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Paradoxical worsening

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https://www.readbyqxmd.com/read/27904430/natalizumab-related-progressive-multifocal-leukoencephalopathy-immune-reconstitution-inflammatory-syndrome-a-case-report-highlighting-clinical-and-mri-features
#1
Bela Purohit, Eranga Ganewatte, Spyros S Kollias
Multiple sclerosis (MS) patients treated with natalizumab often face the uncommon but severe complication of developing progressive multifocal leukoencephalopathy (PML). PML may be further complicated by immune reconstitution inflammatory syndrome (IRIS) after the removal of the drug. Since both PML and IRIS are associated with high morbidity and mortality rates, early clinical and radiological diagnosis of these complications is of paramount importance. Here, we report a case of an adult male patient who was diagnosed with PML after receiving natalizumab therapy for 6 years for the treatment of MS...
September 2016: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/27865719/pre-load-induced-changes-in-forward-lv-stroke-and%C3%A2-functional-mitral%C3%A2-regurgitation-echocardiographic-detection-of-the-descending-limb%C3%A2-of%C3%A2-starling-s-curve
#2
Yukio Abe, Kanako Akamatsu, Atsuko Furukawa, Kazato Ito, Yoshiki Matsumura, Kazuo Haze, Takahiko Naruko, Minoru Yoshiyama, Junichi Yoshikawa
OBJECTIVES: To clarify the prognostic significance of diagnosing whether the failing heart is functioning on the descending limb of the Starling curve by using echocardiography with passive leg lifting (PLL). BACKGROUND: Patients with advanced heart failure can shift to the descending limb of the Starling curve, in which pre-load does not lead to an expected increase in forward left ventricular stroke volume (LVSV). METHODS: Thirty-five consecutive patients with left ventricular (LV) ejection fraction of <40% underwent echocardiography at rest during baseline and during PLL to increase pre-load...
November 10, 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27856941/the-quest-to-extend-health-services-to-vulnerable-substance-users-in-rio-de-janeiro-brazil-in-the-context-of-an-unfolding-economic-crisis
#3
Noa Krawczyk, Deanna Kerrigan, Francisco Inácio Bastos
Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation's most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens...
November 16, 2016: International Journal of Health Services: Planning, Administration, Evaluation
https://www.readbyqxmd.com/read/27807490/a-case-of-tuberculous-meningitis-with-paradoxical-response-in-a-14-year-old-boy
#4
Murat Özer, Yasemin Özsürekci, Ali Bülent Cengiz, Nagehan Emiralioğlu, Deniz Doğru, Kader Karlı Oğuz, Onur Akça, Özgür Özkayar
A clinical or radiological worsening of already existing lesions or an emergence of new lesions after beginning treatment in patients with tuberculosis (TB) is referred to as the paradoxical response. This has aroused suspicion regarding the accuracy of diagnosis, the possibilities of treatment failure, or the presence of another underlying disease, and thus it is an important topic for clinicians to understand. In this article, the development of a paradox reaction in a 14-year-old male patient diagnosed with and treated for tuberculosis meningitis is reported...
2016: Case Reports in Infectious Diseases
https://www.readbyqxmd.com/read/27793583/assessment-of-human-tribbles-homolog-3-genetic-variation-rs2295490-effects-on-type-2-diabetes-patients-with-glucose-control-and-blood-pressure-lowering-treatment
#5
Fazhong He, Mouze Liu, Zhangren Chen, Guojing Liu, Zhenmin Wang, Rong Liu, Jianquan Luo, Jie Tang, Xingyu Wang, Xin Liu, Honghao Zhou, Xiaoping Chen, Zhaoqian Liu, Wei Zhang
Effects of human tribbles homolog 3 (TRIB3) genetic variation (c.251 A>G, Gln84Arg, rs2295490) on the clinical outcomes of vascular events has not been evaluated in patients with type 2 diabetes after blood pressure lowering and glucose controlling treatment. We did an analysis of a 2×2 factorial (glucose control axis and blood pressure lowering axis) randomized controlled clinical trial at 61 centers in China, with a follow-up period of 5years. The major vascular endpoints were the composites of death from cardio-cerebral vascular diseases, non-fatal stroke and myocardial infraction, new or worsening renal and diabetic eye disease...
