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https://www.readbyqxmd.com/read/28333858/immune-reconstitution-inflammatory-syndrome-causing-progressive-optic-nerve-edema-in-cryptococcal-meningitis
#1
Astrid C Werner, Laurel N Vuong, Thomas R Hedges, Caroline R Baumal
PURPOSE: To report an human immunodeficiency virus-positive patient undergoing therapy for cryptococcal meningitis who developed progressive optic disc edema that was steroid responsive. METHODS: Observational case report. RESULTS: One month after commencing antifungal treatment for cryptococcal meningitis, the patient developed bilateral, progressive, recurrent optic disc edema with subretinal fluid that coincided with initiation of highly active antiretroviral therapy and recovery of CD4 cell counts...
March 22, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28333855/serous-retinopathy-associated-with-cisplatin-treatment
#2
Spencer Langevin, Jonathan S Chang, Stanley Chang
BACKGROUND/PURPOSE: To describe a case of serous retinopathy and associated photoreceptor atrophy after intravenous cisplatin therapy. METHODS: Evaluation was performed using electroretinogram, optical coherence tomography, fundus autofluorescence, and funduscopic examinations to assess the extent of retinal disease, toxicity, and eventual atrophy. RESULTS: A 56 year-old man with metastatic small cell carcinoma with vision changes after initiation of cisplatin therapy...
March 22, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28321811/interleukin-2-old-and-new-approaches-to-enhance-immune-therapeutic-efficacy
#3
Pooja Dhupkar, Nancy Gordon
Interleukin-2 (IL-2) is a very well-known cytokine that has been studied for the past 35 years. It plays a major role in the growth and proliferation of many immune cells such NK and T cells. It is an important immunotherapy cytokine for the treatment of various diseases including cancer. Systemic delivery of IL-2 has shown clinical benefit in renal cell carcinoma and melanoma patients. However, its use has been limited by the numerous toxicities encountered with the systemic delivery. Intravenous IL-2 causes the well-known "capillary leak syndrome," or the leakage of fluid from the circulatory system to the interstitial space resulting in hypotension (low blood pressure), edema, and dyspnea that can lead to circulatory shock and eventually cardiopulmonary collapse and multiple organ failure...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28321713/low-titre-gad-antibody-associated-late-onset-cerebellar-ataxia-with-a-significant-clinical-response-to-intravenous-immunoglobulin-treatment
#4
Timotej Petrijan, Marija Menih
Antiglutamic acid decarboxylase antibody-associated cerebellar ataxia (GAD-Abs CA) is a rare, but increasingly detected, autoimmune neurological disorder characterized by the clinical presence of a cerebellar syndrome concomitant with positive GAD-Abs levels in serum and cerebrospinal fluid (CSF). It represents 3% of all immune-mediated sporadic CAs. Low-titre GAD-Abs CA is an even rarer subtype of GAD-Abs CA. We report on a 68-year-old woman with a 3-year history of progressive gait ataxia. In addition to the modified Rankin Scale (mRS), we used two other objective scales to evaluate CA severity, i...
March 20, 2017: Cerebellum
https://www.readbyqxmd.com/read/28306518/biochemical-testing-in-a-laboratory-tent-and-semi-intensive-care-of-ebola-patients-on-site-in-a-remote-part-of-guinea-a-paradigm-shift-based-on-a-bleach-sensitive-point-of-care-device
#5
Leonid M Irenge, Jean-Michel Dindart, Jean-Luc Gala
BACKGROUND: During the West Africa Ebola virus disease (EVD) outbreak, a Belgian laboratory was deployed for supporting the Ebola treatment unit (ETU) of N'Zerekore, Guinea. Besides diagnosis of EVD and malaria, biochemical parameters were tested and used to guide supportive treatment of EVD. METHODS: To preserve analytes stability, lithium-heparin blood samples were analyzed using the i-STAT® point-of-care testing (POCT) handheld device without the viral inactivation step...
