser, H; Dib Nehme, G; Camoin-Schweitzer, M-C; Andre, J-L

    2010-08-01

    Acute renal failure (ARF) following Chlamydia pneumoniae pneumonia is rarely reported in adults. We present an observation in a 10-year-old child, who had C. pneumoniae pneumonia treated with roxithromycin for a period of 10 days, without any other nephrotoxic drug, in particular nonsteroidal anti-inflammatory drugs. At the end of antibiotic treatment, he presented with asthenia, polyuria, polydipsia, increased plasma creatinine, metabolic acidosis, hypokalemia, and markers of tubular damage. The etiological investigations showed positive C. pneumoniae antibodies, increased serum concentrations of C3 and C4 complement, IgA, and IgG. No uveitis was noted. The diagnosis was tubulointerstitial nephropathy after C. pneumoniae pneumonia. C. pneumoniae pneumonia should be considered a differential diagnosis of community-acquired pneumonia, especially in cases of poor response to conventional antibiotic therapy. It may be associated with tubulointerstitial nephropathy and/or rapidly progressive glomerulonephritis whose severity varies in children as in adults. Early and effective treatment of C. pneumoniae infection with macrolide antibiotics usually provides favorable progression of renal function. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

  8. Voice and speech changes in various phases of menstrual cycle.

    Science.gov (United States)

    Çelik, Öner; Çelik, Aygen; Ateşpare, Altay; Boyacı, Zerrin; Çelebi, Saban; Gündüz, Tonguç; Aksungar, Fehime Benli; Yelken, Kürşat

    2013-09-01

    The reproductive system in females undergoes a regular cyclic change known as the menstrual cycle. Laryngeal changes are evident and fluctuate systematically during the reproductive years with the menstrual cycle. The impact of estrogens in concert with progesterone produces the characteristics of the female voice, with a fundamental frequency (F(0)) higher than that of male. To characterize changes in voice and speech in adolescent females in different phases of the menstrual cycle--during menstruation, after menstruation, mid-menstrual cycle, and premenstruation. Sixteen adult females who were nonusers of oral contraceptives participated in a cross-sectional study of menstrual cycle influences on voicing and speaking tasks. Acoustic analysis (F(0), intensity, perturbation measurements [jitter and shimmer], and harmonic-to-noise ratio), maximum phonation time (MPT), s/z ratio, and perceptual assessments (grade [G], roughness [R], breathiness [B], asthenia [A], and strain [S] [GRBAS] and Voice Handicap Index-10 [VHI-10]) scales were performed during all phases. None of the acoustic analysis parameters and MPT and s/z ratio measurements revealed statistically significant difference (P > 0.05). Perceptual voice assessment scales either clinician based or patients self-evaluated showed significant differences among phases (P menstrual cycle. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  9. Renal thrombotic microangiopathy caused by interferon beta-1a treatment for multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Mahe J

    2013-08-01

    Full Text Available Julien Mahe,1 Aurélie Meurette,2 Anne Moreau,3 Caroline Vercel,2 Pascale Jolliet1,4 1Clinical Pharmacology Department, Institute of Biology, University Hospital, Nantes, France; 2Clinical Nephrology and Immunology Department, University Hospital, Nantes, France; 3Laboratory of Pathology, University Hospital, Nantes, France; 4EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France Abstract: Interferon beta-1a is available as an immunomodulating agent for relapsing forms of multiple sclerosis. Common side effects include flu-like symptoms, asthenia, anorexia, and administration site reaction. Kidney disorders are rarely reported. In this study we describe the case of a woman who has been undergoing treatment with interferon beta-1a for multiple sclerosis for 5 years. She developed a hemolytic-uremic syndrome with intravascular hemolysis in a context of severe hypertension. A kidney biopsy showed a thrombotic microangiopathy. This observation highlights an uncommon side effect of long-term interferon beta-1a therapy. Pathophysiological mechanisms leading to this complication might be explained by the antiangiogenic activity of interferon. Keywords: thrombotic microangiopathy, interferon beta, hemolytic-uremic syndrome, antiangiogenic activity

  10. Work-related voice disorder

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    Paulo Eduardo Przysiezny

    2015-04-01

    Full Text Available INTRODUCTION: Dysphonia is the main symptom of the disorders of oral communication. However, voice disorders also present with other symptoms such as difficulty in maintaining the voice (asthenia, vocal fatigue, variation in habitual vocal fundamental frequency, hoarseness, lack of vocal volume and projection, loss of vocal efficiency, and weakness when speaking. There are several proposals for the etiologic classification of dysphonia: functional, organofunctional, organic, and work-related voice disorder (WRVD.OBJECTIVE: To conduct a literature review on WRVD and on the current Brazilian labor legislation.METHODS: This was a review article with bibliographical research conducted on the PubMed and Bireme databases, using the terms "work-related voice disorder", "occupational dysphonia", "dysphonia and labor legislation", and a review of labor and social security relevant laws.CONCLUSION: WRVD is a situation that frequently is listed as a reason for work absenteeism, functional rehabilitation, or for prolonged absence from work. Currently, forensic physicians have no comparative parameters to help with the analysis of vocal disorders. In certain situations WRVD may cause, work disability. This disorder may be labor-related, or be an adjuvant factor to work-related diseases.

  11. Prolonged infusion of gemcitabine in advanced solid tumors: a phase-I-study.

    Science.gov (United States)

    Schmid, Peter; Schweigert, Marcus; Beinert, Thomas; Flath, Bernd; Sezer, Orhan; Possinger, Kurt

    2005-03-01

    Gemcitabine is a pro-drug that has to be phosphorylated to gemcitabine-triphosphate in order to exhibit its antineoplastic activity. This reaction involves the enzyme deoxycytidine kinase which is saturated at plasma concentrations following standard 30-min infusions. Pharmacological studies indicate that prolonged administration of gemcitabine might result in higher intracellular concentrations of active metabolites. This phase I trial was therefore initiated to determine the optimal dose of gemcitabine administered over 4 h in patients with advanced solid tumors. Patients were treated with gemcitabine as 4 h-infusion on day 1, 8 and 15 in 4 week intervals. The starting dose was 350 mg/m(2). Doses were escalated in 50 mg/m(2) increments. Twenty-one patients were treated at doses ranging from 350 to 450 mg/m(2). The maximum tolerated dose was 400 mg/m(2) with neutropenia, thrombocytopenia, stomatitis and elevation of liver enzymes being dose limiting toxicities (DLTs). Hematologic and nonhematological toxicities were generally mild to moderate. Most common side effects were myelosuppression, nausea, elevation of liver enzymes and asthenia. Objective responses were noted in patients with hepatocellular carcinoma and cholangio-carcinoma. In this phase I study of gemcitabine as 4h-infusion, DLTs were neutropenia, thrombocytopenia, stomatitis and elevation of liver enzymes. The recommended dose for phase II studies is 400 mg/m(2).

  12. [Acute renal failure following ingestion of Cortinarius orellanus in 12 patients. Initial presentation and progress over a period of 13 years].

    Science.gov (United States)

    Duvic, C; Hertig, A; Hérody, M; Dot, J-M; Didelot, F; Giudicelli, C-P; Nédélec, G

    2003-02-15

    This study reports the largest series of acute renal failure following collective poisoning by Cortinarius orellanus since 1957. Twelve men, in whom altered renal function appeared following ingestion of mushroom soup (Cortinarius orellanus) when they were 20 to 23 year-old, were followed up for 13 years. After a period of latency of between 2 to 5 days, the patients complained of asthenia, intense thirst and digestive and neurological disorders. On admission, 4 were anuretic and two exhibited polyuria. Leukocyturia was detected in all patients but without proteinuria. Renal biopsy was performed on day 14 in seven patients. It revealed severe tubulo-interstitial lesions with polymorphous cell infiltration, oedema, loose fibrosis and epithelial necrosis. Eight patients required haemodialysis. Nine patients received corticosteroids for less than 6 months. Over a follow-up period of 13 years, seven patients recovered normal renal function, four underwent transplantation and one was still under haemodialysis and died, victim of a car accident. The incidence of acute renal failure varies from 30 to 46%. It depends on individual sensitivity, pre-existing nephropathy and the cumulated dose of toxin ingested. Early and severe interstitial fibrosis, marked interstitial oedema and tubular epithelial necrosis are the most characteristics renal lesions. Renal failure regresses progressively over several months in 60% of cases. In the other patients, terminal renal failure appears immediately or after several years. The evolution is not influenced by corticosteroid therapy.

  13. Nasalance change after sinonasal surgery: analysis of voice after septoturbinoplasty and endoscopic sinus surgery.

    Science.gov (United States)

    Kim, Young Ha; Lee, Sang Hee; Park, Chang Woo; Cho, Jin Hee

    2013-01-01

    Changes in nasalance caused by resonance change after endonasal surgeries have been reported in prior studies. In clinical practice, although patients often complain of a nasal voice just after surgery, their voices recover over time. The objective of this study was to evaluate the long-term nasalance changes before and after endonasal surgery. Patients who underwent sinonasal surgery at Yeouido St. Mary's Hospital between March 2009 and July 2011 were included in this study. We classified the subjects into three groups according to the surgeries they underwent: group 1, the septoturbinoplasty group; group 2, the endoscopic sinus surgery group; and group 3, the septoturbinoplasty and endoscopic sinus surgery group. We checked acoustic profiles, Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scores, and nasalance using a nasometer before and after the sinonasal surgery. When considering multidimensional voice program results, no observed parameters showed statistically meaningful changes before or after the operation in all three groups. GRBAS scales in all patients changed less than two scales postoperatively. Nasalance increased at 1 month after the operation in all groups. However, it returned to original levels with time: 3 months in group 2 and 6 months in groups 1 and 3. Sinonasal surgery can change the acoustic characteristics of the vocal tract and produce a significant increase in nasality in the early phase. However, after proper healing of the nasal cavity, nasality was observed to become similar to the preoperative level. Therefore, patients, especially voice professionals, do not need to be wary of voice changes after sinonasal surgery.

  14. [Evaluation of the feasibility of a program of adapted physical activity in day hospital of digestive oncology: From the point of view of patients].

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    Crespel, Céline; Brami, Cloé; de Boissieu, Paul; Mazza, Camille; Chauvet, Kevin; Lemoine, Amélie; Gavlak, Benoit; Léandri, Chloé; Brasseur, Mathilde; Bertin, Eric; Bouché, Olivier

    2018-02-06

    Adapted physical activity (APA) is recognized as an effective supportive care for asthenia and quality of life in oncology. Before an APA program was organized, the feasibility of such a program was evaluated among the patients. Descriptive, prospective, semi-qualitative, single-center study over a 3-month period in patients treated with ambulatory chemotherapy for digestive cancer. A self-questionnaire was offered to all patients to evaluate their practice and knowledge about APA. In ten patients, fatigue, anxiety and depression were assessed, before and after 9 weeks of hospital-based APA. The scores were compared by matched Student test. Of the 123 patients treated, 80 questionnaires (65%) were exploitable. Before the diagnosis of cancer, 40 patients (50%) were physically active, 20% after (n=16). The reasons for not practicing were: lack of interest/not the idea (42%), lack of time (34%), do not believe in profit (9%), too expensive (8%). Fifty-three patients (66%) were interested in the program. In 10 patients, the APA program significantly reduced the depression score (P=0.024) and a non-significant improvement in anxiety and fatigue. This study shows that patients treated with chemotherapy are unaware of the usefulness of APA and that medical information can improve adherence to such a program. The establishment of an intra-hospital APA program proved to be possible and relevant. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  15. Adrenal bilateral incidentaloma by reactivated histoplasmosis.

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    Lio, S; Cibin, M; Marcello, R; Viviani, M A; Ajello, L

    2000-01-01

    We report a case of bilateral adrenal incidentaloma caused by the capsulatum variety of Histoplasma capsulatum diagnosed in a 74 years old man born in and a life time resident of Treviso, Italy, with the exception of two years spent in Pakistan (1964-1966) as a well-driller. The patient was hospitalized in 1995 for alcoholic chronic hepatitis, chronic Helicobacter pylori gastritis and post-infarction ischemic cardiomyopathy. Abdominal ultrasound incidentally showed bilateral adrenal masses (the right one 6.3 cm in diameter) confirmed by computed tomography, with adrenal function within normal limits. After three months, the patient was again hospitalized due to evening fever, asthenia, anorexia, weight loss and occasional hyperhidrosis. Abdominal ultrasound showed an increase of the right adrenal lesion with normal adrenal function. Ultrasound-guided fine needle aspiration did not prove useful for diagnosis. Accordingly, a laparotomy with bilateral biopsy was performed; histology showed the presence of numerous tissue form cells of H. capsulatum variety capsulatum. Serum anti-H. capsulatum antibodies were negative. Since March, 1996, the patient was given itraconazole and his symptoms quickly regressed but the computed tomography findings, however, have not changed and the patient has adrenal hypofunction that is being treated with cortisone acetate.

  16. Agranulocytosis in a patient with acute Parvovirus B19 infection: a case study

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    Carlo Di Donato

    2016-03-01

    Full Text Available The definition of neutropenia is the reduction in the absolute number of neutrophils below 1.5×109. The chapter about acquired neutropenias affecting the adult population is of particular interest to the internist. PC, 75 years old man, was hospitalized because of fever, asthenia. In anamnesis: recent diagnosis of ulcerative pancolitis treated with mesalazine and corticosteroid therapy. During the hospitalization, to the fever resolution, we witnessed to a gradual reduction in the value of neutrophils leucocytes until the complete agranulocytosis. We set a therapy with granulocytes colony stimulating factors, and antifungal. The osteo-medullar biopsy confirmed a pure aplasia of the granulocyte marrow series without any evidence of cancer. The subsequent clinical development was favorable, with stable apyrexia and recovery of leucocytes count. Few days after, we received the positive response on the research of anti-Parvovirus B19 immunoglobulin M and in qualitative polymerase chain reaction. The patient was discharged with diagnosis agranulocytosis in patient with acute infection of Parvovirus B19. Neutropenia associated with Parvovirus infection is not frequent and is related to the presence of hematological diseases or condition of immunosuppression. The peculiarity of the case described is the complete agranulocytosis found: in fact in literature, only rare cases are described. Patient gave his informed consent.

  17. Diagnosis, complications and management of chronic neutrophilic leukaemia: A case report.

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    Silva, Patrícia Rocha; Ferreira, Cristina; Bizarro, Susana; Cerveira, Nuno; Torres, Lurdes; Moreira, Ilídia; Mariz, José Mário

    2015-06-01

    Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm characterized by sustained neutrophilia and the absence of the Philadelphia chromosome or the BCR-ABL1 fusion gene. The present study reports the case of a 59-year-old Caucasian female that was referred to The Francisco Gentil Portuguese Institute of Oncology (Porto, Portugal) with constitutional symptoms (mainly asthenia), marked leukocytosis (51.33×10(9)/l with 90% neutrophils), macrocytic anemia and splenomegaly. Bone marrow aspiration and biopsy revealed hypercellular marrow with clear predominance of segmented neutrophils. The karyotype was normal and the BCR-ABL1 fusion gene was not detected. After excluding a leukemoid reaction, a diagnosis of CNL was established. The clinical follow-up was complicated by hemorrhagic brain lesions and relapsing episodes of erythematous, well-demarcated and painful subcutaneous nodular lesions, consistent with Sweet's syndrome (SS). Multiple treatment strategies were administered, including use of hydroxyurea, imatinib and intensive chemotherapy. Nevertheless, progression was documented and the patient succumbed at 28 months post-diagnosis. The clinical course of CNL varies, and can be complicated by cerebral hemorrhage, blastic transformation or infection. Dermatological manifestations such as SS have seldom been reported in association. No evidence-based treatment currently exists and the majority of our knowledge is based on results from case reports and small series.

  18. [Acute atrio-ventricular block in sickle cell anemia].

    Science.gov (United States)

    Gacon, P-H; Jourdain, P; Heba, N; Amara, W

    2014-11-01

    Even though sickle cell disease has a high prevalence amongst the black race and despite its well known potential of micro infarction, there have been only a few reports regarding the acute myocardial damage during vaso-occlusive crisis. The risk of atrio ventricular block during these crises has never been described in a large survey. Ten patients (six men and four women, mean age 39 years old) were hospitalized for an acute atrio ventricular block. The patients were all African or Caribbean natives. Three patients were found with a heterozygous phenotype for hemoglobin S (sickle trait) and seven were found with a homozygous phenotype. The most common symptoms were asthenia (10 cases), shortness of breath (8 cases) and acute coronary syndrome (1 case) (syncope was not reported). Four patients had a second degree atrio ventricular block and six patients had third degree block. The treatment involved bed rest, intravenous hydration, and pain relief with opiates. All the cases of atrio ventricular block were only transitory and none of the patients underwent a pacemaker implantation. This report is the largest survey regarding transitory acute atrio ventricular block in patients with sickle cell disease. A local ischemic event affecting the AV node and Hiss bundle area can explain the conduction abnormalities. Sickle cell disease must be ruled out in black patients with an AV block. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Nab-paclitaxel plus gemcitabine for metastatic pancreatic adenocarcinoma after Folfirinox failure: an AGEO prospective multicentre cohort.

    Science.gov (United States)

    Portal, Alix; Pernot, Simon; Tougeron, David; Arbaud, Claire; Bidault, Anne Thirot; de la Fouchardière, Christelle; Hammel, Pascal; Lecomte, Thierry; Dréanic, Johann; Coriat, Romain; Bachet, Jean-Baptiste; Dubreuil, Olivier; Marthey, Lysiane; Dahan, Laetitia; Tchoundjeu, Belinda; Locher, Christophe; Lepère, Céline; Bonnetain, Franck; Taieb, Julien

    2015-09-29

    There is currently no standard second-line treatment for metastatic pancreatic adenocarcinoma (MPA), and progression-free survival is consistently <4 months in this setting. The aim of this study was to evaluate the efficacy and tolerability of Nab-paclitaxel plus gemcitabine (A+G) after Folfirinox failure in MPA. From February 2013 to July 2014, all consecutive patients treated with A+G for histologically proven MPA after Folfirinox failure were prospectively enrolled in 12 French centres. A+G was delivered as described in the MPACT trial, until disease progression, patient refusal or unacceptable toxicity. Fifty-seven patients were treated with Nab-paclitaxel plus gemcitabine, for a median of 4 cycles (range 1-12). The disease control rate was 58%, with a 17.5% objective response rate. Median overall survival (OS) was 8.8 months (95% CI: 6.2-9.7) and median progression-free survival was 5.1 months (95% CI: 3.2-6.2). Since the start of first-line chemotherapy, median OS was 18 months (95% CI: 16-21). No toxic deaths occurred. Grade 3-4 toxicities were reported in 40% of patients, consisting of neutropenia (12.5%), neurotoxicity (12.5%), asthenia (9%) and thrombocytopenia (6.5%). A+G seems to be effective, with a manageable toxicity profile, after Folfirinox failure in patients with MPA.

  20. Investigating the Effects of Glottal Stop Productions on Voice in Children With Cleft Palate Using Multidimensional Voice Assessment Methods.

    Science.gov (United States)

    Aydınlı, Fatma Esen; Özcebe, Esra; Kulak Kayıkçı, Maviş E; Yılmaz, Taner; Özgür, Fatma F

    2016-11-01

    The aim was to investigate the effects of glottal stop productions (GS) on voice in children with cleft palate using multidimensional voice assessment methods. This is a prospective case-control study. Children with repaired cleft palate (n = 34) who did not have any vocal fold lesions were separated into two groups based on the results of the articulation test. The glottal stop group (GSG) consisted of 17 children who had GS. The control group (CG) consisted of an equal number of age- and gender-matched children who did not have GS. The voice evaluation protocol included acoustic analysis, Pediatric Voice Handicap Index (pVHI), and perceptual analysis (Grade, Roughness, Breathiness, Asthenia, Strain method). The velopharyngeal statuses of the groups were compared using the nasopharyngoscopy and the nasometer. The total pVHI score and the subscales of the pVHI were found to be significantly higher in the GSG. The F0, jitter, and shimmer were found to be numerically higher in the GSG with the difference being statistically significant in jitter (P cleft palate who have GS should receive a comprehensive speech and language pathology intervention including voice therapy techniques. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  1. Screening for Cognitive Dysfunction Helped to Unmask Silent Cerebrovascular Disease in a Hypertensive Diabetic Patient — Case Report

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    Germán-Salló Márta

    2017-06-01

    Full Text Available The current guidelines for the diagnosis and treatment of hypertension recommend screening for cognitive impairment in all hypertensive patients as part of the clinical assessment. However, the implementation of this recommendation in clinical practice is still unsatisfactory. We present the case of an elderly hypertensive female patient in order to highlight the importance of screening for cognitive impairment. A patient with a history of poorly controlled hypertension for the last 12 years and recently diagnosed with type 2 diabetes mellitus is admitted complaining of asthenia, dizziness, visual acuity impairment, and difficulty to remember recent information. Cardiovascular imaging showed 70% internal carotid artery stenosis in a neurologically asymptomatic patient. Cognitive testing showed mild cognitive impairment. Retinal imaging identified stage III hypertensive retinopathy accompanied by irreversible end-organ damage due to microvascular changes. At this point brain MRI was performed, which identified both macro- and microvascular brain lesions in the periventricular white matter and sequelae of a former ischemic stroke in the territory of the left posterior cerebral artery. Cognitive testing helped to unmask silent cerebrovascular disease in an otherwise oligosymptomatic hypertensive diabetic patient. Cognitive function testing should be introduced in routine clinical practice in order to help unmask silent cerebrovascular disease.

  2. Uncontrolled seizures resulting from cerebral venous sinus thrombosis complicating neurobrucellosis

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    Fardin Faraji

    2013-01-01

    Full Text Available Cerebral venous sinus thrombosis is a rare form of stroke caused by thrombosis in venous sinuses of the brain. In this study, we reported on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure despite being treated with anti-epileptic drugs at high doses. The case was a 33-year-old woman with a history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month. She was febrile and a brain CT scan indicated hemorrhagic focus in the left posterior parietal and the temporal lobe. Magnetic resonance imaging and magnetic resonance venography also proved venous sinus thrombosis in the left transverse sinus. Besides [In addition], a laboratory assessment confirmed brucellosis. Following the treatment with anti-coagulant, anti-brucellosis, and anti-epileptic agents, the patient was discharged in good condition with medical orders. Clinical suspicion and accurate evaluation of a patient′s history is the most important clue in diagnosis and treatment of brucellosis and cerebral venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control.

  3. Urticarial lesions: if not urticaria, what else? The differential diagnosis of urticaria: part II. Systemic diseases.

    Science.gov (United States)

    Peroni, Anna; Colato, Chiara; Zanoni, Giovanna; Girolomoni, Giampiero

    2010-04-01

    There are a number of systemic disorders that can manifest with urticarial skin lesions, including urticarial vasculitis, connective tissue diseases, hematologic diseases, and autoinflammatory syndromes. All of these conditions may enter into the differential diagnosis of ordinary urticaria. In contrast to urticaria, urticarial syndromes may manifest with skin lesions other than wheals, such as papules, necrosis, vesicles, and hemorrhages. Lesions may have a bilateral and symmetrical distribution; individual lesions have a long duration, and their resolution frequently leaves marks, such as hyperpigmentation or bruising. Moreover, systemic symptoms, such as fever, asthenia, and arthralgia, may be present. The most important differential diagnosis in this group is urticarial vasculitis, which is a small-vessel vasculitis with predominant cutaneous involvement. Systemic involvement in urticarial vasculitis affects multiple organs (mainly joints, the lungs, and the kidneys) and is more frequent and more severe in patients with hypocomplementemia. Clinicopathologic correlation is essential to establishing a correct diagnosis. After completing the learning activity, participants should be able to distinguish urticarial lesions suggesting diagnoses other than common urticaria; assess patients with urticarial lesions, and suspect systemic diseases presenting with urticarial skin lesions. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  4. Hyponatremia in a Teenager: A Rare Diagnosis.

    Science.gov (United States)

    Correia, Filipa; Fernandes, Alexandre; Mota, Teresa C; Garcia, Milagros; Castro-Correia, Cíntia; Fontoura, Manuel; Ribeiro, Augusto

    2015-12-01

    Hyponatremia is a common electrolyte alteration which has the potential for significant morbidity and mortality. Endocrine disorders, such as primary hypothyroidism and adrenal insufficiency are uncommon causes of hyponatremia. We present the case of a teenager with symptomatic hyponatremia caused by a rare disorder. A 17-year-old boy was admitted to the emergency department with abdominal pain, nausea and vomiting, asthenia, and weight loss. He was in poor general condition, hypotensive, and he had dry mucous membranes and skin as well as mucosa hyperpigmentation. The laboratory findings showed severe hyponatremia, hyperkalemia, and renal dysfunction. The patient started inotropic support and antibiotics. Plasma cortisol and corticotropin levels allowed the diagnosis of primary adrenal insufficiency. He began replacement therapy with hydrocortisone and fludrocortisone, with gradual symptom resolution. An abdominal computed tomography scan showed adrenal hypoplasia. Findings for antiadrenal and antithyroid antibodies were positive, allowing the diagnosis of autoimmune polyglandular syndrome type II. Adrenal insufficiency is a rare disease, especially in children, and its clinical manifestations are due to glucocorticoid and mineralocorticoid deficiency. In most of the cases, symptoms are nonspecific, requiring a high index of clinical suspicion. If the diagnosis and treatment are delayed, acute adrenal insufficiency carries a high morbidity and mortality.

  5. Postnatal acquired toxoplasmosis patients in an infectious diseases reference center

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    Cassius Schnell Palhano Silva

    Full Text Available Infection caused by Toxoplasma gondii, toxoplasmosis, is one of the most frequent zoonoses in the world; it normally affects both genders equally. Humans are one of several possible intermediate hosts, and the disease is oligosymptomatic in most cases. Vertical transmission is an important cause of fetal malformation and sequels in newborns. Approximately 10% of postnatal cases present multiple manifestations, ranging from low fever and mild lymphadenopathy to severe encephalitis. In moderate cases, lesions such as retinochoroiditis may emerge during acute infection or even years later. We analyzed 313 cases of toxoplasmosis from 1992 to 2004, including 261 acute cases. Most patients were women (68.1%, and 39% of these were pregnant. Among acute infection cases, 64.8% presented symptomatic disease; the most frequent manifestations were lymphadenomegaly (59.8%, fever (27.2%, headache (10.7%, asthenia (10%, weight loss (8.4%, myalgia (8%, retinochoroiditis (3.4% and hepatosplenomegaly (1.5%. Although ocular lesions by T. gondii are well documented as a possible consequence of postnatal infection, two patients developed retinochoroiditis only two years after primary infection. This demonstrates the need for toxoplasmosis case surveillance, even long after acute manifestations.

  6. Epididymoorchitis as the First Finding in Patients with Brucellosis

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    Ayhan Karaköse

    2013-01-01

    Full Text Available Purpose. Acute scrotal pain as the first symptom of brucellosis is rarely observed. We aimed to evaluate the data of male patients with brucellosis and epididymoorchitis as the initial diagnosis. Material and Methods. The data of seven patients presented with testicular pain, hyperemia, swelling, and increased fever were reviewed. Concomitant focal diseases as well as clinical, laboratory, and radiological findings were retrospectively evaluated. Results. The mean age of the patients was 22.28 ± 7.78 (16–35 years. All patients presented with scrotal pain, swelling, and increased sweating. Additional findings included fever, asthenia, arthralgia, dysuria, shiver and rash, weight loss, and vomiting in 6, 5, 4, 4, 3, 2, and 1 patient, respectively. In all of 7 patients, the agglutination tests of Rose-Bengal and Wright were positive. Coombs test was positive only in 3 patients. The patients underwent antibiotic and conservative treatment. No relapse was observed following the treatment. Conclusion. In endemic regions, epididymoorchitis caused by brucellosis should be considered in the differential diagnosis of patients presenting with acute scrotal pain. Clinical and serological findings are sufficient for the diagnosis. Conservative management combined with antibiotic therapy is adequate for managing brucellar epididymoorchitis.

  7. Mechanisms of anorexia-cachexia syndrome and rational for treatment with selective ghrelin receptor agonist.

    Science.gov (United States)

    Esposito, Angela; Criscitiello, Carmen; Gelao, Lucia; Pravettoni, Gabriella; Locatelli, Marzia; Minchella, Ida; Di Leo, Maria; Liuzzi, Rita; Milani, Alessandra; Massaro, Mariangela; Curigliano, Giuseppe

    2015-11-01

    Cancer cachexia is a multi-organ, multifactorial and often irreversible syndrome affecting many patients with cancer. Cancer cachexia is invariably associated with weight loss, mainly from loss of skeletal muscle and body fat, conditioning a reduced quality of life due to asthenia, anorexia, anaemia and fatigue. Treatment options for treating cancer cachexia are limited. The approach is multimodal and may include: treatment of secondary gastrointestinal symptoms, nutritional treatments, drug, and non-drug treatments. Nutritional counselling and physical training may be beneficial in delaying or preventing the development of anorexia-cachexia. However, these interventions are limited in their effect, and no definitive pharmacological treatment is available to address the relevant components of the syndrome. Anamorelin is a first-in-class, orally active ghrelin receptor agonist that binds and stimulates the growth hormone secretagogue receptor centrally, thereby mimicking the appetite-enhancing and anabolic effects of ghrelin. It represents a new class of drug and an additional treatment option for this patient group, whose therapeutic options are currently limited. In this review we examine the mechanisms of anamorelin by which it contrasts catabolic states, its role in regulation of metabolism and energy homeostasis, the data of recent trials in the setting of cancer cachexia and its safety profile. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. CARACTERÍSTICAS CLÍNICO EPIDEMIOLOGICAS DE LOS PACIENTES CON LEUCEMIA AGUDA DEL SERVICIO DE HEMATOLOGIA DEL HOSPITAL ALMANZOR AGUINAGA ASENJO

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    Ana María Polo-Capuñay

    2014-01-01

    Full Text Available Objective: To identify the organisms that conform the normal flora of the external auditory canal. Material and Methods: Retrospective, transversal and descriptive. We reviewed a total of 55 medical records with a diagnosis of acute leukemia, taken from the HNAAA registration office during the period from January 2005 to March 2010. Results: During the study period, 142 cases were diagnosed with Leukemia, 105 (73.94% were acute leukemia. Of the 105 cases, 55 were evaluated. Of these 39 were males and 16 females. The most common age group was between 31-55 years (30.9% and the least frequent was 0-2 years (3.6%. 38 patients (69.1% were diagnosed as outpatients and 17 (30.9% diagnosed in emergency. Acute lymphocytic leukemia is more common in men than in women. The type of acute leukemia was undetermined for 7.27%. Within the initial manifestations collected we found more anemia, pallor, fever, body aches, and others (gingival, abdominal pain and vomiting, whereas we found fewer asthenia, fatigue, and bleeding. For laboratory data, 20 patients (69.1% had leukopenia, 33 patients (98.2% had thrombocytopenia and 48 patients (87.3% presented low hemoglobin. Conclusions: The prevalence of acute leukemia was 73.94%. The predominant age group was between 31-55 years. The most common signs and symptoms developed during the disease were, splenomegaly, hepatomegaly, anemia, bruising and petechiae. (Horiz Med 2014; 14(1: 18-23

  9. Epidemiology and Characteristics of Kikuchi-Fujimoto Disease in the African-Descent Population of Martinique, French West Indies.

    Science.gov (United States)

    Moinet, Florence; Molinié, Vincent; Béraud, Guillaume; Polomat, Katlyne; Cordel, Nadège; Sainte-Marie, Dominique; Duffas, Olivier; Duflo, Suzy; Bomahou, Charlène; Arfi, Serge; Deligny, Christophe

    2016-12-01

    To provide an epidemiologic description of Kikuchi-Fujimoto disease (KFD), and to describe its relationship with systemic lupus erythematosus (SLE) in a population of sub-Saharan origin. Patients were retrospectively included on the basis of lymph node histology compatible with KFD reported in Martinique from 1991 until 2013. In order to describe the characteristics of the disease in a larger cohort, we subsequently included more patients of Afro-Caribbean origin from Guadeloupe and French Guiana. In Martinique, mean annual incidence between 1991 and 2013 was 2.78 cases for 1 million inhabitants (95% confidence interval 1.73-3.93). A total of 36 Afro-Caribbean patients from the 3 French American regions were included. Mean age was 30.5 years (range 5-59 years) and the female:male ratio was 3:1. The main characteristics were cervical adenopathies (88.8%), fever (83.3%), asthenia (73.0%), weight loss (64.4%), and recurrence in 33.3%. KFD was associated with lupus (n = 9 for SLE, n = 2 for cutaneous lupus) in 36.6% (11 of 30). We report the first epidemiologic description of KFD in a population of sub-Saharan origin. According to our data, this disease is present in the black African diaspora and is strongly associated with autoimmune diseases, particularly lupus. © 2016, American College of Rheumatology.

  10. Influence of methods of physical rehabilitation on quality of life in patients with toxic hepatitis

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    Shmatova E.A.

    2013-11-01

    Full Text Available He purpose was to improve the state of the quality of life in patients with chronic toxic hepatitis in-patient treatment phase by the use of comprehensive program of physical rehabilitation. We examined 84 patients, including 55 - and 29 men - women. Quality of life was measured using a questionnaire SF - 36. The data obtained were compared with those of healthy people - donors. Found that patients significantly reduced quality of life condition. A program of physical rehabilitation with the use of complex tools: physiotherapy, massage, segmental massage, treatment status, respiration system Yoga. On 10 - 15 day in-patient revealed a positive trend against other major symptoms of the disease. At 6 - 7 day disappeared signs asthenia, improved mood, appetite, depression and aggression disappeared, abdominal pain, heaviness in the right upper quadrant. It has also the normalization of the excretory function of the gastrointestinal - intestinal tract. Patients pay attention to the improvement of the symptoms: dyspnea, normalize heart rate, decrease pain and numbness in the legs.

  11. An unusual Erdheim-Chester disease with orbital involvement: a case report

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    Giuseppe Brunori

    2016-11-01

    Full Text Available Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis with multiorgan involvement and a specific tropism for perivascular and fatty connective tissue, of unclear origin, with poor response to therapy. Its identification is difficult because of the variable clinical presentation and its lack of knowledge. We report the case of a 63-years-old woman, with a history of bilateral orbital pseudotumor, who comes to our attention because of progressively worsening asthenia, vomiting and systemic inflammation. Total body computerized tomography scan showed a volumetric increase of choroid plexus of the temporal horn of the left lateral ventricle, presence of solid retrobulbar tissue at the level of both maxillary sinuses, lung fibrosis, and retroperitoneal and peri-aortic infiltration. The association of these signs addressed to a diagnosis of Erdheim-Chester disease. Thus, although extremely rare, the diagnosis of Erdheim-Chester disease must be considered in the case of bilateral retro-orbital tumors and multisystemic involvement.

  12. Chronic polyarthritis in a patient affected by sarcoidosis and chronic HCV infection. Case report and review of the literature

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    A. Carcassi

    2011-09-01

    Full Text Available Sarcoidosis is a systemic granulomatous disease of unknown etiology that has a wide variety of clinical manifestation. Lung involvement may slowly undergo pulmonary fibrosis. Chronic sarcoid arthritis is a rare, usually non destructive arthropathy; may be a mono, oligo or polyarthritis. Knees, ankles, shoulders, wrists and small joint of the hands and feet may be involved. It can involve skin, eyes, exocrine glands such as salivary and lacrimal glands, and many other tissues. We describe the case of a 77 years old woman with a history of rhinopharyngitis with epistaxis and chronic laryngitis since youth; a dry mouth and throat, a erytematous, infiltrative skin lesion in the forehead and in the nape of the neck, a purple lesion of the left ear and nose, skin distrophy of the hands from 30 years before. She underwent an operation for a left femoral fracture with emotrasfusion 14 years ago. Then she developed a polyarthritis of the small joints of the hands (II, III and IV right DIP, I, III, e V left DIP; III and V bilateral PIP, knees, tarsi, toes and left elbow. An HCV chronic hepatitis was discovered 6 years before. She is affected by productive cough, dysphonia, dyspnea at rest, feveret, cephalea and asthenia for over 5 years. Laboratory examination revealed leukopenia, HCV hepatitis with anti HCV, HCV-RNA, transaminases elevated and cryoglobulinemia. HCV may be involved in the etiopathogenesis of rheumatic diseases, lung fibrosis and may moreover contribuite to the onset or progression of sarcoidosis; the possible pathogenesis is discussed.

  13. Structural Fat Grafting to Improve Outcomes of Vocal Folds' Fat Augmentation: Long-term Results.

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    Cantarella, Giovanna; Mazzola, Riccardo F; Gaffuri, Michele; Iofrida, Elisabetta; Biondetti, Pietro; Forzenigo, Laura V; Pignataro, Lorenzo; Torretta, Sara

    2018-01-01

    Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI ( P ranging between .004 and fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.

  14. Spatial distribution of the human development index, HIV infection and AIDS-Tuberculosis comorbidity: Brazil, 1982 - 2007

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    Antonio Luiz Rodrigues-Júnior

    2014-01-01

    Full Text Available INTRODUCTION: AIDS epidemic has given visibility to the incidence of tuberculosis, for being the most frequent opportunistic infection. It is known that individuals who are socially vulnerable are more susceptible to HIV transmission and tuberculosis as well. OBJECTIVE: This study aims to conduct a geoepidemiological study on HIV/AIDS, AIDS-Tuberculosis co-infection and social vulnerability. METHOD: This is an ecological study using incidence rates and the human development index to produce thematic maps and a descriptive analysis of epidemiology. The records of reported cases of HIV/AIDS from 1982 to 2007 were used, considering as cases of AIDS-Tuberculosis those records that were positively diagnosed with tuberculosis and those records with unknown diagnosis of tuberculosis, but showing compatible signs and symptoms with tuberculosis (fever, cough, cachexia and asthenia. RESULTS: The maps allowed the identification of areas with social differences and different patterns of incidence of HIV/AIDS and AIDS-Tuberculosis; regional differences were similar to those found by Josué de Castro, in 1940; regions with higher human development index values also showed higher incidence HIV/AIDS and AIDS-Tuberculosis. CONCLUSION: The prevention of HIV infection must be geographically specific, given socioeconomic and cultural differences. Although official records show decline in AIDS-TB co-infection, treatment of cases of HIV/AIDS should observe the occurrence of opportunistic diseases, which should be notified and/or updated.

  15. Measuring voice outcomes: state of the science review.

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    Carding, Pau N; Wilson, J A; MacKenzie, K; Deary, I J

    2009-08-01

    Researchers evaluating voice disorder interventions currently have a plethora of voice outcome measurement tools from which to choose. Faced with such a wide choice, it would be beneficial to establish a clear rationale to guide selection. This article reviews the published literature on the three main areas of voice outcome assessment: (1) perceptual rating of voice quality, (2) acoustic measurement of the speech signal and (3) patient self-reporting of voice problems. We analysed the published reliability, validity, sensitivity to change and utility of the common outcome measurement tools in each area. From the data, we suggest that routine voice outcome measurement should include (1) an expert rating of voice quality (using the Grade-Roughness-Breathiness-Asthenia-Strain rating scale) and (2) a short self-reporting tool (either the Vocal Performance Questionnaire or the Vocal Handicap Index 10). These measures have high validity, the best reported reliability to date, good sensitivity to change data and excellent utility ratings. However, their application and administration require attention to detail. Acoustic measurement has arguable validity and poor reliability data at the present time. Other areas of voice outcome measurement (e.g. stroboscopy and aerodynamic phonatory measurements) require similarly detailed research and analysis.

  16. Managing side effects of the novel taxane cabazitaxel in castrate-resistant prostate cancer.

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    Doyle-Lindrud, Susan

    2012-06-01

    Cabazitaxel, a novel taxane, was approved in June 2010 by the U.S. Food and Drug Administration for treatment of metastatic castrate-resistant prostate cancer (mCRPC) in men previously treated with docetaxel. In TROPIC (N = 755), an open-label, randomized, phase III trial, cabazitaxel (plus prednisone) was associated with improvement in median overall survival compared with mitoxantrone plus prednisone (15.1 versus 12.7 months, p cabazitaxel versus the mitoxantrone regimen (2.8 versus 1.4 months, p cabazitaxel were hematologic; the rates (all grade) of neutropenia, leukopenia, and anemia were greater than 90%. Diarrhea, fatigue, asthenia, and back pain were the most common grade 3 or higher nonhematologic AEs. Because expected AEs from cabazitaxel therapy can delay or even interrupt treatment, oncology nurses need to be aware of those risks and their management. This article reviews the vital role of nurses in identifying patients at high risk for AEs associated with cabazitaxel therapy and reviews strategies for prevention and management of symptoms.

  17. Real-world cabazitaxel safety: the Italian early-access program in metastatic castration-resistant prostate cancer.

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    Bracarda, Sergio; Gernone, Angela; Gasparro, Donatello; Marchetti, Paolo; Ronzoni, Monica; Bortolus, Roberto; Fratino, Lucia; Basso, Umberto; Mazzanti, Roberto; Messina, Caterina; Tucci, Marcello; Boccardo, Francesco; Cartenì, Giacomo; Pinto, Carmine; Fornarini, Giuseppe; Mattioli, Rodolfo; Procopio, Giuseppe; Chiuri, Vincenzo; Scotto, Tiziana; Dondi, Davide; Di Lorenzo, Giuseppe

    2014-05-01

    Cabazitaxel is a novel taxane that is approved for use in metastatic castration-resistant prostate cancer based on the Phase III TROPIC study, which showed improved overall survival with cabazitaxel/prednisone versus mitoxantrone/prednisone. A global early-access program was initiated in order to provide early access to cabazitaxel in docetaxel-pretreated patients and to obtain real-world data. We report interim safety results from an Italian prospective, single-arm, multicenter, open-label trial of 218 patients receiving cabazitaxel 25 mg/m2 every 3 weeks plus prednisolone 10 mg/day, until disease progression, unacceptable toxicity, investigator's decision or death. Patients completing treatment received a median of six cabazitaxel cycles. The most common grade 3/4 adverse events were neutropenia (33.9%), leukopenia (15.6%), anemia (6%) and asthenia (6%). No peripheral neuropathy or nail disorders were observed. These results confirm that cabazitaxel has a manageable safety profile in daily clinical practice and support its use in patients with prostate cancer who progress during or after a docetaxel-based therapy.