October 20, 2016: EBioMedicine
https://www.readbyqxmd.com/read/27786246/hiv-associated-opportunistic-cns-infections-pathophysiology-diagnosis-and-treatment
#6
REVIEW
Lauren N Bowen, Bryan Smith, Daniel Reich, Martha Quezado, Avindra Nath
Nearly 30 years after the advent of antiretroviral therapy (ART), CNS opportunistic infections remain a major cause of morbidity and mortality in HIV-positive individuals. Unknown HIV-positive disease status, antiretroviral drug resistance, poor drug compliance, and recreational drug abuse are factors that continue to influence the morbidity and mortality of infections. The clinical and radiographic pattern of CNS opportunistic infections is unique in the setting of HIV infection: opportunistic infections in HIV-positive patients often have characteristic clinical and radiological presentations that can differ from the presentation of opportunistic infections in immunocompetent patients and are often sufficient to establish the diagnosis...
October 27, 2016: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/27783331/psoriasiform-eruption-and-worsening-of-pustulosis-palmoplantaris-after-treatment-with-two-anti-tnf-%C3%AE-inhibitors-followed-by-successful-treatment-with-ustekinumab
#7
Nathalie A Bogaards, Menno A de Rie
INTRODUCTION: Tumor necrosis factor (TNF)-α inhibitors are widely used for the treatment of inflammatory diseases. One of the side effects of TNF-inhibitors is the development of a psoriatiform eruption, also known as paradoxical psoriasis. In this case report, we describe a patient with this side effect after treatment with adalimumab and etanercept. CASE REPORT: A 45-year-old female was treated with adalimumab 40 mg once every 2 weeks for pustulosis palmoplantaris and psoriatic arthritis...
October 25, 2016: Dermatology and Therapy
https://www.readbyqxmd.com/read/27780998/detention-of-people-lost-to-follow-up-on-tb-treatment-in-kenya-the-need-for-human-rights-based-alternatives
#8
Gitau Mburu, Enrique Restoy, Evaline Kibuchi, Paula Holland, Anthony D Harries
Adherence to treatment is a key element for global TB control. Public health laws can be used to enforce isolation, adherence, and completion of TB treatment. However, the practical application of public health laws can potentially range from voluntary measures to involuntary detention approaches. This paper explores the potential risks and impacts of using detention approaches to enforce TB treatment adherence. In August 2015, we conducted a literature search regarding the application of public health laws to enforce adherence to TB treatment globally, and specifically in Kenya...
June 2016: Health and Human Rights
https://www.readbyqxmd.com/read/27748793/paradoxical-worsening-of-truncal-acne-with-doxycycline
#9
Pei Ming Yeo, Wei Liang Koh, Chia Chun Ang, Regina Sp Lim
No abstract text is available yet for this article.
September 2016: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/27742504/skull-base-osseous-arteriovenous-fistula-a-rare-clinical-entity-case-report-and-literature-review
#10
Aneesh Mohimen, Santhosh Kumar Kannath, E R Jayadevan
PURPOSE: To describe a rare clinical entity of intraosseous skull base arteriovenous fistula managed with transvenous fistula embolization. CASE PRESENTATION: A 57-year-old woman presented with complaints of headache and episodic tinnitus with progressive left-sided visual deterioration. Cross-sectional imaging of the head revealed multiple vascular channels in the sphenoid bone and in bilateral masticator spaces. Catheter angiography showed the presence of a large osseous arteriovenous fistula epicentered in the body of sphenoid and left pterygoid plates with arterial feeders from bilateral external carotid arteries and venous drainage into bilateral cavernous sinuses and the pterygoid venous plexus...