March 15, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28304180/nanomedicine-for-the-treatment-of-acute-respiratory-distress-syndrome-the-2016-ats-bear-cage-award-winning-proposal
#6
Jacob S Brenner
After dozens of clinical trials, there are still no FDA-approved drugs which improve mortality in acute respiratory distress syndrome (ARDS). These poor results may in part be caused by three unique pharmacological challenges presented by ARDS: 1) ARDS patients are fragile due to concomitant multiple organ dysfunction, so do not tolerate off-target side effects of drugs; 2) inhaled drug delivery is impeded by the column of proteinaceous fluid covering the injured alveoli; 3) ARDS is heterogeneous in its underlying pathophysiology, so targeting one pathway is unlikely to improve most patients...
March 17, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28303068/high-dose-intravenous-pulse-steroid-therapy-for-optic-disc-swelling-and-subretinal-fluid-in-non-arteritic-anterior-ischemic-optic-neuropathy
#7
Kei Takayama, Hiroki Kaneko, Shu Kachi, Eimei Ra, Yasuki Ito, Hiroko Terasaki
Non-arteritic anterior ischemic optic neuropathy (NAION) is a disease with microvascular abnormality that causes acute optic disc swelling (ODS) and, in severe cases, subretinal fluid (SRF) accumulation. ODS causes compartment syndrome and subsequent axonal degeneration and loss of retinal ganglion cells by apoptosis. No treatment modalities have been effective, although some cases improved after the intake of oral systemic steroids. We reported a case of a 72-year-old man who was referred due to a visual defect in the right eye...
February 2017: Nagoya Journal of Medical Science
https://www.readbyqxmd.com/read/28302179/balanced-crystalloids-versus-saline-in-the-intensive-care-unit-study-protocol-for-a-cluster-randomized-multiple-crossover-trial
#8
Matthew W Semler, Wesley H Self, Li Wang, Daniel W Byrne, Jonathan P Wanderer, Jesse M Ehrenfeld, Joanna L Stollings, Avinash B Kumar, Antonio Hernandez, Oscar D Guillamondegui, Addison K May, Edward D Siew, Andrew D Shaw, Gordon R Bernard, Todd W Rice
BACKGROUND: Saline, the intravenous fluid most commonly administered to critically ill adults, contains a high chloride content, which may be associated with acute kidney injury and death. Whether using balanced crystalloids rather than saline decreases the risk of acute kidney injury and death among critically ill adults remains unknown. METHODS: The Isotonic Solutions and Major Adverse Renal Events Trial (SMART) is a pragmatic, cluster-level allocation, cluster-level crossover trial being conducted between 1 June 2015 and 30 April 2017 in five intensive care units at Vanderbilt University Medical Center in Nashville, TN, USA...
March 16, 2017: Trials
https://www.readbyqxmd.com/read/28299615/remote-monitoring-in-heart-failure-the-current-state
#9
REVIEW
Rajeev C Mohan, J Thomas Heywood, Roy S Small
The treatment of congestive heart failure is an expensive undertaking with much of this cost occurring as a result of hospitalization. It is not surprising that many remote monitoring strategies have been developed to help patients maintain clinical stability by avoiding congestion. Most of these have failed. It seems very unlikely that these failures were the result of any one underlying false assumption but rather from the fact that heart failure is a progressive, deadly disease and that human behavior is hard to modify...
March 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28298967/magnetic-resonance-imaging-in-the-assessment-of-brain-involvement-in-alcoholic-and-nonalcoholic-wernicke-s-encephalopathy
#10
Gianvincenzo Sparacia, Andrea Anastasi, Claudia Speciale, Francesco Agnello, Aurelia Banco
AIM: To present the typical and atypical magnetic resonance (MR) imaging findings of alcoholic and non-alcoholic Wernicke's encephalopathy. METHODS: This study included 7 patients with Wernicke's encephalopathy (2 men, 5 women; mean age, 52.3 years) that underwent brain MR examination between January 2012 and March 2016 in a single institution. Three patients were alcoholics and 4 patients were non-alcoholics. MR protocol included a T2-weighted sequence, a fluid attenuation inversion recovery (FLAIR) sequence, a diffusion-weighted sequence (b = 0 and 1000 s/mm(2)), and a contrast-enhanced MR sequence...