  18. YiQiFuMai Powder Injection Protects against Ischemic Stroke via Inhibiting Neuronal Apoptosis and PKCδ/Drp1-Mediated Excessive Mitochondrial Fission

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    Yingqiong Xu

    2017-01-01

    Full Text Available YiQiFuMai (YQFM powder injection has been reported to be used in cardiovascular and nervous system diseases with marked efficacy. However, as a treatment against diseases characterized by hypoxia, lassitude, and asthenia, the effects and underlying mechanisms of YQFM in neuronal mitochondrial function and dynamics have not been fully elucidated. Here, we demonstrated that YQFM inhibited mitochondrial apoptosis and activation of dynamin-related protein 1 (Drp1 in cerebral ischemia-injured rats, producing a significant improvement in cerebral infarction and neurological score. YQFM also attenuated oxidative stress-induced mitochondrial dysfunction and apoptosis through increasing ATP level and mitochondria membrane potential (Δψm, inhibiting ROS production, and regulating Bcl-2 family protein levels in primary cultured neurons. Moreover, YQFM inhibited excessive mitochondrial fission, Drp1 phosphorylation, and translocation from cytoplasm to mitochondria induced by oxidative stress. We provided the first evidence that YQFM inhibited the activation, association, and translocation of PKCδ and Drp1 upon oxidative stress. Taken together, we demonstrate that YQFM ameliorates ischemic stroke-induced neuronal apoptosis through inhibiting mitochondrial dysfunction and PKCδ/Drp1-mediated excessive mitochondrial fission. These findings not only put new insights into the unique neuroprotective properties of YQFM associated with the regulation of mitochondrial function but also expand our understanding of the underlying mechanisms of ischemic stroke.

  19. Safety of Abiraterone Acetate in Castration-resistant Prostate Cancer Patients With Concomitant Cardiovascular Risk Factors.

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    Procopio, Giuseppe; Grassi, Paolo; Testa, Isabella; Verzoni, Elena; Torri, Valter; Salvioni, Roberto; Valdagni, Riccardo; de Braud, Filippo

    2015-10-01

    The aim of this study was to evaluate the safety profile of abiraterone acetate (AA) in metastatic castration-resistant prostate cancer (mCRPC) men with cardiovascular comorbidity, as little conclusive safety data are available in this patient subset. A retrospective analysis of mCRPC patients with controlled cardiovascular comorbidities, receiving AA 1000 mg administered orally once daily and prednisone 5 mg twice daily, between April 2011 and July 2012, was performed. All clinical and instrumental variables and toxicity data were analyzed by descriptive statistics: mean, standard deviation, minimum and maximum values for continuous variables, and absolute and relative frequencies for categorical variables. A total of 51 mCRPC patients were evaluated. Metastatic sites included the bone (74%), lungs, and liver (26%). All patients were previously treated with at least 2 lines of hormone and 1 docetaxel-based chemotherapy. Preexisting cardiac risk factors included hypertension (41%), cardiac ischemia (12%), arrhythmias (6%), dislipidemia (18%), and hyperglycemia (30%). No grade 3-4 adverse events were observed. Grade 1-2 adverse events included fluid retention (18%), asthenia (15%), and hypertension (16%). Median progression-free survival was 5.1 months (95% confidence interval, 0.5-12). Prostate specific antigen assessment revealed a good overall disease control rate (64%). AA appears to be safe and well tolerated even in patients with cardiovascular comorbidities or with increased risk factors for cardiovascular diseases.

  20. [Constitutional syndrome: clinical entity or a mixed bag].

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    Suárez-Ortega, Saturnino; Puente-Fernández, Alicia; Santana-Baez, Sergio; Godoy-Díaz, Davinia; Serrano-Fuentes, Miriam; Sanz-Peláez, Oscar

    2013-01-01

    Fatigue, anorexia and involuntary weight loss have been included under the term constitutional syndrome. These manifestations accompany many diseases in which the diagnosis is made by specific symptoms and signs. However, these events are generally the main reason for consultation and the patient does not report other specific data. This forces us to rigorously investigate the possible causes of the disorder. Usually, three manifestations coexist: asthenia, anorexia and weight loss, but sometimes the patient has only one or two of them. The causes of constitutional symptoms are varied and can be divided into three groups: psychiatric diseases, neoplasms and non-neoplastic diseases. The etiological identification is usually done with a simple protocol, which rules out malignancy; the rest of the cases of uncertain etiology are subject to evolution. The constitutional syndrome correlates well with good prognosis or medical functional processes. Although no clinical guidelines have been developed, score scales may help for the etiological assessment. Given the myriad of different causes of the constitutional syndrome, the treatment of this illness depends primarily on the etiology.

  1. Safety and efficacy of sunitinib in patients from Latin America: subanalysis of an expanded access trial in metastatic renal cell carcinoma

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    Barrios CH

    2016-09-01

    Full Text Available Carlos H Barrios,1 Daniel Herchenhorn,2 Matías Chacón,3 Paula Cabrera-Galeana,4 Peter Sajben,5 Ke Zhang6 1Department of Medicine, PUCRS School of Medicine, Porto Alegre, 2Division of Clinical Oncology, Instituto Nacional do Câncer, Rio de Janeiro, Brazil; 3Clinical Oncology, Alexander Fleming Institute, Buenos Aires, Argentina; 4Department of Medical Oncology, Instituto Nacional de Cancerología, México, Centro Oncológico Issemym Edomex, México; 5Pfizer Oncology, New York, NY, 6Pfizer Oncology, La Jolla, CA, USA Background: Sunitinib is an approved treatment for metastatic renal cell carcinoma (mRCC. The safety profile and efficacy of sunitinib were confirmed in a global expanded access trial (ClinicalTrials.gov identifier: NCT00130897. This report presents a subanalysis of the final trial data from patients in Latin America.Methods: Treatment-naïve or previously treated mRCC patients aged ≥18 years received oral sunitinib at a starting dose of 50 mg/day on a 4-weeks-on/2-weeks-off schedule. Treatment continued until disease progression, unacceptable toxicity, or withdrawal of consent. Safety was assessed regularly, and tumor measurements were scheduled per local practice (using Response Evaluation Criteria in Solid Tumors.Results: In total, 348 patients from Latin America received sunitinib. Overall, 75% of patients had two or more sites of metastatic disease, 28% were aged ≥65 years, 14% had an Eastern Cooperative Oncology Group performance status ≥2, 9% had brain metastases, 9% had no prior nephrectomy, and 5% had non-clear cell RCC. Median treatment duration was 8 months, and median follow-up was 15.1 months. In total, 326 patients (94% discontinued treatment, primarily due to death (41% or lack of efficacy (22%. Most treatment-related adverse events were of mild to moderate severity (grade 1/2. Mucosal inflammation (reported in 54% of patients, diarrhea (53%, and asthenia (41% were the most common any-grade treatment

  2. Macroglobulinemia de Waldenström - remissão completa após tratamento com rituximabe Successful outcome in Waldenström's macroglobulinemia treated with rituximab

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    Flavia C. F. Pimenta

    2008-10-01

    Full Text Available A macroglobulinemia de Waldenström (MW é uma patologia rara dos linfócitos B caracterizada pela produção monoclonal de IgM, e que pode manifestar-se clinicamente com fadiga, astenia, perda de peso, sangramento de mucosas e do trato gastrintestinal, lifonodonomegalias, hepatoesplenomegalia e alterações neurológicas. A doença é mais comum em pacientes idosos, e seus sintomas são decorrentes da hiperviscosidade sangüínea. Na MW observa-se hipergamaglobulinemia com pico monoclonal na eletroforese de proteínas séricas, níveis elevados de IgM e demais imunoglobulinas normais ou diminuídas, imunofenotipagem com linfócitos B CD19+, CD20+ e CD24+, aspirado de medula óssea hipercelular, e biópsia de medula óssea hipercelular com infiltração difusa de linfócitos, linfócitos plasmocitóides e plasmócitos. Atualmente, anticorpos monoclonais estão sendo usados na terapêutica da MW com grande sucesso. O rituximabe, anticorpo monoclonal anti -CD20, tem mostrado excelentes resultados no tratamento da MW, inclusive naqueles indivíduos que não obtiveram resposta adequada ao tratamento convencional. Nós reportamos o caso de uma mulher de 78 anos de idade com história de fadiga, astenia, anorexia, sonolência, inquietação, urticária, dificuldade para deambular e perda excessiva de peso, aproximadamente 22 kg em um período de cinco meses, cujo tratamento foi realizado com rituximabe. O objetivo deste relato é apresentar uma paciente com diagnóstico de MW e revisar aspectos clínicos e terapêutico atual da doença.Waldenström's macroglobulinemia is a rare pathology of B lymphocytes characterized by the production of monoclonal IgM, causing clinical manifestations which may include fatigue, asthenia, weight loss, bleeding of the mucosa and intestinal tract, lymphadenomegaly, hepatosplenomegaly and neurological alterations. The disease is more frequent among elderly patients and its symptoms are a result of the hyperviscosity of

  3. Phase II study of panitumumab and paclitaxel as first-line treatment in recurrent or metastatic head and neck cancer. TTCC-2009-03/VECTITAX study.

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    Del Barco Morillo, Elvira; Mesía, Ricard; Adansa Klain, Juan Carlos; Vázquez Fernández, Silvia; Martínez-Galán, Joaquina; Pastor Borgoñon, Miguel; González-Rivas, Cyntia; Caballero Daroqui, Javier; Berrocal, Alfonso; Martínez-Trufero, Javier; Vera, Ruth; Cruz-Hernández, Juan Jesús

    2016-11-01

    To evaluate the activity and safety profile of panitumumab in combination with paclitaxel in patients with recurrent or metastatic SCCHN. The VECTITAX phase II, open-label, multicenter study included patients with confirmed metastatic and/or recurrent SCCHN deemed to be untreatable by surgery or radiotherapy and ECOG PS=0-1. All patients received paclitaxel (80mg/m2/week) and panitumumab (6mg/kg/2weeks) until disease progression or unacceptable toxicity. EQ-5D-3L andvisual analogic scale (VAS) were used to evaluate impact on quality of life (QoL). The study included 40 patients (ITT population): (median age: 61 years; 87% male). Previous treatment: 29 patients (73%) had undergone surgery, 34 (85%) had received prior radiotherapy and 23 (58%) prior systemic treatment for locally advanced disease. Confirmed response was observed in 19 patients (48%) which was a complete response in 15% of patients. Stable disease was observed in 11 patients (28%). Disease control rate was 75%. Median progression-free survival was 7.5 months (95%CI: 4.9-8.3) and median overall survival 9.9 months (95%CI: 7.9-16.3). Most frequent grade 3-4 adverse events were skin rash (25%); asthenia (17%); neurotoxicity (15%); hypomagnesemia (10%); neutropenia (10%). Permanent discontinuation of panitumumab or paclitaxel due to adverse events was required in 10 (25%) and 13 patients (33%), respectively. There was one toxic death due to febrile neutropenia. Patient-reported QoL was preserved with no decline of median VAS scores. Panitumumab and paclitaxel is an active combination, providing promising outcomes with preservation of the QoL and a favorable safety profile. (EudraCT: 2010-018898-37; NCT01264328). Copyright © 2016. Published by Elsevier Ltd.

  4. Dysphonia in adults with developmental stuttering: A descriptive study

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    Anél Botha

    2017-01-01

    Full Text Available Background: Persons with stuttering (PWS often present with other co-occurring conditions. The World Health Organization’s (WHO International Classification of Functioning, Disability and Health (ICF proposes that it is important to understand the full burden of a health condition. A few studies have explored voice problems among PWS, and the characteristics of voices of PWS are relatively unknown. The importance of conducting future research has been emphasised.Objectives: This study aimed to describe the vocal characteristics of PWS.Method: Acoustic and perceptual data were collected during a comprehensive voice assessment. The severity of stuttering was also determined. Correlations between the stuttering severity instrument (SSI and the acoustic measurements were evaluated to determine the significance. Twenty participants were tested for this study.Result: Only two participants (10% obtained a positive Dysphonia Severity Index (DSI score of 1.6 or higher, indicating that no dysphonia was present, while 90% of participants (n = 18 scored lower than 1.6, indicating that those participants presented with dysphonia. Some participants presented with weakness (asthenia of voice (35%, while 65% presented with a slightly strained voice quality. Moderately positive correlations between breathiness and SSI (r = 0.40, p = 0.08 have been reported. In addition, participants with high SSI scores also scored a poor DSI of below 1.6, as observed by a moderate positive correlation between SSI and DSI (r = 0.41.Conclusion: The majority of PWS presented with dysphonia, evident in the perceptual or acoustic parameters of their voices. These results can be used for further investigation to create awareness and to establish intervention strategies for voice disorders among PWS.

  5. Toxic hepatitis induced by a herbal medicine: Tinospora crispa.

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    Langrand, J; Regnault, H; Cachet, X; Bouzidi, C; Villa, A F; Serfaty, L; Garnier, R; Michel, S

    2014-01-01

    Herbal remedies are becoming increasingly popular in many countries. Tinospora species (Menispermaceae) is commonly used as a herbal medicine in South Asia, but very few toxic effects have been described. We report a case of acute hepatitis associated with chronic use of high doses of Tinospora crispa. A 49-year-old male with chronic low back pain bought a herbal medicine at a market in Vietnam that was supposed to be Tinospora crispa, and started to take 10 pellets per day. He had no medical history and did not take any other drugs or toxins. Four weeks later; he developed dark urine and pale stools, associated with asthenia and right hypochondrial pain. Two months after starting treatment, he was referred to the hepatology department with jaundice. Blood tests showed aspartate aminotransferase: 1.169 IU/l, alanine aminotransferase: 2.029 IU/l, total bilirubin: 20.47 mg/dl, direct bilirubin: 13.29 mg/dl, and γ-glutamyltransferase: 243 IU/l. Viral and autoimmune hepatitis were eliminated. Upper abdominal ultrasound was normal. Histopathological findings were consistent with a toxic reaction. The herbal medicine was stopped on admission and the patient fully recovered without treatment, with normal liver function 2 months after the acute episode. Tinospora crispa was clearly identified in the pellets by microscopic analysis of the botanical characters combined with chromatographic fingerprints. The use of herbal medicines containing Tinospora crispa can induce toxic hepatitis. Recovery can be complete after discontinuation. This case highlights the risk associated with traditional herbal remedies. Copyright © 2014 Elsevier GmbH. All rights reserved.

  6. Chronic fatigue syndrome: aetiology, diagnosis and treatment

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    Avellaneda Fernández, Alfredo; Pérez Martín, Álvaro; Izquierdo Martínez, Maravillas; Arruti Bustillo, Mar; Barbado Hernández, Francisco Javier; de la Cruz Labrado, Javier; Díaz-Delgado Peñas, Rafael; Gutiérrez Rivas, Eduardo; Palacín Delgado, Cecilia; Rivera Redondo, Javier; Ramón Giménez, José Ramón

    2009-01-01

    Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome. PMID:19857242

  7. The profile of patients with obstructive uropathy in Cameroon: case of the Douala General Hospital

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    Halle, Marie Patrice; Toukep, Linda Njonkam; Nzuobontane, Samuel Ekane; Ebana, Hermine Fouda; Ekane, Gregory Halle; Priso, Eugene Belley

    2016-01-01

    Introduction Obstructive uropathy can lead to irreversible kidney damage. The etiology largely determined by the patient's age can be benign or malignant. This study aimed at determining the profile and outcome of patients with obstructive uropathy in Cameroon. Methods A cross sectional study carried out in the urology unit of the Douala General Hospital, including patients with a diagnosis of obstructive uropathy seen from January 2004 to December 2013. Clinical profile, treatment and outcome data were obtained from patients records. Results Of the 229 patients included 69% were men, mean age 50 ±18 years. Associated comorbidities were hypertension, diabetes, and HIV. Mean haemoglobin 8,40±2,4g/dl, mean GFR 10,3 ±10ml/min, 94 (41%) patients needed emergency dialysis. Symptoms at presentation: asthenia (57%), anorexia (55%), loin pain (37%), vomiting (28%), oedema (20%), and anuria (15%). Urinary tract infection was present in 33 patients. Main aetiologies of obstruction: urolithiasis (35%), begnin prostatic hypertrophy (27%), prostatic cancer (12%), cervical cancer (16%), and congenital malformations (5%). Drainage was effective in 102 (45%) patients, 63 (28%) recovered completely, 91 (41%) were loss to follow up, 49 (22%) died and more women (p = 0.02). Mortality was associated with prostatic cancer (p = 0.000), cervical cancer (p = 0.004) and radiotherapy (p = 0.03). Conclusion Patients with obstructive uropathy presented with significant impaired renal function. Main causes were urinary stones, prostatic hypertrophy, prostatic and cervical cancers. Renal recovery was poor, loss to follow up and mortality high. Specific strategies to target improvement in renal recovery and patient's survival are needed in this patient's group. PMID:27217891

  8. A phase I study of irinotecan as a 3-week schedule in children with refractory or recurrent solid tumors.

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    Vassal, Gilles; Doz, Francois; Frappaz, Didier; Imadalou, Karima; Sicard, Evelyn; Santos, Alexandre; O'Quigley, John; Germa, Caroline; Risse, Marie-Laure; Mignard, Dominique; Pein, Francois

    2003-10-15

    A phase I study was performed to determine the maximum-tolerated dose (MTD) and safety profile of irinotecan (CPT-11) administered as a single intravenous infusion every 3 weeks in children with recurrent or refractory solid tumors. Eighty-one patients were enrolled, including 48 less heavily, and 33 heavily pretreated patients (cranial irradiation and/or high-dose chemotherapy). Children received CPT-11 as a 120-minute infusion at doses ranging from 200 to 720 mg/m2. The dose-limiting toxicities (DLT) on first cycle were determined in both cohorts. One hundred twenty-two cycles and 81 cycles were administered in less heavily, and heavily pretreated patients, respectively. The primary DLT was delayed diarrhea in less heavily pretreated patients, and neutropenia in heavily pretreated patients. MTD was 600 mg/m2 in both cohorts. Grade 3 to 4 neutropenia occurred in 33% and 38% of cycles in less heavily, and heavily pretreated patients, respectively. Grade 3 to 4 nonhematologic toxicities included nausea/vomiting (7% and 4% of cycles in less heavily, and heavily pretreated patients, respectively), asthenia (7% and 4% of cycles, respectively), and delayed diarrhea (6% and 2.5% of cycles, respectively). Four partial responses at 600 mg/m2 (high-grade glioma, neuroblastoma, medulloblastoma, and rhabdomyosarcoma) and 21 minor responses and stable diseases were observed. Pharmacokinetic analysis of CPT-11 and SN-38 was performed in 77 patients. The mean +/- standard deviation (SD) CPT-11 plasma clearance was 20.7 +/- 9.5 L/h/m2 (range, 5 to 54). The mean +/- SD SN-38 metabolic ratio was 1.5% +/- 1.1% (range, 0.15% to 5.55%). The recommended phase II dose of CPT-11 in a 3-week schedule is 600 mg/m2 in less heavily, and heavily pretreated children with solid tumors.

  9. Fiebre manchada por rickettsias en el Delta del Paraná: Una enfermedad emergente Rickettsial spotted fever in the Paraná Delta: An emerging disease

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    Alfredo Seijo

    2007-12-01

    Full Text Available Se comunica un caso de fiebre manchada por rickettsia autóctono del delta del Paraná correspondiente a la provincia de Buenos Aires. Luego de cinco días de haber permanecido en una región cercana a la localidad de ingeniero Otamendi, partido de Campana, el paciente presentó un síndrome febril agudo caracterizado por hipertermia con escalofríos y sudoración, mialgias, cefalea, astenia y discreta odinofagia, seguido a las 72 horas por un exantema maculopapuloso congestivo con elementos purpúricos, de distribución universal. En la región preauricular izquierda se observaba una lesión papuloerosiva, producida cinco días antes de iniciada la fiebre por una garrapata adquirida en el lugar. El cuadro clínico remitió rápidamente con la administración de doxiciclina. Por inmunofluorescencia indirecta se identificaron anticuerpos reactivos contra el grupo de rickettsias causantes de fiebres manchadas (CDC, Atlanta, EE.UU.. Se realizan consideraciones sobre la especie de rickettsia, el vector involucrado y la posibilidad que la enfermedad fuera debida a Rickettsia parkeri.We describe a case of rickettsial spotted fever in the Paraná Delta region of Buenos Aires province in Argentina. The patient developed an acute febrile syndrome characterized by myalgias, headache, asthenia and moderate odynophagia, followed by a diffuse macular, papular, and purpuric exanthema. The patient had been bitten recently by a tick on the left preauricular region and an erosive papular lesion was evident at the bite site. An indirect immunofluorescence antibody assay identified antibodies reactive with spotted fever group rickettsiae in the patient's serum. The patient improved rapidly with doxycycline. Several considerations relating to the identity of the rickettsial species and tick vector are discussed, including the possibility that this patient's illness may have been caused by Rickettsia parkeri.

  10. Everolimus for patients with metastatic renal cell carcinoma refractory to anti-VEGF therapy: results of a pooled analysis of non-interventional studies.

    Science.gov (United States)

    Albiges, Laurence; Kube, Ulrich; Eymard, Jean-Christophe; Schmidinger, Manuela; Bamias, Aristotelis; Kelkouli, Nadia; Mraz, Bernhard; Florini, Styliani; Guderian, Gernot; Cattaneo, Agnese; Bergmann, Lothar

    2015-11-01

    To assess the efficacy and safety of everolimus in patients with metastatic renal cell carcinoma (mRCC) who failed one or two anti-VEGF therapies. Data from four prospective, non-interventional studies conducted in Germany, France, Greece and Austria were pooled for this analysis. Patients with mRCC of any histology (clear cell or non-clear cell) were included. VEGF-refractory patients received everolimus 10mg/day until disease progression or unacceptable toxicity. The primary objective was to determine everolimus efficacy as measured by time to progression (TTP; from baseline to progression). The overall population comprised 632 patients; 493 patients received everolimus in the second-line setting. Most patients were of favourable/intermediate MSKCC risk (91%), had clear cell mRCC (89%), and had undergone nephrectomy (89%). Median TTP was 6.3months (95% confidence interval [CI], 5.9-6.8) for the overall population and 6.4months (95% CI, 5.8-6.9) for the second-line everolimus population. Similarly, median progression-free survival was 5.5months (95% CI, 5.0-6.1) for the overall population and 5.8months (95% CI, 5.0-6.4) for second-line everolimus population. Best tumour response (n=349) was complete or partial remission in 12% of patients and stable disease in 59% of patients. Overall population median overall survival (OS) was 11.2months (95% CI, 9.0-not reached). Commonly reported adverse events (AEs) (any grade) were stomatitis (25%), anaemia (15%) and asthenia (11%). Results of this pooled analysis provide evidence of safety and effectiveness of second-line everolimus in routine clinical use and support everolimus as a standard of care for VEGF-refractory patients with mRCC. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Randomized trial of daclatasvir and asunaprevir with or without PegIFN/RBV for hepatitis C virus genotype 1 null responders.

    Science.gov (United States)

    Lok, Anna S; Gardiner, David F; Hézode, Christophe; Lawitz, Eric J; Bourlière, Marc; Everson, Gregory T; Marcellin, Patrick; Rodriguez-Torres, Maribel; Pol, Stanislas; Serfaty, Lawrence; Eley, Timothy; Huang, Shu-Pang; Li, Jianling; Wind-Rotolo, Megan; Yu, Fei; McPhee, Fiona; Grasela, Dennis M; Pasquinelli, Claudio

    2014-03-01

    Patients with chronic hepatitis C virus (HCV) infection and prior null response (daclatasvir plus once- or twice-daily asunaprevir in non-cirrhotic genotype 1 null responders. In this randomized, phase 2a, open-label, 24-week treatment study, 101 patients received daclatasvir (60 mg) once-daily. In addition, 38 genotype 1b patients received asunaprevir (200mg) twice- (DUAL A1) or once-daily (DUAL A2); 36 genotype 1a and 5 genotype 1b patients received asunaprevir twice- (QUAD B1) or once-daily (QUAD B2) plus PegIFN/RBV; and 18 genotype 1a and 4 genotype 1b patients received asunaprevir twice-daily plus ribavirin (TRIPLE B3). The primary endpoint was undetectable HCV RNA 12 weeks post-treatment (sustained virologic response, SVR12). Across all groups, mean HCV RNA was ⩾ 6 log IU/ml, and 99% of patients had a non-CC IL28B genotype. SVR12 rates were 78% (A1), 65% (A2), 95% (B1), and 95% (B2). In B3, most genotype 1a patients experienced virologic breakthrough. The most common adverse events were headache, diarrhea, and asthenia. Grade 3-4 aminotransferase elevations were infrequent and not treatment-limiting. In genotype 1 null responders, daclatasvir plus twice-daily asunaprevir DUAL therapy is effective for most genotype 1b patients, and daclatasvir, asunaprevir, and PegIFN/RBV QUAD therapy is effective for nearly all genotype 1a and 1b patients; but neither DUAL nor TRIPLE therapy is effective for genotype 1a patients. Interferon-free regimens including daclatasvir and twice-daily asunaprevir for genotype 1 null responders should be tailored to subtype. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  12. [Clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño].

    Science.gov (United States)

    Ormeño Julca, Alexis Jose; Alvarez Murillo, Carlos Melchor; Amoretti Alvino, Pedro Miguel; Florian Florian, Angel Aladino; Castro Johanson, Rosa Aurora; Celi Perez, Maria Danisa; Huamán Prado, Olga Rocío

    2017-01-01

    The hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHN) are distinct pulmonary vascular complications of portal hypertension (PHT) and are associated with increased morbidity and mortality. To describe the clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño. We included patients with HTP hospitalized from January 2012 to June 2013 and that during its evolution progressed with SHP or HTPP. For analysis, they were divided into a first group of patients with liver cirrhosis and a second group with extrahepatic portal vein obstruction. Of 22 patients with HPT 45.5% were male and the age range was between 1 month and 17 years. The etiology in the group of cirrhosis (n=14) was: autoimmune hepatitis (35.7%), cryptogenic cirrhosis (35.7%), inborn error of metabolism (14.3%), chronic viral hepatitis C (7.15%) virus and atresia extra-hepatic bile ducts (7.15%). Pulmonary vascular complications more frequently occurred in patients with liver cirrhosis (1 case of HPS and a case of PPHTN). They most often dyspnea, asthenia, edema, malnutrition, ascites, hypersplenism and gastrointestinal bleeding from esophageal varices was found. Also, they had elevated ALT values, alkaline phosphatase and serum albumin values decreased. In children with pulmonary hypertension, pulmonary vascular complications are rare. In the evaluation of these patients pulse oximetry should be included to detect hypoxemia and ubsequently a Doppler echocardiography and contrast echocardiography necessary. Dueto the finding of systolic pulmonary hypertension it is necessary to perform right heart catheterization.

  13. Phase I study of flavopiridol in combination with Paclitaxel and Carboplatin in patients with non-small-cell lung cancer.

    Science.gov (United States)

    George, Saby; Kasimis, Basil S; Cogswell, Janet; Schwarzenberger, Paul; Shapiro, Geoffrey I; Fidias, Panos; Bukowski, Ronald M

    2008-05-01

    The aim of this study was to evaluate the safety and tolerability of escalating doses of flavopiridol/ paclitaxel/carboplatin in patients with advanced-stage non-small-cell lung cancer (NSCLC) as well as the pharmacokinetics and activity of flavopiridol when used in combination with paclitaxel/carboplatin. Eligible patients aged 18-75 years with previously untreated stage IIIB/IV NSCLC received paclitaxel 175 mg/m2 over 3 hours followed by carboplatin area under the curve (AUC) 5 over 1 hour and flavopiridol 30-85 mg/m2 over 24 hours every 3 weeks for 3 cycles. Eighteen patients were enrolled at 4 sites in the United States and received flavopiridol 30 mg/m2 (n = 3), 50 mg/m2 (n = 6), 70 mg/m2 (n = 3), or 85 mg/m2 (n = 6). No dose-limiting toxicities (DLTs) occurred at the 50-mg/m2 or 70-mg/m2 dose levels. Two patients treated at the 85-mg/m2 dose level experienced cardiovascular events that did not meet the criteria for DLT but were fatal in 1 case, prompting no further flavopiridol dose escalations and establishment of 70 mg/m2 as the maximum tolerated dose. The most frequently reported adverse events across all dose levels combined were nausea (89%), asthenia (67%), and diarrhea (56%). Flavopiridol concentrations increased rapidly, reached a plateau, and showed a multiphasic decline after the 24-hour infusion. Of 12 patients evaluable for efficacy, 8 achieved a partial response, and 4 had stable disease. Flavopiridol in doses

  14. HEREDITARY CONNECTIVE TISSUE DISORDERS: NOMENCLATURE AND DIAGNOSTIC ALGORITHM

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    A. V. Klemenov

    2015-01-01

    Full Text Available Hereditary connective tissue disorders (HCTDs are a genetically and clinically diverse group of diseases, which encompasses common congenital disorders of fibrous connective tissue structures. Out of the whole variety of the clinical manifestations of NCTDs, only differentiated monogenic syndromes with the agreed guidelines for their diagnosis have been long the focus of the medical community’s attention. Many unclassified forms of the pathology (dysplasia phenotypes have been disregarded while assessing a person’s prognosis and defining treatment policy. With no clear definition of NCTDs or their approved diagnostic algorithm, it is difficult to study their real prevalence in the population, to compare literature data, and to constructively discuss various scientific and practical aspects of this disease. Efforts to systematize individual clinical types of NCTD and to formulate their diagnostic criteria are set forth in the All-Russian Research Society Expert Committee national guidelines approved in 2009 and revised in 2012. The paper gives current views on the nomenclature of NCTDs, considers diagnostic criteria for both classified monogenic syndromes (Marfan's syndrome, Ehlers–Danlos' syndrome, MASS phenotype, primary mitral valve prolapse, joint hypermobility syndrome and unclassified dysplasia phenotypes (MASS-like phenotype, marfanoid appearance, Ehlers–Danlos-like phenotype, benign joint hypermobility syndrome, unclassified phenotype. The above abnormalities are presented as a continuous list drawn up in the decreasing order of the degree of their clinical manifestations and prognostic value (the phenotypic continuum described by M.J. Glesby and R.E. Pyentz: from monogenic syndromes through dysplasia phenotypes to an unclassified phenotype. Emphasis is laid on the clinical NCTD identification difficulties associated with the lack of specificity of external and visceral markers of connective tissue asthenia and with the certain

  15. Health status of radiation workers in an institute of nuclear research

    Energy Technology Data Exchange (ETDEWEB)

    Popescu, F.; Paunescu, G.; Stroe, F. [Inst. of Public Health, Bucharest (Romania); Andrei, N.

    2000-05-01

    The aim of this study was the identification of the changes in health condition of workers from an institute of nuclear research. Thirty-five workers (25 male and 10 female) radiation exposed to low doses of ionizing radiation were admitted in the Radiopathology Centre Bucharest, after a selection performed during the annual check-up. The workers have had different professions: nuclear fuel processor, engineer laboratory technician, electrician, instrument technician. The time of exposure to ionizing radiation was between 6 to 25 years. Medical specialists in occupational health, dermatology, ophthalmology, O.R.L., endocrinology, haematology, neurology and psychology investigated them. The following lab tests were performed: haematological examination, biochemical examination, immunology tests, alergology skin tests, functional lung tests and cardiogram. No special problems concerning the exposure to ionizing radiation were found, but the following diseases were detected in some extent: neurasthenia, high blood pressure, ischemic heart disease, digestive system disorders, endocrinology disorders and anaemia. High blood pressure, ischemic heart disease and digestive system disorders were related with stress or job strain. Anaemia occurred in connection with gynaecological disorders. Some thyroid dysfunction appeared because of low dietary iodine content in the Sub-Carpathian region. The focus of the psychological exam was the identification of the effect of different factors (exogenous, endogenous or multidimensional) over a person, that could influence the psychological potential. The psychological exam reveals the following disturbances: asthenia, tiredness, chronic fatigue, psycho-emotional impairment, lapses of attention, anxiety. These disturbances may be in relation both with job strain (especially a substantial stress factor for nuclear fuel processor and engineer laboratory technician) and the syndrome of workplace. (author)

  16. Voice disorder in systemic lupus erythematosus.

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    Milena S F C de Macedo

    Full Text Available Systemic lupus erythematosus (SLE is a chronic disease characterized by progressive tissue damage. In recent decades, novel treatments have greatly extended the life span of SLE patients. This creates a high demand for identifying the overarching symptoms associated with SLE and developing therapies that improve their life quality under chronic care. We hypothesized that SLE patients would present dysphonic symptoms. Given that voice disorders can reduce life quality, identifying a potential SLE-related dysphonia could be relevant for the appraisal and management of this disease. We measured objective vocal parameters and perceived vocal quality with the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain scale in SLE patients and compared them to matched healthy controls. SLE patients also filled a questionnaire reporting perceived vocal deficits. SLE patients had significantly lower vocal intensity and harmonics to noise ratio, as well as increased jitter and shimmer. All subjective parameters of the GRBAS scale were significantly abnormal in SLE patients. Additionally, the vast majority of SLE patients (29/36 reported at least one perceived vocal deficit, with the most prevalent deficits being vocal fatigue (19/36 and hoarseness (17/36. Self-reported voice deficits were highly correlated with altered GRBAS scores. Additionally, tissue damage scores in different organ systems correlated with dysphonic symptoms, suggesting that some features of SLE-related dysphonia are due to tissue damage. Our results show that a large fraction of SLE patients suffers from perceivable dysphonia and may benefit from voice therapy in order to improve quality of life.

  17. Comparing acoustic and perceptual voice parameters in female teachers based on voice complaints

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    Maryam Faghani Abukeili

    2014-04-01

    Full Text Available Background and Aim: Teachers are a large group of professional voice users that several risk factors and voice demands causes various voice complaints among them. As the voice is multidimensional, the aim of this study was acoustic and perceptual measurement of teachers’ voice and comparing the findings between two groups with many and few voice complaints.Methods: Sixty female teachers of high school in Sari, north of Iran, were chosen by available sampling to participate in this cross-sectional study. According to a voice complaints questionnaire, 21 subjects located in few voice complaints and 31 in many voice complaints group. After a working day, subjects completed a voice self-assessment questionnaire. Also, teachers’voice were recorded during three tasks including sustained vowels /a/ and /i/, text reading and conversational speech. Acoustic parameters were analyzed by Praat software and 2 speech-language pathalogists performed auditory-perceptual assessment by GRBAS ( Grade, Roughness, Breathiness, Asthenia, Strain scale. Results: Comparing of the voice self-assessment between the two groups demonstrated statistically significant difference (p<0.05; however results of the acoustic and auditory-perceptual measurement did not show significant diffrence.Conclusion: Despite prevalent voice problems in teachers, there are various conditions in terms of complaints and assessments methods. In this study, only a remarkable deviation documented in the client-based assessments in many voice compliants group in comparison with few voice compliants, which would be probably related to different individual’s perception of voice problem between two groups. These results support paying attention to self-assessments in clinical process of voice problems.

  18. Zenker's diverticulum, a rare cause of upper gastrointestinal bleeding.

    Science.gov (United States)

    Bălălău, C; Stoian, S; Motofei, I; Popescu, B; Popa, F; Scăunaşu, R V

    2013-01-01

    The most common complication of Zenker's diverticulum is aspiration pneumonia, compression of the trachea and esophageal obstruction with large diverticulum, and increased risk of development of carcinoma. Thus bleeding occurs rarely, can be massive and life threatening, with ulceration being the most common cause. We describe a patient with sever upper gastrointestinal bleeding as a result of a Zenker's diverticulum. A 75 year-old woman was referred to the emergency room and hospitalized for hematemesis, melena, asthenia and total dysphagia. In this particular case we preferred open technique because of the diverticulum dimensions and bleeding episode. Left cervicotomy was practiced on the anterior edge of the sternocleidomastoid muscle, being known that Zenker diverticulum extend into the left neck 90% of the time, fact also confirmed by radiology in this case. Postoperatively, the patient showed a complication free recovery. Five days after treatment the patient resumed nourishment. Several days later our patient was able to return home. Follow-up at 12 months after the operation showed complete recovery. Ulcer of the basis of Zenker's diverticulum is a rare entity and, only a few cases were reported in the literature to date. Omitting thecricomyotomy predisposes to fistula or diverticulum recurrence due to the persistence of a high pharyngeal intraluminal pressure that acts on the posterior wall just proximal to the upper esophageal sphincter. Zenker's diverticulum is an unusual site of origin for clinically significant upper gastrointestinal hemorrhage and differential diagnosis must include other more frequent causes of upper gastrointestinal bleeding. In our opinion, classicalsurgical therapy is indicated when distal esophageal imaging cannot be obtained during endoscopic examination, there is a large diverticulum or in an emergency setting when fast control over the bleeding source is required.

  19. Associations of Giardia lamblia assemblages with HIV infections and symptomatology: HIV virus and assemblage B were they born to each other?

    Science.gov (United States)

    Faria, Clarissa Perez; Zanini, Graziela Maria; Dias, Gisele Silva; Sousa, Maria do Céu

    2017-08-01

    Giardia lamblia is an intestinal parasite that has an extensive genetic variation among isolates. This species is divided into eight different assemblages (A-H), but only assemblages A and B have been associated with human infections. Studies on the associations of G. lamblia assemblages and symptoms have been done but were inconclusive. The aim of this study was to correlate G. lamblia assemblages with symptoms in patients with and without HIV/AIDS and its association with the CD4T cell count. The cross-sectional survey was conducted among patients attending the Evandro Chagas National Institute of Infectious Diseases (INI/FIOCRUZ) in Rio de Janeiro from January 2011 to February 2015. Thirty-eight of 65 microscopically positive stool samples for G. lamblia were from HIV positive patients and 27 were from HIV negative patients. Of the HIV infected patients, 19 (55.9%) were genotyped as assemblage B of which 9 (47.4%) had a CD4Tcell count below 200cells/mm3. In addition, we found a greater number of samples belonging to assemblage B in symptomatic cases (11 of 19; 57.9%). Our data suggest that assemblage B is very likely to be found in HIV infected patients and probably the lower CD4T count gives advantages for assemblage B replication. Furthermore, assemblage B seems to be associated with symptomatology, particularly abdominal pain, asthenia, diarrhea, fever, headache and myalgia. This study provides information on G. lamblia assemblages and symptoms in patients with and without HIV/AIDS virus and their association with CD4Tcell counts. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010

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    Iúri Paz Lima

    2013-04-01

    Full Text Available INTRODUCTION: Human immunodeficiency virus (HIV coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar, has become a fatal public health problem in the tropics where kala-azar is endemic. METHODS: The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization. RESULTS: During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients. CONCLUSIONS: The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy.

  1. Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R).

    Science.gov (United States)

    Fresán, Ana; León-Ortiz, Pablo; Robles-García, Rebeca; Azcárraga, Mariana; Guizar, Diana; Reyes-Madrigal, Francisco; Tovilla-Zárate, Carlos Alfonso; de la Fuente-Sandoval, Camilo

    2015-02-01

    Several variables have been identified as risk factors for conversion to overt psychosis in ultra-high risk for psychosis (UHR) individuals. Although almost two-thirds of them do not experience a transition to psychosis, they still exhibit functional disabilities. Other subjective developmental features may be useful for a more precise identification of individuals at UHR. Avoidant behaviors are consistently reported in schizophrenia and in UHR individuals and may be the reflection of a pattern of personality. Thus, personality features in UHR individuals deserves further research. The objective of the present study was to compare temperament and character dimensions between UHR individuals, patients with schizophrenia and healthy controls. One hundred participants (25 UHR individuals, 25 schizophrenia patients and 50 control subjects) where evaluated with the Temperament and Character Inventory-Revised (TCI-R). Univariate ANOVAs followed by Bonferroni tests were used. UHR individuals and schizophrenia patients exhibited higher levels of Harm Avoidance (HA) when compared to control subjects. For HA1 Anticipatory worry vs Uninhibited optimism and HA4 Fatigability & asthenia, UHR and schizophrenia groups showed similar scores and both groups were higher compared to control subjects. With respect to Cooperativeness (CO), UHR and schizophrenia reported lower scores than control subjects, in particular CO2 Empathy vs Social disinterest and CO3 Helpfulness vs unhelpfulness. This study replicates and extends the consideration of HA as a psychopathological related endophenotype and gives us further information of the possible role of personality features in the expression of some of the social dysfunctions observed both in prodromal subjects and schizophrenia patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Doxorubicin-Loaded 70–150 μm Microspheres for Liver-Dominant Metastatic Breast Cancer: Results and Outcomes of a Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Ting, E-mail: ymerically@gmail.com [Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Hôpital Européen Georges Pompidou (France); Médioni, Jacques, E-mail: jacques.medioni@aphp.fr [Assistance Publique - Hôpitaux de Paris, Oncology Department, Hôpital Européen Georges Pompidou (France); Amouyal, Grégory, E-mail: gregory.amouyal@aphp.fr; Déan, Carole, E-mail: carole.dean@egp.aphp.fr; Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr; Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr [Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Hôpital Européen Georges Pompidou (France)

    2017-01-15

    PurposePatients with breast cancer liver metastasis have a poor prognosis. Local therapy for liver metastasis increases survival. The purpose of this pilot prospective study was to evaluate the efficacy and safety of doxorubicin drug-eluting beads chemoembolization for liver-dominant breast cancer metastasis (LdBM) refractory to chemotherapy.Materials and MethodsAll patients with LdBM refractory to of two or more lines of systemic chemotherapy were screened. Two chemoembolizations at 1-month intervals were scheduled for each patient. Tumor responses were evaluated by MRI every 3 months until progression or death. Adverse events were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.02) 1 month after each chemoembolization. All patients were free from systemic treatment until progression. Patients with hormone-positive receptors and/or HER-positive disease status continued their targeted therapy.ResultsOut of 23 patients enrolled (mean age: 57.5 ± 11.5 years), 17 completed two chemoembolizations and six underwent only one because of severe adverse events. At 3-month follow-up, the disease control rate was 83 %. The median progression-free survival from the first chemoembolization was 8 months, and the median overall survival was 17 months. Nineteen patients remained free from any systemic chemotherapy for a mean of 209 ± 92 days until progression. Eight grade 3 (asthenia n = 3, anemia n = 2, thrombocythemia n = 2, liver toxicity n = 1) (Rev 1 Comment 1) occurred after the first procedure. No patient died directly due to the procedure.ConclusionWhile chemoembolization with doxorubicin eluding beads for refractory LdBM leads to an 83 % disease control rate, it also causes severe side effects that need to be adequately managed.