October 11, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27727478/injections-of-intravenous-contrast-for-computerized-tomography-scans-precipitate-migraines-in-hereditary-hemorrhagic-telangiectasia-subjects-at-risk-of-paradoxical-emboli-implications-for-right-to-left-shunt-risks
#11
Trishan Patel, Amy Elphick, James E Jackson, Claire L Shovlin
OBJECTIVE: To evaluate if injection of intravenous particles may provoke migraines in subjects with right-to-left shunts due to pulmonary arteriovenous malformations (AVMs). BACKGROUND: Migraine headaches commonly affect people with hereditary hemorrhagic telangiectasia (HHT), especially those with pulmonary AVMs that provide right-to-left shunts. In our clinical practice, patients occasionally reported acute precipitation of migraine headaches following injection of technetium-labeled albumin macroaggregates for nuclear medicine scans...
November 2016: Headache
https://www.readbyqxmd.com/read/27722830/when-global-rating-of-change-contradicts-observed-change-examining-appraisal-processes-underlying-paradoxical-responses-over-time
#12
Carolyn E Schwartz, Victoria E Powell, Bruce D Rapkin
AIMS: Interpreting change scores is challenging when patients' global rating of change (GRC) scores contradict their observed change scores. We examine appraisal processes associated with having GRC-observed change contradictions. METHODS: This secondary analysis of longitudinal multiple sclerosis (MS) registry data examined predictors of GRC scores in the whole sample (n = 858). Logistic modeling then examined predictors of membership in one of two paradoxical subgroups (n = 525): (a) Worsened GRC with unchanged observed Rand-12 Mental Component scores (MCS) (Symptom-Maximizers, n = 171) versus no change GRC among stable MCS subsample; and (b) same GRC with declined observed MCS scores (Symptom-Minimizers, n = 84) versus declining GRC among declining MCS subsample...
October 8, 2016: Quality of Life Research
https://www.readbyqxmd.com/read/27650843/paradox-of-prescribing-late-chemotherapy-oncologists-explain
#13
Minnie Bluhm, Cathleen M Connell, Raymond G De Vries, Nancy K Janz, Kathleen E Bickel, Maria J Silveira
PURPOSE: The value of chemotherapy for patients with cancer in the last weeks of life warrants examination. Late chemotherapy may not improve survival or quality of life but typically precludes hospice enrollment and may result in additional symptoms, increased use of other aggressive treatments, and worsening quality of life. Few studies have explored oncologists' rationales for administering chemotherapy near death. This study examines the self-reported factors that influence oncologists' decisions about late chemotherapy...
September 20, 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27631410/plasma-levels-and-estimated-dopamine-d2-receptor-occupancy-of-long-acting-injectable-risperidone-during-maintenance-treatment-of-schizophrenia-a-3-year-follow-up-study
#14
Saeko Ikai, Takefumi Suzuki, Masaru Mimura, Hiroyuki Uchida
INTRODUCTION: Dopamine D2 receptor occupancy levels needed for the maintenance treatment of schizophrenia remain to be elucidated. We examined 3-year clinical outcomes of patients with schizophrenia who received long-acting injectable risperidone (LAI risperidone) at baseline and investigated their dopamine D2 receptor occupancy levels, estimated from plasma drug concentrations. METHODS: A chart review of 52 outpatients with schizophrenia who participated in the original cross-sectional study was conducted to examine their 3-year clinical outcomes between April and September 2015...
September 8, 2016: Psychopharmacology
https://www.readbyqxmd.com/read/27617496/dysregulated-erythropoietin-hepcidin-and-bone-marrow-iron-metabolism-contribute-to-interferon-induced-anemia-in-hepatitis-c
#15
Marius van Rijnsoever, Sumedha Galhenage, Lindsay Mollison, Joel Gummer, Robert Trengove, John K Olynyk
Anemia is a complication of interferon-containing hepatitis C treatments. We characterized effects of interferon-based therapy on hepcidin and erythropoietin (EPO) production, iron metabolism, hemolysis, and hematopoiesis. Standard hemopoiesis [reticulocyte hemoglobin (Hb), reticulocyte production index (RPI), free Hb, and haptoglobin], iron biochemistry, hepcidin, and EPO levels were measured in 10 subjects over 12 weeks. There was a rapid decline in Hb during treatment, from a mean pretreatment (t = 0 weeks) Hb of 158...
