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Paradoxical worsening

Kenneth Crombie, Zandile Spengane, Michael Locketz, Sipho Dlamini, Rannakoe Lehloenya, Sean Wasserman, Tsidiso G Maphanga, Nelesh P Govender, Chris Kenyon, Ilan S Schwartz
No abstract text is available yet for this article.
March 2018: PLoS Neglected Tropical Diseases
Shuwei Zheng, Humaira Shafi
Paradoxical reactions during tuberculosis (TB) treatment are well-described in the HIV seropositive population but less so in the HIV seronegative group. Abdominal TB rarely presents as spontaneous perforation; cases occurring during anti-TB therapy are even rarer. We describe the clinical progress of a case of an HIV-negative patient who developed acute peritonitis while on anti-TB treatment for peritoneal TB through a series of clinical, radiological and histological images. Visceral perforation can occur as a complication of TB treatment...
January 2018: International Journal of Mycobacteriology
Vikas Kapoor, Azka Latif, Faiza Hassan Warraich, Aneela Majeed
Restoration of immune response by highly active antiretroviral therapy (HAART) effectively improved the overall prognosis of HIV infection. However, 25%-31.7% of patients experience paradoxical worsening of pre-existing infections or unmasking of subclinical infections after starting HAART therapy, which is termed as immune reconstitution inflammatory syndrome (IRIS). Acute granulomatous interstitial nephritis as a consequence of IRIS has never been reported with Mycobacteriumkansasii coinfection. Here, we describe an HIV/AIDS patient coinfected with disseminated M...
February 23, 2018: BMJ Case Reports
Faith H Brennan, Phillip G Popovich
PURPOSE OF REVIEW: In adult mammals, a traumatic spinal cord injury (SCI) elicits a chronic unregulated neuroinflammatory response accompanied by seemingly paradoxical suppression of systemic immunity. These SCI-induced changes in immune function contribute to poor neurological outcomes and enhanced morbidity or mortality. Nonspecific anti-inflammatory or proinflammatory therapies are ineffective and can even worsen outcomes. Therefore, recent experimental SCI research has advanced the understanding of how neuroimmune cross-talk contributes to spinal cord and systemic pathology...
February 19, 2018: Current Opinion in Neurology
Brandon Menke, Alex Walters, John F Payne
An 11-year-old boy presented for central vision blurring in each eye. Visual acuity was 20/80 and examination revealed spoke-wheel foveal schisis and peripheral elevated diaphanous inner retina in each eye. Spectral-domain optical coherence tomography showed inner-retinal, flat-topped cysts in each eye. Electrophysiologic testing was refused, but a clinical diagnosis of X-linked retinoschisis was made. Three months after topical dorzolamide (Trusopt; Santen Pharmaceutical, Osaka, Japan) was started, the macular cysts worsened significantly...
February 1, 2018: Ophthalmic Surgery, Lasers & Imaging Retina
Mritunjai Kumar, Jayantee Kalita, Abhilasha Tripathi, Usha K Misra
Background: Drug-induced hepatitis (DIH) occurs more commonly in tuberculous meningitis (TBM) than non-CNS tuberculosis. We evaluate DIH in TBM and its relationship with disease severity and surrogate markers of stress. Methods: Sixty-seven patients with TBM were included prospectively. The diagnosis of DIH was based on five times elevation of alanine amino transferase (ALT) in asymptomatic and three times in symptomatic patients, serum bilirubin 1.5 mg/dL or more occurring after 3 days of antitubercular drugs without any other cause of liver dysfunction; and improvement in liver function upon drug withdrawal...
February 9, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
Jamal A Nabhani, Ruby Kuang, Hui Liu, Lorna Kwan, Mark S Litwin
PURPOSE: To evaluate the effect of transitioning from a prostate cancer-specific treatment program to comprehensive insurance under the Affordable Care Act (ACA) on the physical, mental, and prostate cancer-related health of poor, previously uninsured men. MATERIALS AND METHODS: We assessed general and prostate cancer-specific health-related quality of life (QOL) using the RAND 12-item short form health survey and UCLA Prostate Cancer Index at 3 time points in 24 men transitioning to comprehensive insurance (insured group) relative to 39 men remaining in the prostate cancer program (control group)...