  3. Phase III Multinational, Randomized, Double-Blind, Placebo-Controlled Study of Tivantinib (ARQ 197) Plus Erlotinib Versus Erlotinib Alone in Previously Treated Patients With Locally Advanced or Metastatic Nonsquamous Non-Small-Cell Lung Cancer.

    Science.gov (United States)

    Scagliotti, Giorgio; von Pawel, Joachim; Novello, Silvia; Ramlau, Rodryg; Favaretto, Adolfo; Barlesi, Fabrice; Akerley, Wallace; Orlov, Sergey; Santoro, Armando; Spigel, David; Hirsh, Vera; Shepherd, Frances A; Sequist, Lecia V; Sandler, Alan; Ross, Jeffrey S; Wang, Qiang; von Roemeling, Reinhard; Shuster, Dale; Schwartz, Brian

    2015-08-20

    Tivantinib, a MET receptor tyrosine kinase inhibitor, demonstrated increased anticancer activity in preclinical and early clinical studies when combined with erlotinib. Our study aimed to confirm efficacy and safety of the combination in previously treated patients with non-small-cell lung cancer (NSCLC). Patients with advanced nonsquamous NSCLC previously treated with one to two systemic regimens, including a platinum doublet, were randomly assigned at a 1:1 ratio to receive erlotinib 150 mg daily plus oral tivantinib 360 mg twice daily (E + T) or erlotinib plus placebo (E + P) until disease progression. Tumor specimens were evaluated for EGFR and KRAS mutations, MET expression, and MET gene amplification. The primary end point was overall survival (OS). Secondary and exploratory objectives included progression-free survival (PFS), OS in molecular subgroups, and safety. The study enrolled 1,048 patients and was discontinued for futility at the interim analysis. OS did not improve with E + T versus E + P (median OS, 8.5 v 7.8 months, respectively; hazard ratio [HR], 0.98; 95% CI, 0.84 to 1.15; P = .81), even though PFS increased (median PFS, 3.6 v 1.9 months; HR, 0.74; 95% CI, 0.62 to 0.89; P < .001). Exploratory subgroup analyses suggested OS improvement in patients with high MET expression (HR, 0.70; 95% CI, 0.49 to 1.01). Most common adverse events occurring with E + T versus E + P were rash (33.1% v 37.3%, respectively), diarrhea (34.6% v 41.0%), asthenia or fatigue (43.5% v 38.1%), and neutropenia (grade 3 to 4; 8.5% v 0.8%). E + T was well tolerated and increased PFS but did not improve OS in the overall nonsquamous NSCLC population. © 2015 by American Society of Clinical Oncology.

  4. Human taeniasis in western Romania and its relationship to multicultural food habits and influences.

    Science.gov (United States)

    Neghina, Raul; Neghina, Adriana Maria; Marincu, Iosif; Iacobiciu, Ioan

    2010-05-01

    Taeniasis, an intestinal infection produced by adult tapeworms of the genus Taenia, is acquired by the consumption of raw or undercooked beef or pork containing the infective cysticerci. The symptoms are generally mild and include abdominal pain, nausea, dizziness, headache, weight loss, anorexia, and allergic syndromes. In Romania, the morbidity of taeniasis ranges between 0.4% and 0.75% with higher rates in Moldavia and Banat regions as a consequence of regional gastronomic customs. This study aimed to overview the epidemiological, clinical, and therapeutic characteristics of taeniasis cases diagnosed in Timis County, part of Banat region, during a 37-year period (1971-2007). The authors have retrospectively analyzed the medical charts of 26 adult patients (mean age 38.3 years) admitted to the reference hospital for infectious diseases in southwestern Romania. Females (77.0%, n = 20), inhabitants of urban areas (65.4%, n = 17), and laborers (46.2%, n = 12) were the most affected categories. The clinical symptoms included abdominal pain (57.7%, n = 15), asthenia (26.9%, n = 7), and loss of appetite (15.4%, n = 4). Eosinophilia was evidenced in 38.5% (n = 10) of the cases. For 80.8% (n = 21) of the patients, the hospitalization period ranged from 1 to 7 days. Niclosamide was administered in 61.5% (n = 16) of the cases. The disease might be more frequently diagnosed in patients with mild symptomatology or asymptomatic ones who usually consult general practitioners and hence the low number of cases treated in hospitals. As a consequence, specific prophylactic measures oriented mainly to sanitary education of the masses must be considered for its eradication. Collaboration between family physicians and veterinary doctors must be strengthened especially in the countryside regions where humans live in close proximity to animals on which they rely mostly for their food resources.

  5. Voice disorder in cystic fibrosis patients.

    Directory of Open Access Journals (Sweden)

    Bruna Mendes Lourenço

    Full Text Available Cystic fibrosis is a common autosomal recessive disorder with drastic respiratory symptoms, including shortness of breath and chronic cough. While most of cystic fibrosis treatment is dedicated to mitigating the effects of respiratory dysfunction, the potential effects of this disease on vocal parameters have not been systematically studied. We hypothesized that cystic fibrosis patients, given their characteristic respiratory disorders, would also present dysphonic symptoms. Given that voice disorders can severely impair quality of life, the identification of a potential cystic fibrosis-related dysphonia could be of great value for the clinical evaluation and treatment of this disease. We tested our hypothesis by measuring vocal parameters, using both objective physical measures and the GRBAS subjective evaluation method, in male and female cystic fibrosis patients undergoing conventional treatment and compared them to age and sex matched controls. We found that cystic fibrosis patients had a significantly lower vocal intensity and harmonic to noise ratio, as well as increased levels of jitter and shimmer. In addition, cystic fibrosis patients also showed higher scores of roughness, breathiness and asthenia, as well as a significantly altered general grade of dysphonia. When we segregated the results according to sex, we observed that, as a group, only female cystic fibrosis patients had significantly lower values of harmonic to noise ratio and an abnormal general grade of dysphonia in relation to matched controls, suggesting that cystic fibrosis exerts a more pronounced effect on vocal parameters of women in relation to men. Overall, the dysphonic characteristics of CF patients can be explained by dysfunctions in vocal fold movement and partial upper airway obstruction, potentially caused by the accumulation of mucus and chronic cough characteristic of CF symptomatology. Our results show that CF patients exhibit significant dysphonia and

  6. Reliability and Validity of the Turkish Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

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    Özcebe, Esra; Aydinli, Fatma Esen; Tiğrak, Tuğçe Karahan; İncebay, Önal; Yilmaz, Taner

    2018-01-11

    The main purpose of this study was to culturally adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to Turkish and to evaluate its internal consistency, validity, and reliability. The Turkish version of CAPE-V was developed, and with the use of a prospective case-control design, the voice recordings of 130 participants were collected according to CAPE-V protocol. Auditory-perceptual evaluation was conducted according to CAPE-V and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale by two ear, nose, and throat specialists and two speech and language therapists. The different types of voice disorders, classified as organic and functional disorders, were compared in terms of their CAPE-V scores. The overall severity parameter had the highest intrarater and inter-reliability values for all the participants. For all four raters, the differences in the six CAPE-V parameters between the study and the control groups were found to be statistically significant. Among the correlations for the comparable parameters of the CAPE-V and the GRBAS scales, the highest correlation was found between the overall severity-grade parameters. There was no difference found between the organic and functional voice disorders in terms of the CAPE-V scores. The Turkish version of CAPE-V has been proven to be a reliable and valid instrument to use in the auditory-perceptual evaluation of voice. For the future application of this study, it would be important to investigate whether cepstral measures correlate with the auditory-perceptual judgments of dysphonia severity collected by a Turkish version of the CAPE-V. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  7. Pitch Strength as an Outcome Measure for Treatment of Dysphonia.

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    Kopf, Lisa M; Jackson-Menaldi, Cristina; Rubin, Adam D; Skeffington, Jean; Hunter, Eric J; Skowronski, Mark D; Shrivastav, Rahul

    2017-03-16

    Measurement of treatment outcomes is critical for the spectrum of voice treatments (ie, surgical, behavioral, or pharmacological). Outcome measures typically include visual (eg, stroboscopic data), auditory (eg, Consensus Auditory-Perceptual Evaluation of Voice; Grade, Roughness, Breathiness, Asthenia, Strain), and objective correlates of vocal fold vibratory characteristics, such as acoustic signals (eg, harmonics-to-noise ratio, cepstral peak prominence) or patient self-reported questionnaires (eg, Voice Handicap Index, Voice-Related Quality of Life). Subjective measures often show high variability, whereas most acoustic measures of voice are only valid for signals where some degree of periodicity can be assumed. However, this assumption is often invalid for dysphonic voices where signal periodicity is suspect. Furthermore, many of these measures are not useful in isolation for diagnostic purposes. We evaluated a recently developed algorithm (Auditory Sawtooth Waveform Inspired Pitch Estimator-Prime [Auditory-SWIPE']) for estimating pitch and pitch strength for dysphonic voices. Whereas fundamental frequency is a physical attribute of a signal, pitch is its psychophysical correlate. As such, the perception of pitch can extend to most signals irrespective of their periodicity. Post hoc analyses were conducted for three groups of patients evaluated and treated for voice problems at a major voice center: (1) muscle tension dysphonia/functional dysphonia, (2) vocal fold mass(es), and (3) presbyphonia. All patients were recorded before and after surgical/behavioral treatment for voice disorders. Pitch and pitch strength for each speaker were computed with the Auditory-SWIPE' algorithm. Comparison of pre- and posttreatment data provides support for pitch strength as a measure of treatment outcomes for dysphonic voices. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  8. Motexafin gadolinium combined with prompt whole brain radiotherapy prolongs time to neurologic progression in non-small-cell lung cancer patients with brain metastases: results of a phase III trial.

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    Mehta, Minesh P; Shapiro, William R; Phan, See C; Gervais, Radj; Carrie, Christian; Chabot, Pierre; Patchell, Roy A; Glantz, Michael J; Recht, Lawrence; Langer, Corey; Sur, Ranjan K; Roa, Wilson H; Mahe, Marc A; Fortin, Andre; Nieder, Carsten; Meyers, Christina A; Smith, Jennifer A; Miller, Richard A; Renschler, Markus F

    2009-03-15

    To determine the efficacy of motexafin gadolinium (MGd) in combination with whole brain radiotherapy (WBRT) for the treatment of brain metastases from non-small-cell lung cancer. In an international, randomized, Phase III study, patients with brain metastases from non-small-cell lung cancer were randomized to WBRT with or without MGd. The primary endpoint was the interval to neurologic progression, determined by a centralized Events Review Committee who was unaware of the treatment the patients had received. Of 554 patients, 275 were randomized to WBRT and 279 to WBRT+MGd. Treatment with MGd was well tolerated, and 92% of the intended doses were administered. The most common MGd-related Grade 3+ adverse events included liver function abnormalities (5.5%), asthenia (4.0%), and hypertension (4%). MGd improved the interval to neurologic progression compared with WBRT alone (15 vs. 10 months; p = 0.12, hazard ratio [HR] = 0.78) and the interval to neurocognitive progression (p = 0.057, HR = 0.78). The WBRT patients required more salvage brain surgery or radiosurgery than did the WBRT+MGd patients (54 vs. 25 salvage procedures, p < 0.001). A statistically significant interaction between the geographic region and MGd treatment effect (which was in the prespecified analysis plan) and between treatment delay and MGd treatment effect was found. In North American patients, where treatment was more prompt, a statistically significant prolongation of the interval to neurologic progression, from 8.8 months for WBRT to 24.2 months for WBRT+MGd (p = 0.004, HR = 0.53), and the interval to neurocognitive progression (p = 0.06, HR = 0.73) were observed. In the intent-to-treat analysis, MGd exhibited a favorable trend in neurologic outcomes. MGd significantly prolonged the interval to neurologic progression in non-small-cell lung cancer patients with brain metastases receiving prompt WBRT. The toxicity was acceptable.

  9. Patients' perception of recovery after third molar surgery following postoperative treatment with moxifloxacin versus amoxicillin and clavulanic acid: a randomized, double-blind, controlled study.

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    Limeres, Jacobo; Sanromán, Jacinto F; Tomás, Inmaculada; Diz, Pedro

    2009-02-01

    To analyze the impact of the postoperative administration of moxifloxacin (MXF) on oral function and quality of life after third molar (TM) surgery. A single-center, prospective, randomized, double-blind, controlled clinical trial was designed. The study population consisted of 100 patients who underwent impacted TM extractions. Patients were distributed into 2 groups of 50 individuals each. Postoperatively, one group was administered MXF (400 mg/24 hours for 5 days); the positive control group received amoxicillin and clavulanic acid (AMX-CLV) (500/125 mg/8 hours for 5 days). Follow-up was performed for 7 postoperative days, during which the patient recorded information on pain, the use of rescue analgesia, undesirable effects of the medication, difficulty in speaking, difficulty in chewing, diet consistency, difficulty performing oral hygiene, asthenia, time in bed, going out of the house, and returning to work. The administration of MFX was significantly associated with headache, and AMX-CLV was significantly associated with diarrhea. Greater difficulty in chewing and performing oral hygiene was observed in the AMX-CLV group compared with the MXF group. The percentage of patients who tolerated a diet of normal consistency was significantly higher in the MXF group compared with the AMX-CLV group. During the first 4 days of follow-up, the percentage of patients who returned to work was significantly higher in the MXF group than in the AMX-CLV group. Moxifloxacin shortens the period of postoperative recovery in terms of oral function and return to work. Therefore, MXF could be a useful option in TM surgery when antibiotics are indicated, particularly if patients are allergic to beta-lactams, their oral flora is resistant to macrolides, or they are intolerant of either of these antibiotics.

  10. A phase I and pharmacokinetic study of irofulven and cisplatin administered in a 30-min infusion every two weeks to patients with advanced solid tumors.

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    Hilgers, Werner; Faivre, Sandrine; Chieze, Stéphanie; Alexandre, Jérôme; Lokiec, François; Goldwasser, François; Raymond, Eric; Kahatt, Carmen; Taamma, Abdelkrim; Weems, Garry; MacDonald, John R; Misset, Jean-Louis; Cvitkovic, Esteban

    2006-07-01

    To determine maximum tolerated dose (MTD), recommended dose, safety and pharmacokinetics of irofulven combined with cisplatin in advanced solid tumor patients. Cisplatin and irofulven were given sequentially i.v. over 30 min on day 1 and 15 every 4 weeks. Four dose levels (DL) were explored: irofulven (mg/kg)/cisplatin (mg/m2): DL1: 0.3/30; DL2: 0.4/30; DL3: 0.4/40; DL4: 0.5/40. Dose-limiting toxicity (DLT) included dosing omission and delay > 1 week. MTD was the DL with DLT in 2/2 or > or = 2/6 patients during cycle 1-2. Between March 2002 and April 2003, 33 patients were treated. DLT occurred in 1/6 patients in DL1 (hypomagnesemia, hypocalcemia); 1/6 in DL2 (thrombocytopenia); 2 heavily pretreated patients out of 6 patients in DL3 (neutropenic infection, thrombocytopenia, stomatitis); 2/3 in DL4 (asthenia, blurred vision). Three DLT occurred in 12 additional patients treated at DL2. No toxic deaths occurred; grade 4 toxicity and grade 3 non-hematological toxicity were infrequent. Six patients reported grade 1-2 visual events. Antitumor activity was observed over a broad spectrum of tumor types in all DLs: 1 partial response in bulky sarcoma (DL1); 1 clinical response in endometrial carcinoma (DL1); 2 partial responses not confirmed due to discontinuation (ovarian DL2, renal DL4); 8 stabilizations > 3 months; PSA response: 3/9 prostate cancer patients. Irofulven showed rapid elimination and high interpatient variability. Platinum and irofulven pharmacokinetics did not suggest drug-drug interactions. Irofulven with cisplatin was adequately tolerated and substantial evidence of antitumor activity was observed. The recommended dose is irofulven 0.4 mg/kg and cisplatin 30 mg/m2.

  11. Irofulven demonstrates clinical activity against metastatic hormone-refractory prostate cancer in a phase 2 single-agent trial.

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    Senzer, Neil; Arsenau, James; Richards, Donald; Berman, Barry; MacDonald, John R; Smith, Sheri

    2005-02-01

    The primary objective of this study was to assess the antitumor activity of irofulven in patients with hormone-refractory prostate cancer by measuring a sustained decrease of 50% or greater in serum prostate-specific antigen (PSA) levels. Forty-two patients (median age, 73 years) received at least 1 dose of 10.6 mg/m2 irofulven per day on days 1-5 of a 28-day course. Eligible patients had pathologically confirmed metastatic hormone-refractory adenocarcinoma of the prostate and had not received prior cytotoxic chemotherapy. Forty-two patients received a median of 3 courses of irofulven. Thirty-two patients received at least 2 courses of therapy and were evaluable for efficacy. Four patients (13%) achieved partial response, with a median duration of 2.9 months (range, 2.6-5.8 months). Twenty-seven patients (84%) had disease stabilization and 1 patient (3%) progressed on study. Median progression-free survival was 3.2 months (95% confidence interval, 2.3-4.2 months), with a median progression-free survival of 4.2 months (range, 3.5-6.9 months) for responders. Grade 4 toxicities consisted of thrombocytopenia, anemia, and neutropenia, occurring in 1 patient each. The most common treatment-related grade 3 nonhematologic toxicities included asthenia (19% of patients), vomiting (14%), nausea (12%), and infection without grade 3/4 neutropenia (10%). Irofulven shows activity in hormone-refractory prostate cancer and has an acceptable safety profile, warranting further investigation of this drug, particularly in combination therapies.

  12. Panobinostat as part of induction and maintenance for elderly patients with newly diagnosed acute myeloid leukemia: phase Ib/II panobidara study.

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    Ocio, Enrique M; Herrera, Pilar; Olave, María-Teresa; Castro, Nerea; Pérez-Simón, José A; Brunet, Salut; Oriol, Albert; Mateo, Marta; Sanz, Miguel-Ángel; López, Javier; Montesinos, Pau; Chillón, María-Carmen; Prieto-Conde, María-Isabel; Díez-Campelo, María; González, Marcos; Vidriales, María-Belén; Mateos, María-Victoria; San Miguel, Jesús F

    2015-10-01

    This phase Ib/II trial combined the pan-deacetylase inhibitor panobinostat with chemotherapy followed by panobinostat maintenance in elderly patients with newly diagnosed acute myeloid leukemia. Patients with prior history of myelodysplastic syndrome were excluded and 38 evaluable patients were included in the study (median age: 71 years; range: 65-83). Study patients received an induction with idarubicin (8 mg/m(2) iv days 1-3) plus cytarabine (100 mg/m(2) iv days 1-7) plus panobinostat po at escalating doses (days 8, 10, 12, 15, 17 and 19) that could be repeated in non-responding patients. Patients achieving complete remission received a consolidation cycle with the same schema, followed by panobinostat maintenance (40 mg po 3 days/week) every other week until progression. Thirty-one patients were treated at the maximum tolerated dose of panobinostat in the combination (10 mg) with good tolerability. Complete remission rate was 64% with a time to relapse of 17.0 months (12.8-21.1). Median overall survival for the whole series was 17 months (5.5-28.4). Moreover, in 4 of 5 patients with persistent minimal residual disease before maintenance, panobinostat monotherapy reduced its levels, with complete negativization in two of them. Maintenance phase was well tolerated. The most frequent adverse events were thrombocytopenia (25% grades 3/4), and gastrointestinal toxicity, asthenia and anorexia (mainly grades 1/2). Five patients required dose reduction during this phase, but only one discontinued therapy due to toxicity. These results suggest that panobinostat is one of the first novel agents with activity in elderly acute myeloid leukemia patients, and suggest further investigation is warranted, particularly in the context of maintenance therapy. This trial is registered at clinicaltrials.gov identifier: 00840346. Copyright© Ferrata Storti Foundation.

  13. Acute Myeloid Leukemia: analysis of epidemiological profile and survival rate.

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    de Lima, Mariana Cardoso; da Silva, Denise Bousfield; Freund, Ana Paula Ferreira; Dacoregio, Juliana Shmitz; Costa, Tatiana El Jaick Bonifácio; Costa, Imaruí; Faraco, Daniel; Silva, Maurício Laerte

    2016-01-01

    To describe the epidemiological profile and the survival rate of patients with acute myeloid leukemia (AML) in a state reference pediatric hospital. Clinical-epidemiological, observational, retrospective, descriptive study. The study included new cases of patients with AML, diagnosed between 2004 and 2012, younger than 15 years. Of the 51 patients studied, 84% were white; 45% were females and 55%, males. Regarding age, 8% were younger than 1 year, 47% were aged between 1 and 10 years, and 45% were older than 10 years. The main signs/symptoms were fever (41.1%), asthenia/lack of appetite (35.2%), and hemorrhagic manifestations (27.4%). The most affected extra-medullary site was the central nervous system (14%). In 47% of patients, the white blood cell (WBC) count was below 10,000/mm(3) at diagnosis. The minimal residual disease (MRD) was less than 0.1%, on the 15th day of treatment in 16% of the sample. Medullary relapse occurred in 14% of cases. When comparing the bone marrow MRD with the vital status, it was observed that 71.42% of the patients with type M3 AML were alive, as were 54.05% of those with non-M3 AML. The death rate was 43% and the main proximate cause was septic shock (63.6%). In this study, the majority of patients were male, white, and older than 1 year. Most patients with WBC count <10,000/mm(3) at diagnosis lived. Overall survival was higher in patients with MRD <0.1%. The prognosis was better in patients with AML-M3. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. Efficacy and safety of daclatasvir plus pegylated-interferon alfa 2a and ribavirin in previously untreated HCV subjects coinfected with HIV and HCV genotype-1: a Phase III, open-label study.

    Science.gov (United States)

    Sulkowski, Mark S; Fessel, Walford J; Lazzarin, Adriano; Berenguer, Juan; Zakharova, Natalia; Cheinquer, Hugo; Côté, Pierre; Dieterich, Douglas; Gadano, Adrian; Matthews, Gail; Molina, Jean-Michel; Moreno, Christophe; Pineda, Juan Antonio; Pulido, Federico; Rivero, Antonio; Rockstroh, Jurgen; Hernandez, Dennis; McPhee, Fiona; Eley, Timothy; Liu, Zhaohui; Mendez, Patricia; Hughes, Eric; Noviello, Stephanie; Ackerman, Peter

    2017-03-01

    Daclatasvir (DCV) is a potent, pangenotypic, hepatitis C virus (HCV) non-structural protein 5A inhibitor with low potential for drug interactions with antiretroviral therapy (ART). We evaluated the safety and efficacy of DCV plus peginterferon alfa-2a/ribavirin (PegIFN/RBV) in HIV-1/HCV genotype-1-coinfected patients. AI444043 (NCT01471574), an open-label, Phase III, single-arm, response-guided treatment (RGT) study included 301 patients. They received DCV doses of 30, 60 or 90 mg once daily (depending on concomitant ART), plus weight-based RBV (<75 kg, 1000 mg/day; or ≥75 kg, 1200 mg/day), and once-weekly PegIFN 180 μg, for 24 weeks. If required by RGT, PegIFN/RBV without DCV was extended for an additional 24 weeks of therapy. The primary endpoint was the proportion of patients with sustained virologic response at post-treatment Week 12 (SVR12). Overall, 224 (74%) patients achieved SVR12 and the lower bound of the 95% confidence interval was higher than the historic SVR rate with PegIFN/RBV alone (70 vs. 29%). Most common adverse events (AEs) were fatigue, neutropenia, anemia, asthenia and headache. On-treatment serious AEs occurred in 24/301 (8%) patients; 18/301 (6%) discontinued treatment due to AE. DCV + PegIFN/RBV led to sustained HCV virologic response in the majority of HIV-1-HCV-coinfected patients, regardless of concomitant ART. HIV control was not compromised and no new safety signals were identified. This study supports DCV use in HIV-1-HCV-coinfected patients, while allowing the vast majority of patients to remain on their existing ART regimen.

  15. Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010

    Directory of Open Access Journals (Sweden)

    Iúri Paz Lima

    2013-09-01

    Full Text Available INTRODUCTION: Human immunodeficiency virus (HIV coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar, has become a fatal public health problem in the tropics where kala-azar is endemic. METHODS: The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization. RESULTS: During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients. CONCLUSIONS: The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy.

  16. Clinical and laboratory profile of HIV-positive patients at the moment of diagnosis in Bahia, Brazil

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    Márcia Sampaio Sá

    Full Text Available In Brazil, current trends of the AIDS epidemic include an increase in transmission through heterosexual contact, predominantly from men to women, with more cases of AIDS in women and more children contaminated by vertical transmission. There is also a high proportion of cases in poor people or people living in small towns. HIV-infected patients with high levels of immunodeficiency are frequently hospitalized after their first visit to the clinic due to opportunistic infections, characteristic of advanced disease. This study characterized the clinical and laboratory pattern of AIDS in a sample of patients attended for the first time in the AIDS clinic of the Federal University of Bahia Hospital (HUPES in Salvador, Brazil. We revised medical charts of cases of subjects registered at the outpatient AIDS clinic from January 1997 to December 2003. The demographics, clinical data, and laboratory characteristics were analyzed to determine the degree of immunodeficiency at the time of admission. A total of 377 patients were evaluated (58.6% were male, with a mean sample age of 33.4 years. The most frequent clinical manifestations were asthenia, weight loss, fever, anemia, dermatitis, oral thrush and diarrhea. CDC criteria were not adequate to define the initial cases. After admission to the outpatient clinic, nearly 25% of the patients were hospitalized immediately, indicating delay in the diagnosis. In Bahia, the initial presentation of HIV-infected patients to health care assistance is occurring at a late stage of the disease, when signs and symptoms of immunodeficiency are already established. Efforts are necessary to construct strategies to make an early diagnosis of these patients, improve the quality of care, and guarantee the benefits of antiretroviral therapy, when it is indicated.

  17. Impact of locally advanced or metastatic prostate cancer on the quality of life.

    Science.gov (United States)

    López-Calderero, I; López-Fando, L; Ríos-González, E; Maisonobe, P; Hernández-Yuste, E; Sarmiento-Jordán, M

    The aim of this study was to assess the health-related quality of life of patients with prostate cancer in advanced phases to obtain additional information on the patients' health. The growing interest in understanding the patient's perspective and the scarcity of prospective studies of this population motivated this research study. We present an observational study performed on 131 urology consultations, with a sample of 601 patients with locally advanced or metastatic prostate cancer, assessed during 2 visits: baseline and at 12 months. We collected demographic, clinical, quality-of-life (PROSQoLI and EuroQoL-5D-5L questionnaires) and anxiety/depression (HADS questionnaire) endpoints. The mean age (SD) was 73.8 (8.2) years, and 87.2% of the participants were retired or pensioners. Some 58.7% of the patients presented locally advanced prostate cancer. Urinary symptoms were the most common, decreasing significantly after one year (P<.05). Urinary problems and fatigue were the most affected measures, and pain/discomfort was the dimension present in most patients (65.3%). According to the linear regression model, asthenia and pain were 2 of the factors most closely related to a poorer quality of life. The presence of anxiety/depression was low. Finally, the health condition as assessed by the clinician was more positive than when assessed by the patients. This study broadens the scarce information on the quality of life of the population with advanced prostate cancer, information of use for the clinical management of these patients. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Rupatadine 10 mg and cetirizine 10 mg in seasonal allergic rhinitis: a randomised, double-blind parallel study.

    Science.gov (United States)

    Martínez-Cócera, C; De Molina, M; Martí-Guadaño, E; Pola, J; Conde, J; Borja, J; Pérez, I; Arnaiz, E; Izquierdo, I

    2005-01-01

    This randomised, double-blind, parallel-group, multicentre clinical trial evaluated the efficacy and safety of rupatadine, a new antihistamine with antiplatelet-activating factor (PAF) activity, and cetirizine in the treatment of patients with seasonal allergic rhinitis (SAR). A total 249 patients were randomised to receive rupatadine 10 mg once daily (127 patients) or cetirizine 10 mg (122 patients) for two weeks. The main efficacy variable was the mean total daily symptom score (mTDSS) and was based on the daily subjective assessment of the severity of each rhinitis symptom--nasal (runny nose, sneezing, nasal itching and nasal obstruction) and non-nasal (conjunctival itching, tearing, and pharyngeal itching)--recorded by patients in their diaries. The mTDSS was 0.7 for both treatment groups (intention to treat analysis). In the investigator's global evaluation of efficacy at the seventh day, 93.3% and 83.7% patients in the rupatadine and cetirizine groups, respectively, showed some or great improvement (p = 0.022). In the per protocol analysis (n = 181), runny nose at the seventh day of treatment was absent or mild in 81.1% of patients in the rupatadine group and in 68.6% of patients in the cetirizine group (p = 0.029). In any case statistical significance was not maintained at the second week. Overall, all treatments were well tolerated. Adverse events (AEs) were similar in both treatment groups, i.e. headache, somnolence and fatigue/asthenia as the most often reported. Somnolence was reported in 9.6% and 8.5% of patients treated with rupatadine or cetirizine, respectively. The most reported AEs (67%) were mild in intensity. Our results suggest that rupatadine 10 mg may be a valuable and safe alternative for the symptomatic treatment of SAR.

  19. Ramadan fasting in patients with adrenal insufficiency.

    Science.gov (United States)

    Chihaoui, Mélika; Chaker, Fatma; Yazidi, Meriem; Grira, Wafa; Ben Amor, Zohra; Rejeb, Ons; Slimane, Hedia

    2017-01-01

    The risks of fasting during Ramadan in patients with adrenal insufficiency are unknown. The aims of this study were to evaluate these risks in such patients, to determine the risk factors and finally to set some recommendations. It is a cross-sectional study about 180 patients with known and treated adrenal insufficiency. The patients responded to a 14-item questionnaire concerning their knowledge about the disease and fasting during the last month of Ramadan. There were 132 women and 48 men. The mean age was 47.6 ± 15.0 years (14-79). One hundred and thirty eight patients (76.7 %) were advised by their physician not to fast. Ninety-one patients (50.5 %) tried to fast. Complications occurred in 61 cases (67.0 %): asthenia in 88.5 % of cases, intense thirst in 32.8 %, symptoms of dehydration in 49.2 % and symptoms of hypoglycaemia in 18 %. One patient was hospitalized. Fifty-five patients (60.4 %) were able to fast for the whole month. Age, gender, duration of the disease, its primary origin, associated hypothyroidism, diabetes mellitus, hypertension or diabetes insipidus and daily dose of hydrocortisone did not significantly differ between fasters and non-fasters, full-month-fasters and partial-month-fasters, and fasters with complications and fasters without complications. The frequency of adequate knowledge about the disease was significantly higher in full-month-fasters vs. partial-month-fasters, and in fasters without complications vs. those with complications. In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.

  20. Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis.

    Science.gov (United States)

    Kono, Takeyuki; Yabe, Haruna; Uno, Kosuke; Saito, Koichiro; Ogawa, Kaoru

    2017-03-01

    Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery. Retrospective study. Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed. The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed. RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate. 3b Laryngoscope, 127:679-684, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  1. First-in-Human Phase I Study of Single-agent Vanucizumab, A First-in-Class Bispecific Anti-Angiopoietin-2/Anti-VEGF-A Antibody, in Adult Patients with Advanced Solid Tumors.

    Science.gov (United States)

    Hidalgo, Manuel; Martinez-Garcia, Maria; Tourneau, Christophe Le; Massard, Christophe; Garralda, Elena; Boni, Valentina; Taus, Alvaro; Albanell, Joan; Sablin, Marie-Paule; Alt, Marie; Bahleda, Ratislav; Varga, Andrea; Boetsch, Christophe; Franjkovic, Izolda; Heil, Florian; Lahr, Angelika; Lechner, Katharina; Morel, Anthony; Nayak, Tapan; Rossomanno, Simona; Smart, Kevin; Stubenrauch, Kay; Krieter, Oliver

    2017-12-07

    Purpose: Vanucizumab is an investigational antiangiogenic, first-in-class, bispecific mAb targeting VEGF-A and angiopoietin-2 (Ang-2). This first-in-human study evaluated the safety, pharmacokinetics, pharmacodynamics, and antitumor activity of vanucizumab in adults with advanced solid tumors refractory to standard therapies. Experimental Design: Patients received escalating biweekly (3-30 mg/kg) or weekly (10-30 mg/kg) intravenous doses guided by a Bayesian logistic regression model with overdose control. Results: Forty-two patients were treated. One dose-limiting toxicity, a fatal pulmonary hemorrhage from a large centrally located mediastinal mass judged possibly related to vanucizumab, occurred with the 19 mg/kg biweekly dose. Arterial hypertension (59.5%), asthenia (42.9%), and headache (31%) were the most common toxicities. Seventeen (41%) patients experienced treatment-related grade ≥3 toxicities. Toxicity was generally higher with weekly than biweekly dosing. A MTD of vanucizumab was not reached in either schedule. Pharmacokinetics were dose-linear with an elimination half-life of 6-9 days. All patients had reduced plasma levels of free VEGF-A and Ang-2; most had reductions in K TRANS (measured by dynamic contrast-enhanced MRI). Two patients (renal cell and colon cancer) treated with 30 mg/kg achieved confirmed partial responses. Ten patients were without disease progression for ≥6 months. A flat-fixed 2,000 mg biweekly dose (phamacokinetically equivalent to 30 mg/kg biweekly) was recommended for further investigation. Conclusions: Biweekly vanucizumab had an acceptable safety and tolerability profile consistent with single-agent use of selective inhibitors of the VEGF-A and Ang/Tie2 pathway. Vanucizumab modulated its angiogenic targets, impacted tumor vascularity, and demonstrated encouraging antitumor activity in this heterogeneous population. Clin Cancer Res; 1-10. ©2017 AACR. ©2017 American Association for Cancer Research.

  2. Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Aaltonen, Leena-Maija, E-mail: leena-maija.aaltonen@hus.fi [Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Rautiainen, Noora; Sellman, Jaana [Institute of Behavioural Sciences, University of Helsinki, Helsinki (Finland); Saarilahti, Kauko [Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Mäkitie, Antti; Rihkanen, Heikki [Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Laranne, Jussi; Kleemola, Leenamaija [Department of Otorhinolaryngology–Head and Neck Surgery, Tampere University Hospital, and University of Tampere, Tampere (Finland); Wigren, Tuija [Department of Oncology, Tampere University Hospital, and University of Tampere, Tampere (Finland); Sala, Eeva [Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku (Finland); Lindholm, Paula [Department of Oncology, Turku University Hospital, and University of Turku, Turku (Finland); Grenman, Reidar [Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku (Finland); Joensuu, Heikki [Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland)

    2014-10-01

    Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Methods and Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO{sub 2} laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.

  3. [Villous adenoma of the rectum with severe hydroelectric alterations. Report of two cases].

    Science.gov (United States)

    Sierra-Montenegro, Ernesto; Rocha-Ramírez, José Luis; Villaneuva-Sáenz, Eduardo; de la Serna-Ortiz, Iván; Fernández-Rivero, José Manuel; Soto-Quirino, René

    2007-01-01

    Approximately 10% of all colorectal adenomas are constituted by villous adenomas. Their relationship with hydroelectrolytic depletion is rare. We report two cases with villous adenoma that presented hydroelectrolytic depletion with clinical and surgical management, exclusively. Case 1. Patient was a 76-year-old female with hypertension and 3 months evolution of symptoms such as asthenia, adynamia, unexplained weight loss, and abundant mucus with diarrhea. Serum potassium value was 2.2 mEq/l . Upon rectal exam we found a sessile, exophitic soft tumor with irregular surface of approximately 10 cm in diameter. We also performed a transanal resection of tumor reporting villous adenoma. The patient was discharged from the hospital at the 4th postoperative day with potassium values within normal limits. Case report 2. Patient was a 76-year-old female with diabetes and hypertension of long evolution. She reported a 4-month clinical evolution with non-bloody diarrhea and abundant mucus. She reported nausea, vomiting and no unexplained weight loss. Serum potassium value was 2.1 mEq/l . During the rectal exam we identified a sessile, polypoid, 5-cm diameter tumor that did not involve deep planes. In addition, we carried out a transanal resection of the polyp. The patient was discharged from the hospital on the 5th postoperative day. Potassium value was 4.3 mEq/l. Size and location of the villous adenoma are related to the production of mucus secretory diarrhea. The inhibiting well-known indomethacin of the prostaglandins has been used to decrease the mucus secretion. In every patient with presence of mucus, persistent diarrhea and occasional rectal bleeding of 1 month, it is necessary to carry out lower endoscopy to rule out the presence of villous adenoma.

  4. Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin.

    Science.gov (United States)

    Ballester-Ferré, Maria Pilar; Martínez, Fernando; Garcia-Gimeno, Natalia; Mora, Francisco; Serra, Miguel A

    2017-01-28

    Chronic hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. In the last 5 years, treatment for HCV infection has experienced a marked development. In 2014, the use of ledipasvir/sofosbuvir with or without concomitant weight-based ribavirin was approved with a very significant increase in the sustained virological response. However, new side effects have been associated. We report the first case of an HCV infected patient treated for 12 wk with the combination of sofosbuvir/ledipasvir plus ribavirin who developed a miliary tuberculosis (TB) infection while on therapy. The patient was a 65-year-old woman, who referred malaise, asthenia, hyporexia, 7 kg weight loss, productive cough, evening fever and night sweats, right after finishing the treatment. The chest computed tomography-scan revealed a superior mediastinal widening secondary to numerous lymphadenopathies with extensive necrosis and bilateral diffuse lung miliary pattern with little subsequent bilateral pleural effusion, highly suggestive of lymph node tuberculosis with lung miliary spread. A bronchoscopy was performed and bronchial suction showed more than 50 acid-alcohol resistant bacillus per line. A Mycobacterium tuberculosis DNA was detected in blood by polymerase chain reaction, which confirmed the diagnosis of miliary tuberculosis. Some cases of TB infection have been identified with α-interferon-based therapy and with the triple therapy of pegylated interferon, ribavirin and boceprevir or telaprevir. However, significant infection has not been reported with sofosbuvir/ledipasvir plus ribavirin. We believe that the case is relevant to increase awareness of opportunistic infections and particularly TB infection. Although the international guidelines offer no recommendation regarding TB screening, we wonder whether it would be advisable to screen for opportunistic infections prior to the introduction of HCV therapy.

  5. Specific behaviour, mood and personality traits may contribute to obesity in patients with craniopharyngioma.

    Science.gov (United States)

    Roemmler-Zehrer, J; Geigenberger, V; Störmann, S; Ising, M; Pfister, H; Sievers, C; Stalla, G K; Schopohl, J

    2015-01-01

    Patients with craniopharyngioma (CP) often suffer from obesity, but the underlying causes are still not fully understood. We compared CP to patients with nonfunctioning pituitary adenoma (NFPA) and to a control group (CG) using standardized questionnaires to investigate whether behavioural, mood or personality traits contribute to obesity. We compared 31 patients with CP (42% male, 53 ± 15·1 years) to 26 patients with NFPA (71% male, 63·2 ± 10·3 years) and to age- and gender-matched local CG (ratio 2:1). Normative data from the literature are included for reference. Patients were asked to complete eleven standardized questionnaires. Two questionnaires were used to evaluate eating disorders (FEV, EDE-Q), one depression (BDI), one anxiety (STAI), three health-related quality of life (SF-36, EuroQoL, QoL-AGHDA), one sleepiness (Epworth Sleepiness Scale), two personality (EPQ-RK, TPQ) and one body image (FKB-20). Patients with CP scored significantly higher in conscious hunger perception (FEV, CP 5·8 ± 3·2 scores, NFPA 3·6 ± 3·3 scores, CG 3·0 ± 2·5, P personality traits such as harm avoidance, fatigability and asthenia and slightly higher for neuroticism. No differences were seen for EDE-Q, quality of life, daytime sleepiness and body image between CP and NFPA. However, differences could be observed to normative data from the literature. Obesity in patients with CP might be influenced by eating disorders, negative mood alterations and increased anxiety-related personality traits. © 2014 John Wiley & Sons Ltd.

  6. Chronic fatigue syndrome: aetiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Palacín Delgado Cecilia

    2009-10-01

    Full Text Available Abstract Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress, although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.

  7. First-in-man phase I study assessing the safety and pharmacokinetics of a 1-hour intravenous infusion of the doxorubicin prodrug DTS-201 every 3 weeks in patients with advanced or metastatic solid tumours.

    Science.gov (United States)

    Schöffski, Patrick; Delord, Jean-Pierre; Brain, Etienne; Robert, Jacques; Dumez, Herlinde; Gasmi, Jamal; Trouet, André

    2017-11-01

    DTS-201 is a doxorubicin (Dox) prodrug that shows encouraging data in experimental models in terms of both efficacy and safety compared with conventional Dox. The purpose of this phase I study was to assess the safety profile, to establish the recommended dose (RD) for clinical phase II studies and to assess potential anticancer activity of the compound. DTS-201 was administered as a 1-hour infusion every 3 weeks in eligible patients with advanced solid tumours according to common clinical phase I criteria. Dose escalation was performed according to a modified Fibonacci schema. Twenty-five patients with a median age of 58 years (range, 30-72) were enrolled in the study. The median number of treatment cycles was 2 (range, 1-8). DTS-201 was administered at four dose levels (DLs) ranging from 80 to 400 mg/m2, which is equivalent to 45-225 mg/m2 of conventional Dox. No dose-limiting toxicity (DLT) occurred at the first two DLs. Three DLTs were observed at DL3 and DL4 (diarrhoea for DL3, vomiting and neutropenia for DL4). DL4 (400 mg/m2) was considered the maximum tolerated dose. Myelosuppression was the main toxicity, and NCI-CTC grade III-IV neutropenia was common at RD. Non-haematological adverse reactions were mild to moderate and included nausea, anorexia, asthenia and alopecia. No treatment-related severe cardiac adverse events were observed. DTS-201 is well tolerated and safe in heavily pretreated solid tumour patients. A high equivalent dose of Dox could be delivered without severe drug-related cardiac events. DTS-201 showed evidence of clinical activity with a confirmed partial response in a patient with soft-tissue sarcoma. The recommended phase II dose is 400 mg/m2. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Vocal parameters and voice-related quality of life in adult women with and without ovarian function.