September 12, 2016: Journal of Interferon & Cytokine Research
https://www.readbyqxmd.com/read/27598542/optical-coherence-tomography-angiography-features-of-paradoxical-worsening-in-tubercular-multifocal-serpiginoid-choroiditis
#16
Aniruddha Agarwal, Kanika Aggarwal, Ankit Deokar, Spoorti Krishna Reddy Mandadi, Simar Rajan Singh, Ramandeep Singh, Aman Sharma, Reema Bansal, Vishali Gupta
PURPOSE: To describe optical coherence tomography angiography (OCTA) features of lesions of tubercular multifocal serpiginoid choroiditis (TB MSC) that developed paradoxical worsening (PW). METHODS: In this prospective study, subjects with TB MSC who developed PW upon initiation of anti-tubercular therapy were included. Multimodal imaging was performed using OCTA, enhanced-depth imaging OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA)...
September 6, 2016: Ocular Immunology and Inflammation
https://www.readbyqxmd.com/read/27594823/pramipexole-impairs-stimulus-response-learning-in-healthy-young-adults
#17
Haley Gallant, Andrew Vo, Ken N Seergobin, Penny A MacDonald
Dopaminergic therapy has paradoxical effects on cognition in Parkinson's disease (PD) patients, with some functions worsened and others improved. The dopamine overdose hypothesis is proposed as an explanation for these opposing effects of medication taking into account the varying levels of dopamine within different brain regions in PD. The detrimental effects of medication on cognition have been attributed to exogenous dopamine overdose in brain regions with spared dopamine levels in PD. It has been demonstrated that learning is most commonly worsened by dopaminergic medication...
2016: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/27578471/patent-foramen-ovale-in-idiopathic-pulmonary-arterial-hypertension-long-term-risk-and-morbidity
#18
Alice Gallo de Moraes, Abhay Vakil, Teng Moua
INTRODUCTION: Little is known about the presence of patent foramen ovale in idiopathic pulmonary arterial hypertension. While there is suspected worsening of hypoxemia confounding assessment and management of pulmonary hypertension, as well as possible increased morbidity from paradoxical emboli, there may be theoretical relief of worsening right-sided pressures by the same mechanism of right-to-left shunting. METHODS: Retrospective review of consecutive patients diagnosed with idiopathic pulmonary arterial hypertension (WHO Group 1) via right heart catheterization, from 1998 to 2010...
September 2016: Respiratory Medicine
https://www.readbyqxmd.com/read/27566775/immune-reconstitution-inflammatory-syndrome-associated-with-secondary-syphilis
#19
Simona Frunza-Stefan, Gyanendra Acharya, Viktoryia Kazlouskaya, Paunel Vukasinov, Yushan Chiou, Zeyar Thet
Immune reconstitution inflammatory syndrome (IRIS) is a condition associated with paradoxical worsening and/or new onset of an opportunistic infection in HIV patients following the initiation of anti-retroviral therapy or switching to more potent antiretroviral therapy (ART) regimen. Although IRIS associated with many opportunistic infections (OIs) has been well reported, syphilis has very rarely been mentioned in this regard. A 52-year-old male, diagnosed with AIDS six weeks ago, presented with the disseminated non-pruritic painless skin rash...
August 26, 2016: International Journal of STD & AIDS
https://www.readbyqxmd.com/read/27562835/multidisciplinary-consideration-of-potential-pathophysiologic-mechanisms-of-paradoxical-erythema-with-topical-brimonidine-therapy
#20
REVIEW
James R Docherty, Martin Steinhoff, Dianne Lorton, Michael Detmar, Gregor Schäfer, Anna Holmes, Anna Di Nardo
: Rosacea is a chronic inflammatory disease with transient and non-transient redness as key characteristics. Brimonidine is a selective α2-adrenergic receptor (AR) agonist approved for persistent facial erythema of rosacea based on significant efficacy and good safety data. The majority of patients treated with brimonidine report a benefit; however, there have been sporadic reports of worsening erythema after the initial response. A group of dermatologists, receptor physiology, and neuroimmunology scientists met to explore potential mechanisms contributing to side effects as well as differences in efficacy...
November 2016: Advances in Therapy
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