February 6, 2018: Journal of Urology
Frank P Schmidt, Claus Schmitt, Matthias Hochadel, Evangelos Giannitsis, Harald Darius, Lars S Maier, Claus Schmitt, Gerd Heusch, Thomas Voigtländer, Harald Mudra, Tommaso Gori, Jochen Senges, Thomas Münzel
BACKGROUND: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients...
March 15, 2018: International Journal of Cardiology
Savitha Subramanian, Leela Goodspeed, Shari Wang, Yilei Ding, Kevin D O'Brien, Godfrey S Getz, Alan Chait, Catherine A Reardon
Obesity is a chronic inflammatory state characterized by altered levels of adipose tissue immune cell populations. Natural killer T (NKT) cells are CD1d restricted lymphocyte subsets that recognize lipid antigens whose level decreases in obese adipose tissue. However, studies in mice with deficiency or increased levels of NKT cells have yielded contradictory results, so the exact role of these cells in obesity and adipose tissue inflammation is not yet established. We previously showed that Ldlr-/- mice with excess invariant NKT (iNKT) cells demonstrate significant weight gain, adiposity, metabolic abnormalities, and atherosclerosis...
February 8, 2018: International Journal of Molecular Sciences
James E Scriven, Francois Cj Botha, Charlotte Schutz, David G Lalloo, Helen Wainwright, Graeme Meintjes
We present a 27-year-old lady with HIV-1 infection who died due to rapidly worsening respiratory failure one day after commencing amphotericin B deoxycholate therapy for cryptococcal meningitis. Chest x-ray appearances were consistent with pneumocystis pneumonia but post mortem examination showed evidence of severe necrotizing cryptococcal pneumonia. Cryptococcal pneumonia is an underrecognized condition and should be considered in the differential of patients with HIV-1 infection and low CD4 count who develop respiratory symptoms...
March 2018: Medical Mycology Case Reports
Muhammad Adnan Saleem, Zeeshan Mustafa, Noman Qayyum, Muhammad Badar Ganaie
Hemidiaphragmatic paralysis is usually caused by surgery, malignancy or trauma and rarely by viral infections. Herpes zoster (shingles) results in varied neurological complications, but peripheral motor involvement or diaphragmatic paralysis is rare. We report the case of an 87-year-old male who presented with worsening breathlessness soon after an episode of shingles, affecting his right neck and upper chest. He had no alarm symptoms, history of trauma or malignancy. Skin lesions resolved after a few weeks, but his breathing did not improve...
January 23, 2018: BMJ Case Reports
Tariq Ahmad, Keyanna Jackson, Veena S Rao, W H Wilson Tang, Meredith A Brisco-Bacik, Horng H Chen, G Michael Felker, Adrian F Hernandez, Christopher M O'Connor, Venkata S Sabbisetti, Joseph V Bonventre, F Perry Wilson, Steven G Coca, Jeffrey M Testani
Background -Worsening renal function (WRF) in the setting of aggressive diuresis for acute heart failure (AHF) treatment may reflect renal tubular injury or simply indicate a hemodynamic or functional change in glomerular filtration. Well-validated tubular injury biomarkers-NAG, NGAL, and KIM-1- are now available that can quantify the degree of renal tubularinjury. The ROSE-AHF trial provides an experimental platform for the study of mechanisms of WRF during aggressive diuresis for AHF, as the ROSE-AHF protocol dictated high dose loop diuretic therapy in all patients...
January 19, 2018: Circulation
Jayne C Carberry, Lauren P Fisher, Ronald R Grunstein, Simon C Gandevia, David K McKenzie, Jane E Butler, Danny J Eckert
Hypnotics are contraindicated in obstructive sleep apnoea (OSA) because of concerns of pharyngeal muscle relaxation and delayed arousal worsening hypoxaemia. However, human data are lacking. This study aimed to determine the effects of three common hypnotics on the respiratory arousal threshold, genioglossus muscle responsiveness and upper airway collapsibility during sleep.21 individuals with and without OSA (18-65 years) completed 84 detailed sleep studies after receiving temazepam (10 mg), zolpidem (10 mg), zopiclone (7...
December 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Aniruddha Agarwal, Sabia Handa, Kanika Aggarwal, Mansi Sharma, Ramandeep Singh, Aman Sharma, Rupesh Agrawal, Kusum Sharma, Vishali Gupta
PURPOSE: To study the safety and efficacy of intravitreal injection of dexamethasone implant in the management of posterior segment involvement in tubercular uveitis (TBU). METHODS: In this study, retrospective analysis of safety and efficacy of intravitreal injection of dexamethasone implant for various indications such as cystoid macular edema (CME), vitritis, or paradoxical worsening in TB-related intermediate uveitis, retinal vasculitis, and multifocal serpiginoid choroiditis (MSC) was performed...
