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Paradoxical worsening

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https://www.readbyqxmd.com/read/29145012/the-gut-brain-interaction-in-opioid-tolerance
#1
REVIEW
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...
November 13, 2017: Current Opinion in Pharmacology
https://www.readbyqxmd.com/read/29135395/pattern-and-predictors-of-paradoxical-response-in-patients-with-peripheral-lymph-node-tuberculosis
#2
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
https://www.readbyqxmd.com/read/29080684/chronic-social-stress-ameliorates-psoriasiform-dermatitis-through-upregulation-of-the-hypothalamic-pituitary-adrenal-axis
#3
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
https://www.readbyqxmd.com/read/29075540/immune-reconstitution-inflammatory-syndrome-and-cytomegalovirus-pneumonia-case-report-highlights-and-missing-links-in-classification-criteria-and-standardized-treatment
#4
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
https://www.readbyqxmd.com/read/29073113/%C3%AE-2-adrenoceptor-signaling-in-airway-epithelial-cells-promotes-eosinophilic-inflammation-mucous-metaplasia-and-airway-contractility
#5
Long P Nguyen, Nour A Al-Sawalha, Sergio Parra, Indira Pokkunuri, Ozozoma Omoluabi, Adedoyin A Okulate, Elizabeth Windham Li, Matthew Hazen, Jose M Gonzalez-Granado, Craig J Daly, John C McGrath, Michael J Tuvim, Brian J Knoll, Burton F Dickey, Richard A Bond
The mostly widely used bronchodilators in asthma therapy are β2-adrenoreceptor (β2AR) agonists, but their chronic use causes paradoxical adverse effects. We have previously determined that β2AR activation is required for expression of the asthma phenotype in mice, but the cell types involved are unknown. We now demonstrate that β2AR signaling in the airway epithelium is sufficient to mediate key features of the asthmatic responses to IL-13 in murine models. Our data show that inhibition of β2AR signaling with an aerosolized antagonist attenuates airway hyperresponsiveness (AHR), eosinophilic inflammation, and mucus-production responses to IL-13, whereas treatment with an aerosolized agonist worsens these phenotypes, suggesting that β2AR signaling on resident lung cells modulates the asthma phenotype...
October 24, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/29053577/electrographic-changes-accompanying-recurrent-seizures-under-ketogenic-diet-treatment
#6
Chiara Lucchi, Maddalena Marchiò, Elisa Caramaschi, Carmela Giordano, Rocco Giordano, Azzurra Guerra, Giuseppe Biagini
The ketogenic diet (KD) is increasingly used to treat epilepsy refractory to antiepileptic drugs and other neurological disorders. In animal models, the KD was found to increase the threshold to seizures induced by different convulsive stimulations. However, in models in which suprathreshold stimuli were used, a paradoxical seizure worsening was consistently observed in KD-fed animals. To better define this phenomenon, we characterized the electrographic response to seizures induced in mice which were treated with the KD, and then corneally stimulated at 6-Hz in four different sessions...
October 20, 2017: Pharmaceuticals
https://www.readbyqxmd.com/read/29044307/immune-reconstitution-inflammatory-syndrome-as-a-cause-of-autoimmune-hepatitis-and-acute-liver-failure
#7
Edison Moraes Rodrigues, Rogério Fernandes, Ruth Susin, Bárbara Fior
Acute liver failure is a rare syndrome with high mortality and is often diagnosed late. Intensivist physicians play fundamental roles in the diagnostic suspicion and the management of the multiple-organic dysfunctions characteristic of this entity. Immune reconstitution inflammatory syndrome is an entity that is characterized by the paradoxical worsening of the patient's previous condition, after the initiation of antiretrovirals, triggered against either pathogens present in the host or autoantigens. Autoimmune hepatitis has recently been described as one of these autoimmune manifestations...
July 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29044084/infectious-chorioretinitis-in-an-immunocompetent-patient-a-diagnostic-dilemma
#8
Sudha K Ganesh, B Sowkath Ali, H N Madhavan
A 44-year-old male presented with a history of defective vision in the right eye for the past 5 months with the previous history of tubercular cervical lymphadenitis. On examination, right eye revealed panuveitis with dense vitritis and chorioretinitis in the superotemporal quadrant. His Mantoux test was positive (25 mm × 25 mm induration), QuantiFERON-TB Gold was test positive, aqueous aspirate was positive for Mycobacterium tuberculosis genome, negative for viruses and toxoplasma, and hence he was initiated on four-drug antitubercular therapy (ATT) with oral steroids...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29024786/neurobiological-correlates-of-pain-avoidance-like-behavior-in-morphine-dependent-and-non-dependent-rats
#9
Amanda R Pahng, Rod I Paulsen, M Adrienne McGinn, Kimberly N Edwards, Scott Edwards
Repeated use of opioids can lead to the development of analgesic tolerance and dependence. Additionally, chronic opioid exposure can cause a paradoxical emergence of heightened pain sensitivity to noxious stimuli, termed hyperalgesia, which may drive continued or escalated use of opioids to manage worsening pain symptoms. Opioid-induced hyperalgesia has traditionally been measured in rodents via reflex-based assays, including the von Frey method. To better model the cognitive/motivational dimension of pain in a state of opioid dependence and withdrawal, we employed a recently developed non-reflex-based method for measuring pain avoidance-like behavior in animals (mechanical conflict avoidance test)...
October 9, 2017: Neuroscience
https://www.readbyqxmd.com/read/29020501/ultra-wide-field-imaging-in-paradoxical-worsening-of-tubercular-multifocal-serpiginoid-choroiditis-after-the-initiation-of-anti-tubercular-therapy
#10
Kanika Aggarwal, Aniruddha Agarwal, Ankit Deokar, Ramandeep Singh, Reema Bansal, Aman Sharma, Kusum Sharma, Mangat R Dogra, Vishali Gupta
PURPOSE: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid choroiditis (MSC). METHODS: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of choroiditis lesions and PW was compared...