February 28, 2017: World Journal of Radiology
https://www.readbyqxmd.com/read/28296723/surgical-treatment-for-bacterial-meningitis-after-spinal-surgery-a-case-report
#11
Li-Min Zhang, Liang Ren, Zhen-Qi Zhao, Yan-Rui Zhao, Yin-Feng Zheng, Jun-Lin Zhou
RATIONALE: Bacterial meningitis (BM) has been recognized as a rare complication of spinal surgery. However, there are few reports on the management of postoperative BM in patients who have undergone spinal surgery. The initial approach to the treatment of patients suspected with acute BM depends on the stage at which the syndrome is recognized, the speed of the diagnostic evaluation, and the need for antimicrobial and adjunctive therapy. PATIENT CONCERNS: Here, we report the case of a patient with lumbar spinal stenosis and underwent a transforaminal lumbar interbody fusion at L4-L5...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28293378/hepatorenal-syndrome-update-on-diagnosis-and-therapy
#12
EDITORIAL
Juan G Acevedo, Matthew E Cramp
Hepatorenal syndrome (HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality. A new definition has been recently recommended by the International Club of Ascites, according to which HRS diagnosis relies in serum creatinine changes instead that on a fixed high value. Moreover, new data on urinary biomarkers has been recently published. In this sense, the use of urinary neutrophil gelatinase-associated lipocalin seems useful to identify patients with acute tubular necrosis and should be employed in the diagnostic algorithm...
February 28, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28292990/-nephropathy-in-patients-undergoing-cancer-drug-therapy-platinum-derivatives-cisplatin-and-carboplatin
#13
Ayumu Matsuoka, Yuichi Ando
Cisplatin, a first-generation platinum derivative, is one of the most widely used anticancer agents and can treat a broad spectrum of malignancies. Cisplatin-induced nephrotoxicity is a major dose-limiting side effect resulting from damage to the proximal tubules of the kidney. This nephrotoxicity can be prevented by lowering the concentration of cisplatin and shortening the period of cisplatin exposure to the proximal tubules. In clinical practice, high-volume hydration(>3 L intravenous isotonic saline), forced diuresis(mannitol and/or furosemide), and magnesium supplementation have been generally used to lower the risk of cisplatin-induced nephrotoxicity...
March 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28283606/predictive-value-of-rapid-assessed-perfusion-thresholds-on-final-infarct-volume-in-swift-prime-solitaire-with-the-intention-for-thrombectomy-as-primary-endovascular-treatment
#14
Maxim Mokin, Elad I Levy, Jeffrey L Saver, Adnan H Siddiqui, Mayank Goyal, Alain Bonafé, Christophe Cognard, Reza Jahan, Gregory W Albers
BACKGROUND AND PURPOSE: Computed tomography perfusion imaging can estimate the size of the ischemic core, which can be used for the selection of patients for endovascular therapy. The relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) thresholds chosen to identify ischemic core influence the accuracy of prediction. We aimed to analyze the accuracy of various rCBV and rCBF thresholds for predicting the 27-hour infarct volume using RAPID automated analysis software from the SWIFT PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment) data...
March 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28277412/the-use-of-a-triage-based-protocol-for-oral-rehydration-in-a-pediatric-emergency-department
#15
Marissa A Hendrickson, Jennifer Zaremba, Andrew R Wey, Philippe R Gaillard, Anupam B Kharbanda
BACKGROUND: Guidelines recommend oral rehydration therapy (ORT) and avoidance of laboratory tests and intravenous fluids for mild to moderate dehydration in children with gastroenteritis; oral ondansetron has been shown to be an effective adjunct. OBJECTIVES: The aim of this study was to determine if a triage-based, nurse-initiated protocol for early provision of ondansetron and ORT could safely improve the care of pediatric emergency department (ED) patients with symptoms of gastroenteritis...