    Science.gov (United States)

    Ferraz, Pablo Rodrigo Rocha; Bertoldo, Simão Veras; Costa, Luanne Gabrielle Morais; Serra, Emmeliny Cristini Nogueira; Silva, Eduardo Magalhães; Brito, Luciane Maria Oliveira; Chein, Maria Bethânia da Costa

    2013-05-01

    To identify the perceptual and acoustic parameters of voice in adult women with and without ovarian function and its impact on quality of life related to voice. Cross-sectional and analytical study with 106 women divided into, two groups: G1, with ovarian function (n=43) and G2, without physiological ovarian function (n=63). The women were instructed to sustain the vowel "a" and the sounds of /s/ and /z/ in habitual pitch and loudness. They were also asked to classify their voices and answer the voice-related quality of life (V-RQOL) questionnaire. The perceptual analysis of the vocal samples was performed by three speech-language pathologists using the GRBASI (G: grade; R: roughness; B: breathness; A: asthenia; S: strain; I: instability) scale. The acoustic analysis was carried out with the software VoxMetria 2.7h (CTS Informatica). The data were analyzed using descriptive statistics. In the perceptual analysis, both groups showed a mild deviation for the parameters roughness, strain, and instability, but only G2 showed a mild impact for the overall degree of dysphonia. The mean of fundamental frequency was significantly lower for the G2, with a difference of 17.41Hz between the two groups. There was no impact on V-RQOL in any of the V-RQOL domains for this group. With the menopause, there is a change in women's voices, impacting on some voice parameters. However, there is no direct impact on their quality of life related to voice. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  9. Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study

    Energy Technology Data Exchange (ETDEWEB)

    Mendez Romero, Alejandra; Wunderink, Wouter [Erasmus MC - Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Radiation Oncology; Hussain, Shahid M. [Univ. of Nebraska Medical Center, Omaha, NE (US). Dept. of Radiology] (and others)

    2006-09-15

    The feasibility, toxicity and tumor response of stereotactic body radiation therapy (SBRT) for treatment of primary and metastastic liver tumors was investigated. From October 2002 until June 2006, 25 patients not suitable for other local treatments were entered in the study. In total 45 lesions were treated, 34 metastases and 11 hepatocellular carcinoma (HCC). Median follow-up was 12.9 months (range 0.5-31). Median lesion size was 3.2 cm (range 0.5-7.2) and median volume 22.2 cm{sup 3} (range 1.1-322). Patients with metastases, HCC without cirrhosis, and HCC < 4 cm with cirrhosis were mostly treated with 3x12.5 Gy. Patients with HCC =4cm and cirrhosis received 5x5 Gy or 3x10 Gy. The prescription isodose was 65%. Acute toxicity was scored following the Common Toxicity Criteria and late toxicity with the SOMA/LENT classification. Local failures were observed in two HCC and two metastases. Local control rates at 1 and 2 years for the whole group were 94% and 82%. Acute toxicity grade =3 was seen in four patients; one HCC patient with Child B developed a liver failure together with an infection and died (grade 5), two metastases patients presented elevation of gamma glutamyl transferase (grade 3) and another asthenia (grade 3). Late toxicity was observed in one metastases patient who developed a portal hypertension syndrome with melena (grade 3). SBRT was feasible, with acceptable toxicity and encouraging local control. Optimal dose-fractionation schemes for HCC with cirrhosis have to be found. Extreme caution should be used for patients with Child B because of a high toxicity risk.

  10. Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real-world population of hormone receptor-positive (ER+/PgR+), HER2-negative advanced breast cancer (ABC) patients: a multicenter Italian experience.

    Science.gov (United States)

    Ciccarese, Mariangela; Fabi, Alessandra; Moscetti, Luca; Cazzaniga, Maria Elena; Petrucelli, Luciana; Forcignanò, Rosachiara; Lupo, Laura Isabella; De Matteis, Elisabetta; Chiuri, Vincenzo Emanuele; Cairo, Giuseppe; Febbraro, Antonio; Giordano, Guido; Giampaglia, Marianna; Bilancia, Domenico; La Verde, Nicla; Maiello, Evaristo; Morritti, Maria; Giotta, Francesco; Lorusso, Vito; Latorre, Agnese; Scavelli, Claudio; Romito, Sante; Cusmai, Antonio; Palmiotti, Gennaro; Surico, Giammarco

    2017-06-01

    This retrospective analysis focused on the effect of treatment with EVE/EXE in a real-world population outside of clinical trials. We examined the efficacy of this combination in terms of PFS and RR related to dose intensity (5 mg daily versus 10 mg daily) and tolerability. 163 HER2-negative ER+/PgR+ ABC patients, treated with EVE/EXE from May 2011 to March 2016, were included in the analysis. The primary endpoints were the correlation between the daily dose and RR and PFS, as well as an evaluation of the tolerability of the combination. Secondary endpoints were RR, PFS, and OS according to the line of treatment. Patients were classified into three different groups, each with a different dose intensity of everolimus (A, B, C). RR was 29.8% (A), 27.8% (B) (p = 0.953), and not evaluable (C). PFS was 9 months (95% CI 7-11) (A), 10 months (95% CI 9-11) (B), and 5 months (95% CI 2-8) (C), p = 0.956. OS was 38 months (95% CI 24-38) (A), median not reached (B), and 13 months (95% CI 10-25) (C), p = 0.002. Adverse events were stomatitis 57.7% (11.0% grade 3-4), asthenia 46.0% (6.1% grade 3-4), hypercholesterolemia 46.0% (0.6% grade 3-4), and hyperglycemia 35.6% (5.5% grade 3-4). The main reason for discontinuation/interruption was grade 2-3 stomatitis. No correlation was found between dose intensity (5 vs. 10 mg labeled dose) and efficacy in terms of RR and PFS. The tolerability of the higher dose was poor in our experience, although this had no impact on efficacy.

  11. Chronic fatigue syndrome: aetiology, diagnosis and treatment.

    Science.gov (United States)

    Avellaneda Fernández, Alfredo; Pérez Martín, Alvaro; Izquierdo Martínez, Maravillas; Arruti Bustillo, Mar; Barbado Hernández, Francisco Javier; de la Cruz Labrado, Javier; Díaz-Delgado Peñas, Rafael; Gutiérrez Rivas, Eduardo; Palacín Delgado, Cecilia; Rivera Redondo, Javier; Ramón Giménez, José Ramón

    2009-10-23

    Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.

  12. Sofosbuvir plus ribavirin in treatment-naïve patients with chronic hepatitis C virus genotype 1 or 3 infection in India.

    Science.gov (United States)

    Shah, S R; Chowdhury, A; Mehta, R; Kapoor, D; Duseja, A; Koshy, A; Shukla, A; Sood, A; Madan, K; Sud, R; Nijhawan, S; Pawan, R; Prasad, M; Kersey, K; Jiang, D; Svarovskaia, E; Doehle, B; Kanwar, B; Subramanian, M; Acharya, S K; Sarin, S

    2017-05-01

    Until 2014, pegylated interferon plus ribavirin was the recommended standard of care for the treatment of chronic hepatitis C virus (HCV) infection in India. This open-label phase 3b study, conducted across 14 sites in India between 31 March 2014 and 30 November 2015, evaluated the efficacy and safety of sofosbuvir plus ribavirin therapy among treatment-naïve patients with chronic genotype 1 or 3 HCV infection. A total of 117 patients with genotype 1 or 3 HCV infection were randomized 1:1 to receive sofosbuvir 400 mg and weight-based ribavirin (1000 or 1200 mg) daily for 16 or 24 weeks. Among those with genotype 1 infection, the primary efficacy endpoint of sustained virologic response at 12 weeks post-treatment (SVR12) was reported in 90% (95% confidence intervals [CI], 73-98) and 96% (95% CI, 82-100) of patients following 16 and 24 weeks of treatment, respectively. For patients with genotype 3 infection, SVR12 rates were 100% (95% CI, 88-100) and 93% (95% CI, 78-99) after 16 and 24 weeks of therapy, respectively. Adverse events, most of which were mild or moderate in severity, occurred in 69% and 57% of patients receiving 16 and 24 weeks of treatment, respectively. The most common treatment-emergent adverse events were asthenia, headache and cough. Only one patient in the 24-week group discontinued treatment with sofosbuvir during this study. Overall, sofosbuvir plus ribavirin therapy achieved SVR12 rates ≥90% and was well tolerated among treatment-naïve patients with chronic genotype 1 or 3 HCV infection in India. © 2016 John Wiley & Sons Ltd.

  13. Safety and efficacy of nivolumab in the treatment of cancers: A meta-analysis of 27 prospective clinical trials.

    Science.gov (United States)

    Tie, Yan; Ma, Xuelei; Zhu, Chenjing; Mao, Ye; Shen, Kai; Wei, Xiawei; Chen, Yan; Zheng, Heng

    2017-02-15

    Immune checkpoint inhibition therapy has benefited people and shown powerful anti-tumor activity during the past several years. Nivolumab, a fully human IgG4 monoclonal antibody against PD-1, is a widely studied immune checkpoint inhibitor for the treatment of cancers. To assess the safety and efficacy of nivolumab, 27 clinical trials on nivolumab were analyzed. Results showed that the summary risks of all grade adverse effects (AEs) and grade ≥3 AEs were 0.65 and 0.12. The rate of nivolumab-related death was 0.25%. The most common any grade AEs were fatigue (25.1%), rush (13.0%), pruritus (12.5%), diarrhea (12.1%), nausea (11.8%) and asthenia (10.4%). The most common grade ≥3 AEs were hypophosphatemia (only 2.3%) and lymphopenia (only 2.1%). The pooled objective response rate (ORR), 6-month progression-free survival (PFS) rate and 1-year overall survival (OS) rate were 0.26, 0.40 and 0.52, respectively. The odds ratio of ORR between PD-L1 positive and negative was 2.34 (95% CI 1.77-3.10, p nivolumab and chemotherapeutics were 2.77 (95% CI 1.69-4.56, p nivolumab has durable outcomes with tolerable AEs and drug-related deaths in cancer patients. Nivolumab monotherapy has better treatment response compared with chemotherapy, whereas chemotherapeutics have significantly higher risk of adverse effects than nivolumab. © 2016 UICC.

  14. Sequential chemotherapy with dose-dense docetaxel, cisplatin, folinic acid and 5-fluorouracil (TCF-dd) followed by combination of oxaliplatin, folinic acid, 5-fluorouracil and irinotecan (COFFI) in metastatic gastric cancer: results of a phase II trial.

    Science.gov (United States)

    Dalla Chiesa, Matteo; Tomasello, Gianluca; Buti, Sebastiano; Rovere, Rodrigo Kraft; Brighenti, Matteo; Lazzarelli, Silvia; Donati, Gianvito; Passalacqua, Rodolfo

    2011-01-01

    To evaluate a new strategy of two sequential, intensified chemotherapy regimens in metastatic gastric cancer. Chemo-naïve patients with metastatic gastric cancer were enrolled to receive 4 cycles of TCF-dd (docetaxel initially 85 mg/m(2) and cisplatin initially 75 mg/m(2) on day 1 [later modified due to toxicity: 70 and 60 mg/m(2) respectively], l-folinic acid 100 mg/m(2) on days 1 and 2, 5-fluorouracil 400 mg/m(2) bolus and then 600 mg/m(2) as a 22 h continuous infusion on day 1 and 2, every 14 days). Subsequently, patients with CR, PR or SD received 4 cycles of COFFI (oxaliplatin 85 mg/m(2), irinotecan 140 mg/m(2), l-folinic acid 200 mg/m(2), 5-fluorouracil bolus 400 mg/m(2) on day 1 followed by 2,400 mg/m(2) as a 48 h continuous infusion, every 14 days). In both regimens pegfilgrastim 6 mg subcutaneously on day 3 was included. Forty consecutive patients were enrolled. TCF-dd regimen achieved an ORR of 55% (95% CI, 40-70). Twenty-three patients proceeded to COFFI. After this regimen the ORR was then increased to 60% (95% CI, 45-75). Among the 21 patients treated with TCF-dd after the protocol amendments, main grade 3-4 toxicities were: neutropenia (29%), thrombocytopenia (19%), asthenia (24%) and diarrhea (14%). COFFI caused grade 3-4 neutropenia (all not febrile) and diarrhea in 35% and 17% of patients respectively. A sequential strategy with TCF-dd followed by COFFI is very active and may be of special interest in selected patients.

  15. Evaluating voice characteristics of first-year acting students in Israel: factor analysis.

    Science.gov (United States)

    Amir, Ofer; Primov-Fever, Adi; Kushnir, Tami; Kandelshine-Waldman, Osnat; Wolf, Michael

    2013-01-01

    Acting students require diverse, high-quality, and high-intensity vocal performance from early stages of their training. Demanding vocal activities, before developing the appropriate vocal skills, put them in high risk for developing vocal problems. A retrospective analysis of voice characteristics of first-year acting students using several voice evaluation tools. A total of 79 first-year acting students (55 women and 24 men) were assigned into two study groups: laryngeal findings (LFs) and no laryngeal findings, based on stroboscopic findings. Their voice characteristics were evaluated using acoustic analysis, aerodynamic examination, perceptual scales, and self-report questionnaires. Results obtained from each set of measures were examined using a factor analysis approach. Significant differences between the two groups were found for a single fundamental frequency (F(0))-Regularity factor; a single Grade, Roughness, Breathiness, Asthenia, Strain perceptual factor; and the three self-evaluation factors. Gender differences were found for two acoustic analysis factors, which were based on F(0) and its derivatives, namely an aerodynamic factor that represents expiratory volume measurements and a single self-evaluation factor that represents the tendency to seek therapy. Approximately 50% of the first-year acting students had LFs. These students differed from their peers in the control group in a single acoustic analysis factor, as well as perceptual and self-report factors. No group differences, however, were found for the aerodynamic factors. Early laryngeal examination and voice evaluation of future professional voice users could provide a valuable individual baseline, to which later examinations could be compared, and assist in providing personally tailored treatment. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  16. Renal lithiasis in patients with primary hyperparathyroidism. Evolution and treatment.

    Science.gov (United States)

    Valle Díaz de la Guardia, Francisco; Arrabal Martín, Miguel; Arrabal Polo, Miguel Angel; Quirosa Flores, Susana; Miján Ortiz, Jose Luis; Zuluaga Gómez, Armando

    2010-01-01

    The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography. We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows. Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected. We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student's t test on two independent samples revealed significant statistical differences in calcium levels (plithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and

  17. A prospective longitudinal study of voice characteristics and health-related quality of life outcomes following laryngeal cancer treatment with radiotherapy.

    Science.gov (United States)

    Karlsson, Therese; Bergström, Liza; Ward, Elizabeth; Finizia, Caterina

    2016-06-01

    Background To investigate potential changes in perceptual, acoustic and patient-reported outcomes over 12 months for laryngeal cancer patients treated with radiotherapy. Material and methods A total of 40 patients with Tis-T3 laryngeal cancer treated with curative intent by radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, one month, six months and 12 months post-radiotherapy, where voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed at each appointment. Perceptual analysis, using the Grade-Roughness-Breathiness-Asthenia-Strain scale and vocal fry parameters, and acoustic measures including harmonics-to-noise ratio (HNR), jitter, shimmer and mean spoken fundamental frequency (MSFF) were produced from voice recordings. Results All patients presented with dysphonic voices pre-radiotherapy, where 95% demonstrated some degree of vocal roughness. This variable improved significantly immediately post-radiotherapy, however, then deteriorated again between six and 12 months. Vocal fry also increased significantly at 12 months. Acoustic measures were abnormal pre- and post-treatment with no significant change noted except for MSFF, which lowered significantly by 12 months. Health-related quality of life (HRQL) deteriorated post-radiotherapy but returned to pretreatment levels by 12 months. Conclusion By 12 months, most perceptual, acoustic, patient-reported voice and HRQL outcomes for laryngeal cancer patients treated by radiotherapy had showed no significant improvements compared to pretreatment function. Further studies are required to investigate potential benefits of voice rehabilitation following radiotherapy.

  18. Primary chemotherapy with gemcitabine as prolonged infusion, non-pegylated liposomal doxorubicin and docetaxel in patients with early breast cancer: final results of a phase II trial.

    Science.gov (United States)

    Schmid, P; Krocker, J; Jehn, C; Michniewicz, K; Lehenbauer-Dehm, S; Eggemann, H; Heilmann, V; Kümmel, S; Schulz, C O; Dieing, A; Wischnewsky, M B; Hauptmann, S; Elling, D; Possinger, K; Flath, B

    2005-10-01

    Combinations of anthracyclines, taxanes and gemcitabine have shown high activity in breast cancer. This trial was designed to evaluate a modified combination regimen as primary chemotherapy. Non-pegylated liposomal doxorubicin (NPLD) was used instead of conventional doxorubicin to improve cardiac safety. Gemcitabine was given 72 h after NPLD and docetaxel as a prolonged infusion over 4 h in order to optimize synergistic effects and accumulation of active metabolites. Forty-four patients with histologically confirmed stage II or III breast cancer were treated with NPLD (60 mg/m(2)) and docetaxel (75 mg/m(2)) on day 1 and gemcitabine as 4-h infusion (350 mg/m(2)) on day 4. Treatment was repeated every 3 weeks for a maximum of six cycles. All patients received prophylactically recombinant granulocyte colony-stimulating factor. Patients with axillary lymph node involvement after primary chemotherapy received adjuvant treatment with cyclophosphamide, methotrexate and fluorouracil. The clinical response rate was 80%, and complete remissions of the primary tumor occurred in 10 patients (25%). Breast conservation surgery was performed in 19 out of 20 patients (95%) with an initial tumor size of less than 3 cm and in 14 patients (70%) with a tumor size asthenia and elevation of liver enzymes. The evaluated schedule provides a safe and highly effective combination treatment for patients with early

  19. Biweekly Pegylated Liposomal Doxorubicin (Caelyx) in Heavily Pretreated Metastatic Breast Cancer: A Phase 2 Study.

    Science.gov (United States)

    Jehn, Christian F; Hemmati, Philipp; Lehenbauer-Dehm, Silvia; Kümmel, Sherko; Flath, Bernd; Schmid, Peter

    2016-12-01

    Pegylated liposomal doxorubicin (PLD) has shown to be as effective as conventional doxorubicin in the treatment of metastatic breast cancer but provides a lower risk of cardiotoxicity. This phase 2 study in heavily pretreated patients with metastatic breast cancer was initiated to evaluate a biweekly instead of a 4-week schedule of PLD in order to obtain a more flexible and tolerable regimen. A total of 25 patients with 2 or more prior lines of chemotherapy for metastatic disease were treated with PLD (25 mg/m2) at 2-week intervals for a maximum of 12 courses. Pretreatment with anthracyclines was allowed as long as the cumulative doxorubicin dose at study entry was below 400 mg/m2. Most patients were pretreated with anthracyclines, taxanes, vinorelbine, alkylating agents, and capecitabine. The clinical benefit rate, ie, objective response or stable disease, for at least 6 months was 22.7% for all patients and 22.2% in anthracycline- and taxane-pretreated patients, respectively. Median duration of clinical benefit and median time to progression were 12.5 months (95% confidence interval [CI], 10.1-32.3) and 7 weeks (95% CI, 5.4-8.6), respectively. Median overall survival was 9.6 months (95% CI, 5.4-13.9). One- and 2-year survival rates were 38% and 4%, respectively. Myelosuppression was low, with no grade 3 or 4 neutropenia or thrombocytopenia. Most common nonhematologic toxicities were nausea, alopecia, asthenia, and hand-foot syndrome. The low rate of hematologic toxicity and hand-foot syndrome is clinically noteworthy. Biweekly PLD is an easily manageable schedule with a favorable toxicity profile. Efficacy was moderate in heavily pretreated patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Multiple lymphomatous polyposis of the gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Maria Isete Fares Franco

    Full Text Available CONTEXT: Gastrointestinal multiple lymphomatous polyposis is a rare type of malignant lymphoma that has aggressive biological behavior, early systemic dissemination and poor prognosis. It is considered to be a manifestation of non-Hodgkin lymphoma and represents the gastrointestinal counterpart of mantle cell nodal lymphoma. OBJECTIVE: A case of gastrointestinal multiple lymphomatous polyposis is presented and the anatomopathological, clinical, diagnostic and treatment aspects of this unusual neoplasia are discussed. CASE REPORT: The patient was a 59-year-old white male with a complaint of asthenia, night sweating, alteration in intestinal habit and weight loss over the preceding two months. The physical examination showed pallid mucosa and a palpable mass in the epigastrium and mesogastrium. Endoscopy of the upper digestive tract showed the presence of gastric and duodenal polyps. An opaque enema showed multiple polypoid lesions, especially in the cecum. A rectal biopsy revealed infiltration of the mucosa and submucosa by diffuse lymphoma consisting of small cleaved cells. Immunohistochemical study showed lymphocytes that expressed the antibody CD20 (L-26 and light-chain kappa (k immunoglobulin, but not light-chain lambda (l immunoglobulin. The patient presented a condition of acute intestinal obstruction with the presence of a mesenteric mass formed by agglutinated lymph nodes that surrounded the proximal ileum, thereby obstructing its lumen. He was submitted to a segmental enterectomy and gastrotomy with excisional biopsies of the gastric polypoid lesions. After two cycles of chemotherapy there was a worsening of the general state, with an increase in the dimensions of the abdominal masses and sepsis, accompanied by progressive respiratory insufficiency, leading to death.

  1. Effects of changes in nasal volume on voice in patients after endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Kim, Do Hyun; Hong, Yong-Kil; Jeun, Sin-Soo; Park, Jae-Sung; Kim, Soo Whan; Cho, Jin Hee; Park, Yong Jin; Lee, Hyuck Jae; Hwang, Yeon-Shin; Kim, Sung Won

    2017-05-01

    To investigate a potential correlation between changes in voice and changes in nasal volume. The endoscopic endonasal transsphenoidal approach (EETSA) was performed on 120 patients between February 2009 and August 2016 by using the bilateral modified nasoseptal rescue flaps method. All the patients were subjected to pre- and postoperative paranasal computed tomography (CT) and voice evaluations by using acoustic analyses, a nasometer to measure the nasalance, and determination of the voice handicap index (VHI). Paranasal CT and the medical image processing software were used to calculate changes in nasal cavity volume in three nasal sections. Enlargement of the nasal cavity after surgery was evident in all three areas (anteronasal, p < 0.001; midnasal, p = 0.005; postnasal, p = 0.025). In addition, EETSA resulted in significantly higher mean nasalance scores for the oronasal passage (p < 0.001) and nasal passage (p < 0.001); more frequency perturbation (jitter) (p < 0.001) and amplitude perturbation (shimmer) (p < 0.001); and higher grade, roughness, breathiness, asthenia, and strain scores (p < 0.001), and VHI (p = 0.01). However, only changes in the nasal volume after EETSA correlated with postnasal hypernasality (r = 0.2; p = 0.029). Although changes in nasal volume, voice, and speech may develop after EETSA, we found that changes in nasal volume were not correlated with changes in any voice-quality measure. However, the postnasal cavity was the region most dramatically affected by EETSA, and postnasal volume changes after surgery may be associated with hypernasal speech.

  2. A phase 2 randomised discontinuation trial of cabozantinib in patients with ovarian carcinoma.

    Science.gov (United States)

    Vergote, Ignace B; Smith, David C; Berger, Raanan; Kurzrock, Razelle; Vogelzang, Nicholas J; Sella, Avishay; Wheler, Jennifer; Lee, Yihua; Foster, Paul G; Weitzman, Ron; Buckanovich, Ronald J

    2017-09-01

    Cabozantinib (XL184), an orally bioavailable inhibitor of vascular endothelial growth factor receptor 2 and MET, was assessed in a cohort of ovarian carcinoma patients as part of a phase 2 randomised discontinuation trial (RDT) with cohorts from nine different tumour types. Patients received 100-mg cabozantinib daily. Those with stable disease (SD) per Response Evaluation Criteria in Solid Tumors at week 12 were randomised to cabozantinib or placebo. Primary end-points were objective response rate (ORR) at week 12 and progression-free survival (PFS) after random assignment. Seventy patients with ovarian carcinoma, 50% of whom were platinum refractory/resistant, were enrolled in this RDT. Median PFS from day 1 was 5.5 months for all patients. The ORR at week 12 was 21%; one patient achieved a complete response (CR), and 14 patients (20%) achieved a confirmed partial response (PR). The overall disease control rate (CR + PR + SD) at week 12 was 50%. Throughout the study, 70% of the patients with ≥1 postbaseline scan had tumour regression, and randomisation was discontinued early. For patients with SD randomised to cabozantinib, PFS was 5.9 months after randomisation. The most common grade 3/4 adverse events were diarrhoea (14%), palmar-plantar erythrodysesthesia syndrome (6%), asthenia (6%), hypertension (6%) and neutropenia (6%). Dose reductions were required in 37% of the patients during the first 12 weeks. Cabozantinib demonstrates clinical activity, with acceptable toxicities, in patients with ovarian carcinoma based on ORR and regression of tumour target lesions. This trial is registered at ClinicalTrial.gov (NCT00940225). Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Functional analysis after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

    Science.gov (United States)

    Bron, Luc; Pasche, Philippe; Brossard, Edgar; Monnier, Philippe; Schweizer, Velérie

    2002-07-01

    To assess prospectively speech and swallowing function in a series of 17 patients after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Retrospective study. From 1983 to 1996, 69 patients at Department of Otolaryngology-Head and Neck Surgery, CHUV (Lausanne, Switzerland) underwent a supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Seventeen of them (25%) could be contacted and accepted participation in a functional evaluation that included a questionnaire to document their present nutritional status and diet. A formal voice evaluation was also performed, which included psychoacoustic evaluation of vocal qualities, fundamental frequency parameters, phonation intensity range, phonatory quotient (vital capacity divided by maximum phonation time), and a laryngeal video laryngoscopy performed with a rigid endoscope. Median postoperative follow-up was 66 months (range, 12-152 mo). Nine of 17 patients (53%) recovered a normal diet with no increased incidence of aspirations. Seven of 17 had minor limitations such as no peanuts, dry bread, or rice. Two of 17 patients were restricted to pureed food. Assessment of voice showed a clearly decreased mean fundamental frequency at 70.1 Hz (normal range, 121-211 Hz) and a narrowed frequency range of phonation with a mean value of 8.8 semitones (normal value, 27). Forty-two percent of the patients went back to their normal professional life after the operation. Among the 10 who did not, 3 (16%) retired and 7 actually had to give up their profession, because of the modification of their voice or general asthenia and age close to retirement. Restoration of laryngeal function after supracricoid partial laryngectomy with cricohyoidoepiglottopexy is satisfactory. Although most of the patients seem to recover normal swallowing function, severe voice alterations appear to be inevitable.

  4. DX-8951f: summary of phase I clinical trials.

    Science.gov (United States)

    De Jager, R; Cheverton, P; Tamanoi, K; Coyle, J; Ducharme, M; Sakamoto, N; Satomi, M; Suzuki, M

    2000-01-01

    Exatecan mesylate (DX-8951f) is a new hexacyclic camptothecin analogue with favorable attributes compared to topotecan and CPT-11, including watersolubility, greater potency against topoisomerase I, lack of esterase-dependent activation, broad antitumor activity, and low cross-resistance against MDR-1 overexpressing tumors. In preclinical studies, the compound demonstrated a favorable toxicology profile with hematologic dose-limiting toxicity and moderate gastrointestinal toxicity, linear pharmacokinetics, P450 hepatic metabolism (CYP3A4 and CYP1A2), and predominately fecal excretion. The results of six U.S. and European phase I clinical trials as well as two Japanese studies are presented including total DX-8951 and lactone DX-8951 pharmacokinetics. The toxicity profile was similar for all schedules of administration. Hematologic toxicity was dose-dependent and reversible. Neutropenia was dose-limiting in minimally pretreated patients, whereas neutropenia and thrombocytopenia were dose-limiting in heavily pretreated patients. Non-hematologic toxicity included moderate gastrointestinal toxicity (nausea, vomiting > diarrhea), transient elevation of hepatic transaminases, asthenia, and alopecia. Two cases of acute pancreatitis not predicted by preclinical toxicology were also observed. Antineoplastic activity was detected in several solid tumor types: non-small cell lung cancer, extrapulmonary small cell cancer, colorectal cancer, hepatocellular cancer, and sarcoma. Antitumor activity was seen in CPT-11 and topotecan-resistant tumors. Pharmacokinetics were linear within the dose range tested. A pharmacokinetic/pharmacodynamic model predictive of DX-8951f-induced neutropenia in individual patients was developed. The daily x5, every 3-week schedule with the drug administered as a 30-minute intravenous infusion was selected for future phase II clinical trials based on its superior antitumor activity.

  5. A case of osseous scintigraphy showing focuses of multifocal tuberculosis; Un cas de scintigraphie osseuse montrant des foyers de tuberculose multifocale

    Energy Technology Data Exchange (ETDEWEB)

    Faurous-Vanaud, R. [Services de Medecine Nucleaire, Clinique Clementville, Montpellier (France); Faurous, P. [CRLC, Montpellier (France); Kalfa, G.; Collet, H. [Services de Medecine Nucleaire, Clinique Clementville, Montpellier (France); Couty, H.; Artus, J.C. [CRLC, Montpellier (France)

    1997-12-31

    Incidence of tuberculosis in developed countries presents in the last years a spectacular boost. However, the osteo-articular system is afflicted by tuberculosis only in a few percent of cases and the multifocal character represents less than 5% of osseous tuberculosis. It is presented here a case of multifocal osseous tuberculosis only to stress its rarity. A woman 28 years old from Djibouti presents since 8 months an asthenia and dorsal pains long thought as psychalgia. The examination has shown a major vertebral stiffness and limitation of right haunch. The radiographs showed a scoliosis centered on D8 with modifications. The biologic data are VS = 90, CRP = 124 and the hemogram is normal. The intradermal reaction (10 U of tuberculin) is phlyctenular. The TDM indicates lytic vertebral extension on D7 - D8, the osseous scintigraphy with MDP - 99 mTc indicates no anomaly in the vascular arrival time; a few minutes after injection: dorsal and upper and of right femur hyperactivity; 2 h after injection: hyper-fixation of D7 to D9 and of the upper end of right femur. The IRM indicates para-vertebral abscess of D7 to D9 with epidural abscess; abscess in the upper part of the loge of right adductors with osseous affliction of the femur`s upper end; a bacillary infectious process was a priori evoked. The patient was then placed under quadruple antibiotic-therapy anti-tuberculous care. In case of anomalous multifocal osseous scintigraphy the tuberculous affliction is part of the differential diagnosis, particularly in the immigrant populations or in HIV+ persons

  6. Ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin is safe and effective in HCV-infected patients in a real-life cohort from Latin America.

    Science.gov (United States)

    Mendizabal, Manuel; Haddad, Leila; Gallardo, Patricia E; Ferrada, Alejandro; Soza, Alejandro A; Adrover, Raul; Aravena, Edmundo; Roblero, Juan P; Prieto, Jhon; Vujacich, Claudia; Romero, Gustavo; Muñoz, Alberto; Anders, Margarita; Hernández, Nelia; Coccozella, Daniel; Gruz, Fernando; Reggiardo, Maria V; Ruf, Andres E; Varón, Adriana; Cartier, Mariano; Pérez Ravier, Roberto; Ridruejo, Ezequiel; Peralta, Mirta; Poncino, Daniel; Vorobioff, Julio; Aballay Soteras, Gabriel; Silva, Marcelo O

    2017-09-01

    Information about the use of ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin (OBV/PTV/r/DSV ± RBV) in real-clinical practice in Latin America is scarce. We aimed to confirm safety and effectiveness of OBV/PTV/r/DSV ± RBV therapy in real-world setting. We analyzed a cohort of patients with genotype 1 infection treated with OBV/PTV/r/DSV ± RBV. Data on demographics, clinical features, safety, and virological response were retrospectively collected from 21 centers in Latin America. A total of 96 patients received OBV/PTV/r/DSV, associated with RBV in 68% of the cases. Most were genotype 1b (80%), 56 (58%) had cirrhosis, and 45 (47%) failed prior HCV treatment. Adverse events occurred in 62% of patients. The most common adverse events were pruritus (21%), hyperbilirubinemia (17%), and asthenia (17%). Five patients discontinued therapy prematurely due to hepatic decompensation, three of them were Child-Pugh B at baseline and one patient died due to multi-organ failure. Follow up HCV-RNA 12 weeks after completion of therapy was evaluated in all the patients and sustained virologic response rate was 97%. No virologic breakthrough was detected. Our study confirms that OBV/PTV/r/DSV treatment is highly effective in patients with chronic HCV without cirrhosis or with Child-Pugh A cirrhosis in non-European populations. Adverse events were often mild and rarely led to treatment discontinuation except for patients with Child-Pugh B cirrhosis or with previous history of hepatic decompensation. These results can support the development of public strategies to expand the access of OBV/PTV/r + DSV and other DAAs combinations in order to reduce the burden of HCV infection in our region. © 2017 Wiley Periodicals, Inc.

  7. Clinical voice analysis of Carnatic singers.

    Science.gov (United States)

    Arunachalam, Ravikumar; Boominathan, Prakash; Mahalingam, Shenbagavalli

    2014-01-01

    Carnatic singing is a classical South Indian style of music that involves rigorous training to produce an "open throated" loud, predominantly low-pitched singing, embedded with vocal nuances in higher pitches. Voice problems in singers are not uncommon. The objective was to report the nature of voice problems and apply a routine protocol to assess the voice. Forty-five trained performing singers (females: 36 and males: 9) who reported to a tertiary care hospital with voice problems underwent voice assessment. The study analyzed their problems and the clinical findings. Voice change, difficulty in singing higher pitches, and voice fatigue were major complaints. Most of the singers suffered laryngopharyngeal reflux that coexisted with muscle tension dysphonia and chronic laryngitis. Speaking voices were rated predominantly as "moderate deviation" on GRBAS (Grade, Rough, Breathy, Asthenia, and Strain). Maximum phonation time ranged from 4 to 29 seconds (females: 10.2, standard deviation [SD]: 5.28 and males: 15.7, SD: 5.79). Singing frequency range was reduced (females: 21.3 Semitones and males: 23.99 Semitones). Dysphonia severity index (DSI) scores ranged from -3.5 to 4.91 (females: 0.075 and males: 0.64). Singing frequency range and DSI did not show significant difference between sex and across clinical diagnosis. Self-perception using voice disorder outcome profile revealed overall severity score of 5.1 (SD: 2.7). Findings are discussed from a clinical intervention perspective. Study highlighted the nature of voice problems (hyperfunctional) and required modifications in assessment protocol for Carnatic singers. Need for regular assessments and vocal hygiene education to maintain good vocal health are emphasized as outcomes. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  8. Personality traits as an endophenotype in genetic studies on suicidality in bipolar disorder.

    Science.gov (United States)

    Pawlak, J; Dmitrzak-Węglarz, M; Maciukiewicz, M; Kapelski, P; Czerski, P; Leszczyńska-Rodziewicz, A; Zaremba, D; Hauser, J

    2017-04-01

    Introduction The influence of personality traits on suicidal behaviour risk has been well documented. Personality traits and suicidal behaviour are partially genetically determined and personality has been described as an endophenotype of suicidal behaviour. The aim of this study was to investigate a possible association between personality traits with suicidal behaviour and selected serotonergic gene polymorphisms. In the study we included 156 patients meeting DSM-IV criteria for bipolar disorder (BP) and 93 healthy controls. The personality dimensions were assessed using the Temperament and Character Inventory (TCI). We genotyped two selected polymorphisms of the tryptophan hydroxylase 1 (TPH1) gene (rs1800532 218A>C and rs1799913 779A>C) and polymorphism in the promoter region of serotonin transporter gene (5-HTTLPR, rs25531) related to serotoninergic neurotransmission. Multiple poisson regression, logistic regression and Kruskal-Wallis tests were applied. We found numerous differences between the BP patients and the control group in terms of their TCI dimensions/subdimensions. Significant differences were found between patients with, and without, suicidal attempts in fatigability and asthenia (Ha4), as well as in harm avoidance (Ha). We also found that the interactions between TCI subdimensions (the interaction of disordiness (Ns4) and spiritual acceptance (St3), disordiness (Ns4) and integrated conscience (C5), extravagance (Ns3) and resourcefulness (Sd3)) were significantly contributing for suicidal behaviour risk. We found association between all studied genetic polymorphisms and several TCI dimensions and subdimensions. Our results confirm that personality traits are partially determined by genes. Both personality traits and the interactions between temperament and character traits, may be helpful in predicting suicidal behaviour.

  9. Differences in adverse event profiles between everolimus and temsirolimus and the risk factors for non-infectious pneumonitis in advanced renal cell carcinoma.

    Science.gov (United States)

    Nozawa, Masahiro; Ohzeki, Takayuki; Tamada, Satoshi; Hongo, Fumiya; Anai, Satoshi; Fujimoto, Kiyohide; Miki, Tsuneharu; Nakatani, Tatsuya; Fukasawa, Satoshi; Uemura, Hirotsugu

    2015-08-01

    There have been few reports of the differences in safety between the mammalian target of rapamycin inhibitors, everolimus and temsirolimus. The purpose of this study is to compare the adverse event profiles of both agents and to estimate the risk factors for non-infectious pneumonitis in patients with advanced renal cell carcinoma on the basis of our real-world clinical experience. Data from 218 consecutive patients that received either everolimus or temsirolimus for advanced renal cell carcinoma at five Japanese centers were retrospectively analyzed. Chi-squared test and univariate and multivariate logistic regression analyses were performed to investigate the differences in adverse event profiles and the risk factors associated with non-infectious pneumonitis, respectively. A total of 196 patients were evaluable. In the everolimus group compared with temsirolimus, stomatitis (56 vs 30 %, p infectious pneumonitis (38 vs 22 %, p = 0.018) were more frequently observed, and asthenia (11 vs 23 %, p = 0.027), rash (20 vs 36 %, p = 0.018), and fatigue (33 vs 48 %, p = 0.032) occurred less frequently in all grades. On multivariate analysis, male gender (odds ratio 3.65; 95 % confidence interval 1.44-9.26, p = 0.007) and everolimus treatment (odds ratio 2.00; 95 % confidence interval 1.01-3.96, p = 0.046) were significantly associated with development of non-infectious pneumonitis. Our findings suggest that adverse event profiles may differ between everolimus and temsirolimus and that non-infectious pneumonitis may occur more frequently in patients treated with everolimus than temsirolimus. Further investigations are needed to confirm these results.

  10. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC

    Science.gov (United States)

    Mohan, Alladi; Kiran, DHN; Manohar, I Chiranjeevi; Kumar, D Prabath

    2010-01-01

    Chikungunya fever, caused by “Chikungunya virus,” is an arbovirus disease transmitted by the bite of infected mosquitoes belonging to the genus Aedes. Chikungunya fever epidemics have been reported from several countries around the world. The disease that was silent for nearly 32 years re-emerged in the October 2005 outbreak in India that is still ongoing. The incubation period ranges from 3 to 12 days. The onset is usually abrupt and the acute stage is characterized by sudden onset with high-grade fever, severe arthralgias, myalgias, and skin rash. Swollen tender joints and crippling arthritis are usually evident. In the chronic stage, relapses that include sensation of fever, asthenia, exacerbation of arthralgias, inflammatory polyarthritis, and stiffness may be evident. Neurological, ocular, and mucocutaneous manifestations have also been described. Chronic arthritis may develop in about 15% of the patients. Viral culture is the gold standard for the diagnosis of Chikungunya fever. Reverse transcription polymerase chain reaction and real-time loop-mediated isothermal amplification have also been found to be useful. Serodiagnostic methods for the detection of immunoglobulin M and immunoglobulin G antibodies against Chikungunya virus are more frequently used. Chikungunya is a self-limiting disease; however, severe manifestations such as meningoencephalitis, fulminant hepatitis, and bleeding manifestations may sometimes be life-threatening. Treatment is symptomatic and supportive. Prevention by educating the community and public health officials, vector control measures appear to be the best approach at controlling Chikungunya fever as no commercially available vaccine is available for public use in India for this condition presently. PMID:20418981

  11. Third-Line Chemotherapy with Irinotecan plus 5-Fluorouracil in Caucasian Metastatic Gastric Cancer Patients.

    Science.gov (United States)

    Pasquini, Giulia; Vasile, Enrico; Caparello, Chiara; Vivaldi, Caterina; Musettini, Gianna; Lencioni, Monica; Petrini, Iacopo; Fornaro, Lorenzo; Falcone, Alfredo

    2016-01-01

    The aim of this study was to evaluate the activity of the combination of 5-fluorouracil/folinic acid and irinotecan (FOLFIRI) as third-line chemotherapy (CT) in metastatic gastric cancer (mGC) patients pretreated with platinum derivatives, fluoropyrimidines, and taxanes. We prospectively collected data of mGC patients treated with third-line FOLFIRI at our institution from 2009 to 2014. Eligible patients should be treated with a fluoropyrimidine-platinum first-line CT and a subsequent taxane-based second-line CT. FOLFIRI consisted of irinotecan 180 mg/m2 and leucovorin 200 mg/m2, followed by 5-fluorouracil 2,800 mg/m2 (administered as 48-hour i.v. continuous infusion from day 1 to 3), with cycles repeated every 2 weeks. Response rate (RR) was evaluated according to RECIST version 1.0, while progression-free (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. A total of 33 patients were included. The majority (97%) had good performance status (0-1 according to ECOG), while median PFS after first-line and second-line CT was 5.2 and 4.4 months, respectively. Two patients experienced an objective response (RR: 6%), while 14 patients achieved disease stabilization (disease control rate: 42%). Median PFS and OS from the start of third-line CT were 3.3 and 7.5 months, respectively. Hematological and nonhematological grade 3-4 toxicities were uncommon and included neutropenia (6.1%), diarrhea (9.1%), vomiting (3%), and asthenia (3%). Febrile neutropenia was not reported. Third-line CT with FOLFIRI may be an option in heavily pretreated mGC patients with preserved performance status and organ function. This regimen has a favorable safety profile, and signs of activity have been observed after standard first- and second-line CT. © 2016 S. Karger AG, Basel.

