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https://www.readbyqxmd.com/read/28911256/immune-reconstitution-inflammatory-syndrome-in-patients-with-aids-and-disseminated-coccidioidomycosis-a-case-series-and-review-of-the-literature
#1
Anandit Mu, Thwe Thwe Shein, Priya Jayachandran, Simon Paul
Coccidioidomycosis causes substantial morbidity and mortality in endemic areas, and dissemination is frequent in patients with impaired cellular immunity such as AIDS. Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical worsening after initiation of antiretroviral therapy (ART) in a patient with HIV and a simultaneous opportunistic infection (OI). Immune reconstitution inflammatory syndrome has been well described for a host of mycobacterial, viral, and fungal OIs and malignancies such as Kaposi sarcoma...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
https://www.readbyqxmd.com/read/28889114/the-paradoxes-of-asthma-management-time-for-a-new-approach
#2
REVIEW
Paul M O'Byrne, Christine Jenkins, Eric D Bateman
Poor adherence to maintenance pharmacotherapy is a reality in asthma. Studies confirm that when symptoms worsen, most patients increase short-acting β2-agonist (SABA) use, instead of using controller medication. This behaviour might be attributable to several paradoxes in the current treatment approach. These paradoxes include the recommended use of a SABA bronchodilator alone at Global Initiative for Asthma (GINA) step 1, despite the fact that asthma is a chronic inflammatory disease. At step 1, the patient has autonomy and their perception of need and disease control is accepted, but at higher asthma treatment steps a fixed-dose approach is recommended, irrespective of symptom severity...
September 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28830548/paradoxical-worsening-of-hypoxemia-in-a-patient-treated-by-noninvasive-positive-pressure-ventilation-for-obesity-hypoventilation-syndrome-with-concomitant-obstructive-sleep-apnea-a-case-report
#3
Carole de Picciotto, Coraline Duménil, Olivier Auzel, Violaine Giraud, Marcel Bonay
BACKGROUND: Noninvasive positive pressure ventilation is frequently prescribed to obese patients with obstructive sleep apnea syndrome and obesity hypoventilation syndrome. However, mechanical ventilation with a positive end-expiratory pressure can induce or worsen a right-to-left shunt through a patent foramen ovale associated with systemic hypoxemia. Thus, in obese patients treated with noninvasive positive pressure ventilation, a paradoxical worsening of hypoxemia may reveal the existence of a patent foramen ovale...
August 23, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28821684/medication-overuse-headache-an-entrenched-idea-in-need-of-scrutiny
#4
REVIEW
Ann I Scher, Paul B Rizzoli, Elizabeth W Loder
It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression...
August 18, 2017: Neurology
https://www.readbyqxmd.com/read/28820685/immune-reconstitution-inflammatory-syndrome-in-hiv-infected-immigrants
#5
María Pérez-Rueda, Michele Hernández-Cabrera, Adela Francés-Urmeneta, Alfonso Angel-Moreno, Elena Pisos-Álamo, Nieves Jaén-Sánchez, Cristina Carranza-Rodríguez, Jose-Luis Pérez-Arellano
Immune reconstitution inflammatory syndrome (IRIS) includes a group of potentially serious inflammatory processes that may be present in HIV-infected patients after initiating highly active antiretroviral therapy (HAART). Paradoxical IRIS is a worsening of symptoms, after an overwhelming response to a previously diagnosed opportunistic infection (OI); unmasking IRIS reveals a previously occult OI. The main objective of the study was to describe the epidemiological, clinical, and outcome data of HIV-infected immigrants, stratified according to high- or low-income countries of origin, who developed IRIS and to compare them with native-born Spanish patients...
August 14, 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28820170/paradoxical-worsening-of-a-case-of-tb-subretinal-abscess-with-serpiginous-like-choroiditis-following-the-initiation-of-antitubercular-therapy
#6
Sudha K Ganesh, B Sowkath Ali
A 37-year-old immunocompetent male patient presented with the blurring of vision, both eyes for the past1 year. Fundus examination revealed bilateral multiple subretinal abscesses with areas of healed serpiginous-like choroiditis. Laboratory investigations showed positive tuberculin skin test, positive QuantiFERON TB-Gold Test, and high resolution computed tomography chest showed enlarged mediastinal lymph nodes. The aqueous sample revealed polymerase chain reaction (PCR) positive for Mycobacterium tuberculosis (MTB) (MPB64 genome)...
August 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/28818004/identification-and-treatment-of-augmentation-in-patients-with-restless-legs-syndrome-practical-recommendations
#7
REVIEW
James Geyer, Richard Bogan
Restless legs syndrome (RLS) is a chronic disorder causing clinically significant discomfort to approximately 3% of adults. Although RLS was first identified centuries ago, our understanding of this disorder, its causes, and its treatments is still evolving. In particular, our knowledge of the potential negative effects of RLS treatments, including dopaminergic augmentation, continues to expand. Augmentation, which refers to a paradoxical treatment-related increase in RLS symptoms, has been associated with all three dopamine agonists approved for the treatment of RLS - rotigotine, pramipexole, and ropinirole...