March 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28277352/sildenafil-citrate-therapy-for-oligohydramnios-a-randomized-controlled-trial
#16
Mohammad Ahmed Maher, Tarek Mohammad Sayyed, Nabih Elkhouly
OBJECTIVE: To compare sildenafil plus hydration with hydration alone in improving the amniotic fluid index and neonatal outcomes in pregnancies complicated by idiopathic oligohydramnios ( amniotic fluid index less than 5 cm without underlying maternal or fetal causes and with normal fetal growth). METHODS: This was an open-label randomized trial for women carrying singleton pregnancies at 30 weeks of gestation or more with idiopathic oligohydramnios detected during routine ultrasonogram...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28273399/clinical-presentation-and-outcomes-of-norovirus-infection-in-intestinal-allograft-compared-to-native-intestine
#17
Diana F Florescu, Jessica L Sonderup, Wendy Grant, Pearlie P Chong, David van Duin, Andre C Kalil
BACKGROUND: No data are available on clinical manifestations and course of norovirus gastroenteritis (NVE) in intestinal allograft (from intestinal and multivisceral transplant recipients, ITR) compared to native intestine (from other allograft recipients, nITR). METHODS: This was a retrospective study of solid organ transplant recipients with NVE at two centers from January 1, 2010 to April 1, 2014. Chi-square, t-test, linear and logistic regression analyses were done to compare NVE in ITR vs nITR patients...
March 8, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28267276/hyponatremia-in-children-with-acute-respiratory-infections-a-reappraisal
#18
REVIEW
Camilla Lavagno, Gregorio P Milani, Peter Uestuener, Giacomo D Simonetti, Carmen Casaulta, Mario G Bianchetti, Pietro B Fare, Sebastiano A G Lava
Hyponatremia (<135 mmol/L), typically associated with an elevated anti-diuretic hormone level, is common among children admitted with bronchiolitis, pneumonia, or pulmonary exacerbation of cystic fibrosis. The main consequences of acute hyponatremia include cerebral edema and Ayus-Arieff pulmonary edema. A widespread belief is that, in children with pneumonia or bronchiolitis, hyponatremia results from inappropriate anti-diuresis. By contrast, the pathogenic role of extracellular fluid volume depletion or decreased effective circulating blood volume is underscored...
March 7, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28259855/restrictive-versus-liberal-fluid-therapy-in-major-abdominal-surgery-relief-rationale-and-design-for-a-multicentre-randomised-trial
#19
Paul Myles, Rinaldo Bellomo, Tomas Corcoran, Andrew Forbes, Sophie Wallace, Philip Peyton, Chris Christophi, David Story, Kate Leslie, Jonathan Serpell, Shay McGuinness, Rachel Parke
INTRODUCTION: The optimal intravenous fluid regimen for patients undergoing major abdominal surgery is unclear. However, results from many small studies suggest a restrictive regimen may lead to better outcomes. A large, definitive clinical trial evaluating perioperative fluid replacement in major abdominal surgery, therefore, is required. METHODS/ANALYSIS: We designed a pragmatic, multicentre, randomised, controlled trial (the RELIEF trial). A total of 3000 patients were enrolled in this study and randomly allocated to a restrictive or liberal fluid regimen in a 1:1 ratio, stratified by centre and planned critical care admission...
March 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/28248876/obturator-externus-abscess-in-a-9-year-old-child-a-case-report-and-literature-review
#20
Charlotte de Bodman, Dimitri Ceroni, Justine Dufour, Pierre-Alex Crisinel, Aline Bregou-Bourgeois, Pierre-Yves Zambelli
RATIONALE: Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis...
March 2017: Medicine (Baltimore)
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