  12. Cabazitaxel for metastatic castration-resistant prostate cancer: safety data from the Spanish expanded access program.

    Science.gov (United States)

    Castellano, Daniel; Antón Aparicio, Luis M; Esteban, Emilio; Sánchez-Hernández, Alfredo; Germà, Jose Ramón; Batista, Norberto; Maroto, Pablo; Pérez-Valderrama, Begoña; Luque, Raquel; Méndez-Vidal, María José

    2014-09-01

    Based on the TROPIC study results, cabazitaxel was approved for the management of metastatic castration-resistant prostate cancer (mCRPC) progressing on or after docetaxel. This multi-centre program provided early access to cabazitaxel to patients with mCRPC before its commercialization. Safety data from 153 Spanish patients receiving cabazitaxel 25 mg/m(2) i.v. Q3W, plus oral prednisone/prednisolone 10 mg daily, are reported. Median age of patients was 70 years (26.8% ≥ 75 years), 94.1 and 26.8% had bone and visceral metastasis, respectively. Most had an Eastern Cooperative Oncology Group ≤ 1 (88.9%) and had received a median of 8.0 cycles of last docetaxel treatment. The median of cabazitaxel cycles and cumulative dose were 6.0 (Interquartile range [IQR]: 4.0; 8.0) and 148.9 (IQR: 98.2; 201.4) mg/m(2), respectively. Adverse events (AEs) possibly related to cabazitaxel occurred in 143 (93.5%) patients. The most frequent grade ≥ 3 AEs were neutropenia (n = 25, 16.3%) and asthenia (n = 17, 11.1%). Febrile neutropenia and grade ≥ 3 diarrhea occurred in 5.2% of the patients each. There were five (3.3%) possibly treatment-related deaths, mainly infection-related. G-CSFs were used in 114 (74.5%) patients, generally as prophylaxis (n = 107; 69.9%). Grade ≥ 3 peripheral neuropathy and nail disorders were uncommon. Cabazitaxel administration, in a real-world setting, is tolerated by Spanish patients with mCRPC, and the AEs are manageable.

  13. Tolerability of cabazitaxel in patients with metastatic castration-resistant prostate cancer progressing after docetaxel and abiraterone acetate: a single-institution experience.

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    Francini, Edoardo; Fiaschi, Anna I; Petrioli, Roberto; Laera, Letizia; Bianco, Vincenzo; Ponchietti, Roberto; Roviello, Giandomenico

    2015-09-01

    Both abiraterone acetate (AA) and cabazitaxel (Cbz) have been shown to prolong survival in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing during or after docetaxel (D). Although no standard sequencing has been established as yet, Cbz has recently been proven to be active after AA. However, to date, few data are available on its safety in this setting. Therefore, the primary endpoint of this study was to investigate Cbz tolerability in mCRPC patients treated previously with D and AA. From April 2011 to the present, 43 mCRPC patients received AA after D at our institution. Of these, 22 patients were subsequently treated with Cbz and were evaluable for toxicity in the present retrospective study. Cbz was administered at a dose of 25 mg/m plus 10 mg oral prednisone every 3 weeks. Adverse events (AEs) were reported using the NCI CTCAE (National Cancer Institute Common Terminology Criteria for Adverse Events) version 3.0. Despite the advanced stage of disease and frailty of our study population, there were no unexpected side effects. The most common AEs were hematologic. Neutropenia was observed in nine (40.9%) patients and of grade≥3 in six (27.2%). No febrile neutropenia occurred. The most common nonhematologic AEs were diarrhea and asthenia, reported in eight (36.3%) and in five (22.7%) patients, respectively. In this setting, Cbz toxicity seems to be manageable and comparable with second-line Cbz. Therefore, our results seem to support the safety of Cbz as a third-line treatment for mCRPC patients.

  14. Phase I/II trial of cabazitaxel plus abiraterone in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel and abiraterone.

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    Massard, C; Mateo, J; Loriot, Y; Pezaro, C; Albiges, L; Mehra, N; Varga, A; Bianchini, D; Ryan, C J; Petrylak, D P; Attard, G; Shen, L; Fizazi, K; de Bono, J

    2017-01-01

    Abiraterone and cabazitaxel improve survival in patients with metastatic castration-resistant prostate cancer (mCRPC). We conducted an open-label phase I/II trial of cabazitaxel plus abiraterone to assess the antitumor activity and tolerability in patients with progressive mCRPC after docetaxel (phase I), and after docetaxel and abiraterone (phase II) (NCT01511536). The primary objectives were to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of cabazitaxel plus abiraterone (phase I), and the prostate-specific antigen (PSA) response defined as a ≥ 50% decrease confirmed ≥3 weeks later with this combination (phase II). Ten patients were enrolled in the phase I component; nine were evaluable. No DLTs were identified. The MTD was established as the approved doses for both drugs (cabazitaxel 25 mg/m2 every 3 weeks and abiraterone 1000 mg once daily). Daily abiraterone treatment did not impact on cabazitaxel clearance. Twenty-seven patients received cabazitaxel plus abiraterone plus prednisone (5 mg twice daily) in phase II. The median number of cycles administered (cabazitaxel) was seven (range: 1-28). Grade 3-4 treatment-emergent adverse events included asthenia (in 5 patients; 14%), neutropenia (in 5 patients; 14%) and diarrhea (in 3 patients; 8%). Nine patients (24%) required dose reductions of cabazitaxel. Of 26 evaluable patients, 12 achieved a PSA response [46%; 95% confidence interval (CI): 26.6-66.6%]. Median PSA-progression-free survival was 6.9 months (95% CI: 4.1-10.3 months). Of 14 patients with measurable disease at baseline, 3 (21%) achieved a partial response per response evaluation criteria in solid tumors. The combination of cabazitaxel and abiraterone has a manageable safety profile and shows antitumor activity in patients previously treated with docetaxel and abiraterone.

  15. Cabazitaxel (jevtana): a novel agent for metastatic castration-resistant prostate cancer.

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    Nightingale, Ginah; Ryu, Jae

    2012-08-01

    This article presents current clinical evidence supporting the use of cabazitaxel (Jevtana) in men with metastatic castration-resistant prostate cancer (mCRPC). We conducted a literature search using abstracts from MEDLINE and PubMed (from January 1966 to December 2011) and the American Society of Clinical Oncology (from January 2000 to December 2011). The search included clinical studies and abstracts in the English language that described the pharmacology, pharmacokinetics, clinical activity, and safety of cabazitaxel in mCRPC. Cabazitaxel, a semisynthetic microtubule inhibitor that induces cell death by microtubule stabilization, was approved in combination with prednisone for the treatment of mCRPC in patients who had been treated with a docetaxel-(Taxotere)-containing regimen. The approval of this taxane derivative was based primarily on the results of a randomized, open-label trial in patients with mCRPC who were treated with either cabazitaxel 25 mg/m(2) or mitoxantrone (Novantrone) 12 mg/m(2) intravenously every 3 weeks, both in combination with prednisone 10 mg/day. The median survival period was 15.1 months with cabazitaxel and 12.7 months with mitoxantrone. Neither group experienced complete responses. Cabazitaxel has also shown activity in breast cancer and other malignancies. In clinical trials, common grade 3 or grade 4 adverse reactions were myelosuppression, febrile neutropenia, diarrhea, fatigue, and asthenia. Other adverse effects included abdominal pain, back pain, arthralgia, and peripheral neuropathy. Cabazitaxel appeared to be an effective second-line agent in patients with mCRPC refractory to a docetaxel-containing regimen. Studies comparing cabazitaxel with existing first-line regimens for mCRPC are under way. Until the results of these head-to-head trials are published, it remains uncertain whether cabazitaxel is more effective or more tolerable than the currently available first-line regimens.

  16. Safety and efficacy of 2-weekly cabazitaxel in metastatic castration-resistant prostate cancer.

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    Clément-Zhao, Alice; Auvray, Marie; Aboudagga, Hail; Blanc-Durand, Félix; Angelergues, Antoine; Vano, Yann Alexandre; Mercier, Florence; El Awadly, Nader; Verret, Benjamin; Thibault, Constance; Oudard, Stéphane

    2017-03-28

    To evaluate the safety and efficacy of a 2-weekly cabazitaxel schedule in patients with metastatic castration-resistant prostate cancer (mCRPC). During the period October 2013 to February 2016, 43 patients with mCRPC were treated with cabazitaxel (16 mg/m2 , on days 1 and 15 of a 4-week cycle) together with prophylactic granulocyte colony-stimulating factor (G-CSF). The safety profile and efficacy (prostate-specific antigen [PSA] response; biological, clinical or radiological progression-free survival [PFS] and overall survival [OS]) of the treatment were analysed. All patients had received prior docetaxel and 79.1% abiraterone acetate. At inclusion, 46.5% were aged >70 years and 27.9% had an Eastern Cooperative Oncology Group performance status ≥2. Six patients stopped treatment because of toxicity. Grade ≥3 toxicities were: asthenia (16.3%); neutropenia (11.6%); thrombocytopenia (9.3%); diarrhoea (7%), anaemia (4.7%), febrile neutropenia (4.7%) and haematuria (2.3%). In all, 52.4% achieved a ≥30% PSA response and 40.5% had a ≥50% PSA response. The median OS was 15.2 months. This prospective pilot study suggests that cabazitaxel 16 mg/m² given 2-weekly has a manageable toxicity profile in docetaxel- and abiraterone acetate-pretreated patients with mCRPC. A prospective phase III trial comparing this regimen with the standard cabazitaxel regimen is planned to confirm these results. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  17. Imported submicroscopic malaria in Madrid

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    Ramírez-Olivencia Germán

    2012-09-01

    Full Text Available Abstract Background Submicroscopic malaria (SMM can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM. The goals of this study were two-fold: a to know the frequency of imported SMM, and b to describe epidemiological, laboratorial and clinical features of imported SMM. Methods A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. Results SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95% was 40.38 years (37.41-43.34, and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%. Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients, fever (60% and arthromialgias (53.3%. The associated laboratory abnormalities were anaemia (27.9%, leukopaenia (15.4% and thrombopaenia (15.4%. Co-morbidity was described in 75 cases (72.1%. Conclusions Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has

  18. The efficacy and safety of vinflunine in second-line therapy of patients with disseminated transitional cell carcinoma of the urinary tract in clinical practice

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    M. I. Volkova

    2016-01-01

    Full Text Available Objective: to investigate the safety of vinflunine, the rate and duration of its treatment response, progression-free and overall survival rates in patients receiving this drug in routine clinical practice for first-line chemotherapy (CT – resistant disseminated transitional cell carcinoma of the urinary tract.Materials and methods. This retrospective observational multicenter study included data on 25 patients with verified disseminated transitional cell carcinoma of the urinary tract who took vinflunine for tumor progression after first-line CT performed in 11 Russian clinical centers in 23 March 2013 to 26 June 2016. The median age of the patients was 60 (44‒81 years. Their baseline somatic status was rated as ECOG 0 in 1 (4.0 % patient, ECOG 1 in 13 (52.0 % patients, EGOG 2 in 9 (36.0 %, and ECOG 3 in 2 (8.0 %. The most common sites of tumor foci were bones (n = 14, 56.0 %, lymph nodes of different groups (n = 14; 56.0 %, and lung (n = 9; 36.0 %.Results. Adverse reactions were recorded in 24 (96.0 % cases. The most common types of toxicity were asthenia (n = 19; 76.0 %, anemia (n = 18; 72.0 %, neutropenia (n = 13; 52 %, and nausea (n = 12; 48.0 %. Most adverse events were grades I–II and well controlled. There were no deaths due to adverse events. The best treatment response was regarded as partial in 6 (24.0 % patients; stabilization and progression were observed in 10 (40.0 % and 9 (36.0 % patients, respectively. The median duration of partial response was 5.1 (95 % confidence interval (CI, 0.6–15.0 months; that of stabilization was 3.4 (95 % CI, 1.2–6.3 months. In all the 25 cases, the median progression-free and overall survival rates were 3.7 (95 % CI, 2.1‒5.3 and 6.5 (95 % CI, 5.2‒7.8 months, respectively. The somatic status was a predictor of overall survival (p < 0.0001.Conclusion. The efficacy and safety of vinflunine in second-line therapy for first-line CT-resistant disseminated transitional cell carcinoma of the

  19. Axitinib treatment in advanced RAI-resistant differentiated thyroid cancer (DTC) and refractory medullary thyroid cancer (MTC).

    Science.gov (United States)

    Capdevila, Jaume; Trigo, José Manuel; Aller, Javier; Manzano, José Luís; Adrián, Silvia García; Llopis, Carles Zafón; Reig, Òscar; Bohn, Uriel; Cajal, Teresa Ramón Y; Duran-Poveda, Manuel; Astorga, Beatriz González; López-Alfonso, Ana; Martínez, Javier Medina; Porras, Ignacio; Reina, Juan Jose; Palacios, Nuria; Grande, Enrique; Cillán, Elena; Matos, Ignacio; Grau, Juan Jose

    2017-10-01

    Axitinib, an antiangiogenic multikinase inhibitor (MKI), was evaluated in the compassionate use programme (CUP) in Spain (October 2012-November 2014). 47 patients with advanced radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC, n = 34) or medullary thyroid cancer (MTC, n = 13) with documented disease progression were treated with axitinib 5 mg b.i.d. The primary efficacy endpoint was objective response rate (ORR) by Response Evaluation Criteria In Solid Tumors (RECIST) v1.1. Progression-free survival (PFS) and adverse events (AEs) were secondary objectives. Regulatory authorities validated the CUP, and all patients signed informed consent form. Axitinib was administered as first-line therapy in 17 patients (36.2%), as second-line in 18 patients (38.3%) and as third/fourth-line in 12 patients (25.5%). With a median follow-up of 11.5 months (0-24.3), ORR was 27.7% (DTC: 29.4% and MTC: 23.1%) and median PFS was 8.1 months (95% CI: 4.1-12.2) (DTC: 7.4 months (95% CI: 3.1-11.8) and MTC: 9.4 months (95% CI: 4.8-13.9)). Better outcomes were reported with first-line axitinib, with an ORR of 53% and a median PFS of 13.6 months compared with 16.7% and 10.6 months as second-line treatment. Twelve (25.5%) patients required dose reduction to 3 mg b.i.d. All-grade AEs included asthenia (53.2%), diarrhoea (36.2%), hypertension (31.9%) and mucositis (29.8%); grade 3/4 AEs included anorexia (6.4%), diarrhoea (4.3%) and cardiac toxicity (4.3%). Axitinib had a tolerable safety profile and clinically meaningful activity in refractory and progressive thyroid cancer regardless of histology as first-line therapy. To our knowledge, this is the first time that cross-resistance between MKIs is suggested in thyroid cancer, highlighting the importance of prospective sequential clinical studies. © 2017 European Society of Endocrinology.

  20. Results of paclitaxel (day 1 and 8 and carboplatin given on every three weeks in advanced (stage III-IV non-small cell lung cancer

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    Salepci Taflan

    2005-01-01

    Full Text Available Abstract Background Both paclitaxel (P and carboplatin (C have significant activity in non-small cell lung cancer (NSCLC. The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT regimen in advanced stage NSCLC to evaluate the efficacy and toxicity. Methods Patients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS ECOG 0–2 were given P 112.5 mg/m2 intravenously (IV over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles. Results Median age was 58 (age range 39–77 and 41 patients (80% were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 (1–6. Seven patients (14% did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR in 45% and stable disease (SD in 18%. Twelve patients (24% received local RT. Thirteen patients (25% received 2nd line CT at progression. At a median follow-up of 7 months (range, 1–20, 25 (49% patients died and 35 patients (69% progressed. Median overall survival (OS was 11 ± 2 months (95% CI; 6 to 16, 1-year OS ratio was 44%. Median time to progression (TTP was 6 ± 1 months (95% CI; 4 to 8, 1-year progression free survival (PFS ratio was 20%. We observed following grade 3 toxicities: asthenia (10%, neuropathy (4%, anorexia (4%, anemia (4%, hypersensitivity to P (2%, nausea/vomiting (2%, diarrhea (2% and neutropenia (2%. Two patients (4% died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%. Conclusions P on day 1 and 8 and C every three weeks is practical and fairly

  1. Paniculitis mesentérica: experiencia en nuestro centro Mesenteric panniculitis: Experience in our center

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    L. Delgado Plasencia

    2007-05-01

    Full Text Available A pesar de que se han reconocido distintos factores precipitantes en la paniculitis mesentérica, su etiología en determinados casos es incierta. Presentamos un análisis retrospectivo de 8 pacientes afectados de paniculitis mesentérica en un periodo comprendido entre mayo 2000 hasta diciembre 2006. En nuestra serie la edad media de presentación fue 63 años, siendo la mayoría de pacientes varones (proporción 3:1. Las manifestaciones clínicas más frecuentes fueron el dolor abdominal (n = 4 y la astenia (n = 4. Tres casos se presentaron como cuadro de obstrucción y tres casos presentaron antecedentes de cirugía abdominal. El antecedente más común fue el tabaquismo (5 casos eran fumadores activos y 2 exfumadores y hubo un paciente que desarrolló un linfoma folicular en el seguimiento. Revisamos la literatura para analizar nuestros resultados y formular una hipótesis. En nuestra opinión, pensamos que debe ser analizada de forma más exhaustiva la relación entre el tabaco y sus componentes con la aparición de la enfermedad debido a la fuerte asociación encontrada en este estudio.Although several etiological factors have been associated with mesenteric panniculitis, the exact etiology in some cases remains unknown. Herein, we present a retrospective analysis of 8 patients affected with this disorder performed between May 2000 and December 2006. In our series the mean age at which patients presented was 63 years. The majority of the patients were male (with a male: female ratio of 3:1. The most common clinical manifestations were abdominal pain (n = 4 and asthenia (n = 4. Three cases presented with obstructive symptoms and three had a history of abdominal surgery. Notably, seven had a background of tobacco use (five smokers and two ex-smokers and one patient developed follicular lymphoma. A literature research was carried out to analyze our results and formulate a new hypothesis. In our opinion, we believe that the study of causal

  2. Pioglitazone treatment increases survival and prevents body weight loss in tumor-bearing animals: possible anti-cachectic effect.

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    Beluzi, Mércia; Peres, Sidney B; Henriques, Felipe S; Sertié, Rogério A L; Franco, Felipe O; Santos, Kaltinaitis B; Knobl, Pâmela; Andreotti, Sandra; Shida, Cláudio S; Neves, Rodrigo X; Farmer, Stephen R; Seelaender, Marília; Lima, Fábio B; Batista, Miguel L

    2015-01-01

    Cachexia is a multifactorial syndrome characterized by profound involuntary weight loss, fat depletion, skeletal muscle wasting, and asthenia; all symptoms are not entirely attributable to inadequate nutritional intake. Adipose tissue and skeletal muscle loss during cancer cachexia development has been described systematically. The former was proposed to precede and be more rapid than the latter, which presents a means for the early detection of cachexia in cancer patients. Recently, pioglitazone (PGZ) was proposed to exhibit anti-cancer properties, including a reduction in insulin resistance and adipose tissue loss; nevertheless, few studies have evaluated its effect on survival. For greater insight into a potential anti-cachectic effect due to PGZ, 8-week-old male Wistar rats were subcutaneously inoculated with 1 mL (2×107) of Walker 256 tumor cells. The animals were randomly assigned to two experimental groups: TC (tumor + saline-control) and TP5 (tumor + PGZ/5 mg). Body weight, food ingestion and tumor growth were measured at baseline and after removal of tumor on days 7, 14 and 26. Samples from different visceral adipose tissue (AT) depots were collected on days 7 and 14 and stored at -80o C (5 to 7 animals per day/group). The PGZ treatment showed an increase in the survival average of 27.3% (P< 0.01) when compared to TC. It was also associated with enhanced body mass preservation (40.7 and 56.3%, p< 0.01) on day 14 and 26 compared with the TC group. The treatment also reduced the final tumor mass (53.4%, p<0.05) and anorexia compared with the TC group during late-stage cachexia. The retroperitoneal AT (RPAT) mass was preserved on day 7 compared with the TC group during the same experimental period. Such effect also demonstrates inverse relationship with tumor growth, on day 14. Gene expression of PPAR-γ, adiponectin, LPL and C/EBP-α from cachectic rats was upregulated after PGZ. Glucose uptake from adipocyte cells (RPAT) was entirely re-established due to

  3. Epidemiology of Chikungunya fever outbreak in Western Jamaica during July–December 2014

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    Pham PN

    2017-01-01

    Full Text Available Phuong N Pham,1 LaQueena T Williams,1 Uduak Obot,1 Luz A Padilla,1 Maung Aung,2 Tomi F Akinyemiju,1 April P Carson,1 Pauline E Jolly1 1Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; 2Epidemiology Unit, Western Regional Health Authority, Ministry of Health, Montego Bay, Jamaica Objective: Our study describes the 2014 Chikungunya outbreak in Western Jamaica in terms of geographic distribution and trend of the outbreak over time, and evaluates clinical symptoms of the disease based on pre-existing conditions.Methods: We conducted a retrospective, cross-sectional study of 609 clinically defined ­Chikungunya virus (CHIKV fever cases that occurred in the four parishes of the Western Regional Health Authority of Jamaica from July 2014 to December 2014. Cases were not confirmed by laboratory tests but met clinical and epidemiological criteria of CHIKV fever.Results: Our results show a propagated spread of CHIKV fever during the outbreak period with the peak at the end of October. Main urban cities, such as Montego Bay and Lucea, were identified as places that had high numbers of cases. Fever and arthralgia were the two most common clinical symptoms in CHIKV patients. Although a majority (80% of infants aged <2 years had up to four symptoms (80%, the percentage of infants with higher numbers of symptoms (9–10 was higher than in older age groups. However, back pain was found to occur significantly more in older patients. Those with arthritis as a pre-existing condition were more likely to experience headache, asthenia, back pain, and periarticular edema.Conclusion: These findings can help public health officials develop more effective programs to prevent the spread of CHIKV outbreaks by focusing on crowded urban cities. The findings indicate that those who are likely to develop a higher number of symptoms, such as young infants and people with pre-existing conditions, such as arthritis, should be more closely

  4. Saturnismo: a propósito de un caso Lead poisoning: A case report

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    Pablo Honorio Labanda Urbano

    2012-06-01

    Full Text Available Profesora de pintura sobre vidrio y restauración de vidrieras de 65 años acude a la Unidad Médica de Valoración de Incapacidades del Instituto Nacional de la Seguridad Social (INSS con diagnóstico de exposición laboral a plomo. La paciente ha permanecido en Incapacidad Temporal por astenia durante varios meses, y se le detecta tras una reincorporación al trabajo plumbemia elevada, asociada a otros síntomas típicos de la intoxicación por plomo, por lo que se la separa de su ambiente de trabajo. Finalmente, el Equipo de Valoración de Incapacidades, reunido para valorar su caso resuelve Incapacidad Laboral Permanente Total derivada de enfermedad profesional para trabajos en que haya exposición a plomo y otros ototóxicos, exposición a ruidos de riesgo, y para aquellos trabajos en que sea necesaria una comunicación verbal fluida en frecuencias conversacionales normales. Con este caso clínico pretendemos revisar los síntomas del cuadro clínico de saturnismo, así como hacer una reflexión sobre los efectos de la prevención de riesgos para el trabajador.Lead poisoning is most commonly caused by occupational exposure. We report a case of a 65-year-old woman, paint teacher, which was working in reparation of stained glass window. She consults the Medical Incapacity Valoration Unit of National Institute of Social Security with diagnosis of lead occupational intoxication. The patient was not able to word for several months because of presenting asthenia. After reporting for work high lead blood levels were detected, in association with physical symptoms. She was evaluated by a tribunal which settled total long sick-leave due to occupational lead exposure and was restricted for loud works and other ones that need verbal communication in conversational frequencies. With this clinical case we try to check the symptoms of lead poisoning, as well as to think about the effects of prevention of occupational hazards.

  5. Subjective and Objective Voice Assessments After Recurrent Laryngeal Nerve-Preserved Total Thyroidectomy.

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    Papadakis, Chariton E; Asimakopoulou, Panagiota; Proimos, Efklidis; Perogamvrakis, George; Papoutsaki, Effrosyni; Chimona, Theognosia

    2017-07-01

    This study aims to investigate early voice changes after total thyroidectomy, to assess the improved parameters in intermediate postoperative intervals, to evaluate the effect of age on voice after thyroidectomy, and to determine the correlation between the objective and the subjective method outcomes. This is a prospective, nonrandomized study. One hundred ninety-one participants, divided into two age groups, underwent three full voice assessments (preoperatively and 1 and 8 weeks after thyroidectomy) by means of videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic evaluation, and a self-evaluation questionnaire. Two control groups enrolled in the study: (1) patients with an indication of neck surgery not related to laryngeal nerve injury risk or strap muscle dissection and (2) patients with an indication of a non-neck surgery. No statistically significant difference was found in any voice parameter, between preoperative and 1-week postoperative assessment regarding the control groups. A statistically significant difference was found between preoperative evaluation and 1 week after thyroidectomy for the total study population, as well as for the ≥40 years' age subgroup for all parameters evaluated except for shimmer. The <40 years' age subgroup showed a statistically significant difference in pitch, maximum phonation time, and grade, roughness, breathiness, asthenia, and strain (GRBAS) score between preoperative evaluation and 1 week after thyroidectomy. None of the parameters showed a statistical significant difference in the <40 years' age subgroup at 8 weeks' evaluation. The Voice Handicap Index (VHI) score correlated significantly with the GRBAS score preoperatively and postoperatively at 1 and 8 weeks' evaluations. Furthermore, VHI correlated significantly with pitch a week postoperatively. GRBAS scores showed significant correlation not only with VHI but also with acoustic parameters including pitch, shimmer, and noise-to-harmonic ratio

  6. Retrospective study of hypersensitivity reactions to chemotherapeutic agents in a thoracic oncology service.

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    Capelle, H; Tummino, C; Greillier, L; Gouitaa, M; Birnbaum, J; Ausias, N; Barlesi, F; Montana, M

    2017-11-01

    With the increasing use of cancer chemotherapy agents, hypersensitivity reactions are commonly encountered. The allergic clinical symptoms are variable and unpredictable. The aim of this study was to identify the characteristics of hypersensitivity reactions and to assess the value of skin tests for platinum salts and pemetrexed in the treatment of patients with non-small cell lung cancers or malignant pleural mesothelioma. A single-centre retrospective study was performed for 2 years. Patients treated with the drugs of interest for an advanced or metastatic non-small cell lung cancers or malignant pleural mesothelioma and who experienced hypersensitivity reactions symptoms were eligible for this study. Clinical symptoms of hypersensitivity reactions, population characteristics and administered chemotherapy regimens were identified. The hypersensitivity reactions frequency was rare (1.2%) and concerned 17 patients in our study. Typical clinical features of immediate hypersensitivity reactions associated with treatment were observed for nine patients (anaphylactic reactions for three cases, angioedema and hypotension associated with asthenia and heat in one case, respectively, and other cutaneous symptoms in the remaining four cases). Skin tests were positive in three patients, but only for platinum salts. The outcome after reintroduction of a negatively tested platinum salt allowed us to calculate a negative predictive value for platinum salt skin tests of 100%. For pemetrexed, skin tests were negative for all patients. Skin tests could be used to diagnose hypersensitivity reactions with platinum salts or to evaluate the possibility of cross-reactions between two platinum salts. A negative skin test may predict with reasonable reliability the absence of future hypersensitivity reactions in case of reintroduction of drug infusion. Because the IgE-mediated mechanism has never been demonstrated for pemetrexed, skin tests are not valid and have no diagnostic value for

  7. Ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin for patients with hepatitis C virus genotype 1 or 4 infection with cirrhosis (ABACUS): a prospective observational study.

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    Petta, Salvatore; Marzioni, Marco; Russo, Pierluigi; Aghemo, Alessio; Alberti, Alfredo; Ascione, Antonio; Antinori, Andrea; Bruno, Raffaele; Bruno, Savino; Chirianni, Antonio; Gaeta, Giovanni Battista; Giannini, Edoardo G; Merli, Manuela; Messina, Vincenzo; Montilla, Simona; Perno, Carlo Federico; Puoti, Massimo; Raimondo, Giovanni; Rendina, Maria; Silberstein, Francesca Ceccherini; Villa, Erica; Zignego, Anna Linda; Pani, Luca; Craxì, Antonio

    2017-06-01

    We ran a compassionate use nationwide programme (ABACUS) to provide access to ombitasvir, paritaprevir, and ritonavir, with dasabuvir, plus ribavirin for hepatitis C virus (HCV) genotype 1 infection and ombitasvir, paritaprevir, and ritonavir, plus ribavirin for HCV genotype 4 infection in patients with cirrhosis at high risk of decompensation while approval of these regimens was pending in Italy. In this prospective observational study, we collected data from a compassionate use nationwide programme from March 17, 2014, to May 28, 2015. Patients with HCV genotype 1 infection and cirrhosis at high risk of decompensation were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once daily and dasabuvir (250 mg) twice daily for 12 weeks (patients with HCV genotype 1b infection) or 24 weeks (patients with HCV genotype 1a infection). Patients with HCV genotype 4 infection were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once per day for 24 weeks. All patients were given weight-based ribavirin. The primary efficacy endpoint was sustained virological response at week 12 after the end of treatment (SVR12), analysed by intention-to-treat. Univariate and multivariate logistic regression analyses were used to identify baseline characteristics associated with SVR12. Adverse events were recorded throughout the study. 728 (96%) of 762 patients with cirrhosis who were given ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin therapy for 12 or 24 weeks achieved SVR12. Logistic regression analyses identified that bilirubin concentrations of less than 2 mg/dL were associated with SVR12 (odds ratio [OR] 4·76 [95% CI 1·83-12·3]; p=0·001). 166 (23%) of 734 patients included in safety analyses had an adverse event. 25 (3%) patients discontinued treatment because of adverse events. Asthenia was the most commonly reported adverse event, occurring in 36 (5%) patients. Our findings

  8. Patients attended by palliative care teams: are they always comparable populations?

    Science.gov (United States)

    Nabal, Maria; Barcons, Miquel; Moreno, Roberto; Busquets, Xavier; Trujillano, Javier J; Requena, Antonio

    2013-12-01

    Patients attended by palliative care teams: are they always comparable populations? To answer this question we have compared the basic epidemiological characteristics of patients attended by home palliative care teams (HPCT) in two autonomous regions of Spain. We carried out a coordinated analytical, observational and prospective study in two Spanish autonomous regions: Aragon and Catalonia. Data were kept during each home care visit according to patients' needs. Inclusion criteria were: advanced cancer, over 18 years old and first contact with a HPCT. The recruitment period was 6 months. Variables included were: Survival time (days), age, sex, primary disease and extension, place of residence. Functional and cognitive state, and co-morbidity. 10 signs/symptoms: asthenia, anorexia, cachexia, dysphagia, xerostomy, dyspnoea, oedemas, level of consciousness, presence of delirium, presence of pressure ulcers and some treatment data. Others variables considered were: responsible team, origin, destination when discharge, date and place of death, number of visits made and duration of monitoring. We developed a comparison between groups by Chi-squared test or the non-parametric Mann-Whitney U test and a survival analysis by Kaplan-Meier curves and the logrank test to determine differences between factors. The SPSS version 15.0 software package was used. 698 patients were included, 56.2% from Aragon and 43.8% from Catalonia. 60.3% were males, without differences between the regions. Characteristics relative to age, sex, place of residence and extension of oncological diseases were similar for both groups. We found significant differences between the two populations relative to survival time, co-morbidity, functional state, presence and intensity of a number of symptoms and the treatments, patient monitoring and the their destination after discharge. We can conclude that palliative care teams cover different profiles of patients with regard to their co-morbidity, functional

  9. Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients.

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    Cappello, Gianfranco; Franceschelli, Antonella; Cappello, Annalisa; De Luca, Paolo

    2012-10-30

    Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion. 19,036 patients (age 44.3 ± 13, M:F = 2:5) with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50-65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females. After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%. Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

  10. Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

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    Cappello Gianfranco

    2012-10-01

    Full Text Available Abstract Background Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion. Methods 19,036 patients (age 44.3 ± 13, M:F = 2:5 with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50–65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females. Results After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%. Conclusion Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

  11. Small bowel diverticulitis with severe anemia and abdominal pain

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    De Minicis, Samuele; Antonini, Filippo; Belfiori, Valerio; Lo Cascio, Massimiliano; Marraccini, Barbara; Piergallini, Simona; Mosca, Piergiorgio; Macarri, Giampiero

    2015-01-01

    The current case report is related to a male patient with diabetes, obesity [body mass index (BMI) 33], hypertension and recurrence of anemia associated to melena and deep asthenia. M.P., a 60-year-old obese individual, was referred to our department by the primary care unit (PCU) of our hospital for severe anemia (Hemoglobin 6.5 g/dL) associated to episodes of melena and abdominal pain. In the past 5 mo the patient referred to the local hospital 3 times for episodes of melena (hemoglobin levels showed anemia 9.8 g/dL) but the main gastroenterological exams were completely negative (colonoscopy and gastroscopy). The PCU of our Hospital, after stabilization of the main parameters and blood transfusion for the low levels of hemoglobin, referred the patient to gastroenterologists: the patient was subjected to both colonoscopy and gastroscopy that were negative. Due to the condition of acute severe hemorrhage the patient, during the first 3 h from the access to the PCU, was subjected to arteriography that did not reveal any hemorrhagic foci or vascular alterations. The video capsule for the study of the small bowel showed the presence of blood beginning from the third portion of duodenum but deep gastroscopy did not reveal it. The patient was then subjected to double balloon endoscopy that revealed a severe diverticulosis of the small bowel with blood from the diverticula. The entero-tomografia computerizzata confirmed the diagnosis and revealed an extension of the diverticula for almost the entire small bowel (no diverticula in the colon). The patient was subjected to wide spectrum antibiotic therapy with resolution of the symptoms and stabilization of hemoglobin levels. The surgeon suggests no indication to surgery for the wide area involved from the disease and potential high risk of complication due to the high BMI. At home, the patient started a monthly therapy with rifaximin and probiotics associated to mesalazine. At present, after 12 mo from the last episode of

  12. Epidemiology and outcomes of children with renal failure in the pediatric ward of a tertiary hospital in Cameroon.

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    Halle, Marie Patrice; Lapsap, Carine Tsou; Barla, Esther; Fouda, Hermine; Djantio, Hilaire; Moudze, Beatrice Kaptue; Akazong, Christophe Adjahoung; Priso, Eugene Belley

    2017-12-06

    Pediatric nephrology is challenging in developing countries and data on the burden of kidney disease in children is difficult to estimate due to absence of renal registries. We aimed to describe the epidemiology and outcomes of children with renal failure in Cameroon. We retrospectively reviewed 103 medical records of children from 0 to 17 years with renal failure admitted in the Pediatric ward of the Douala General Hospital from 2004 to 2013. Renal failure referred to either acute kidney injury (AKI) or Stage 3-5 chronic kidney disease (CKD). AKI was defined and graded using either the modified RIFLE criteria or the Pediatrics RIFLE criteria, while CKD was graded using the KDIGO criteria. Outcomes of interest were need and access to dialysis and in-hospital mortality. For patients with AKI renal recovery was evaluated at 3 months. Median age was 84 months (1QR:15-144) with 62.1% males. Frequent clinical symptoms were asthenia, anorexia, 68.8% of participants had anuria. AKI accounted for 84.5% (n = 87) and CKD for 15.5% (n = 16). Chronic glomerulonephritis (9/16) and urologic malformations (7/16) were the causes of CKD and 81.3% were at stage 5. In the AKI subgroup, 86.2% were in stage F, with acute tubular necrosis (n = 50) and pre-renal AKI (n = 31) being the most frequent mechanisms. Sepsis, severe malaria, hypovolemia and herbal concoction were the main etiologies. Eight of 14 (57%) patients with CKD, and 27 of 40 (67.5%) with AKI who required dialysis, accessed it. In-hospital mortality was 50.7% for AKI and 50% for CKD. Of the 25 patients in the AKI group with available data at 3 months, renal recovery was complete in 22, partial in one and 2 were dialysis dependent. Factors associated to mortality were young age (p = 0.001), presence of a coma (p = 0.021), use of herbal concoction (p = 0.024) and acute pulmonary edema (p = 0.011). Renal failure is severe and carries a high mortality in hospitalized children in Cameroon

  13. Brote epidémico de neumonías por Legionella pneumophila en niños cubanos

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    Roberto Razón Behar

    2002-09-01

    Full Text Available La Legionella pneumophila es uno de los patógenos responsable de neumonías atípicas, a través de la inhalación de aerosoles o aspiración de líquidos infectados. Se detectó un brote epidémico de neumonías por Legionella, originado por la aspiración de agua contaminada de una piscina en un grupo de niños cubanos. El agente causal se identificó en 5 de 9 pacientes, por la técnica de inmunofluorescencia indirecta en muestras de sueros pareados. Los síntomas y signos más frecuentes fueron malestar general, anorexia, astenia, fiebre persistente de 39 °C a 40 °C (103 °F a 105 °F, mialgias, cefaleas, náuseas, vómitos, dolor abdominal, diarreas, tos húmeda, dolor torácico y polipnea. Durante el desarrollo de la enfermedad, el tratamiento antibiótico fue empírico (incluyendo los macrólidos, por no tener confirmado el diagnóstico. Todos los pacientes evolucionaron satisfactoriamente. Se reportó un brote epidémico de neumonías por Legionella en niños por primera vez en Cuba, lo cual tiene importancia clínica y epidemiológica.The legionella pneumophila is one of the pathogens responsible for atypic pneumonias by the inhalation of aerosols or aspiration of infected liquids. An epidemic outbreak of pneumonias caused by Legionella was detected among a group of Cuban children. It was originated by the aspiration of contaminated water in a swimming pool. The causal agent was identified in 5 of 9 patients by using the indirect immunofluorescence technique in samples of matched sera. The most frequent symptoms and signs were malaise, anorexia, asthenia, persistent fever from 39°C to 40°C (103° F to 105° F, myalgias, headache, nauseas, vomits, abdominal pain, diarrheas, moist cough, thoracic pain and polypnoea. The antibiotic treatment was empiric (including the macrolides during the development of the disease, since the diagnosis was not confirmed. The patients’ evolution was satisfactory. An epidemic outbreak of pneumonias

  14. Directory of Open Access Journals (Sweden)

    Frederico F. Gil

    2013-04-01

    Full Text Available Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF, we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively. Blastocystis was the most common infection in the control group (41.9%, however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38. The most common symptoms in this group were flatulence (36.4%, asthenia (30.0% and weight loss (30.0%. In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703. A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05. Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with

  15. Did Napoleon suffer from chronic rhonchopathy?

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    Chouard, Claude-Henri

    2017-04-01

    If Napoleon had been treated, Europa would then have doubtless been different, and perhaps would not have known the last two World wars. This study plans to demonstrate that Napoleon very probably suffered from Chronic Rhonchopathy. Between 1983-1993, the author led their ENT department of CHU Saint-Antoine to contribute in the knowledge of chronic snoring and Obstructive Sleep Apneas Syndrome (OSAS), and to define the treatment of their consequences. As a result of these efforts, in Paris in 1987 the First International Congress on Chronic Rhonchopathy was organized. Obstructive Sleep Apnoea Syndrome (OSAS) is caused by anatomical and intermittent obstruction of the upper airway, which impedes passage of air to the lungs during sleep. Recent literature demonstrates that chronic snoring frequently precedes this obstruction by several years, and always accompanies this syndrome. All life long, there is a severity increasing continuum between more light snoring and more severe OSAS, i.e. Pickwick Syndrome. This continuum is described as a new disease called Chronic Rhonchopathy. This term was never discussed; since 2006, it has been implicitly recognized. Napoleon would sleep very little. He used to wake up in the night and then grasp the chance to work. Brief sleeping time in day repaired his fatigue. He also had a short and thick neck. In the last quarter of his life he had progressively suffered from obesity, daily involuntary sleepiness, and his intellectual capabilities had been undoubtedly decreasing. In the vast literature concerning Napoleon's behavior, the author brought together the clinical elements which could be due to this disease. This study looked for the morphological peculiarities of this OSAS in sculpture and painting, that had the Emperor as the model. Napoleon presented surely diurnal somnolence, asthenia, obesity, neck shortness, retrognatia, and nasal pathology. He did not suffer from these troubles while he was young. On the contrary, he took

  16. Proxies of quality of life in metastatic colorectal cancer: analyses in the RECOURSE trial

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    Van Cutsem, Eric; Falcone, Alfredo; Garcia-Carbonero, Rocio; Komatsu, Yoshito; Pastorino, Alessandro; Peeters, Marc; Shimada, Yasuhiro; Yamazaki, Kentaro; Yoshino, Takayuki; Zaniboni, Alberto; Amellal, Nadia; Kanehisa, Akira; Winkler, Robert; Makris, Lukas; Mayer, Robert J; Ohtsu, Atsushi; Tabernero, Josep