September 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28771778/new-onset-or-transition-of-disease-state-of-psoriatic-arthritis-during-treatment-with-ustekinumab-a-single-center-retrospective-study
#8
Akihiko Asahina, Yoshinori Umezawa, Mami Momose, Hiromi Honda, Koichi Yanaba, Hidemi Nakagawa
Ustekinumab (UST) is a treatment option for psoriatic arthritis (PsA), but recent observations indicate that some psoriatic patients may experience new onset of PsA or worsening of pre-existent PsA. We retrospectively analyzed all cases of psoriasis vulgaris (PsV) and PsA treated with UST in our facility between 2011 and 2015. PsA developed in eight out of 179 PsV patients, mostly later than 8 months after initiation of UST. It was generally not severe, and none had received tumor necrosis factor (TNF)-α inhibitors previously, indicating that the possibility of unmasking pre-existing subclinical arthritis is minimal...
August 3, 2017: Journal of Dermatology
https://www.readbyqxmd.com/read/28757763/immune-reconstitution-inflammatory-syndrome-associated-disseminated-kaposi-s-sarcoma-in-a-patient-infected-with-human-immunodeficiency-virus-report-of-an-autopsy-case
#9
Chiu-Hsuan Cheng, Yung-Hsiang Hsu
Immune reconstitution inflammatory syndrome is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of highly active antiretroviral therapy (HAART) in individuals infected with human immunodeficiency virus (HIV). It involves a wide range of pathogens, neoplasms such as Kaposi's sarcoma (KS) and some autoimmune diseases. We describe an autopsy report of a 40-year-old man infected with HIV. He experienced a rapid dissemination of KS resulting in death within 6 months after starting HAART...
January 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/28736615/pulmonary-arteriovenous-malformations-complicated-by-splenic-infarction-and-abscess
#10
Jun Naito, Hajime Kasai, Masaki Suga, Toshihiko Sugiura, Nobuhiro Tanabe, Koichiro Tatsumi
Pulmonary arteriovenous malformation (PAVM) is an abnormal blood vessel connecting a pulmonary artery and a vein, and is accompanied by paradoxical embolism to other organs due to a right-to-left shunt. We report the case of a 66-year-old woman with PAVM complicated by splenic infarction and abscess. Although the PAVM had been detected on a chest image 2 years previously, and she had been advised to have further investigations, she decided not to follow this further at the time. She then visited our hospital complaining of worsening dyspnoea on exertion...
September 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28707161/a-weight-independent-association-between-atypical-antipsychotic-medications-and-obstructive-sleep-apnea
#11
Habibolah Khazaie, Amir Sharafkhaneh, Sepideh Khazaie, Mohammad Rasoul Ghadami
BACKGROUND: With increasing use of atypical antipsychotic (AAP) agents, the concern has been raised about the association between AAP agents and medical complications. Obstructive sleep apnea (OSA) is a common breathing disorder that adversely affects health and quality of life. Because the major risk factors for OSA are weight gain and obesity by altering the upper airway anatomy, an association between AAP and development of OSA is predictable. However, we hypothesized that AAP may promote OSA not only by weight gain but also because of its potential effects on upper airway muscle function...
July 13, 2017: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/28704280/the-paradox-of-transient-worsening-renal-function-in-patients-with-acute-heart-failure-the-role-of-b-type-natriuretic-peptide-and-diuretic-response
#12
Gaetano Ruocco, Ranuccio Nuti, Amalia Giambelluca, Isabella Evangelista, Oreste De Vivo, Cosimo Daniello, Alberto Palazzuoli
AIMS: Worsening renal function (WRF) occurs in one-third of patients hospitalized for acute decompensated heart failure. Recently, WRF was categorized in two subtypes: persistent and transient WRF. Thus, we sought to investigate the different prognostic impact of persistent vs. transient WRF; we also evaluate the relation of two WRF phenotypes with congestion, B-type natriuretic peptide (BNP) changes, and diuretic response at discharge. METHODS: The prospective was a single centre study including patients screened for interventional Diur-heart failure Trial (NCT01441245)...
July 12, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28688983/subjective-perception-of-sleep-benefit-in-parkinson-s-disease-valid-or-irrelevant
#13
Will Lee, Andrew Evans, David R Williams
INTRODUCTION: The phenomenon of sleep benefit (SB) in Parkinson's disease (PD), whereby waking motor function is improved despite no dopaminergic treatment overnight, is controversial. Previous studies suggested a significant discrepancy between subjective functional and objective motor improvement. The aim of this study was to determine how well subjective reporting of SB correlates with objective measures and if true motor improvement can be predicted by a standardized questionnaire...
June 30, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/28595149/evidence-of-the-paradoxical-effect-of-social-network-support-a-study-among-filipino-domestic-workers-in-china
#14
Norman B Mendoza, Imelu G Mordeno, Carl A Latkin, Brian J Hall
Labor migrants are at an increased risk for poor mental health. Post-migration stressors contribute significantly to this risk. Social network supports are vitally important to protect health but little is known about the role of social network supports among labor migrants. The current study evaluated the role of migration stressors on poor mental health among Filipino female domestic workers (FDW) and whether family and friend social network support (SNS) modified this relationship. Data were collected from 261 FDWs in Macau, China from May to September 2013...