October 11, 2017: Ocular Immunology and Inflammation
https://www.readbyqxmd.com/read/29020406/new-insights-into-mitral-valve-dystrophy-a-filamin-a-genotype-phenotype-and-outcome-study
#11
Thierry Le Tourneau, Solena Le Scouarnec, Caroline Cueff, Daniel Bernstein, Jan J J Aalberts, Simon Lecointe, Jean Mérot, Jonathan A Bernstein, Toon Oomen, Christian Dina, Matilde Karakachoff, Hubert Desal, Ousama Al Habash, Francesca N Delling, Romain Capoulade, Albert J H Suurmeijer, David Milan, Russell A Norris, Roger Markwald, Elena Aikawa, Susan A Slaugenhaupt, Xavier Jeunemaitre, Albert Hagège, Jean-Christian Roussel, Jean-Noël Trochu, Robert A Levine, Florence Kyndt, Vincent Probst, Hervé Le Marec, Jean-Jacques Schott
Aims: Filamin-A (FLNA) was identified as the first gene of non-syndromic mitral valve dystrophy (FLNA-MVD). We aimed to assess the phenotype of FLNA-MVD and its impact on prognosis. Methods and results: We investigated the disease in 246 subjects (72 mutated) from four FLNA-MVD families harbouring three different FLNA mutations. Phenotype was characterized by a comprehensive echocardiography focusing on mitral valve apparatus in comparison with control relatives...
September 6, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29017477/mechanism-of-worsening-diabetic-retinopathy-with-rapid-lowering-of-blood-glucose-the-synergistic-hypothesis
#12
Ahmadou M Jingi, Aurel T Tankeu, Narcisse Assene Ateba, Jean Jacques Noubiap
Insulin treatment has been associated with a paradoxical worsening of diabetes retinopathy since many years in European cohorts. Recently, this issue has been stressed by some studies conducted in other parts of the world. However, the mechanism underlying such evolution is not well understood. An osmotic theory has been evocated but failed to explain the clinical features of the disease. Considering recent findings from basic and clinical research, we discuss the possibility of a synergistic hypothesis based on the simultaneous action of insulin and vascular endothelial growth factor on eye blood vessels...
October 10, 2017: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/28988934/bis-choline-tetrathiomolybdate-in-patients-with-wilson-s-disease-an-open-label-multicentre-phase-2-study
#13
Karl Heinz Weiss, Frederick K Askari, Anna Czlonkowska, Peter Ferenci, Jeff M Bronstein, Danny Bega, Aftab Ala, David Nicholl, Susan Flint, Lars Olsson, Thomas Plitz, Carl Bjartmar, Michael L Schilsky
BACKGROUND: Wilson's disease is a genetic disorder in which copper accumulates in the liver, brain, and other tissues. Therapies are limited by efficacy, safety concerns, and multiple daily dosing. Bis-choline tetrathiomolybdate (WTX101) is an oral first-in-class copper-protein-binding molecule that targets hepatic intracellular copper and reduces plasma non-ceruloplasmin-bound copper (NCC) by forming tripartite complexes with albumin and increasing biliary copper excretion. We aimed to assess the efficacy and safety of WTX101 in the initial or early treatment of patients with Wilson's disease...
October 5, 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28940220/t-helper-immune-phenotype-may-underlie-paradoxical-tumour-necrosis-factor-%C3%AE-inhibitor-therapy-related-psoriasiform-dermatitis
#14
A P Moy, M Murali, D Kroshinsky, T D Horn, R M Nazarian
BACKGROUND: Therapeutics targeting tumour necrosis factor (TNF)-α are effective for psoriasis; however, in patients treated for other disorders, psoriasis may worsen and psoriasiform dermatitis (PsoD) may arise. T helper (Th) cytokines in psoriasis upregulate keratin (K)17, which modulates TNF-α transduction, leading to vascular adhesion molecule upregulation and lymphocytic extravasation. AIM: We investigated Th phenotype and expression of K17, intercellular adhesion molecule (ICAM)-1 and vascular adhesion molecule (VCAM)-1 in psoriasis and anti-TNF-α-related PsoD...
September 22, 2017: Clinical and Experimental Dermatology
https://www.readbyqxmd.com/read/28932918/long-term-outcome-after-endovascular-treatment-of-cavernous-sinus-dural-arteriovenous-fistula-and-a-literature-review
#15
Yosuke Nishimuta, Ryuji Awa, Sei Sugata, Tetsuya Nagayama, Tsuneo Makiuchi, Tetsuzo Tomosugi, Ryosuke Hanaya, Hiroshi Tokimura, Hirofumi Hirano, F M Moinuddin, Muhammad Kamil, Akari Kibe, Kazunori Arita
BACKGROUND: The long-term efficacy of endovascular treatment (EVT) for cavernous sinus dural arteriovenous fistulae (CS-dAVF) was assessed with a special focus on residual shunts after initial EVT. PATIENTS AND METHODS: This retrospective survey included 50 patients who had undergone EVT and were followed for 1 month or longer (median follow-up 56 months). RESULTS: Common preoperative symptoms were chemosis (78%), extra-ocular motor palsy (72%), exophthalmos (66%), and tinnitus (26%)...
November 2017: Acta Neurochirurgica
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
#16
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
#17
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
#18
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
#19
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...
September 19, 2017: Neurology
https://www.readbyqxmd.com/read/28820685/immune-reconstitution-inflammatory-syndrome-in-hiv-infected-immigrants
#20
COMPARATIVE STUDY
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...
October 2017: American Journal of Tropical Medicine and Hygiene
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