    2017-01-01

    Background In the pivotal phase III, randomised, double-blind, placebo-controlled RECOURSE study, treatment with trifluridine/tipiracil was well tolerated and associated with prolonged progression-free and overall survival in patients with metastatic colorectal cancer (mCRC). There was no formal analysis of quality of life (QoL) in RECOURSE. The aim of the present analysis was to assess proxies of QoL during the RECOURSE treatment period, in terms of adverse events (AEs) likely to affect QoL and Eastern Cooperative Oncology Group performance status (ECOG PS). Patients and methods Enrolled patients had documented, previously treated (≥2 prior chemotherapy lines) mCRC and an ECOG PS of 0 or 1. Patients received best supportive care plus trifluridine/tipiracil 35 mg/m2 twice daily (n=534) or placebo (n=266) in a 28-day cycle. AEs analysed included nausea, vomiting, diarrhoea, dysgeusia and fatigue/asthenia. ECOG PS was determined at baseline, on day 1 of each treatment cycle, at treatment end and 30 days post-treatment discontinuation. Results AEs that affect QoL were more frequent in patients treated with trifluridine/tipiracil than placebo. Median treatment duration for patients experiencing at least one of these AEs was longer than that observed for the overall RECOURSE population (trifluridine/tipiracil: 12 vs 7 weeks; placebo: 10 vs 6 weeks). Versus placebo, the duration of most AEs was longer in trifluridine/tipiracil recipients; however, all AEs except nausea and vomiting occupied a lower proportion of the total treatment period. Of the patients who had their PS recorded at discontinuation, PS was maintained in 67% and 63% of trifluridine/tipiracil and placebo recipients, and 84% and 81% of the trifluridine/tipiracil and placebo patients remained at a PS of 0 or 1 at discontinuation. Conclusions Analysis of ECOG PS and AEs thought to affect QoL in the RECOURSE patient population suggests that trifluridine/tipiracil treatment does not result in a

  17. Rabdomiólisis por spinning en nueve pacientes Rhabdomyolysis caused by spinning in nine patients

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    Javier Montero

    2009-02-01

    Full Text Available La rabdomiólisis es un síndrome que resulta de la destrucción del músculo esquelético. Aquella producida por ejercicio se observa luego de un esfuerzo físico intenso. Un tipo de actividad física basado en el pedaleo sobre bicicleta fija llamado spinning o indoor cycling, que trae consigo los fundamentos teóricos del ciclismo sobre una bicicleta estática, ha sido descrito excepcionalmente como factor precipitante de rabdomiólisis. Se realizó un estudio retrospectivo que evaluó la presentación clínica y complicaciones ocurridas en 9 pacientes que desarrollaron rabdomiólisis por pedaleo sobre bicicleta fija. Los síntomas predominantes fueron mialgias, astenia, eliminación de orinas oscuras e impotencia funcional de miembros inferiores. Todos presentaron elevaciones significativas de las enzimas musculares y los valores de creatinfosfoquinasa variaron entre 1.650 y 165 000 UI/l. Sólo un paciente presentó insuficiencia renal y otro hipocalcemia; ambos parámetros se normalizaron con el tratamiento instaurado. No se halló relación entre el aumento de enzimas musculares y la aparición de complicaciones. El objetivo del trabajo es presentar una serie de casos de rabdomiólisis por este deporte y alertar sobre el posible riesgo de dicha actividad.Rhabdomyolysis is a syndrome that results from the destruction of the skeletal muscle. The one produced by exercise is observed after an intense physical effort. A form of high-intensity exercise called spinning or indoor cycling that involves using a stationary bicycle, has been exceptionally reported as a generating factor of muscular damage in the medical literature. A retrospective study was performed to assess the clinical presentation and the complications shown by nine patients who experienced rhabdomyolysis caused by indoor cycling. The prevailing symptoms were myalgias, asthenia, myoglobinuria and functional impotence of the lower limbs. All the patients showed significant muscular

  18. Anxiety of first cadaver demonstration in medical, dentistry and pharmacy faculty students.

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    Bati, Ayse Hilal; Ozer, Mehmet Asim; Govsa, Figen; Pinar, Yelda

    2013-07-01

    Anatomy is the fundamental of medical and health professional education. Anatomic dissection enables the examination of the organs in the human cadavers systematically and topographically. The aim of this study was to determine the effect of the first cadaver demonstration and the anxiety of medical, dental and pharmacy students. A questionnaire was distributed to 486 students in the same academic year (2009-2010) at Ege University. The review of anxiety reveals the circumstances such as exhaustion, stress, depression, anxiety, destructive life, deterioration of mental or physical quality or asthenia (over-fatigue), professionally having a serious effect on the students. 486 (85.3 %) students in total participated in this research carried out as based on voluntariness as 338 (93.9 %) students from the medical faculty, 78 (70.9 %) students from the faculty of dentistry and 70 (70 %) students from the faculty of pharmacy.A medium level of anxiety was detected in the students in their first encounter with the cadaver. The state anxiety score (SAS) average taken by all the students who took part in the research is 42.6 ± 5.60 and trait anxiety score average is 46.6 ± 5.0. No discrepancy was detected among the faculties with respect to anxiety score. While the SASs of the male students were higher than the girls, the trait anxiety scores of the girl students were detected to be higher than male students. While the characteristics and the cultural life of our society force the male students into stronger behavioral patterns, they may actually increase their anxiety level in distressed conditions. The fact that trait anxiety is high in both sexes, particularly in female students can be explained by the patient responsibility and the work load undertaken in the professions in the medical field as early as the period of education.Before the students' applied lessons with the cadavers start, a preparatory session must be planned for this education to decrease the

  19. Four artemisinin-based treatments in African pregnant women with malaria.

    Science.gov (United States)

    Pekyi, Divine; Ampromfi, Akua A; Tinto, Halidou; Traoré-Coulibaly, Maminata; Tahita, Marc C; Valéa, Innocent; Mwapasa, Victor; Kalilani-Phiri, Linda; Kalanda, Gertrude; Madanitsa, Mwayiwawo; Ravinetto, Raffaella; Mutabingwa, Theonest; Gbekor, Prosper; Tagbor, Harry; Antwi, Gifty; Menten, Joris; De Crop, Maaike; Claeys, Yves; Schurmans, Celine; Van Overmeir, Chantal; Thriemer, Kamala; Van Geertruyden, Jean-Pierre; D'Alessandro, Umberto; Nambozi, Michael; Mulenga, Modest; Hachizovu, Sebastian; Kabuya, Jean-Bertin B; Mulenga, Joyce

    2016-09-01

    Information regarding the safety and efficacy of artemisinin combination treatments for malaria in pregnant women is limited, particularly among women who live in sub-Saharan Africa. We conducted a multicenter, randomized, open-label trial of treatments for malaria in pregnant women in four African countries. A total of 3428 pregnant women in the second or third trimester who had falciparum malaria (at any parasite density and regardless of symptoms) were treated with artemether-lumefantrine, amodiaquine-artesunate, mefloquine-artesunate, or dihydroartemisinin-piperaquine. The primary end points were the polymerase-chain-reaction (PCR)-adjusted cure rates (i.e., cure of the original infection; new infections during follow-up were not considered to be treatment failures) at day 63 and safety outcomes. The PCR-adjusted cure rates in the per-protocol analysis were 94.8% in the artemether-lumefantrine group, 98.5% in the amodiaquine-artesunate group, 99.2% in the dihydroartemisinin-piperaquine group, and 96.8% in the mefloquine-artesunate group; the PCR-adjusted cure rates in the intention-to-treat analysis were 94.2%, 96.9%, 98.0%, and 95.5%, respectively. There was no significant difference among the amodiaquine-artesunate group, dihydroartemisinin-piperaquine group, and the mefloquine-artesunate group. The cure rate in the artemether-lumefantrine group was significantly lower than that in the other three groups, although the absolute difference was within the 5-percentage-point margin for equivalence. The unadjusted cure rates, used as a measure of the post-treatment prophylactic effect, were significantly lower in the artemether-lumefantrine group (52.5%) than in groups that received amodiaquine-artesunate (82.3%), dihydroartemisinin-piperaquine (86.9%), or mefloquine-artesunate (73.8%). No significant difference in the rate of serious adverse events and in birth outcomes was found among the treatment groups. Drug-related adverse events such as asthenia, poor

  20. [Electrolyte metabolism and emergency].

    Science.gov (United States)

    Nakao, I; Ito, T; Kasai, N

    1983-02-01

    In outlining the pathology of various electrolyte metabolism abnormalities in cancer patients we considered the main clinical points between pathologies and emergency treatment. In regard to sodium (Na+) metabolism, one pathologic state that requires our attention is hypernatremia. Hypernatremia is accompanied with dehydration and is due to water loss, vomiting, diarrhea and renal insufficiency. One of the major causes of this condition is lack of the antidiuretic hormone due to intracranial metastasis of the tumor. When hypernatremia becomes severe, it is accompanied with circulatory failure, muscular asthenia, disorientation, convulsions, coma and other cerebral symptoms. Treatment consists of replenishing the water content by infusion of electrolyte solutions which should be carefully conducted after complete diagnose of the severity of the patient's pathological condition. Hyponatremia, like sick cell syndrome, is observed relatively frequently in cancer patients. When the serum Na level falls markedly, it induces cerebral edema and causes disorders of consciousness. The major treatment consists of providing both water and sodium supplements. Hyperkalemia is observed at the time of renal insufficiency, tissue lesions, vomiting, and diarrhea. When serum potassium level rises, it causes bradycardia, ventricular fibrillation, or cardiac arrest. It is important to diagnostically apprehend the severity of this condition using EKG and determining the serum K1+ level. For emergency treatment injection of calcium gluconate is very effective. Hypokalemia is often manifested by the loss of intestinal fluids due to diarrhea or during administration of diuretic agents. Clinical symptoms include neural paralysis but emergencies occur relatively infrequently. K C1 injections are used in treating this condition. Hypercalcemia is manifested in cancer patients during hyperparathyroidism. Its clinical symptoms include lassitude, tachycardia, nausea, vomiting, and renal dys

  1. Ciliary neurotrophic factor (CNTF) for amyotrophic lateral sclerosis/motor neuron disease.

    Science.gov (United States)

    Bongioanni, P; Reali, C; Sogos, V

    2004-01-01

    Amyotrophic lateral sclerosis, also known as motor neuron disease, is a fatal neuromuscular disease characterized by progressive muscle weakness resulting in paralysis, which might be treated with ciliary neurotrophic factor. The objective of this review was to examine the efficacy of ciliary neutrophic factor in amyotrophic lateral sclerosis. We searched the Cochrane Neuromuscular Disease Group trials register (searched June 2003) for randomized trials, MEDLINE (from January 1966 to October 2003) and EMBASE (from January 1980 to October 2003), checked the reference lists of papers identified and contacted the authors of studies identified to get additional unpublished results. We considered the following selection criteria: Types of studies: randomized controlled clinical trials; adults with a diagnosis of either probable or definite amyotrophic lateral sclerosis according to the El Escorial criteria; Types of interventions: treatment with ciliary neurotrophic factor for at least six months, in a placebo-controlled randomized format; Types of outcome measures Primary: survival; Secondary: muscle strength, respiratory function, changes in bulbar functions, changes in quality of life, proportion of patients with adverse side effects (such as cough, asthenia, nausea, anorexia, weight loss and increased salivation). We identified two randomized trials. The data were extracted and examined independently by the reviewers. Some missing data were obtained from investigators. Two trials, with a total population of 1,300 amyotrophic lateral sclerosis patients treated with subcutaneous injections of recombinant human ciliary neurotrophic factor, were examined in this review. The methodological quality of these trials was considered adequate. No significant difference was observed between ciliary neurotrophic factor and placebo groups for survival, the primary outcome measure. The relative risk was 1.07 (95% CI 0.81 to 1.41). No significant differences between the groups were

  2. Clinical Characteristics of Cerebrovascular Pathology with Patients Suffering from Ph-Negative Myeloproliferative Disease

    Directory of Open Access Journals (Sweden)

    Marine M. Tanashyan

    2016-09-01

    Full Text Available Background: Disturbances of microcirculation play a significant role in the development and progression of both acute and chronic cerebrovascular diseases (CVD and may be associated with different hemogram abnormalities. One of the reasons of the prothrombogenic state of the endothelium is the increase in the number of blood corpuscles leading to (non-Ph myeloproliferative disorders (MPD including essential thrombocythemia (ET, polycythemia vera (PV, and primary myelofibrosis (PM. Materials and Methods: The study included 167 patients: 102 patients with Ph-MPD and the control group comprising 65 patients with CVD. According to MPD subtype, the patients were divided into three groups: patients with ET (37%, n = 38, male/female 7/31, age 52 ± 7 years, those with PV (40%, n = 41, male/female 20/21, age 50 ± 6 years and those with PM (23%, n = 23, male/female 5/18, age 54 ± 4 years. Results: In 79% (n = 81 of cases in the study group (with Ph-MPD, patients had chronic CVD, with the most frequently identified symptoms being asthenia (92% and headache (72%. Headache in Ph-MPD patients was more frequently (86% associated with PM, while in patients with PV and ET it was equally distributed (70%. Neurological symptoms in 53% of cases were associated with focal changes of the brain on MRI localized in the subcortical area of the frontal and parietal lobes. Twenty-one (21% patients suffered an acute cerebrovascular accident, 8 of them had thrombotic occlusion of one of the internal carotid arteries leading to hemispheric infarcts. Endothelial function (as measured by flow-dependent dilation of the brachial artery was severely impaired in all study groups (median 5% with normal cut-off at 10%, the lowest degree of vasodilator activity being specific for patients with a history of stroke (p = 0.011. Conclusion: Patients suffering from MPD had asymptomatic focal changes in the brain in the absence of concomitant vascular disease (hypertension

  3. Monitoring the use of nifurtimox-eflornithine combination therapy (NECT in the treatment of second stage gambiense human African trypanosomiasis

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    Franco JR

    2012-08-01

    Full Text Available Jose R Franco,1 Pere P Simarro,1 Abdoulaye Diarra,2 Jose A Ruiz-Postigo,3 Mireille Samo,1 Jean G Jannin11World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, Geneva, Switzerland; 2World Health Organization, Regional Office for Africa, Brazzaville, Congo; 3World Health Organization, Communicable Disease Control, Control of Tropical Diseases and Zoonoses Regional Office for the Eastern Mediterranean, Cairo, EgyptAbstract: After inclusion of the nifurtimox-eflornithine combination therapy (NECT in the Model List of Essential Medicines for the treatment of second-stage gambiense human African trypanosomiasis (HAT, the World Health Organization, in collaboration with National Sleeping Sickness Control Programs and nongovernmental organizations set up a pharmacovigilance system to assess the safety and efficacy of NECT during its routine use. Data were collected for 1735 patients treated with NECT in nine disease endemic countries during 2010–2011. At least one adverse event (AE was described in 1043 patients (60.1% and a total of 3060 AE were reported. Serious adverse events (SAE were reported for 19 patients (1.1% of treated, leading to nine deaths (case fatality rate of 0.5%. The most frequent AE were gastrointestinal disorders (vomiting/nausea and abdominal pain, followed by headache, musculoskeletal pains, and vertigo. The most frequent SAE and cause of death were convulsions, fever, and coma that were considered as reactive encephalopathy. Two hundred and sixty-two children below 15 years old were treated. The characteristics of AE were similar to adults, but the major AE were less frequent in children with only one SAE and no deaths registered in this group. Gastrointestinal problems (vomiting and abdominal pain were more frequent than in adults, but musculoskeletal pains, vertigo, asthenia, neuropsychiatric troubles (headaches, seizures, tremors, hallucinations, insomnia were less

  4. Relative bioavailability of tizanidine 4-mg capsule and tablet formulations after a standardized high-fat meal: a single-dose, randomized, open-label, crossover study in healthy subjects.

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    Henney, Herbert R; Shah, Jaymin

    2007-04-01

    An immediate-release, multiparticulate capsule formulation of tizanidine has been developed to modify tizanidine pharmacokinetic characteristics in an attempt to decrease adverse events (AEs) while maintaining effectiveness in the management of spasticity. This study was designed to compare the pharmacokinetic properties and tolerability of a single dose (4 mg) of an immediate-release, multiparticulate tizanidine capsule versus a commercially available tablet (reference) administered after a standardized high-fat meal. This single-dose, randomized, open-label, 2-way crossover study in healthy, nonsmoking adult subjects was conducted at MDS Pharma Services, Belfast, United Kingdom. Subjects were randomly assigned to receive the capsule-tablet or tablet-capsule treatment. The 2 treatment periods were separated by a 6-day washout period. All treatments were administered after a standardized high-fat meal. To determine plasma tizanidine pharmacokinetic properties, blood samples were collected over 24 hours after administration. The predetermined bioequivalence range for the test drug (capsule) was 80% to 125% of the reference drug (tablet). Drug tolerability was assessed using routine physical examination, including vital-sign measurements; laboratory analysis (hematology, biochemistry, and urinalysis); 12-lead electrocardiography; direct observation; spontaneous reporting; and non specific questioning. This study included 18 subjects (12 men, 6 women; mean [SD] age, 26 [7] years). The mean height and body weight of the subjects were 176 (8) cm and 70.1 (9.6) kg, respectively. The peak exposure, as measured by mean natural logarithm-transformed C(max) values, was significantly lower with the capsule compared with the tablet (2.7 vs 4.0 ng/mL; P definition of bioequivalence when given after a high-fat meal. All AEs were transient and mild in intensity, with asthenia being the most common event with the capsule and tablet formulations, occurring in 5 (28%) and 8 (44

  5. Prospective study of Chikungunya virus acute infection in the Island of La Réunion during the 2005-2006 outbreak.

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    Frederik Staikowsky

    Full Text Available BACKGROUND: Chikungunya virus (CHIKV is a recently re-emerged arthropod borne virus responsible for a massive outbreak in the Indian Ocean and India, and extended to Southeast Asia as well as Italy. CHIKV has adapted to Aedes albopictus, an anthropophilic mosquito species widely distributed in Asia, Europe, Africa and America. Our objective was to determine the clinical and biological features of patients at the acute phase of CHIKV infection. METHODS AND FINDINGS: A prospective study enrolled 274 consecutive patients with febrile arthralgia recorded at the Emergency Department of the Groupe Hospitalier Sud-Réunion between March and May 2006. Three groups were defined: one group of 180 viremic patients (positive CHIKV RT-PCR, one group of 34 patients with acute post-viremic infection (negative CHIKV RT-PCR, positive anti-CHIKV IgM and negative IgG, and one group of 46 uninfected patients (negative CHIKV RT-PCR, anti-CHIKV IgM and IgG. Bivariate analyses of clinical and biological features between groups were performed. Patients with CHIKV viremia presented typically with asymmetrical bilateral polyarthralgia (96.5% affecting the lower (98% and small joints (74.8%, as well as asthenia (88.6%, headache (70%, digestive trouble (63.3%, myalgia (59%, exanthems (47.8%, conjunctival hyperhemia (23% and adenopathy (8.9%. Vertigo, cutaneous dysesthesia, pharyngitis and haemorrhages were seldom observed. So far unreported symptoms such as chondrocostal arthralgia (20%, entesopathies (1.6%, talalgia (14% were also noted. Prurit was less frequent during the viremic than post-viremic phase (13.9% vs. 41.2%; p<0.001, whereas lymphopenia was more frequent (87.6% vs. 39.4%; p<0.001. Others biological abnormalities included leukopenia (38.3%, thrombocytopenia (37.3%, increased ASAT and ALAT blood levels (31.6 and 7.3%, respectively and hypocalcemia (38.7%. Lymphopenia <1,000/mm(3 was very closely associated with viremic patients (Yule coefficient 0.82, positive

  6. Prospective study of Chikungunya virus acute infection in the Island of La Réunion during the 2005-2006 outbreak.

    Science.gov (United States)

    Staikowsky, Frederik; Talarmin, François; Grivard, Philippe; Souab, Abdel; Schuffenecker, Isabelle; Le Roux, Karin; Lecuit, Marc; Michault, Alain

    2009-10-28

    Chikungunya virus (CHIKV) is a recently re-emerged arthropod borne virus responsible for a massive outbreak in the Indian Ocean and India, and extended to Southeast Asia as well as Italy. CHIKV has adapted to Aedes albopictus, an anthropophilic mosquito species widely distributed in Asia, Europe, Africa and America. Our objective was to determine the clinical and biological features of patients at the acute phase of CHIKV infection. A prospective study enrolled 274 consecutive patients with febrile arthralgia recorded at the Emergency Department of the Groupe Hospitalier Sud-Réunion between March and May 2006. Three groups were defined: one group of 180 viremic patients (positive CHIKV RT-PCR), one group of 34 patients with acute post-viremic infection (negative CHIKV RT-PCR, positive anti-CHIKV IgM and negative IgG), and one group of 46 uninfected patients (negative CHIKV RT-PCR, anti-CHIKV IgM and IgG). Bivariate analyses of clinical and biological features between groups were performed. Patients with CHIKV viremia presented typically with asymmetrical bilateral polyarthralgia (96.5%) affecting the lower (98%) and small joints (74.8%), as well as asthenia (88.6%), headache (70%), digestive trouble (63.3%), myalgia (59%), exanthems (47.8%), conjunctival hyperhemia (23%) and adenopathy (8.9%). Vertigo, cutaneous dysesthesia, pharyngitis and haemorrhages were seldom observed. So far unreported symptoms such as chondrocostal arthralgia (20%), entesopathies (1.6%), talalgia (14%) were also noted. Prurit was less frequent during the viremic than post-viremic phase (13.9% vs. 41.2%; p<0.001), whereas lymphopenia was more frequent (87.6% vs. 39.4%; p<0.001). Others biological abnormalities included leukopenia (38.3%), thrombocytopenia (37.3%), increased ASAT and ALAT blood levels (31.6 and 7.3%, respectively) and hypocalcemia (38.7%). Lymphopenia <1,000/mm(3) was very closely associated with viremic patients (Yule coefficient 0.82, positive predictive value 92.3%). Age

  7. Prospective Study of Chikungunya Virus Acute Infection in the Island of La Réunion during the 2005–2006 Outbreak

    Science.gov (United States)

    Staikowsky, Frederik; Talarmin, François; Grivard, Philippe; Souab, Abdel; Schuffenecker, Isabelle; Le Roux, Karin

    2009-01-01

    Background Chikungunya virus (CHIKV) is a recently re-emerged arthropod borne virus responsible for a massive outbreak in the Indian Ocean and India, and extended to Southeast Asia as well as Italy. CHIKV has adapted to Aedes albopictus, an anthropophilic mosquito species widely distributed in Asia, Europe, Africa and America. Our objective was to determine the clinical and biological features of patients at the acute phase of CHIKV infection. Methods and Findings A prospective study enrolled 274 consecutive patients with febrile arthralgia recorded at the Emergency Department of the Groupe Hospitalier Sud-Réunion between March and May 2006. Three groups were defined: one group of 180 viremic patients (positive CHIKV RT-PCR), one group of 34 patients with acute post-viremic infection (negative CHIKV RT-PCR, positive anti-CHIKV IgM and negative IgG), and one group of 46 uninfected patients (negative CHIKV RT-PCR, anti-CHIKV IgM and IgG). Bivariate analyses of clinical and biological features between groups were performed. Patients with CHIKV viremia presented typically with asymmetrical bilateral polyarthralgia (96.5%) affecting the lower (98%) and small joints (74.8%), as well as asthenia (88.6%), headache (70%), digestive trouble (63.3%), myalgia (59%), exanthems (47.8%), conjunctival hyperhemia (23%) and adenopathy (8.9%). Vertigo, cutaneous dysesthesia, pharyngitis and haemorrhages were seldom observed. So far unreported symptoms such as chondrocostal arthralgia (20%), entesopathies (1.6%), talalgia (14%) were also noted. Prurit was less frequent during the viremic than post-viremic phase (13.9% vs. 41.2%; p<0.001), whereas lymphopenia was more frequent (87.6% vs. 39.4%; p<0.001). Others biological abnormalities included leukopenia (38.3%), thrombocytopenia (37.3%), increased ASAT and ALAT blood levels (31.6 and 7.3%, respectively) and hypocalcemia (38.7%). Lymphopenia <1,000/mm3 was very closely associated with viremic patients (Yule coefficient 0.82, positive

  8. Work-related Mental Consequences: Implications of Burnout on Mental Health Status Among Health Care Providers

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    Papathanasiou, Ioanna V.

    2015-01-01

    Introduction: Burnout can create problems in every aspect of individual’s’ human life. It may have an adverse effect on interpersonal and family relations and can lead to a general negative attitude towards life. Aim: The purpose of this study is to investigate whether burnout is associated with the mental health status of health care providers. Material and Methods: The sample in this study consisted of 240 health care employees. The Greek version of Maslach’s Burnout Inventory (MBI) was used for measuring burnout levels and the Greek version of the Symptoms Rating Scale for Depression and Anxiety (SRSDA) questionnaire was used to evaluate health care providers’ mental health status. Descriptive statistics were initially generated for sample characteristics. Normality was checked by the Kolmogorov-Smirnov test and data was processed with parametric tests. General linear models with MBI dimensions as independent variables and SRSDA subscales as dependent variables were used to determine the relation between burnout and mental health status. Statistics were processed with SPSS v. 17.0 (SPSS, Chicago, IL, USA). Statistical significance was set at p=0.05. Results: The average age of the sample is 40.00±7.95 years. Regarding gender the percentage of men is 21.40% (N=49) and of women is 78.60% (N=180). Overall the professional burnout of health care workers is moderate. The mean score for emotional exhaustion is 26.41, for personal accomplishment 36.70 and for depersonalization 9.81. The mean for each subscale of SRSDA is 8.23±6.79 for Depression Beck-21, 3.96±4.26 for Depression Beck-13, 4.91±4.44 for Melancholia, 6.32±4.35 for Asthenia and 6.36±4.72 for Anxiety. The results of general linear models with the MBI dimensions as independent variables and the SRSDA subscales as dependent variables are shown that emotional exhaustion and personal accomplishment are statistically correlated with all subscales of SRSDA, while depersonalization is not correlated

  9. Trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel in the neoadjuvant setting of HER-2 positive breast cancer.

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    Uriarte-Pinto, Moisés; Escolano-Pueyo, Ángel; Gimeno-Ballester, Vicente; Pascual-Martínez, Oihana; Abad-Sazatornil, María Reyes; Agustín-Ferrández, María José

    2016-04-01

    Neoadjuvant treatment based on the combination of trastuzumab plus chemotherapy is the standard of care in patients with HER2-positive early or locally advanced breast cancer. The concurrent use of trastuzumab, anthracyclines and taxanes is frequently used in this setting despite the potential cardiotoxicity of both anthracyclines and trastuzumab. However, not much information is available about this chemotherapy scheme. We wanted to evaluate the efficacy and safety profile of the combination of trastuzumab, liposome-encapsulated doxorubicin and paclitaxel as neoadjuvant scheme. We also tried to establish predictive factors of pathologic complete response. The study was carried out in a tertiary University Hospital of Spain. This is a descriptive study of the clinical practice performed in our hospital. Efficacy was measured in terms of pathologic complete response, which was defined as the absence of invasive cancer cells in the breast and the axilla after neoadjuvant treatment. Thirty patients were included, the median age was 48. Seventeen (56.7 %) were hormonal receptor (HR) positive, 14 (46.6 %) had IIIa-b clinical stage and one of them had inflammatory breast cancer. 12 patients (40 %) achieved pCR. Patients with HR-negative BC achieved a higher pCR rate than those ones with HR-positive BC (61.5 % and 23.5 %, respectively; p value = 0.035). 21 patients (70 %) underwent breast conservative surgery. The treatment was in general well tolerated, most frequent grade 3-4 adverse events were neutropenia (20 %), asthenia and liver enzyme alteration (10 %) and febrile neutropenia (6.7 %). No patient developed heart failure, but one (3.3 %) presented a 10 % asymptomatic absolute reduction in left ventricular fraction ejection. The studied treatment for the neoadjuvant setting of HER2 positive breast cancer seems to be an effective therapeutic option. Despite the expected high rate of cardiotoxicity of this regimen, the study results shows that this treatment regimen

  10. Meningitis por Streptococcus suis en un paciente inmunocompetente Streptococcus suis meningitis in an immunocompetent patient

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    A. Nagel

    2008-09-01

    Full Text Available Se describe un caso de meningitis por Streptococcus suis en un paciente inmunocompetente. Presentaba astenia, debilidad generalizada, fiebre (39 °C, vómitos, deterioro del sensorio y desorientación témporo-espacial. Los cultivos de sangre (2/2 y de líquido cefalorraquídeo fueron positivos. La identificación preliminar se realizó utilizando las pruebas bioquímicas convencionales y fue completada en el Servicio Bacteriología Especial del INEI-ANLIS "Dr. Carlos G. Malbrán". Se comenzó el tratamiento con ampicilina y ceftriaxona. El microorganismo aislado demostró sensibilidad a ampicilina, cefotaxima y vancomicina. El paciente evolucionó favorablemente, pero se comprobó leve hipoacusia. Reingresó a los 4 meses con marcha atáxica, anacusia en oído izquierdo e hipoacusia en oído derecho. Continúa con seguimiento neurológico y audiométrico. Retrospectivamente se constató el contacto del paciente con cerdos. Se destaca la importancia de la anamnesis para alertar la sospecha de este agente etiológico en meningitis y bacteriemias.A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles were positive. The isolate was preliminary identified by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient’s retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about

  11. Pioglitazone treatment increases survival and prevents body weight loss in tumor-bearing animals: possible anti-cachectic effect.

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    Mércia Beluzi

    Full Text Available Cachexia is a multifactorial syndrome characterized by profound involuntary weight loss, fat depletion, skeletal muscle wasting, and asthenia; all symptoms are not entirely attributable to inadequate nutritional intake. Adipose tissue and skeletal muscle loss during cancer cachexia development has been described systematically. The former was proposed to precede and be more rapid than the latter, which presents a means for the early detection of cachexia in cancer patients. Recently, pioglitazone (PGZ was proposed to exhibit anti-cancer properties, including a reduction in insulin resistance and adipose tissue loss; nevertheless, few studies have evaluated its effect on survival. For greater insight into a potential anti-cachectic effect due to PGZ, 8-week-old male Wistar rats were subcutaneously inoculated with 1 mL (2×107 of Walker 256 tumor cells. The animals were randomly assigned to two experimental groups: TC (tumor + saline-control and TP5 (tumor + PGZ/5 mg. Body weight, food ingestion and tumor growth were measured at baseline and after removal of tumor on days 7, 14 and 26. Samples from different visceral adipose tissue (AT depots were collected on days 7 and 14 and stored at -80o C (5 to 7 animals per day/group. The PGZ treatment showed an increase in the survival average of 27.3% (P< 0.01 when compared to TC. It was also associated with enhanced body mass preservation (40.7 and 56.3%, p< 0.01 on day 14 and 26 compared with the TC group. The treatment also reduced the final tumor mass (53.4%, p<0.05 and anorexia compared with the TC group during late-stage cachexia. The retroperitoneal AT (RPAT mass was preserved on day 7 compared with the TC group during the same experimental period. Such effect also demonstrates inverse relationship with tumor growth, on day 14. Gene expression of PPAR-γ, adiponectin, LPL and C/EBP-α from cachectic rats was upregulated after PGZ. Glucose uptake from adipocyte cells (RPAT was entirely re

  12. Effects of first-dose volume and exercise on the efficacy and tolerability of bowel preparations for colonoscopy in Chinese people

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    Qin Y

    2016-04-01

    Full Text Available Ying Qin, Wei Liu, Songbai Lin, Xiangfeng Li International Medical Services, Peking Union Medical College Hospital, Beijing, People’s Republic of China Aim: This study was designed to compare the efficacy and tolerability of bowel preparations with and without the higher first-dose volume of polyethylene glycol (PEG solution or exercise after drinking PEG solution in Chinese people. Methods: A total of 330 participants who had a colonoscopy done in Peking Union Medical College Hospital were randomly and evenly assigned to three groups. Participants in Group A ingested 1 L PEG solution and then ingested 2 L PEG solution at a rate of 250 mL every 15 minutes. Participants in Group B ingested 3 L PEG solution at a rate of 250 mL every 15 minutes and then exercised more than 10 minutes after ingesting each liter of PEG solution. Participants in Group C ingested 3 L PEG solution at a rate of 250 mL every 15 minutes. Experienced gastrointestinal endoscopists rated the efficacy of bowel preparations based on the Boston Bowel Preparation Scale score. A questionnaire regarding participants’ symptoms associated with bowel preparations was administered to evaluate participants’ tolerability. Results: The three groups had insignificant difference in the percentages of participants’ symptoms including dizziness, nausea, stomach ache, bloating, and asthenia. However, the percentages of participants having hunger sensation, sleep disturbance, and anal discomfort were significantly higher in groups with the higher first-dose volume of PEG solution or exercise after drinking PEG solution than without them. The three groups had insignificant difference in the Boston Bowel Preparation Scale score. Conclusion: Whether to add the higher first-dose volume of PEG solution and exercise after drinking PEG solution or not, all participants achieved a similar quality of bowel preparations. Bowel preparations without the additional first-dose volume of PEG

  13. ED-33ELDERLY PATIENTS WITH GLIOBLASTOMA: SHOULD BE TREATED IN A DIFFERENT WAY?

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    Salgado, Maria Angeles Vaz; del Toro, Jacobo Muñoz; Cerco, José Antonio Gutierrez; Urzaiz, Luis Ley; Mena, Alfredo Carrato; Pian, Hector; Olmos, Vanessa Pachón; Rueda, Ana Gomez; de Pedro, Marta Del Alamo

    2014-01-01

    BACKGROUND: The management of glioblastoma (GB) in elderly patients is not well established, since until recently they have been excluded from randomized trials and there are concerns about the toxicity. METHODS: The authors retrospectively reviewed 53 patients at a single institution from 2005 to 2013. Patients were 70 years of age and older with histologically confirmed GB. RESULTS: Median age was 75 years (70-88y). Fifty-six percent men, 43% women. Majority had some kind of minor morbidity (89%), mainly arterial hypertension (55%). Complete resection was performed in 52%. Biopsy in 8%. 90% had presurgical KPS >70. Seven (14%) had worse KPS after surgery. 71% received radiotherapy, in 45% 60 Gy and in 26% 30 Gy. Nearly 40% were treated with concomitant and adjuvant temozolomide. The median number of cycles was 4,43 (1-14). 6% had grade 3 or 4 neutropenia or trombocitopenia. 24% had grade 1 asthenia or nausea and vomits. Median overall survival (OS) for the whole cohort was 7,36 m (95% CI 4,8-9,8). Median progression free survival was 5.9 m (3-8.7m). Treatment with temozolomide concomitant and adjuvant (Stupp regimen) was associated with longer OS (11,16 vs 4,1m p = 0.008 ). The median OS was 8,3 m. for those who received radiotherapy and 1,5m for those who did not (p = 0,046). No statistical differences were found between those treated with 60 or 30 Gy (p = 0.143). Nearly 10% was older than 80. Median OS in these patients was 4,2m even though 71% had a complete resection. CONCLUSION: In our experience, in selected patients with newly diagnosed glioblastoma over the age of 70, more intensive treatment was associated with prolonged OS, and results are close to those obtained in younger patients. Nevertheless these are retrospective data, selection bias should be considerer. Further randomized trial should be conducted to investigate this topic.

  14. Global Epidemiology of Dengue Outbreaks in 1990–2015: A Systematic Review and Meta-Analysis

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    Congcong Guo

    2017-07-01

    Full Text Available Dengue is an arthropod-borne infectious disease caused by dengue virus (DENV infection and transmitted by Aedes mosquitoes. Approximately 50–100 million people are infected with DENV each year, resulting in a high economic burden on both governments and individuals. Here, we conducted a systematic review and meta-analysis to summarize information regarding the epidemiology, clinical characteristics, and serotype distribution and risk factors for global dengue outbreaks occurring from 1990 to 2015. We searched the PubMed, Embase and Web of Science databases through December 2016 using the term “dengue outbreak.” In total, 3,853 studies were identified, of which 243 studies describing 262 dengue outbreaks met our inclusion criteria. The majority of outbreak-associated dengue cases were reported in the Western Pacific Region, particularly after the year 2010; these cases were primarily identified in China, Singapore and Malaysia. The pooled mean age of dengue-infected individuals was 30.1 years; of the included patients, 54.5% were male, 23.2% had DHF, 62.0% had secondary infections, and 1.3% died. The mean age of dengue patients reported after 2010 was older than that of patients reported before 2010 (34.0 vs. 27.2 years; however, the proportions of patients who had DHF, had secondary infections and died significantly decreased after 2010. Fever, malaise, headache, and asthenia were the most frequently reported clinical symptoms and signs among dengue patients. In addition, among the identified clinical symptoms and signs, positive tourniquet test (OR = 4.86, ascites (OR = 13.91 and shock (OR = 308.09 were identified as the best predictors of dengue infection, DHF and mortality, respectively (both P < 0.05. The main risk factors for dengue infection, DHF and mortality were living with uncovered water container (OR = 1.65, suffering from hypotension (OR = 6.18 and suffering from diabetes mellitus (OR = 2.53, respectively (all P < 0.05. The

  15. Ledipasvir-sofosbuvir with or without ribavirin to treat patients with HCV genotype 1 infection and cirrhosis non-responsive to previous protease-inhibitor therapy: a randomised, double-blind, phase 2 trial (SIRIUS).

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    Bourlière, Marc; Bronowicki, Jean-Pierre; de Ledinghen, Victor; Hézode, Christophe; Zoulim, Fabien; Mathurin, Philippe; Tran, Albert; Larrey, Dominique G; Ratziu, Vlad; Alric, Laurent; Hyland, Robert H; Jiang, Deyuan; Doehle, Brian; Pang, Phillip S; Symonds, William T; Subramanian, G Mani; McHutchison, John G; Marcellin, Patrick; Habersetzer, François; Guyader, Dominique; Grangé, Jean-Didier; Loustaud-Ratti, Véronique; Serfaty, Lawrence; Metivier, Sophie; Leroy, Vincent; Abergel, Armand; Pol, Stanislas

    2015-04-01

    Patients with cirrhosis resulting from chronic hepatitis C virus (HCV) infection are at risk of life-threatening complications, but consistently achieve lower sustained virological response (SVR) than patients without cirrhosis, especially if treatment has previously failed. We assessed the efficacy and safety of the NS5A inhibitor ledipasvir and the nucleotide polymerase inhibitor sofosbuvir, with and without ribavirin. In this multicentre, double-blind trial, between Oct 21, 2013, and Oct 30, 2014, we enrolled patients with HCV genotype 1 and compensated cirrhosis who had not achieved SVR after successive treatments with pegylated interferon and protease-inhibitor regimens at 20 sites in France. With a computer-generated randomisation sequence, patients were assigned in a 1:1 ratio to receive placebo matched in appearance to study drugs for 12 weeks followed by once daily combination fixed-dose tablets of 90 mg ledipasvir and 400 mg sofosbuvir plus weight-based ribavirin for 12 weeks, or ledipasvir-sofosbuvir plus placebo once daily for 24 weeks. The primary endpoint was SVR 12 weeks after the end of treatment (SVR12), for which 95% CIs were calculated with the Clopper-Pearson method. This study is registered with ClinicalTrials.gov, number NCT01965535. Of 172 patients screened, 155 entered randomisation, 77 were assigned to receive ledipasvir-sofosbuvir plus ribavirin and 78 ledipasvir-sofosbuvir. 114 (74%) were men, 151 (97%), were white, 98 (63%) had HCV genotype 1a, and 145 (94%) had non-CC IL28B alleles. SVR12 rates were 96% (95% CI 89-99) for patients in the ledipasvir-sofosbuvir plus ribavirin group and 97% (91-100) in the ledipasvir-sofosbuvir group. One patient discontinued treatment because of adverse events while receiving only placebo. The most frequent adverse events were asthenia and headache, pruritus, and fatigue. Ledipasvir-sofosbuvir plus ribavirin for 12 weeks and ledipasvir-sofosbuvir for 24 weeks provided similarly high SVR12 rates in

  16. Treatment With Ledipasvir-Sofosbuvir for 12 or 24 Weeks in Kidney Transplant Recipients With Chronic Hepatitis C Virus Genotype 1 or 4 Infection: A Randomized Trial.

    Science.gov (United States)

    Colombo, Massimo; Aghemo, Alessio; Liu, Hong; Zhang, Jie; Dvory-Sobol, Hadas; Hyland, Robert; Yun, Chohee; Massetto, Benedetta; Brainard, Diana M; McHutchison, John G; Bourlière, Marc; Peck-Radosavljevic, Markus; Manns, Michael; Pol, Stanislas

    2017-01-17

    Use of interferon and ribavirin to treat chronic hepatitis C virus (HCV) infection in kidney transplant recipients is limited because of the risk for allograft rejection and poor tolerability. To evaluate the safety and efficacy of the interferon- and ribavirin-free regimen ledipasvir-sofosbuvir in kidney transplant recipients with chronic genotype 1 or 4 HCV infection. Randomized, phase 2, open-label study. (ClinicalTrials.gov: NCT02251717). 5 sites in Europe. Treatment-naive or -experienced kidney transplant recipients with chronic genotype 1 or 4 HCV infection, with or without compensated cirrhosis, and with an estimated glomerular filtration rate (eGFR) of 40 mL/min or greater were randomly assigned 1:1 to receive ledipasvir (90 mg) and sofosbuvir (400 mg) for 12 or 24 weeks. The primary end point was sustained virologic response at 12 weeks after therapy ended (SVR12). Among 114 patients, the median age was 53 years, 58% were male, 91% had genotype 1 infection, 69% were treatment naive, and 15% had compensated cirrhosis. The median eGFR was 56 mL/min (range, 35 to 135 mL/min). One hundred percent of patients (57 of 57) treated for 12 weeks (95% CI, 94% to 100%) and 100% of those (57 of 57) treated for 24 weeks (CI, 94% to 100%) achieved SVR12. Serious adverse events were reported in 13 patients (11%). Of these, 3 events-syncope, pulmonary embolism, and serum creatinine increase-in 3 patients were determined to be treatment related. One patient permanently discontinued treatment because of an adverse event (syncope). The most frequent adverse events overall were headache (n = 22 [19%]), asthenia (n = 16 [14%]), and fatigue (n = 11 [10%]). The study was open label, no inferential statistics were planned, and only patients with genotype 1 or 4 infection were included. Few patients with HCV genotype 1a and cirrhosis were enrolled. Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks was well-tolerated and seemed to have an acceptable safety profile among

  17. Ledipasvir-sofosbuvir in patients with hepatitis C virus genotype 5 infection: an open-label, multicentre, single-arm, phase 2 study.