September 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28588577/immune-reconstitution-inflammatory-syndrome-unmasking-or-worsening-aids-related-progressive-multifocal-leukoencephalopathy-a-literature-review
#15
REVIEW
Anna Fournier, Guillaume Martin-Blondel, Emmanuèle Lechapt-Zalcman, Julia Dina, Apolline Kazemi, Renaud Verdon, Emmanuel Mortier, Arnaud de La Blanchardière
Incidence of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients has declined in the combined antiretroviral therapy (cART) era although a growing number of acquired immunodeficiency syndrome (AIDS)-related PML-immune reconstitution inflammatory syndromes (PML-IRIS) have been published during the same period. Therapeutic management of PML-IRIS is not consensual and mainly relies on corticosteroids. Our main aim was, in addition to provide a thoughtful analysis of published PML-IRIS cases, to assess the benefit of corticosteroids in the management of PML-IRIS, focusing on confirmed cases...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28576906/factors-associated-with-frailty-and-its-trajectory-among-patients-on-hemodialysis
#16
Kirsten L Johansen, Lorien S Dalrymple, Cynthia Delgado, Glenn M Chertow, Mark R Segal, Janet Chiang, Barbara Grimes, George A Kaysen
BACKGROUND AND OBJECTIVES: Frailty is common among patients on hemodialysis and associated with adverse outcomes. However, little is known about changes in frailty over time and the factors associated with those changes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: To address these questions, we examined 762 participants in the A Cohort to Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD cohort study, among whom frailty was assessed at baseline and 12 and 24 months...
July 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28477389/paradoxical-ulcerative-colitis-during-adalimumab-treatment-of-psoriasis-resolved-by-switch-to-ustekinumab
#17
A G A Kolios, L Biedermann, A Weber, A A Navarini, J Meier, A Cozzio, L E French
Here we report the case of a psoriasis patient who developed an ulcerative colitis (UC) most likely caused by Adalimumab. After cessation of Adalimumab, colitis improved significantly. However, since psoriasis worsened, the patient was switched to Ustekinumab which resulted in complete cessation of colitis. During the two-year follow-up under Ustekinumab therapy no further gastrointestinal complaints occurred. Paradoxical psoriasis manifestations in inflammatory bowel disease (IBD) under TNF-inhibitor therapy have been reported and rarely paradoxical IBD occurred (mostly Crohn's disease) in rheumatologic patients treated with Infliximab or Etanercept...
May 6, 2017: British Journal of Dermatology
https://www.readbyqxmd.com/read/28463219/-possible-paradoxical-reaction-to-treatment-of-tubercular-meningitis-in-an-hiv-negative-patient
#18
Ana C Rey Deutsch, Luz M Curi Dasso, José Stringa, Sebastián Grinspon, Mariano Volpachio, Octavio Mazzocchi
The paradoxical response to tuberculosis treatment consists in the appearance of new clinical or radiologic manifestations or worsening of previous injuries after an initial improvement with anti-tuberculosis therapy. It can be observed in 6 to 30 percent of the cases of tubercular meningitis. It is the consequence of an exaggerated immune reaction that should be considered since the treatment is based on the use of immunomodulators and not in the change of anti-tuberculous drugs. We present the case of an HIV negative adult with tuberculous meningitis with a good initial response to specific therapy who showed, 10 weeks later, a paradoxical reaction to treatment that responded successfully to corticosteroids...
2017: Medicina
https://www.readbyqxmd.com/read/28438221/isolated-splenic-tuberculosis-with-subsequent-paradoxical-deterioration-a-case-report
#19
Frederick Wangai, Loice Achieng, George Otieno, Jacqueline Njoroge, Tabitha Wambaire, Jamilla Rajab
BACKGROUND: Isolated tuberculosis of the spleen has been described occasionally in literature, mostly in immunosuppressed individuals with various risk factors. Sequestration in the spleen makes such Mycobacterium tuberculosis infection difficult to diagnose. This report describes an extremely rare case of isolated splenic tuberculosis in an immunocompetent individual. CASE PRESENTATION: A 26 year old Kenyan male presented with pyrexia of unknown origin, with negative screening tests for bacterial, fungal and parasitic infections...
April 24, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28397700/narcotic-bowel-syndrome
#20
REVIEW
Adam D Farmer, Jayne Gallagher, Caroline Bruckner-Holt, Qasim Aziz
Narcotic bowel syndrome is characterised by worsening abdominal pain in the context of escalating or continuous opioid therapy. Although narcotic bowel syndrome is rarely diagnosed, given the current epidemic of opioid use, it is likely to be under-recognised. The underlying pathophysiological mechanisms of narcotic bowel syndrome are incompletely understood; however, opioid-induced hyperalgesia is likely to be a central facet. The putative mechanisms of hyperalgesia include activation of bimodal opioid regulatory systems, counter-regulatory mechanisms, neuroinflammation, opioid facilitation, and interactions of the N-methyl D-aspartate receptor with opioids at the level of the spinal cord...
May 2017: Lancet. Gastroenterology & Hepatology
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