November 30, 2017: Ocular Immunology and Inflammation
Trevor Hawkins, Brian D Berman
Purpose of review: In April 2016, the Food and Drug Administration (FDA) approved a first-in-class atypical antipsychotic medication called pimavanserin for the treatment of Parkinson disease psychosis (PDP). We aim to inform readers about its indications, effectiveness, and safety profile. Recent findings: Pimavanserin acts as an inverse agonist at serotonin 5-HT2A receptors and has negligible effects on other receptors, thereby avoiding the D2 receptor antagonism that can potentially worsen motor symptoms...
April 2017: Neurology. Clinical Practice
William Clifton, Austin Feindt, David Skarupa, Laura McLauchlin, Daryoush Tavanaiepour, Gazanfar Rahmathulla
BACKGROUND: Atlanto-occipital dislocation (AOD) is the most uncommon form of traumatic cervical spine injury. The majority of patients die before reaching higher-level care, and only a small percentage of patients with AOD survive the initial injury after receiving tertiary care. As such, there is a paucity of evidence-based management guidelines for treating this condition. Halo vest fixation has been a proposed method for interim stability while these patients undergo medical optimization for surgical intervention...
February 2018: World Neurosurgery
Hamid I Akbarali, William L Dewey
The prevailing opioid crisis has necessitated the need to understand mechanisms leading to addiction and tolerance, the major contributors to overdose and death and to develop strategies for developing drugs for pain treatment that lack abuse liability and side-effects. Opioids are commonly used for treatment of pain and symptoms of inflammatory bowel disease. The significant effect of opioids in the gut, both acute and chronic, includes persistent constipation and paradoxically may also worsen pain symptoms...
December 2017: Current Opinion in Pharmacology
Supreet Batra, Govind Singh Rajawat, Rajendra Prasad Takhar, Manohar Lal Gupta
Introduction: Many of the patients with lymph node tuberculosis show 'Paradoxical Response" in the form of appearance of new lymph node (LN) or increase in the size of existing LN, development of new disease in other organ and worsening of the disease while on treatment. Reason behind such response in only selective patients is not clearly understood. We evaluated the pattern and predictors for paradoxical response(s) (PR) in patients with peripheral lymph node tuberculosis (TB). Materials and Methods: Study included patients aged > 6 years with peripheral lymphadenopathy of tubercular etiology attending a tertiary care hospital from Jan 2010 to Dec 2010...
September 2017: Tüberküloz Ve Toraks
Oscar Vegas, Brian Poligone, Paul Blackcloud, Elaine S Gilmore, JoAnne VanBuskirk, Christopher T Ritchlin, Alice P Pentland, Scott A Walter, Yasmine Nousari, Francisco Tausk
Acute stress is a physiological response of an organism to adverse conditions, contributing to survival; however, persistence through time may lead to disease. Indeed, exacerbation of inflammatory conditions such as psoriasis has been reported to follow stressors in susceptible patients. Because chronic stress cannot ethically be elicited in patients under controlled laboratory conditions, we studied genetically modified mice that naturally develop psoriasiform dermatitis, and subjected them to an ethological chronic social contact stress paradigm...
October 25, 2017: Brain, Behavior, and Immunity
Stefania Petarra-Del Río, Adrian Rodriguez-Hernandez, Luis Anguiano-Landa, Georgina Aguilar-Portillo, Isidro Zavala-Trujillo, Arnulfo Hernan Nava-Zavala, Maria G Zavala-Cerna
BACKGROUND: Cytomegalovirus (CMV) pulmonary involvement is rarely associated with IRIS; therefore, limited information is available. CASE PRESENTATION: Here, we describe the case of a 43-year-old HIV-infected male who developed an unusual case of IRIS after cytomegalovirus (CMV) pneumonia. Clinically there was a progressive and paradoxical worsening of respiratory distress, despite being treated for CMV after initiation with antiretroviral therapy. Chest X-ray revealed disseminated infiltrates in both lungs; chest CT-scan showed generalized lung involvement and mediastinal adenopathy...
2017: Case Reports in Infectious Diseases
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