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    Abergel, Armand; Asselah, Tarik; Metivier, Sophie; Kersey, Kathryn; Jiang, Deyuan; Mo, Hongmei; Pang, Phillip S; Samuel, Didier; Loustaud-Ratti, Véronique

    2016-04-01

    events were asthenia (16 [39%] patients), headache (11 [27%] patients), and fatigue (four [10%] patients). One patient had a serious adverse event, worsening depression, which we judged to be unrelated to study treatment. The oral regimen of ledipasvir-sofosbuvir is an effective and well-tolerated treatment for patients with HCV genotype 5 infection who are treatment naive or treatment experienced. Gilead Sciences. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Effect of everolimus on survival in advanced hepatocellular carcinoma after failure of sorafenib: the EVOLVE-1 randomized clinical trial.

    Science.gov (United States)

    Zhu, Andrew X; Kudo, Masatoshi; Assenat, Eric; Cattan, Stéphane; Kang, Yoon-Koo; Lim, Ho Yeong; Poon, Ronnie T P; Blanc, Jean-Frederic; Vogel, Arndt; Chen, Chao-Long; Dorval, Etienne; Peck-Radosavljevic, Markus; Santoro, Armando; Daniele, Bruno; Furuse, Junji; Jappe, Annette; Perraud, Kevin; Anak, Oezlem; Sellami, Dalila B; Chen, Li-Tzong

    2014-07-02

    Aside from the multikinase inhibitor sorafenib, there are no effective systemic therapies for the treatment of advanced hepatocellular carcinoma. To assess the efficacy of everolimus in patients with advanced hepatocellular carcinoma for whom sorafenib treatment failed. EVOLVE-1 was a randomized, double-blind, phase 3 study conducted among 546 adults with Barcelona Clinic Liver Cancer stage B or C hepatocellular carcinoma and Child-Pugh A liver function whose disease progressed during or after sorafenib or who were intolerant of sorafenib. Patients were enrolled from 17 countries between May 2010 and March 2012. Randomization was stratified by region (Asia vs rest of world) and macrovascular invasion (present vs absent). Everolimus, 7.5 mg/d, or matching placebo, both given in combination with best supportive care and continued until disease progression or intolerable toxicity. Per the 2:1 randomization scheme, 362 patients were randomized to the everolimus group and 184 patients to the placebo group. The primary end point was overall survival. Secondary end points included time to progression and the disease control rate (the percentage of patients with a best overall response of complete or partial response or stable disease). No significant difference in overall survival was seen between treatment groups, with 303 deaths (83.7%) in the everolimus group and 151 deaths (82.1%) in the placebo group (hazard ratio [HR], 1.05; 95% CI, 0.86-1.27; P = .68; median overall survival, 7.6 months with everolimus, 7.3 months with placebo). Median time to progression with everolimus and placebo was 3.0 months and 2.6 months, respectively (HR, 0.93; 95% CI, 0.75-1.15), and disease control rate was 56.1% and 45.1%, respectively (P = .01). The most common grade 3/4 adverse events for everolimus vs placebo were anemia (7.8% vs 3.3%, respectively), asthenia (7.8% vs 5.5%, respectively), and decreased appetite (6.1% vs 0.5%, respectively). No patients experienced hepatitis C

  19. [Severe upper gastrointestinal hemorrhage of a rare cause: aorto-esophageal fistula successfully treated].

    Science.gov (United States)

    Tonea, A; Andrei, S; Andronesi, D; Vasilescu, C; Diculescu, M; Andrei, Adriana; Ionescu, M

    2005-01-01

    Aorto-esophageal fistula is a rare entity, determining huge digestive bleeding with a very poor prognostic most often. We present the case of a patient with aorto-esophageal fistula of unknown origin, treated successfully in the Center of Surgery and Liver Transplantation from Fundeni Clinical Institute. A young man, 21 years old, was admitted in our clinic from another hospital for repetitive severe upper gastrointestinal bleeding, with hematemesis and melena, pale, asthenia, without any pain; the bleeding stopped when he was admitted. The upper digestive endoscopy and esophago-gastro-duodenal radioscopy with barium did not show any lesion. During the 7th day the patient presents sudden massive hematemesis with hemodynamic instability; during the surgery we found two subcardial ulcers (stress ulcers?) for which we have done excision and suture which temporary stopped the bleeding. After 14 days, the patient had another massive bleeding; the upper endoscopy shows 28 cm far from the dental arch a protrusive formation of 6-7 mm with a telangiectasis aspect and with a white spot (possibly a central ulceration); 1 ml pure alcohol was injected inside it with temporary bleeding ceasing. After 3 days the patient is bleeding again, with marked decrease in blood pressure; a Blakemore tube stopped the bleeding until surgery was performed. During the intervention an aorto-oesophageal fistula is detected; we made the excision of the fistula with simple suture of the aorta, subtotal esophagectomy, cervico-stoma and gastrostomy, with good postoperative evolution. After 4 months the digestive transit is restored by esophagoplasty with tubulized stomach placed behind the sternum. The diagnostic and treatment difficulties encountered in these kind of cases need to consider also an aorto-esophageal fistula diagnosis, especially for the cases with Chiari triad (mild thoracic pain, sentinel digestive bleeding and exsanguination). The Blakemore tube can save patient's life by ensuring

  20. Efficacy and tolerability of chemotherapy with modified dose-dense TCF regimen (TCF-dd) in locally advanced or metastatic gastric cancer: final results of a phase II trial.

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    Tomasello, Gianluca; Liguigli, Wanda; Poli, Rossana; Lazzarelli, Silvia; Brighenti, Matteo; Negri, Federica; Curti, Alessandra; Martinotti, Mario; Olivetti, Lucio; Rovatti, Massimo; Donati, Gianvito; Passalacqua, Rodolfo

    2014-10-01

    We previously studied a dose-dense TCF (TCF-dd) regimen demonstrating its feasibility and an activity comparable to epirubicin-based chemotherapy and TCF q3w in terms of overall survival and time to progression (TTP). We report here the final results of a phase II study of chemotherapy with a modified TCF-dd regimen in locally advanced or metastatic gastric cancer (MGC). Patients with histologically confirmed measurable MGC, not previously treated for advanced disease, received docetaxel 70 mg/m(2) day 1, cisplatin 60 mg/m(2) day 1, l-folinic acid 100 mg/m(2) days 1 and 2, followed by 5-fluorouracil (5-FU) 400 mg/m(2) bolus days 1 and 2, and then 600 mg/m(2) as a 22-h continuous infusion days 1 and 2, every 14 days, plus pegfilgrastim 6 mg on day 3. Patients aged ≥65 years received the same schedule with a dose reduction of 30 %. Study duration: December 2007-November 2010. Forty-six consecutive patients were enrolled (78 % male, 22 % female; median age, 66 years, range, 38-76 years; ECOG PS: 0, 48 %, 1, 46 %). Primary endpoint was overall response rate (ORR). A median of four cycles (range, one to six) was administered. Forty-three patients were evaluated for response (93.5 %) and all for toxicity: 3 complete response (CR), 25 partial response (PR), 10 stable disease (SD), and 5 progressive disease (PD) were observed, for an ORR by intention to treat (ITT) of 61 % (95 % CI 47-75). Median overall survival (OS) was 17.63 months (95 % CI, 13.67-20.67); median progression-free survival was 8.9 months (95 % CI, 6.5-13.4). Twenty-one patients (46.0 %) were treated at full doses without any delay, thus respecting the dose-dense criterion. Most frequent grade 3-4 toxicities were neutropenia (20 %), leukopenia (4 %), thrombocytopenia (2 %), anemia (2 %), febrile neutropenia (6 %), asthenia (22 %), diarrhea (4 %), nausea/vomiting (11 %), and hypokalemia (6 %). Overall, TCF-dd was shown to be safe. The TCF-dd regimen in locally advanced or MGC

  1. Dermatomiositis: a propósito de 3 casos interesantes Dermatomyositis: with regard to 3 interesting cases

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    Zianna Almanza Liranza

    2010-12-01

    Full Text Available Se presentan los casos de 3 pacientes atendidos en el Hospital Pediátrico «Juan Manuel Márquez», 2 de las cuales presentaron como primeras manifestaciones debilidad en los miembros inferiores y artritis que dificultaba la marcha de forma progresiva. El tercer paciente presentaba lesiones escamosas en la piel, hipopigmentadas en la cara y los miembros, acompañadas de astenia y artritis de las rodillas. Se realizaron estudios para concluir el diagnóstico, incluida la biopsia de músculo. Se aplicaron los criterios para confirmar el diagnóstico de dermatomiositis y se excluyeron otras enfermedades según el cuadro clínico y los exámenes complementarios realizados. A los 2 primeros pacientes se les indicó tratamiento inmunomodulador con prednisona y metotrexato, y al tercer paciente se le indicó prednisona y azathioprina. Se observó una buena respuesta al tratamiento y control de la enfermedad. El primer paciente falleció a los 4 meses de tratamiento a causa de complicaciones (vasculitis intestinal y sepsis asociada al tratamiento quirúrgico. Los restantes pacientes se siguen actualmente por consulta.Authors present three patients seen in the "Juan Manuel Márquez" Children Hospital where two of them had as first manifestations weakness in lower extremities and arthritis provoking a progressive difficulty to walk. The third patient had skin squamous lesions with hypopigmentation in the case and limbs as well as asthenia and knee arthritis. To made the diagnosis studies were conducted including thigh biopsy Criteria were applied to confirm diagnosis of dermatomyositis with exclusion of other diseases according to clinical picture and complementary examinations performed. In the two first patients a imunomodulation treatment was prescribed including Prednisone and Methotrexate, and the other patient received Prednisone and Azathioprine. There was a good response to treatment and a disease control. The first patient dye at 4 months of

  2. Inhibition of the mammalian target of rapamycin (mTOR in advanced pancreatic cancer: results of two phase II studies

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    Zhang Yujian

    2010-07-01

    Full Text Available Abstract Background The phosphoinositide 3-kinase (PI3K/Akt pathway is constitutively activated in pancreatic cancer and the mammalian target of rapamycin (mTOR kinase is an important mediator for its signaling. Our recent in vitro studies suggest that prolonged exposure of pancreatic cancer cells to mTOR inhibitors can promote insulin receptor substrate-PI3K interactions and paradoxically increase Akt phosphorylation and cyclin D1 expression in pancreatic cancer cells (negative feedback loop. The addition of erlotinib to rapamycin can down-regulate rapamycin-stimulated Akt and results in synergistic antitumor activity with erlotinib in preclinical tumor models. Methods Two studies prospectively enrolled adult patients with advanced pancreatic cancer, Eastern Cooperative Oncology Group performance status 0-1, adequate hematologic, hepatic and renal parameters and measurable disease. In Study A, temsirolimus was administered intravenously at 25 mg weekly. In Study B, everolimus was administered orally at 30 mg weekly and erlotinib was administered at 150 mg daily. The primary endpoint in both studies was overall survival at 6 months. Secondary endpoints included time to progression, progression-free survival, overall survival, response rate, safety and toxicity. Pretreatment tumor biopsies were analyzed by immunofluorescence and laser scanning cytometry for the expression of pmTOR/mTOR, pAkt/Akt, pErk/Erk, pS6, p4EBP-1 and PTEN. Results Five patients enrolled in Study A; Two patients died within a month (rapid disease progression and hemorrhagic stroke, respectively. One patient developed dehydration and another developed asthenia. Sixteen patients enrolled in Study B.: 12 males, all ECOG PS = 1. Median cycles = 1 (range 1-2. Grade 4 toxicity: hyponatremia (n = 1, Grade 3: diarrhea (n = 1, cholangitis (n = 3, hyperglycemia (n = 1, fatigue (n = 1. Grade 2: pneumonia (n = 2, dehydration (n = 2, nausea (n = 2, neutropenia (n = 1, mucositis (n = 2

  3. Pharmacology of Schisandra chinensis Bail.: an overview of Russian research and uses in medicine.

    Science.gov (United States)

    Panossian, Alexander; Wikman, Georg

    2008-07-23

    , vessels and CNS. Numerous clinical trials have demonstrated the efficiency of Schizandra in asthenia, neuralgic and psychiatric (neurosis, psychogenic depression, astheno-depressive states, schizophrenia and alcoholism) disorders, in impaired visual function, hypotension and cardiotonic disorders, in epidemic waves of influenza, in chronic sinusitis, otitis, neuritis and otosclerosis, in pneumonia, radioprotection of the fetoplacental system of pregnant women, allergic dermatitis, acute gastrointestinal diseases, gastric hyper- and hypo-secretion, chronic gastritis, stomach and duodenal ulcers, wound healing and trophic ulcers. This review describes the considerable diversity of pharmacological effects of Schisandra chinensis reported in numerous studies carried out in the former USSR and which have been confirmed over more than 40 years of use of the plant as an official medicinal remedy. Such knowledge can be applied in the expansion of the use of Schizandra in the pharmacotherapy of European and other countries as well as for the further discovery of new drugs based on the lignans that constitute the main secondary metabolites of this plant.

  4. Connective tissue disorders in domestic animals.

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    Halper, Jaroslava

    2014-01-01

    Though soft tissue disorders have been recognized and described to some detail in several types of domestic animals and small mammals for some years, not much progress has been made in our understanding of the biochemical basis and pathogenesis of these diseases in animals. Ehlers-Danlos syndrome described in dogs already in 1943 and later in cats affects mainly skin in these animals. The involved skin is thin and hyperextensible with easily inflicted injuries resulting in hemorrhagic wounds and atrophic scars. Joint laxity and dislocation common in people are less frequently found in dogs. No systemic complications, such as organ rupture or cardiovascular problems which have devastating consequences in people have been described in cats and dogs. The diagnosis is based on clinical presentation and on light or electron microscopic features of disorganized and fragmented collagen fibrils. Several cases of bovine and ovine dermatosparaxis analogous to human Ehlers-Danlos syndrome type VIIC were found to be caused by mutations in the procollagen I N-proteinase (pnPI) or ADAMTS2 gene, though mutations in other sites are likely responsible for other types of dermatosparaxis. Cattle suffering from a form of Marfan syndrome were described to have aortic dilatation and aneurysm together with ocular abnormalities and skeletal involvement. As in people mutations at different sites of bovine FBN1 may be responsible for Marfan phenotype. Hereditary equine regional dermal asthenia (HERDA), or hyperelastosis cutis, has been recognized in several horse breeds as affecting primarily skin, and, occasionally, tendons. A mutation in cyclophilin B, a chaperon involved in proper folding of collagens, has been identified in some cases. Degenerative suspensory ligament desmitis (DSLD) affects primarily tendons and ligaments of certain horse breeds. New data from our laboratory showed excessive accumulation of proteoglycans in organs with high content of connective tissues. We have

  5. Work-related Mental Consequences: Implications of Burnout on Mental Health Status Among Health Care Providers.

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    Papathanasiou, Ioanna V

    2015-02-01

    Burnout can create problems in every aspect of individual's' human life. It may have an adverse effect on interpersonal and family relations and can lead to a general negative attitude towards life. The purpose of this study is to investigate whether burnout is associated with the mental health status of health care providers. The sample in this study consisted of 240 health care employees. The Greek version of Maslach's Burnout Inventory (MBI) was used for measuring burnout levels and the Greek version of the Symptoms Rating Scale for Depression and Anxiety (SRSDA) questionnaire was used to evaluate health care providers' mental health status. Descriptive statistics were initially generated for sample characteristics. Normality was checked by the Kolmogorov-Smirnov test and data was processed with parametric tests. General linear models with MBI dimensions as independent variables and SRSDA subscales as dependent variables were used to determine the relation between burnout and mental health status. Statistics were processed with SPSS v. 17.0 (SPSS, Chicago, IL, USA). Statistical significance was set at p=0.05. The average age of the sample is 40.00±7.95 years. Regarding gender the percentage of men is 21.40% (N=49) and of women is 78.60% (N=180). Overall the professional burnout of health care workers is moderate. The mean score for emotional exhaustion is 26.41, for personal accomplishment 36.70 and for depersonalization 9.81. The mean for each subscale of SRSDA is 8.23±6.79 for Depression Beck-21, 3.96±4.26 for Depression Beck-13, 4.91±4.44 for Melancholia, 6.32±4.35 for Asthenia and 6.36±4.72 for Anxiety. The results of general linear models with the MBI dimensions as independent variables and the SRSDA subscales as dependent variables are shown that emotional exhaustion and personal accomplishment are statistically correlated with all subscales of SRSDA, while depersonalization is not correlated with any SRSDA subscale. Burnout appears to implicate

  6. Imported malaria in pregnancy in Madrid

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    Jiménez Beatriz C

    2012-04-01

    Full Text Available Abstract Background Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce. The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain. Methods Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records. Results There were 19 pregnant women among 346 malaria cases (5.4%. The average age was 27 years. The gestational age (trimester was: 53% 3rd, 31% 1st, 16% 2nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89% had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice. Presentation: 16 symptomatic patients (fever in fourteen, asthenia in two, three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl 78.9% (mild 31.6%, moderate 31.6%, severe 15.8% thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to Plasmodium falciparum, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%. Outcomes: no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up. Conclusions Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic

  7. Docetaxel in hormone-sensitive advanced prostate cancer; GENESIS-SEFH evaluation reporta

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    Emilio Jesús Alegre del Rey

    2017-07-01

    Full Text Available Prostate cancer (PC is the most common urogenital malignancy in older men and the second leading cause of death by cancer in men in Europe. Current therapeutic practice considers Androgen Deprivation Therapy (ADT as first line treatment for clinically localized prostate cancer at high-risk, either locally advanced or metastatic. ADT can be achieved through orchiectomy (surgical castration, luteinizing hormone-releasing hormone (LHRH agonists, or through complete androgen blockade (LHRH agonist combined with an anti-androgen. Docetaxel in combination with prednisone or prednisolone is indicated for the treatment of patients with hormone-refractory metastatic prostate cancer. The CHAARTED and STAMPEDE clinical trials studied the effect of bringing forward the use of docetaxel added on to ADT in the context of hormone-sensitive patients. The CHAARTED clinical trial showed a significant increase in a variable with maximum relevance such as Overall Survival (OS, with a difference of 13.6 months between medians. There was also clinical benefit in the secondary variables: median time until castration-resistant disease or until clinical progression. In the STAMPEDE clinical trial, which included 39% of non-metastatic patients, a 10-month difference between medians was demonstrated in OS, and 17 months in the primary co-variable of Progression Free Survival. The most frequent adverse events were: neutropenia, febrile neutropenia, leucopenia, and general disorders such as asthenia, lethargy or fever. According to data from the CHAARTED and STAMPEDE studies, and the incremental cost of € 3 196.98 for adding on docetaxel to standard treatment, the estimated additional cost for each year of life gained is compatible with an incremental cost-effectiveness ratio between € 2 267.36 and € 3 851.78. In view of the efficacy and safety results, the proposed positioning is: to advance the use of docetaxel added to androgen deprivation therapy to first

  8. Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies

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    Zlateva Gergana

    2010-11-01

    Full Text Available Abstract Background Older patients are typically underrepresented in clinical trials of medications for chronic pain. A post hoc analysis of multiple clinical studies of pregabalin in patients with painful diabetic peripheral neuropathy (DPN or postherpetic neuralgia (PHN was conducted to evaluate the efficacy and safety of pregabalin in older patients. Methods Data from 11 double-blind, randomized, placebo-controlled clinical studies of pregabalin in patients with DPN or PHN were pooled. Efficacy outcomes included change in Daily Pain Rating Scale score, ≥30% and ≥50% responders, and endpoint pain score ≤3. Safety was based on adverse events (AEs. Primary efficacy was analyzed by analysis of covariance with terms for treatment, age category, protocol, baseline pain, and treatment-by-age category interaction. Results 2516 patients (white, n = 2344 [93.2%]; men, n = 1347 [53.5%]; PHN, n = 1003 [39.9%]; pregabalin, n = 1595 were included in the analysis. Patients were grouped by age: 18 to 64 years (n = 1236, 65 to 74 years (n = 766, and ≥75 years (n = 514. Baseline mean pain and sleep interference scores were comparable across treatment and age groups. Significant improvements in endpoint mean pain were observed for all pregabalin dosages versus placebo in all age groups (p ≤ 0.0009, except for the lowest dosage (150 mg/day in the youngest age group. Clinically meaningful pain relief, defined as ≥30% and ≥50% pain response, was observed in all age groups. The most common AEs were dizziness, somnolence, peripheral edema, asthenia, dry mouth, weight gain, and infections. The relative risks for these AEs increased with pregabalin dose, but did not appear related to older age or type of neuropathic pain. Conclusions Pregabalin (150-600 mg/day significantly reduced pain in older patients (age ≥65 years with neuropathic pain and improvements in pain were comparable to those observed in younger patients. Titration of pregabalin to the

  9. Injectable interferon beta-1b for the treatment of relapsing forms of multiple sclerosis

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    Slobodan M Jankovic

    2010-03-01

    -specific reactions, insomnia, influenza-like syndrome, asthenia, headache, myalgia, hypoesthesia, nausea, paresthesia, myasthenia, chills and depression. Efficacy of IFN-β1b in  relapsing-remitting MS is higher than that of IFN-β1a, and similar to the efficacy of glatiramer acetate. These facts promote IFN-β1b as one of the most important drugs in the spectrum of immunological therapies for this debilitating disease.Keywords: multiple sclerosis, interferon beta 1b, mechanism of action, efficacy, safety

  10. Adenoma corticosuprarrenal no funcionante Non-functional corticosuprarenal adenoma

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    Evelio Salvador Reyes Balseiro

    2011-12-01

    Full Text Available Alrededor del 50 % de las tumoraciones corticosuprerrenales son benignas y funcionales, muchas son sólidas con signos y síntomas de exceso de glucocorticoides (Cushing o mineralocorticoides (Conn. El otro 50 % de neoplasias sólidas corresponde a carcinomas adrenocorticales primarios, la mitad funcionales. Dentro de las tumoraciones sólidas benignas la más frecuente es el adenoma. Se presenta un paciente de 36 años de edad, de piel blanca, sexo masculino, con buena salud anterior, que ingresó por astenia desde hace 6 meses y dolor abdominal en el flanco derecho, de ligera intensidad, irradiado a la espalda, además de la pérdida de peso. Al examen físico se constata tumoración en flanco derecho. Se diagnostica tumoración suprarrenal voluminosa por ultrasonografía, tomografía axial computarizada y elevación del cortisol en sangre. Se extirpa el tumor por una incisión combinada anterior y lateral en posición semidecúbito, que brindó un buen campo, y se obtuvieron excelentes resultados. El diagnóstico anatomopatológico fue adenoma corticosuprarrenal, que se analizan y comparan con otros reportes.About the 50 % of the cortical-suprarenal tumor are benign and functional, much of them are solid with signs and symptoms of glucocorticoids (Cushing or mineralocorticoid (Conn. The remainder 50 % of solid neoplasm corresponds to primary adrenocortical carcinomas whose half is functional. Within the benign solid tumors the more frequent is the adenoma. This is the case of a white male patient aged 36 with a prior good health admitted due to asthenia from 6 months ago and slightly intensive abdominal pain the right flank irradiating to back as well as weight loss. In physical examination it was verified a right flank tumor. A bulky suprarenal tumor was diagnosed by ultrasonography, computerized axial tomography and a rise of blood cortisol. Tumor is removed b y anterior and lateral combined incision in semi-decubitus position allowed a

  11. [The impact of some bad habits and environmental factors on the somatic status of male adolescents].

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    Lalić, Hrvoje; Kalebota, Natasa; Kabalin, Milena

    2006-09-01

    The aim of the study was to investigate whether some bad habits of sedentary lifestyle influence the occurrence of diagnoses in male adolescents, divided according to their environment into urban, rural and and island groups. A total of 437 male adolescents underwent physical examination and functional diagnostic tests at Occupational Medicine Clinic in Rijeka, in order to evaluate their fitness for military service. The method of physical examination and anthropologic measurements was used. The results were analyzed by the Stat Soft, Statistics 6.0 software. Pearson chi-squared-test test and correlation matrices were used. The results showed obesity to be present in a relatively high percentage of subjects from urban area (10.94%) and rural area (13.19%), whereas asthenia was more pronounced in islanders (8.69%), yielding a statistically significant between-group difference (pInternet. Physical activity cannot be readily performed in towns because of the increasing presence of pollutants in the atmosphere. The prevalence of bronchial asthma was slightly higher than expected, which was explained by the permanent residence of atopics on the islands in order to prevent disease relapses. The lowest incidence of flatfoot among islanders was explained by their free lifestyle, barefoot walking along the rocky seaside, and high level of physical activity. Refraction errors including myopia as the leading diagnosis were equally present in the three groups, exceeding 20%. Besides heredity, the sight is influenced by intensified effects of ultraviolet radiation that causes changes of the eye structure. Also, neon signs and lights as well as too strong night streetlights lead to phototoxic vision damage in adolescents. Study results showed that male adolescents who lead physically inactive life should not to be blamed for the occurrence of the mentioned diagnoses. Like all of us they are daily affected by harmful pollutants that cause damage to the eyes, cardiovascular

  12. Perfil epidemiológico do beribéri notificado de 2006 a 2008 no Estado do Maranhão, Brasil Epidemiological profile of reported beriberi cases in Maranhão State, Brazil, 2006-2008

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    Estela Maura Padilha

    2011-03-01

    Full Text Available O objetivo do estudo foi descrever o perfil epidemiológico dos casos e óbitos de beribéri notificados de 2006-2008 no Estado do Maranhão, Brasil. Informações foram obtidas de fichas de notificação da Secretaria de Estado da Saúde do Maranhão e utilizou-se o Índice Global de Moran para avaliar autocorrelação espacial. Foram notificados 1.207 casos e 40 óbitos. Regiões oeste e central mostraram forte presença de autocorrelação espacial da incidência. Ocorrência de casos e óbitos concentrou-se de maio a agosto, em homens jovens (20-40 anos. Hábito de consumir álcool e fumar esteve presente entre os óbitos; baixa renda e ocupação com atividade pesada, entre os casos. Os sintomas mais comuns foram diminuição da força, dormência e edema das pernas, dificuldade para caminhar e dor na panturrilha. O perfil dos acometidos e os sintomas, exceto edema de membros inferiores, são característicos de beribéri seco. É pertinente que estudos sobre seu ressurgimento no país sejam aprofundados.This study aimed to describe the epidemiological profile of beriberi cases and related deaths reported from 2006 to 2008 in Maranhão State, Brazil. Data were obtained from beriberi notification forms at the State Health Department. The global Moran index was used to evaluate spatial auto-correlation. 1207 cases and 40 deaths were reported. The western and central regions of the State showed strong spatial auto-correlation of incidence rates. Cases and deaths were concentrated from May to August, in young men (20-40 years. Regular alcohol consumption and smoking were recorded among fatal cases. Low income and heavy labor were widespread among cases. Common symptoms were asthenia, numbness, and swollen legs, difficulty walking, and calf pain. The profile of cases and their symptoms (except swollen legs are characteristic of dry beriberi. We recommend further studies on the resurgence of beriberi in Brazil.

  13. Oncostatic activity of pineal neuroendocrine treatment with the pineal indoles melatonin and 5-methoxytryptamine in untreatable metastatic cancer patients progressing on melatonin alone.

    Science.gov (United States)

    Lissoni, Paolo; Rovelli, Franco; Frassineti, Andrea; Fumagalli, Luca; Malysheva, Ola; Conti, Ario; Maestroni, Georges

    2000-01-01

    OBJECTIVE: The recent advances in psycho-neuro-endocrino-immunology have demonstrated the existence of several endogenous neuroendocrine substances, capable of affecting both tumor growth and host anticancer immune defenses. The pineal gland would represent one of the most important organs releasing antiproliferative and immunostimulating substances, the most known of them is melatonin (MLT). However, MLT would not be the only pineal indole provided by antitumor activity. Other pineal indoles, namely 5-methoxytryptamine (5-MTT), would play antitumor effects, by either inhibiting cancer cell proliferation or stimulating the anticancer immunity. Preliminary data have shown that MLT may deserve antitumor activity in the treatment of human neoplasms, whereas at present there are no clear data about 5-MTT. In an attempt to obtain some preliminary data about the anticancer properties of 5-MTT in humans, we have evaluated the efficacy of MLT plus 5-MTT in untreatable advanced cancer patients progressing on MLT alone. METHODS: The study included 73 untreatable advanced solid tumor patients, who had progressed after two months of MLT therapy alone. According to tumor histotype, patients were randomized to receive MLT alone (20 mg/day orally in the evening) or MLT plus 5-MTT (1 mg at noon orally), every day for at least two months. The clinical response was evaluated according to WHO criteria. RESULTS: A partial response (PR) occurred in two patients treated with MLT + 5-MTT and in none of the patients receiving MLT alone. A stable disease (SD) was achieved in only 2/37 patients on MLT therapy alone, and in 8/36 patients receiving MLT plus 5-MTT. Therefore, the percent of non-progressing patients (SD + PR) obtained with MLT plus 5-MTT was significantly higher than that obtained with MLT alone. Moreover, the relief of asthenia and depressant symptoms was significantly higher in patients concomitantly treated with 5-MTT. DISCUSSION: This preliminary study would suggest that

  14. Lamotrigine. An update of its pharmacology and therapeutic use in epilepsy.

    Science.gov (United States)

    Fitton, A; Goa, K L

    1995-10-01

    Lamotrigine is an antiepileptic agent which blocks voltage-dependent sodium channels, thereby preventing excitatory neurotransmitter release. Clinical evidence indicates that lamotrigine is effective against partial and secondarily generalised tonic-clonic seizures, as well as idiopathic (primary) generalised epilepsy. As monotherapy, lamotrigine 100 to 300 mg/day has similar medium term (30 to 48 weeks) efficacy to carbamazepine 300 to 1400 mg/day and phenytoin 300 mg/day against partial onset seizures and idiopathic generalised tonic-clonic seizures in adults with newly diagnosed epilepsy, and appears to be better tolerated than the older agents. As adjunctive therapy, lamotrigine (50 to 500 mg/day) has shown efficacy in short term ( epilepsy, reducing total seizure frequency (by or = 50% reduction in seizure frequency) in generalised tonic-clonic seizures are reduced by lamotrigine, with generalised seizures (particularly absence seizures, atonic seizures and Lennox-Gastaut syndrome) tending to be more responsive than partial seizures. This reduction in seizure frequency is sustained on long term ( lamotrigine ( or = 50% reductions in seizure frequency and approximately equal to 10 % achieving abolition of seizures after 3 months' treatment. Generalised seizures, including atypical and typical absence seizures, atonic and tonic seizures and Lennox-Gastaut syndrome are most responsive. The most common adverse events associated with lamotrigine are primarily neurological, gastrointestinal and dermatological. Maculopapular or erythematous skin rash, occasionally severe, occurs in approximately equal to 10% of patients and is the most common cause of treatment withdrawal. The risk of rash can, however, be minimised through adoption of a low, slow dosage titration schedule on initiating therapy. As monotherapy, lamotrigine produces less drowsiness than carbamazepine or phenytoin, and less asthenia and ataxia than phenytoin. Clinical experience would therefore suggest

  15. Safety of long-term use of linezolid: results of an open-label study

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    Vazquez JA

    2016-09-01

    Full Text Available Jose A Vazquez,1 Anthony C Arnold,2 Robert N Swanson,3 Pinaki Biswas,3 Matteo Bassetti4 1Section of Infectious Diseases, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA; 2UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, CA, USA; 3Clinical Research, Global Innovative Pharmaceutical, Pfizer Inc., New York, NY, USA; 4Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy Objective: The objective of this study was to assess the long-term safety of linezolid in patients with chronic infections requiring treatment for ≥6 weeks. Enhanced monitoring for optic neuropathy was included to characterize the early development of this side effect and to identify ophthalmologic tests that might be valuable in early detection of this event. Methods: This was a multicenter, open-label, pilot study of patients aged ≥18 years on long-term linezolid therapy. Matched control patients were included for baseline assessment comparison. Patients were assessed at study entry, monthly while on treatment, at the end of treatment, and 30 days following the last dose. Aggregate ocular safety data were reviewed. Response to treatment was reported. Results: The study was terminated owing to slow enrollment. Twenty-four patients received linezolid; nine patients were included as matched controls. Linezolid was prescribed for a median of 80.5 days (range, 50–254 days. In patients with a reported clinical outcome, the majority were considered improved or cured. Common treatment-related adverse events (AEs included anemia, peripheral neuropathy, polyneuropathy, vomiting, and asthenia, and were consistent with the known safety profile. Most AEs resolved or stabilized with discontinuation of treatment. Results of ophthalmologic tests in the one case adjudicated as probable linezolid-associated optic neuropathy revealed abnormal color vision, characteristic changes in the optic disk

  16. Ebola Virus Disease Outbreak in Isiro, Democratic Republic of the Congo, 2012: Signs and Symptoms, Management and Outcomes.

    Science.gov (United States)

    Kratz, Thomas; Roddy, Paul; Tshomba Oloma, Antoine; Jeffs, Benjamin; Pou Ciruelo, Diana; de la Rosa, Olimpia; Borchert, Matthias

    2015-01-01

    Data collected during the 2012 Ebola virus disease (EVD) epidemic in the Democratic Republic of the Congo were analysed for clinical signs, symptoms and case fatality of EVD caused by Bundibugyo virus (BDBV), establishment of differential diagnoses, description of medical treatment and evaluation of the quality of clinical documentation. In a quantitative observational prospective study, global epidemiological data from 52 patients (34 patients within the community, 18 patients treated in the Ebola Treatment Centre) were entered anonymously into a database, subsequently matched and analysed. Relevant findings include an over-representation of females among community EVD cases (85.3%) and of community EVD cases in the age group of 15-54 years (82.4%). All ETC patients had fever (55.6% of all 18 ETC patients during their hospital stay) or self-reported fever (88.2% upon admission) at some point of time during their illness. Major symptoms of ETC patients during hospital stay included asthenia (82.4%), anorexia (82.4%), myalgia (70.6%), sore throat/difficulty swallowing (70.6%), arthralgia (76.5%) and nausea (70.6%). Gastrointestinal signs and symptoms (nausea, diarrhoea, vomiting) (76.4%) as well as general pain (94.1%) were frequent in ETC patients. The median duration of EVD was 18 days, while the mean incubation period was 11.3 days. Differential diagnosis of EVD included malaria (28.3%), intestinal parasitosis (10.9%), and infectious syndrome (10.9%). There was also an important variation in clinical evolvement. Quality of documentation was adversely affected by the way patient file contents were transferred from inside to outside the high-risk zone, entailing a mean mismatch value of 27.3% between patient file contents inside vs. outside the high-risk zone. This study adds further description of EVD (frequently non-specific signs and symptoms, non frequent bleeding, a long incubation period, long duration of disease) and emphasizes the need for improving

  17. Chronic psychological effects of exposure to mercury vapour among chlorine-alkali plant workers.

    Science.gov (United States)

    Pranjić, N; Sinanović, O; Jakubović, R

    2003-01-01

    Quantitative assessment of nervous system function is essential in characterising the nature and extent of impairment in individuals experiencing symptoms following work-place mercury vapour exposure. The purpose of this study was the application of standardised tests of behavioural, psychomotor and memory function to understand the neuropsychological effects of mercury in occupationally exposed chlorine-alkali plant workers. The study comprised 45 workers at a chlorine-alkali plant with the mean age of 39.36 +/- 5.94 years, who had been exposed to daily inhalation of mercury vapour over long-term employment of 16.06 +/- 4.29 years. The cumulative mercury index was 155.32 +/- 95.02 micrograms/g creatinine, the mean of urinary mercury concentrations on the first day of the study was 119.50 +/- 157.24 micrograms/g creatinine, and the mean of urinary mercury concentrations 120 days after cessation of exposure was 21.70 +/- 26.07 micrograms/g creatinine. The analysis included tests of behavioural, psychomotor and memory function. The behavioural test battery consisted of: Environmental Worry Scale (EWS), Minnesota Modified Personal Inventory (MMPI-2), Purdue standard 25 minute test, and adapted, 10 minutes test, Bender's Visual-Motor Gestalt test (BGT), and Eysenck Personality Inventory (EPQ). The data were compared to a control group of 32 not directly exposed workers. In the mercury vapour exposed workers with relatively high level exposure to inorganic mercury vapour (TWA/TLV = 0.12 mg/m3/0.025 mg/m3) we identified somatic depression-hypochondria symptoms with higher scores for scales: hysteria (P < 0.001), schizoid and psycho-asthenia (MMPI-2). The mercury-exposed workers had introvert behaviour (EPQ, MMPI-2). The cognitive disturbances in mercury-exposed workers were identified as: concentration difficulty, psychomotor, perceptual and motor coordination disturbances, and brain effects. We identified fine tremor of the hands in 34 out of 45 mercury-exposed workers

  18. Comparison of tamsulosin plus serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia in Korean men: 1-year randomized open label study.

    Science.gov (United States)

    Ryu, Young Woo; Lim, Song Won; Kim, Jung Hoon; Ahn, Seung Hyun; Choi, Jae Duck

    2015-01-01

    In Korea, increasing attention has recently been given to the use of phytotherapeutic agents to alleviate the symptoms of BPH. Serenoa repens has been shown to have an equivalent efficacy to Finasteride or Tamsulosin in the treatment of BPH in previous studies. The present study was designed to compare the efficacy and safety of Serenoa repens plus tamsulosin with tamsulosin only over 12 months in men with LUTS secondary to BPH. One hundred forty men with symptomatic BPH (IPSS≥10) were recruited in our hospital for a 12-month, open-label, randomized trial. Patients were randomly assigned to either tamsulosin 0.2 mg/day plus Serenoa repens 320 mg/day (n=60) or tamsulosin 0.2 mg/day only (n=60). Prostate volume and PSA were measured at baseline and at end-point, whereas total IPSS, and its storage and voiding subscores, LUTS-related QoL, Qmax, and PVR were evaluated at baseline and later every 6 months. Total 103 patients were finally available: 50 in the TAM+SR group and 53 in the TAM group. At 12 months, total IPSS decreased by 5.8 with TAM+SR and 5.5 with TAM (p=0.693); the storage symptoms improved significantly more with TAM+SR (-1.7 vs. -0.8 with TAM, p=0.024). This benefit with regard to storage symptom in the TAM+SR group lasts at 12 months (-1.9 vs. -0.9, p=0.024). The changes of voiding subscore, LUTS-related QoL, Qmax, PVR, PSA, and prostate volume showed no significant differences between the TAM+SR and TAM groups. During the treatment period, 8 patients (16.9%) with TAM and 10 (20%) with TAM+SR had drug-related adverse reactions, which included ejaculatory disorders, postural hypotension, dizziness, headache, gastro-intestinal disorders, rhinitis, fatigue and asthenia. The combination treatment of Serenoa repens and tamsulosin was shown to be more effective than tamsulosin monotherapy in reducing storage symptoms in BPH patients after 6 months and up to 12 months of treatment. © 2015 S. Karger AG, Basel.

  19. Gefitinib Plus Interleukin-2 in Advanced Non-Small Cell Lung Cancer Patients Previously Treated with Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bersanelli, Melissa, E-mail: melissa.bersanelli@alice.it; Buti, Sebastiano; Camisa, Roberta [Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (Italy); Brighenti, Matteo; Lazzarelli, Silvia [Oncology Unit, Azienda Istituti Ospitalieri di Cremona, Largo Priori, 1, 26100 Cremona (Italy); Mazza, Giancarlo [Radiology Division, Spedali Civili di Brescia, P.le Spedali Civili,1, 25123 Brescia (Italy); Passalacqua, Rodolfo, E-mail: melissa.bersanelli@alice.it [1Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (Italy)

    2014-09-30

    The activation of lymphocytes by gefitinib treatment has been described. In this phase II pilot trial, we explored the possible synergism between IL-2 and gefitinib for non-small cell lung cancer (NSCLC) treatment. From September, 2003, to November, 2006, 70 consecutive patients with advanced, progressive NSCLC, previously treated with chemotherapy, received oral gefitinib 250 mg daily. The first 39 patients received gefitinib alone (G group). The other 31 also received subcutaneous IL-2 (GIL-2 group): 1 MIU/m{sup 2} (Million International Unit/m{sup 2})twice a day on Days 1 and 2, once a day on Days 3, 4, 5 every week for four consecutive weeks with a four-week rest period. Median follow-up was 25.2 months. Grade 3–4 toxicity of gefitinib was represented by skin rash (7%), asthenia/anorexia (6%) and diarrhea (7%); patients treated with IL-2 showed grade 2–3 fever (46%), fatigue (21%) and arthralgia (13%). In the GIL-2 group and G-group, we respectively observed: an overall response rate of 16.1% (6.4% complete response) and 5.1% (only partial response); a disease control rate of 41.9% and 41%; a median time to progression of 3.5 (CI 95% = 3.2–3.8) and 4.1 (CI 95% = 2.6–5.7) months; a median overall survival of 20.1 (CI 95% = 5.1–35.1) and 6.9 (CI 95% = 4.9–8.9) months (p = 0.002); and an actuarial one-year survival rate of 54% and 30%. Skin toxicity (p < 0.001; HR = 0.29; CI 95% = 0.16–0.54) and use of IL-2 (p < 0.001; HR = 0.33; CI 95% = 0.18–0.60) were independently associated with improvement of survival. In this consecutive, non-randomized, series of advanced NSCLC patients, the use of IL-2 increased the efficacy of gefitinib.

  20. Ebola Virus Disease Outbreak in Isiro, Democratic Republic of the Congo, 2012: Signs and Symptoms, Management and Outcomes.

