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Paradoxical worsening

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
Aneesh Mohimen, Santhosh Kumar, E R Jayadevan
PURPOSE: To describe a rare clinical entity of intra-osseous skull base arterio-venous fistula managed with transvenous fistula embolization. CASE DETAILS: 57 year old lady 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 presence of a large osseous arterio-venous fistula (AVF) epicentered in the body of sphenoid and left pterygoid plates with arterial feeders from bilateral external carotid arteries and venous drainage...
October 11, 2016: World Neurosurgery
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...
October 11, 2016: Headache
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
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
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
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
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
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
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
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
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...
August 25, 2016: Advances in Therapy
Begoña Carazo Gallego, David Moreno-Pérez, Esmeralda Nuñez Cuadros, Alba Mesa Fernandez, María Martin Cantero, Pablo Obando Pacheco, Antonio Urda Cardona
BACKGROUND: A paradoxical reaction (PR) during anti-tuberculosis treatment is a phenomenon that is poorly studied in immunocompetent children. It is defined as a clinical or radiological worsening of pre-existing tuberculosis (TB) disease. METHODS: A retrospective descriptive study of children younger than 14 years of age was performed; these children developed PR during the years 2009 to 2014, following a diagnosis of TB. Demographic characteristics, microbiological results, treatment and outcome data were collected...
August 17, 2016: International Journal of Infectious Diseases: IJID
Sasa Dusanov, Eli Heggen, Serena Tonstad
BACKGROUND: Metabolic syndrome (MetSyn) magnifies risks of cardiovascular disease (CVD) and type 2 diabetes, but its expression varies within the obese population. We examined body mass index (BMI), metabolic traits, and fat distribution in morbidly obese individuals. METHODS: Lipids and inflammatory, oxidative stress and hepatic biomarkers in 346 women and 203 men (BMI ≥35 kg/m(2) and co-morbidity or ≥40 kg/m(2)) were stratified by MetSyn components (1-5, excluding diabetes)...
August 11, 2016: Metabolic Syndrome and related Disorders
B Mikulášková, L Maletínská, J Zicha, J Kuneš
Obesity is a risk factor that worsens cardiovascular events leading to higher morbidity and mortality. However, the exact mechanisms of relation between obesity and cardiovascular events are unclear. Nevertheless, it has been demonstrated that pharmacological therapy for obesity has great potential to improve some cardiovascular problems. Therefore, it is important to determine the common mechanisms regulating both food intake and blood pressure. Several hormones produced by peripheral tissues work together with neuropeptides involved in the regulation of both food intake and blood pressure...
November 15, 2016: Molecular and Cellular Endocrinology
Angela Papalamprou, Chia Wei Chang, Natalia Vapniarsky, Alycia Clark, Naomi Walker, Leigh G Griffiths
: Cardiac extracellular matrix (cECM) scaffolds are promising biomaterials for reconstructive surgery applications since they possess the structure/function properties of native tissue. Production of cECM scaffolds has been achieved using decellularization approaches, which commonly employ denaturing detergents, such as sodium dodecyl sulfate (SDS). Our antigen removal (AR) method has been shown to remove cellular and nonmyocyte components, while preserving cECM scaffold structure/function relationships...
November 2016: Acta Biomaterialia
Glen T Granati, Getu Teressa
BACKGROUND Patent foramen ovale (PFO) are common, normally resulting in a left-to-right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure...
2016: American Journal of Case Reports
Meredith A Brisco, Michael R Zile, Jennifer S Hanberg, F Perry Wilson, Chirag R Parikh, Steven G Coca, W H Wilson Tang, Jeffrey M Testani
BACKGROUND: Worsening renal function (WRF) is a common endpoint in decompensated heart failure clinical trials because of associations between WRF and adverse outcomes. However, WRF has not universally been identified as a poor prognostic sign, challenging the validity of WRF as a surrogate endpoint. Our aim was to describe the associations between changes in creatinine and adverse outcomes in a clinical trial of decongestive therapies. METHODS AND RESULTS: We investigated the association between changes in creatinine and the composite endpoint of death, rehospitalization or emergency room visit within 60 days in 301 patients in the Diuretic Optimization Strategies Evaluation (DOSE) trial...
October 2016: Journal of Cardiac Failure
Alejandro Gugliucci
Fructose may be a key contributor to the biochemical alterations which promote the metabolic syndrome (MetS), non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM): (a) its consumption in all forms but especially in liquid form has much increased alongside with incidence of MetS conditions; (b) it is metabolized almost exclusively in the liver, where it stimulates de novo lipogenesis to drive hepatic triglyceride (TG) synthesis which (c) contributes to hepatic insulin resistance and NAFLD (Lustig et al...
August 2016: Medical Hypotheses
Amol Raheja, Aleksandra Sowder, Cheryl Palmer, Fausto J Rodriguez, William T Couldwell
Epstein-Barr virus (EBV)-associated smooth muscle tumors (SMTs) have recently been associated with primary and secondary immunodeficiencies. They are broadly divided into 3 subgroups: HIV-related, posttransplant, and congenital immunodeficiency. Subsequent to organ transplantation and acquired immunosuppression, a few cases of EBV-associated SMTs have been described in the liver, respiratory tract, and gastrointestinal system. To the authors' knowledge, intracranial involvement after peripheral blood stem cell transplantation has never been reported previously...
June 24, 2016: Journal of Neurosurgery
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