    Directory of Open Access Journals (Sweden)

    Thomas Kratz

    Full Text Available Data collected during the 2012 Ebola virus disease (EVD epidemic in the Democratic Republic of the Congo were analysed for clinical signs, symptoms and case fatality of EVD caused by Bundibugyo virus (BDBV, establishment of differential diagnoses, description of medical treatment and evaluation of the quality of clinical documentation. In a quantitative observational prospective study, global epidemiological data from 52 patients (34 patients within the community, 18 patients treated in the Ebola Treatment Centre were entered anonymously into a database, subsequently matched and analysed. Relevant findings include an over-representation of females among community EVD cases (85.3% and of community EVD cases in the age group of 15-54 years (82.4%. All ETC patients had fever (55.6% of all 18 ETC patients during their hospital stay or self-reported fever (88.2% upon admission at some point of time during their illness. Major symptoms of ETC patients during hospital stay included asthenia (82.4%, anorexia (82.4%, myalgia (70.6%, sore throat/difficulty swallowing (70.6%, arthralgia (76.5% and nausea (70.6%. Gastrointestinal signs and symptoms (nausea, diarrhoea, vomiting (76.4% as well as general pain (94.1% were frequent in ETC patients. The median duration of EVD was 18 days, while the mean incubation period was 11.3 days. Differential diagnosis of EVD included malaria (28.3%, intestinal parasitosis (10.9%, and infectious syndrome (10.9%. There was also an important variation in clinical evolvement. Quality of documentation was adversely affected by the way patient file contents were transferred from inside to outside the high-risk zone, entailing a mean mismatch value of 27.3% between patient file contents inside vs. outside the high-risk zone. This study adds further description of EVD (frequently non-specific signs and symptoms, non frequent bleeding, a long incubation period, long duration of disease and emphasizes the need for improving

  1. Epidemiology, clinical, immune, and molecular profiles of microsporidiosis and cryptosporidiosis among HIV/AIDS patients

    Directory of Open Access Journals (Sweden)

    Wumba R

    2012-07-01

    Neelsen stainings, real-time polymerase chain reaction (PCR, immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR and 95% confidence intervals were used to quantify the risk.Results: Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of <100 cells/mm³, and no antiretroviral therapy (ART, respectively. The majority of those with opportunistic intestinal parasites and C. hominis, and all with C. parvum and new E. bieneusi genotypes, had diarrhea, low CD4+ counts of <100 cells/mm³, and no ART. There was a significant association between Entamoeba coli, Kaposi sarcoma, herpes zoster, chronic diarrhea, and asthenia, and the presence of 28 cases with opportunistic intestinal parasites. Rural areas, public toilets, and exposure to farm pigs were the univariate risk factors present in the 28 cases with opportunistic intestinal parasites. In logistic regression analysis, a CD4 count of <100 cells/mm³ (OR = 4.60; 95% CI 1.70–12.20; P = 0.002, no ART (OR = 5.00; 95% CI 1.90–13.20; P < 0.001, and exposure to surface water (OR = 2.90; 95% CI 1.01–8.40; P = 0.048 were identified as the significant and independent determinants for the presence of opportunistic intestinal parasites.Conclusion: E. bieneusi and Cryptosporidium are becoming more prevalent in Kinshasa, Congo. Based on the findings, we recommend epidemiology surveillance and prevention by means of hygiene, the emphasis of sensitive PCR methods, and

  2. Vismodegib in patients with advanced basal cell carcinoma (STEVIE): a pre-planned interim analysis of an international, open-label trial.

    Science.gov (United States)

    Basset-Seguin, Nicole; Hauschild, Axel; Grob, Jean-Jacques; Kunstfeld, Rainer; Dréno, Brigitte; Mortier, Laurent; Ascierto, Paolo A; Licitra, Lisa; Dutriaux, Caroline; Thomas, Luc; Jouary, Thomas; Meyer, Nicolas; Guillot, Bernard; Dummer, Reinhard; Fife, Kate; Ernst, D Scott; Williams, Sarah; Fittipaldo, Alberto; Xynos, Ioannis; Hansson, Johan

    2015-06-01

    %) patients; 180 (36%) had adverse events, 70 (14%) had progressive disease, and 51 (10%) requested to stop treatment. Median duration of vismodegib exposure was 36·4 weeks (IQR 17·7-62·0). Adverse events happened in 491 (98%) patients; the most common were muscle spasms (317 [64%]), alopecia (307 [62%]), dysgeusia (269 [54%]), weight loss (162 [33%]), asthenia (141 [28%]), decreased appetite (126 [25%]), ageusia (112 [22%]), diarrhoea (83 [17%]), nausea (80 [16%]), and fatigue (80 [16%]). Most adverse events were grade 1 or 2. We recorded serious adverse events in 108 (22%) of 499 patients. Of the 31 patients who died, 21 were the result of adverse events. As assessed by investigators, 302 (66·7%, 62·1-71·0) of 453 patients with locally advanced basal cell carcinoma had an overall response (153 complete responses and 149 partial responses); 11 (37·9%; 20·7-57·7) of 29 patients with metastatic basal cell carcinoma had an overall response (two complete responses, nine partial responses). This study assessed the use of vismodegib in a setting representative of routine clinical practice for patients with advanced basal cell carcinoma. Our results show that treatment with vismodegib adds a novel therapeutic modality from which patients with advanced basal cell carcinoma can benefit substantially. F Hoffmann-La Roche. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Longa sobrevida com erlotinib como tratamento de segunda linha do cancro do pulmão de não pequenas células

    Directory of Open Access Journals (Sweden)

    Mariana Sousa

    2008-10-01

    Full Text Available Resumo: Homem, de 69 anos, caucasiano, trabalhador agrícola. Antecedentes de HTA, dislipidemia e exposição a pesticidas; sem hábitos tabágicos nem antecedentes familiares relevantes. Em Outubro/2005 iniciou dispneia e astenia para esforços moderados, tosse seca e pieira nocturna, que manteve apesar de vários tratamentos antibióticos. Em Dezembro/2005, foi encaminhado à urgência do hospital, onde se diagnosticou derrame pleural direito. O estudo do líquido pleural, a broncofibroscopia, a biópsia e os estudos de estadiamento permitiram o diagnóstico: adenocarcinoma pulmonar estádio IIIB (derrame pleural positivo em Dezembro 2005. Fez toracocentese, pleurodese e radioterapia local. Realizou tratamento citostático com protocolo gemcitabina-carboplatina de 16/02/2006 até 13/07/2006 com alguma toxicidade hematológica. A avaliação de resposta demonstrou agravamento da doença, iniciando segunda linha de tratamento com erlotinib 150 mg, em 21/08/2006. Nesta altura, mantém tratamento com erlotinib e estabilidade da doença. Apresenta bom estado geral, sendo o principal efeito secundário do tratamento um rash na face, antebraços e mãos.Rev Port Pneumol 2008; XIV (Supl 3: S83-S86 Abstract: Male, of 69 years old, caucasian, farmer, non smoker, with hypertension, dyslipidemia and past pesticide exposition, without known familiar diseases. In October/2005, he initiated dyspnoea and asthenia for moderate efforts, cough and night sibling, with persisted although several antibiotic treatments were done. In December/2005, he went to the Emergency department, where it was seen a right pleural effusion. The pleural liquid study, the bronchofiberscope examination, the biopsy and the studies for cancer staging allowed the diagnosis: Lung Adenocarcinoma stage IIIB (positive pleural effusion – December 2005. He was submitted to thoracocentesis, pleurodesis and local radiotherapy. He

  4. Miastenia grave: avaliação clínica de 153 pacientes Myasthenia gravis: clinical evaluation of 153 patients

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    FRANCISCO MARCOS B. CUNHA

    1999-06-01

    Full Text Available São analisados, retrospectivamente, os prontuários dos doentes miastênicos diagnosticados e seguidos no período de fevereiro de 1973 a março de l995. Os principais achados clínicos foram ptose palpebral, diplopia, disfagia, disfonia ou disatria, dificuldade de mastigação, dispnéia, astenia, paresia da musculutura cervical e das extremidades. A partir das informações coletadas, os pacientes foram classificados clinicamente pela escala de Osserman-Genkins modificada, mas considerando o aspecto não dinâmico dessa escala, adotou-se a escala funcional de Niakan modificada, na qual os doentes são colocados nas seguintes condições: remissão, controlado, compensado, controle parcial, controle precário, sem resposta. Na casuística foram estudados 153 pacientes: 104 (68,0% do sexo feminino e 49 (32,0% do sexo masculino, numa proporção de 2,1:1. O tempo de doença variou de sete dias a 27 anos, com média de 6,26 anos (± 5,44. A idade dos primeiros sintomas variou entre 24 horas a 80 anos, com média de idade de 32,13 anos (±19,48. Até os 15 anos foram observados 30 doentes; entre 15 e 50 anos, 91 doentes; com idade acima de 50 anos, 32 doentes; após os 60 anos, a doença tem nítido predomínio entre os homens (1,5:1. Na amostra estudada, a forma auto-imunoadquirida foi a mais frequente, com comprometimento muscular generalizado, porém o envolvimento da musculatura ocular com ptose e diplopia se constituiu nas manifestações clínicas mais frequentes.We have retrospectively analysed the records of patients diagnosed as having myasthenia gravis and followed up in our departament from February 1973 to March 1995. The main clinical findings were ptosis, diplopia, dysphagia, disphonia or dysarthria, mastigatory impairment, dyspnea, asthenia, weakness of the cervical muscles and of the extremities, as well as findings of the physical and neurological examination. Based on the information collected, the patients were classified

  5. AL Amyloidosis

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    Desport Estelle

    2012-08-01

    Full Text Available Abstract Definition of the disease AL amyloidosis results from extra-cellular deposition of fibril-forming monoclonal immunoglobulin (Ig light chains (LC (most commonly of lambda isotype usually secreted by a small plasma cell clone. Most patients have evidence of isolated monoclonal gammopathy or smoldering myeloma, and the occurrence of AL amyloidosis in patients with symptomatic multiple myeloma or other B-cell lymphoproliferative disorders is unusual. The key event in the development of AL amyloidosis is the change in the secondary or tertiary structure of an abnormal monoclonal LC, which results in instable conformation. This conformational change is responsible for abnormal folding of the LC, rich in β leaves, which assemble into monomers that stack together to form amyloid fibrils. Epidemiology AL amyloidosis is the most common type of systemic amyloidois in developed countries with an estimated incidence of 9 cases/million inhabitant/year. The average age of diagnosed patients is 65 years and less than 10% of patients are under 50. Clinical description The clinical presentation is protean, because of the wide number of tissues or organs that may be affected. The most common presenting symptoms are asthenia and dyspnoea, which are poorly specific and may account for delayed diagnosis. Renal manifestations are the most frequent, affecting two thirds of patients at presentation. They are characterized by heavy proteinuria, with nephrotic syndrome and impaired renal function in half of the patients. Heart involvement, which is present at diagnosis in more than 50% of patients, leading to restrictive cardiopathy, is the most serious complication and engages prognosis. Diagnostic methods The diagnosis relies on pathological examination of an involved site showing Congo red-positive amyloid deposits, with typical apple-green birefringence under polarized light, that stain positive with an anti-LC antibody by immunohistochemistry and

  6. CSF1R inhibition with emactuzumab in locally advanced diffuse-type tenosynovial giant cell tumours of the soft tissue: a dose-escalation and dose-expansion phase 1 study.

    Science.gov (United States)

    Cassier, Philippe A; Italiano, Antoine; Gomez-Roca, Carlos A; Le Tourneau, Christophe; Toulmonde, Maud; Cannarile, Michael A; Ries, Carola; Brillouet, Anne; Müller, Claudia; Jegg, Anna-Maria; Bröske, Ann-Marie; Dembowski, Markus; Bray-French, Katharine; Freilinger, Christine; Meneses-Lorente, Georgina; Baehner, Monika; Harding, Ross; Ratnayake, Jayantha; Abiraj, Keelara; Gass, Nathalie; Noh, Karen; Christen, Randolph D; Ukarma, Lidia; Bompas, Emmanuelle; Delord, Jean-Pierre; Blay, Jean-Yves; Rüttinger, Dominik

    2015-08-01

    . Owing to different cutoff dates for safety and efficacy readouts, the safety population comprised 25 patients. Common adverse events after emactuzumab treatment were facial oedema (16 [64%] of 25 patients), asthenia (14 [56%]), and pruritus (14 [56%]). Five serious adverse events (periorbital oedema, lupus erythematosus [occurring twice], erythema, and dermohypodermitis all experienced by one [4%] patient each) were reported in five patients. Three of the five serious adverse events-periorbital oedema (one [4%]), lupus erythematosus (one [4%]), and dermohypodermitis (one [4%])-were assessed as grade 3. Two other grade 3 events were reported: mucositis (one [4%]) and fatigue (one [4%]). 24 (86%) of 28 patients achieved an objective response; two (7%) patients achieved a complete response. Further study of dt-GCT is warranted and different possibilities, such as an international collaboration with cooperative groups to assure appropriate recruitment in this rare disease, are currently being assessed. F Hoffmann-La Roche. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Activity and safety of ODM-201 in patients with progressive metastatic castration-resistant prostate cancer (ARADES): an open-label phase 1 dose-escalation and randomised phase 2 dose expansion trial.

    Science.gov (United States)

    Fizazi, Karim; Massard, Christophe; Bono, Petri; Jones, Robert; Kataja, Vesa; James, Nicholas; Garcia, Jorge A; Protheroe, Andrew; Tammela, Teuvo L; Elliott, Tony; Mattila, Leena; Aspegren, John; Vuorela, Annamari; Langmuir, Peter; Mustonen, Mika

    2014-08-01

    to ODM-201. Of the phase 1 patients, the four who received 200 mg, seven who received 400 mg, and three who received 1400 mg entered the phase 2 part of the trial. In addition to these patients, 110 were randomly assigned to three groups: 200 mg (n=38), 400 mg (n=37), and 1400 mg (n=35). For these patients, the most common treatment-emergent adverse events were fatigue or asthenia (15 [12%] of 124 patients), hot flush (six [5%]), and decreased appetite (five [4%]). One patient (patients had a treatment-emergent grade 4 adverse event. 38 patients who received 200 mg, 39 who received 400 mg, and 33 who received 1400 mg were assessable for PSA response at 12 weeks. 11 (29%) patients in the 200 mg group, 13 (33%) in the 400 mg group, and 11 (33%) in the 1400 mg group had a PSA response at 12 weeks. Our results suggest that ODM-201 monotherapy in men with progressive metastatic castration-resistant prostate cancer provides disease suppression and that ODM-201 has a favourable safety profile. These findings support further investigation of clinical responses with ODM-201 in men with castration-resistant prostate cancer. Orion Corporation Orion Pharma, Endo Pharmaceuticals Inc. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Structure of comorbid psychopathological disorders in patients with type 2nd diabetes mellitus

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    V. V. Chugunov

    2017-04-01

    prevalence among all study groups was detected for hysterical (χ2 = 13.416, p < 0.01 and phobic syndromes (χ2 = 6.161, p < 0.05 in g CG-1 compared to CG-2 and CG-3; and asthenia (χ2 = 162.663, p < 0.01, anxiety (χ2 = 7.177, p < 0.05, depression (χ2 = 13.298, p < 0.01, dyssomnia (χ2 = 171.058, p < 0.01, hypochondric (χ2 = 19.331, p < 0.01, psychoorganic (χ2 = 47.830, p < 0.01 syndromes in CG-3 compared to CG-1 and CG-2. Direct correlation between the severity of type 2nd DM and the presence of the clinical picture asthenic (rs = 0.4033, p < 0.01 and psychoorganic (rs = 0.2344, p < 0.01 syndromes was identified; and inverse correlation between the severity of type 2nd DM and the presence of the clinical manifestation of patients with hysterical syndrome (rs = -0.1444, p < 0.01. Conclusion. The study established the frequency of occurrence and genesis of nonpsychotic mental disorders of varying severity in patients with type 2 DM. Correlation between the severity of type 2nd DM and comorbid psychopathological symptoms was revealed. The identified dominant psychopathological syndromes among patients with type 2nd DM, as well as the structure of psychopathological disorders depended on the severity of type 2nd DM.

  9. O laboratório clínico livre de mercúrio The clinical laboratory free of mercury

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    Evelyn Rodrigues

    2011-06-01

    contaminated fish. It affects the central nervous system and the inhalation of mercury vapors cause asthenia, fatigue, anorexia, weight loss and gastrointestinal disturbances. The contamination detection is carried out through hair and blood sample analysis. The replacement of mercury-containing equipment used in health services is crucial in order to reduce environmental and occupational hazards. OBJECTIVE: To describe the implementation of "Zero Mercury" program at the Central Laboratory Division of University of São Paulo Medical School Hospital - CLD/USP-MSH (Divisão de Laboratório Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo [DLC/HC-FMUSP]. METHODS: The project was developed within the period of three years (2008-2010. During its elaboration, the action plans were defined, including a training program for the team responsible for the implementation of equipment and reagent replacement. RESULTS: By the end of the project, CLD/USP-MSH received an honorable mention by the Brazilian Ministry of Labor and Employment for the fulfillment of "Mercury Zero" program requirements. CONCLUSION: A mercury-free laboratory environment requires managerial commitment, a consistent action plan and staff awareness of health and environmental risks.

  10. Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial.

    Science.gov (United States)

    Pujade-Lauraine, Eric; Ledermann, Jonathan A; Selle, Frédéric; Gebski, Val; Penson, Richard T; Oza, Amit M; Korach, Jacob; Huzarski, Tomasz; Poveda, Andrés; Pignata, Sandro; Friedlander, Michael; Colombo, Nicoletta; Harter, Philipp; Fujiwara, Keiichi; Ray-Coquard, Isabelle; Banerjee, Susana; Liu, Joyce; Lowe, Elizabeth S; Bloomfield, Ralph; Pautier, Patricia

    2017-09-01

    error and did not receive study treatment. Investigator-assessed median progression-free survival was significantly longer with olaparib (19·1 months [95% CI 16·3-25·7]) than with placebo (5·5 months [5·2-5·8]; hazard ratio [HR] 0·30 [95% CI 0·22-0·41], p<0·0001). The most common adverse events of grade 3 or worse severity were anaemia (38 [19%] of 195 patients in the olaparib group vs two [2%] of 99 patients in the placebo group), fatigue or asthenia (eight [4%] vs two [2%]), and neutropenia (ten [5%] vs four [4%]). Serious adverse events were experienced by 35 (18%) patients in the olaparib group and eight (8%) patients in the placebo group. The most common in the olaparib group were anaemia (seven [4%] patients), abdominal pain (three [2%] patients), and intestinal obstruction (three [2%] patients). The most common in the placebo group were constipation (two [2%] patients) and intestinal obstruction (two [2%] patients). One (1%) patient in the olaparib group had a treatment-related adverse event (acute myeloid leukaemia) with an outcome of death. Olaparib tablet maintenance treatment provided a significant progression-free survival improvement with no detrimental effect on quality of life in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation. Apart from anaemia, toxicities with olaparib were low grade and manageable. AstraZeneca. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Çanakkale Muharebelerimde Cephede ve Cephe Dışında Sağlık Hizmetleri

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    Ahmet ESENKAYA

    2011-04-01

    Full Text Available It is essential to know not only the shooting-war in the combats occurred in different fronts in the Gallipoli peninsula like Seddülbahir, Arıburnu, Anafartalar and Suvla, but also how the medical services such as hospital was operated in those fronts. With launching the Gallipoli campaign, the entente states aimed at a front which would last very shortly and bring many gains. However, their all expectations came to naught. The Gallipoli became a long-duration battle-front and resulted in more casualties than expected. On the other hand, that situation was a resurrection for Turkish people. Nevertheless, the price of the victory was very high. Due to long-term battle, there were so many injuries as much as the number of deaths. The case of injury was accompanied by pediculosis, malaria, cholera, dysentery, paratyphoid, typhus, icterus, inflammation and scorbutic. Besides, the war environment also brought about some other health problems among soldiers. These were in general insomnia, asthenia, irregular heartbeats and deafness. Despite all these problems, hygenic measures were carried out sensitively. The Turkish Medical Department averted any imminent spread of infectious disease among the army which was deployed in a narrow area. In 9 months, 110.220 injuries, 70.939 patients and those who needed sick leave were sent to the hospitals of "Menzil" and "Kızılay". In this period, 48.268 patients and 22.619 injuries were treated at hospitals. Surprisingly, the deathrate at hospitals was low. Only 11.6 per cent of patients and 2.7 per cent of injuries were lost. The hospitals of the fifth army were dominantly in østanbul. When the hospitals reached full capacity, the army and Kızılay began to use the public buildings such as schools as hospitals, just like the Balkan wars. Since most of their students were in the battle, the medical schools, Gülhane and østanbul, interrupted their education and became additional military hospitals. This

  12. Coexistência de colonização fúngica intracavitária (bola fúngica e tuberculose ativa Coexistence of intracavitary fungal colonization (fungus ball and active tuberculosis

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    Gisela Unis

    2005-04-01

    evolution in patients with tuberculosis and fungus ball. METHOD: We reviewed, retrospectively, the records of 625 patients diagnosed with fungus ball between 1974 and 2002. All of the patients had been diagnosed through immunodiffusion or mycological study, or both. The inclusion criterion was positivity for acid-fast bacilli in sputum smear microscopy or histopathology. RESULTS: The charts of 14 patients were selected. All had presented hemoptysis, followed by productive cough, dyspnea, weight loss, fever, asthenia and chest pain. In one patient colonized by Aspergillus niger and in another colonized by Scedosporium apiospermum (Teleomorph, Pseudallescheria boydii, active tuberculosis was seen concomitant to the fungus ball. In the remaining cases, the mycobacteria were found in the adjacent parenchyma or in the contralateral lung. CONCLUSION: This study corrobates the assertion that antagonism exists between Mycobacterium tuberculosis and Aspergillus fumigatus. The potential for fungal colonization and mycobacteriosis to occur concomitantly is demonstrated in other fungal agents, S. apiospermum (P. boydii and A. niger in particular.

  13. Vasculite e padrão de panbronquiolite difusa no lúpus eritematoso sistémico: Caso clínico Vasculitis and diffuse panbronchiolitis-like in systemic lupus erythematosus: Case report

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    Lina Carvalho

    2007-03-01

    émico.Visceral involvement in systemic lupus erythematosus (SLE extends beyond renal and cutaneous management. Pleuro-pulmonary lesions have been recognised and diffuse alveolar damage and hemorrhage are the most difficult patterns to control. Pulmonary compromise in clinical evolution of SLE differs from children to adults, both in morphological patterns and in clinical presentation, depending on immunocompetence and the treatment prescribed. A 16-year-old boy presented asthenia, malaise and bilateral cervical painless adenopathies understood as EBV infection as serological EBV IgG, IgM and EBNA were positive. The symptoms persisted for eight months when discrete erythematous and desquamative nasal and malar rash expressed together with persistent fever, dispnoea and bibasilar crackles. Lymph node and pulmonary biopsises were performed. Lymph node presented follicular hyperplasia and LMP1 (EBV immunostaining was negative. In lung biopsy bronchovascular lesions were consistent with vasculitis and bronchiolitis due to intense macrophage infiltration, validated with CD68 antibody and intra-alveolar macrophages were also present with septal compromise; LMP1 (EBV positive cells were not visualized. The lung pattern seen in CAT as diffuse micronodules all over the lung parenchyme resolved after corticosteroid therapy. The diagnosis of SLE was confirmed by ANA, anti-dsDNA, anti-nDNA and anti-histones positivity. To the best of our knowledge this is the first reported case of pulmonary SLE involvement with vasculitis and diffuse panbronchiolitis - like pattern as the first clinical sign of the disease.

  14. Hospitalized cases of influenza A(H1N1pdm09 in the French territories of the Americas, July 2009-March 2010 Casos hospitalizados de gripe A(H1N1pdm09 en los territorios franceses de las Américas entre julio de 2009 y marzo de 2010

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    Marie Barrau

    2012-08-01

    Full Text Available OBJECTIVE: To describe the methodology used for implementing a surveillance system specifically for influenza A(H1N1pdm09 in the French West Indies and French Guiana during an outbreak of this new virus in 2009-2010, and to report its main results. METHODS: This was an observational descriptive study of confirmed and probable cases of influenza A(H1N1pdm09 hospitalized for at least 24 hours in 23 July 2009-3 March 2010. Reverse transcription polymerase chain reaction was performed on nasopharyngeal swab samples according to the Centers for Disease Control and Prevention protocol. A probable case was defined as fever > 38ºC or aches or asthenia with respiratory symptoms (cough or dyspnea. All confirmed and probable hospitalized cases were reported, along with patient's age, sex, clinical condition at admission, place and length of hospitalization, antiviral treatment, underlying conditions, complications, and clinical evolution. A case was classified as severe if respiratory assistance or intensive care was required or if death resulted. RESULTS: A total of 331 confirmed and 16 probable cases were hospitalized, with a hospitalization rate ranging from 4.3 per 1 000 clinical cases in Saint Martin to 10.3 in French Guiana. Of these, 36 were severe, and subsequently, 10 were fatal. The median length of stay was 4 days for non-severe cases and 9 days for severe (P OBJETIVO: Describir la metodología usada para implementar un sistema de vigilancia específico para la gripe A(H1N1pdm09 en las Indias Occidentales Francesas y la Guayana Francesa durante un brote ocasionado por este virus nuevo ocurrido en 20092010 y presentar sus principales resultados. MÉTODOS: Se llevó a cabo un estudio de observación descriptivo de los casos confirmados y probables de gripe por A(H1N1pdm09 hospitalizados durante al menos 24 horas entre el 23 de julio de 2009 y el 3 de marzo de 2010. De conformidad con el protocolo de los Centros para el Control y la Prevención de

  15. Directory of Open Access Journals (Sweden)

    Frederico F. Gil

    2013-04-01

    Full Text Available Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF, we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively. Blastocystis was the most common infection in the control group (41.9%, however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38. The most common symptoms in this group were flatulence (36.4%, asthenia (30.0% and weight loss (30.0%. In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703. A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p Doenças parasitárias infectam grande número de indivíduos em todo o mundo. Manifestações clínicas mais severas podem se apresentar em pacientes imunocomprometidos. Considerando o importante comprometimento imunológico observado

  16. Testes genéticos na eqüideocultura

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    Eduardo Geraldo Alves Coelho

    2008-07-01

    the progresses in the area of the animal genetics, which allow identifying, not only anomalies, but also several genes of economical interest. With the aid of the cytogenetics, individuals with alterations in the number or in the structure of the chromosomes can be identified, which in many cases affect mainly the reproduction. Also the genealogy confirmation, previously done by blood type and now by DNA tests, has extremely important role, not just for guaranteeing the origin of the animals. Due to a reliable pedigree, the breeder can identify the origin of genetic problems and can reduce or even eliminate them. With the tools of the molecular biology, today, we can identify individuals that present desirable or undesirable genes, allowing us to select them early, reducing the costs of the producer and increasing the joined value of the animals. Among those genes we can detach the ones that identify carriers or affected animals for undesirable genetic mutations such as: SCID (Severe Combined Immunodeficiency Disease, HYPP (Hyperkalemic Periodic Paralysis, HERDA (Hereditary Equine Regional Dermal Asthenia, etc. Also the identification of the genes that determine the coat color or coat pattern can already be made directly or indirectly (through genetic markers, as it is the case of the genes for the coat colors Overo, Tobiano, etc. With the progresses in the study of the equine genoma much more will be available soon, which will certainly bring larger contributions to the world horse breeding industry.

  17. Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: a multicentre, randomised, double-blind phase 3 trial.

    Science.gov (United States)

    San-Miguel, Jesús F; Hungria, Vânia T M; Yoon, Sung-Soo; Beksac, Meral; Dimopoulos, Meletios Athanasios; Elghandour, Ashraf; Jedrzejczak, Wieslaw Wiktor; Günther, Andreas; Nakorn, Thanyaphong Na; Siritanaratkul, Noppadol; Corradini, Paolo; Chuncharunee, Suporn; Lee, Je-Jung; Schlossman, Robert L; Shelekhova, Tatiana; Yong, Kwee; Tan, Daryl; Numbenjapon, Tontanai; Cavenagh, Jamie D; Hou, Jian; LeBlanc, Richard; Nahi, Hareth; Qiu, Lugui; Salwender, Hans; Pulini, Stefano; Moreau, Philippe; Warzocha, Krzysztof; White, Darrell; Bladé, Joan; Chen, WenMing; de la Rubia, Javier; Gimsing, Peter; Lonial, Sagar; Kaufman, Jonathan L; Ocio, Enrique M; Veskovski, Ljupco; Sohn, Sang Kyun; Wang, Ming-Chung; Lee, Jae Hoon; Einsele, Hermann; Sopala, Monika; Corrado, Claudia; Bengoudifa, Bourras-Rezki; Binlich, Florence; Richardson, Paul G

    2014-10-01

    , 95% CI 0·52-0·76; p<0·0001). Overall survival data are not yet mature, although at the time of this analysis, median overall survival was 33·64 months (95% CI 31·34-not estimable) for the panobinostat group and 30·39 months (26·87-not estimable) for the placebo group (HR 0·87, 95% CI 0·69-1·10; p=0·26). The proportion of patients achieving an overall response did not differ between treatment groups (235 [60·7%, 95% CI 55·7-65·6] for panobinostat vs 208 [54·6%, 49·4-59·7] for placebo; p=0·09); however, the proportion of patients with a complete or near complete response was significantly higher in the panobinostat group than in the placebo group (107 [27·6%, 95% CI 23·2-32·4] vs 60 [15·7%, 12·2-19·8]; p=0·00006). Minimal responses were noted in 23 (6%) patients in the panobinostat group and in 42 (11%) in the placebo group. Median duration of response (partial response or better) was 13·14 months (95% CI 11·76-14·92) in the panobinostat group and 10·87 months (9·23-11·76) in the placebo group, and median time to response (partial response or better) was 1·51 months (1·41-1·64) in the panobinostat group and 2·00 months (1·61-2·79) in the placebo group. Serious adverse events were reported in 228 (60%) of 381 patients in the panobinostat group and 157 (42%) of 377 patients in the placebo group. Common grade 3-4 laboratory abnormalities and adverse events (irrespective of association with study drug) included thrombocytopenia (256 [67%] in the panobinostat group vs 118 [31%] in the placebo group), lymphopenia (202 [53%] vs 150 [40%]), diarrhoea (97 [26%] vs 30 [8%]), asthenia or fatigue (91 [24%] vs 45 [12%]), and peripheral neuropathy (67 [18%] vs 55 [15%]). Our results suggest that panobinostat could be a useful addition to the treatment armamentarium for patients with relapsed or relapsed and refractory multiple myeloma. Longer follow up will be necessary to determine whether there is any effect on overall survival. Novartis

  18. Efficacy and safety of long-acting pasireotide or everolimus alone or in combination in patients with advanced carcinoids of the lung and thymus (LUNA): an open-label, multicentre, randomised, phase 2 trial.

    Science.gov (United States)

    Ferolla, Piero; Brizzi, Maria Pia; Meyer, Tim; Mansoor, Wasat; Mazieres, Julien; Do Cao, Christine; Léna, Hervé; Berruti, Alfredo; Damiano, Vincenzo; Buikhuisen, Wieneke; Grønbæk, Henning; Lombard-Bohas, Catherine; Grohé, Christian; Minotti, Vincenzo; Tiseo, Marcello; De Castro, Javier; Reed, Nicholas; Gislimberti, Gabriella; Singh, Neha; Stankovic, Miona; Öberg, Kjell; Baudin, Eric

    2017-12-01

    41 to the combination group. At month 9, the proportion of patients with an overall lesion assessment of complete response, partial response, or stable disease was 16 of 41 patients (39·0%, 95% CI 24·2-55·5) in the long-acting pasireotide group, 14 of 42 patients (33·3%, 19·6-49·5) in the everolimus group, and 24 of 41 patients (58·5%, 42·1-73·7) in the combination group. The most common grade 1-2 adverse events with a suspected association with long-acting pasireotide monotherapy were diarrhoea (15 [37%] of 41), hyperglycaemia (17 [41%]), and weight loss (8 [20%]); those with a suspected association with everolimus monotherapy were stomatitis (26 [62%] of 42) and diarrhoea (16 [38%]); and those suspected to be associated with combination treatment were hyperglycaemia (27 [66%] of 41]), diarrhoea (19 [46%]), and asthenia (8 [20%]). The most common grade 3-4 adverse events with a suspected association with long-acting pasireotide monotherapy were γ-glutamyltransferase increased (four [10%] of 41 patients), diarrhoea (three [7%]), and hyperglycaemia (three [7%]); those for everolimus were hyperglycaemia (seven [17%] of 42 patients), stomatitis (four [10%]), and diarrhoea (three [7%]); those for combination treatment were hyperglycaemia (nine [22%] of 41 patients) and diarrhoea (four [10%]). 11 patients died during the core 12-month treatment phase or up to 56 days after the last study treatment exposure date: two (5%) of 41 in the long-acting pasireotide group, six (14%) of 42 in the everolimus group, and three (7%) of 41 in the combination group. No deaths were suspected to be related to long-acting pasireotide treatment. One death in the everolimus group (acute kidney injury associated with diarrhoea), and two deaths in the combination group (diarrhoea and urinary sepsis in one patient, and acute renal failure and respiratory failure in one patient) were suspected to be related to everolimus treatment. In the latter patient, acute renal failure was not

  19. Prevalência de TB ativa e TB latente em internos de um hospital penal na Bahia Prevalence of active and latent TB among inmates in a prison hospital in Bahia, Brazil

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    Antônio Carlos Moreira Lemos

    2009-01-01

    questionnaire was applied and completed by medical students. The detainees were systematically submitted to the following tests: tuberculin skin test, chest X-ray (anteroposterior, sputum smear microscopy and culture for mycobacteria. The events of interest were active TB and latent TB. RESULTS: The mean age of the participants was 36.6 years, and 89.9% were male. Smoking and alcohol consumption were reported by 70.0% and 43.9% of the inmates, respectively. A history of treatment for TB was reported by 11.3% of the inmates. Of the inmates evaluated, 36.3% reported cough and 31.4% reported expectoration. Other less common symptoms were asthenia (in 26.2%, weight loss (in 23.1%, loss of appetite (in 17.7%, fever (in 11.3% and hemoptysis (in 6.7%. Of the 86 inmates tested, none presented positive HIV serology. The prevalence of latent TB was 61.5% (96 of the 156 inmates submitted to tuberculin skin tests, whereas that of active TB was 2.5% (6 of the 237 inmates evaluated. The presence of cough was a determinant of active TB (prevalence ratio = 8.8; 95% CI: 1.04-73.9; p = 0.025. CONCLUSIONS: Active and latent TB are highly prevalent among inmates hospitalized in the Bahia State Prison Hospital. Our findings justify the need to implement public policies specifically directed towards the control of TB in this population.

  20. Custirsen (OGX-011) combined with cabazitaxel and prednisone versus cabazitaxel and prednisone alone in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel (AFFINITY): a randomised, open-label, international, phase 3 trial.

    Science.gov (United States)

    Beer, Tomasz M; Hotte, Sebastien J; Saad, Fred; Alekseev, Boris; Matveev, Vsevolod; Fléchon, Aude; Gravis, Gwenaelle; Joly, Florence; Chi, Kim N; Malik, Zafar; Blumenstein, Brent; Stewart, Patricia S; Jacobs, Cindy A; Fizazi, Karim

    2017-11-01

    01578655. Between Sept 9, 2012, and Sept 29, 2014, 795 patients were screened for enrolment. 635 men were eligible for inclusion and were randomly assigned (n=317 in the cabazitaxel and prednisone plus custirsen group and n=318 in the cabazitaxel and prednisone group). Median follow up was 28·3 months (IQR 24·4-34·5) for the custirsen group and 29·8 months (IQR 25·3-35·2) for the control group. Median overall survival in all randomly assigned patients did not differ between the two groups (14·1 months [95% CI 12·7-15·9] in the curtisen group vs 13·4 months [12·1-14·9] in the control group; hazard ratio [HR] 0·95 [95% CI 0·80-1·12]; log-rank p=0·53). In the poor prognosis subgroup, median overall survival also did not differ between the two treatment groups (11·0 months [95% CI 9·3-13·3] in the custursin group vs 10·9 months [8·2-12·4] in the control group; HR 0·97 [95% CI 0·80-1·21]; two-sided p=0·80). The most frequently reported grade 3 or worse adverse events in the custirsen versus control groups were neutropenia (70 [22%] of 315 vs 61 [20%] of 312), anaemia (68 [22%] vs 49 [16%]), fatigue (23 [7%] vs 18 [6%]), asthenia (16 [5%] vs 8 [3%]), bone pain (16 [5%] vs 5 [2%]), and febrile neutropenia (16 [5%] vs 9 [3%]). Serious adverse events were reported in 155 (49%) versus 132 (42%). 27 patients died within 30 days of treatment in the cabazitaxel and prednisone plus custirsen group, seven of which were deemed to be treatment related, versus 17 in the cabazitaxel and prednisone group, eight of which were deemed to be treatment related. Of the 21 deaths reported, 15 were reported as complications related to study treatment, either chemotherapy (eight and three, respectively) or study drug (none and four, respectively). We noted no survival benefit in men with metastatic castration-resistant prostate cancer with the addition of custirsen to cabazitaxel and prednisone treatment. Cabazitaxel and prednisone remains the standard of care for patients

  1. [The Gulf War Syndrome twenty years on].

    Science.gov (United States)

    Auxéméry, Y

    2013-10-01

    After Operation Desert Storm which took place in Iraq from August 1990 to July 1991 involving a coalition of 35 countries and a 700,000 strong contingent of mainly American men, some associations of war veterans, the media and researchers described a new diagnostic entity: the Gulf War Syndrome (GWS). GWS seems to be a new disorder which associates a litany of functional symptoms integrating the musculoskeletal, digestive, tegumentary and neurosensory systems. The symptoms presented do not allow a syndrome already known to be considered and the aetiology of the clinical picture remains unexplained, an increasing cause for concern resulting from the extent of the phenomenon and its media coverage. It quickly appears that there is no consensus amongst the scientific community concerning a nosographic description of GWS: where can all these functional complaints arise from? Different aetiopathogenic hypotheses have been studied by the American administration who is attempting to incriminate exposure to multiple risks such as vaccines and their adjuvants, organophosphorous compounds, pyridostigmine (given to the troops for the preventive treatment of the former), impoverished uranium, and the toxic emanations from oil well fires. But despite extremely in-depth scientific investigations, 10 years after the end of the war, no objective marker of physical suffering has been retained to account for the disorders presented. It would appear that the former soldiers are in even better objective health than the civil population whereas their subjective level of health remains low. Within this symptomatic population, some authors have begun to notice that the psychological disorders appear and persist associating: asthenia, fatigability, mood decline, sleep disorders, cognitive disorders and post-traumatic stress disorder (PTSD). Within the nosological framework, does GWS cause functional disorders or somatisation? Finally, 20 years after the end of the fighting, only PTSD has

  2. Paroxetine : a review of its pharmacology and therapeutic potential in the management of panic disorder.

    Science.gov (United States)

    Foster, R H; Goa, K L

    1997-08-01

    Paroxetine is the first selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) to be approved for the treatment of patients with panic disorder with or without agoraphobia. It is a highly selective inhibitor of presynaptic serotonin reuptake and does not interact with adrenergic, dopaminergic, histaminergic or serotonergic receptors to any significant extent. Oral paroxetine 10 to 60 mg/day is significantly more effective than placebo in reducing the frequency of panic attacks and improving associated symptoms, as shown in short term trials in patients with panic disorder with or without agoraphobia. The efficacy of the drug was maintained during up to 6 months'; treatment, and continued therapy reduced the risk of relapse. Oral paroxetine 10 to 60 mg/day was at least as effective as clomipramine 10 to 150 mg/day, but appeared to have a more rapid onset of effect, in a placebo-controlled trial. The tolerability profile of paroxetine is similar to that established for other SSRIs and is characterised by adverse events such as nausea, headache, somnolence, dry mouth, tremor, insomnia, asthenia, sweating, constipation, dizziness and sexual dysfunction. Paroxetine was better tolerated overall than clomipramine and was associated with a lower incidence of certain anticholinergic events (such as dry mouth and constipation) in a comparative trial. It is not associated with the type of dependence seen with benzodiazepines, and it appears to be safer in overdose than the tricyclic antidepressants. Paroxetine 20 or 30mg does not significantly impair psychomotor function or interact with alcohol (ethanol). In conclusion, the good tolerability profile of paroxetine, including lack of dependence potential and relative safety in overdose, makes it attractive for the treatment of patients with panic disorder. It appears to be at least as effective as clomipramine in reducing panic attacks and associated symptoms. Although further trials to compare the efficacy

  3. [Alpha-interferon and mental disorders].

    Science.gov (United States)

    Debien, C; De Chouly De Lenclave, M B; Foutrein, P; Bailly, D

    2001-01-01

    The interferon alpha stands as a reference both in oncology and virology. But its efficiency is limited by frequent somatic as well as neuropsychic side effects. As a matter of fact, the reduction or the ending of a chemotherapy treatment come chiefly from the psychiatric complications caused by the use of interferon. For about 30% of patients, various psychic disorders are noticed: personality disorders, mood disorders, anxiety states, suicidal tendencies, manic and psychotic symptoms. We thus propose a review which shall be completed by a discussion on wether the interferon is responsible or not of the appearance of the described mental disorders. We shall conclude with a synthesis of the proposed practical management when confronted with such disorders. Psychiatric complications under interferon-Alpha. The appearance of psychiatric complications caused by interferon has been the subject of many publications. They have also raised the question of the toxicity mechanism which is still misunderstood today. This toxicity appears to be dose-dependent with variations depending on the daily dose given, the mode of administration, the combination with other chemotherapy treatments, the concomitance with a cerebral radiotherapy or a medical history of psychiatric disorders. Most of these effects occur after three weeks of treatment but non specific neuropsychic symptoms can be observed earlier. Non specific symptoms. They appear early but are difficult to detect, though they bring together a whole lot of clinical signs: asthenia, irritability, psychomotor slowdown, depressive mood or even a real "subsyndromic" depressive syndrome, anorexia, decline of the libido, concentration and attention problems, dizzy spells and headaches. Some authors have described intense and fluctuating of personality, mixing anxiety, irritability and disorder of drive control. Depression. Depression is the most frequently found psychiatric pathology in studies but the real frequency of clear