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https://www.readbyqxmd.com/read/29346710/an-extensive-caseous-calcification-of-the-mitral-annulus-complicated-with-severe-mitral-regurgitation
#1
Alper Karakus, Hakan Tibilli, Ibrahim H Inanc, Hakan Tasolar, Serdar Turkmen, Erdal Akturk
Caseous calcification of the mitral annulus (CCMA) is considered a rare variant of mitral annular calcification (MAC) due to caseous transformation of the inner material and prevalence of CCMA, about 0.63% of all MAC cases and 0.06%-0.07% of the population. The precise pathophysiology of CCMA is still unknown. It is a chronic degenerative disorder common in the elderly, particularly in women. Caseous calcification of the mitral annulus (CCMA) is a soft peri-annular extensive calcification, resembling cardiac tumors, abscesses, vegetation, or calcified thrombus, which is composed of an admixture of calcium, fatty acids, and cholesterol with a toothpaste-like texture...
January 18, 2018: Echocardiography
https://www.readbyqxmd.com/read/29346227/refractory-pain-management-in-amyloid-associated-peripheral-neuropathy
#2
Nafisseh S Warner, James C Watson, Markus A Bendel, Susan M Moeschler
OBJECTIVE: Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. CASE REPORT: A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief...
January 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29346185/higher-art-adherence-is-associated-with-lower-systemic-inflammation-in-treatment-na%C3%A3-ve-ugandans-who-achieve-virologic-suppression
#3
Jose R Castillo-Mancilla, Mary Morrow, Yap Boum, Helen Byakwaga, Jessica E Haberer, Jeffrey N Martin, David Bangsberg, Samantha Mawhinney, Nicholas Musinguzi, Yong Huang, Russell P Tracy, Tricia H Burdo, Kenneth Williams, Conrad Muzoora, Peter W Hunt, Mark J Siedner
BACKGROUND: Residual systemic inflammation persists despite suppressive antiretroviral therapy (ART) and is associated with non-AIDS clinical outcomes. We aimed to evaluate the association between ART adherence and inflammation in Ugandans living with HIV who were predominantly receiving nevirapine-based ART with a thymidine analog backbone and were virologically suppressed by conventional assays. METHODS: Plasma concentrations of interleukin-6 (IL-6), D-dimer, soluble (s)CD14, sCD163, the kynurenine/tryptophan (K/T) ratio, in addition to CD8 T-cell activation, were measured at baseline and 6 months after ART initiation in treatment-naïve adults who achieved an undetectable plasma HIV RNA (<400 copies/mL) at their 6-month visit...
January 16, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/29345417/catheter-based-edge-to-edge-mitral-valve-repair-for-pulmonary-pressure-reduction-and-to-postpone-heart-transplantation-in-a-teenaged-patient
#4
Moritz Messner, Florian Hintringer, Silvana Müller, Marc Michael Zaruba, Nikolaos Bonaros, Herwig Antretter, Daniel Basic, Gerhard Pölzl
We report a case of catheter-based edge-to-edge mitral valve repair in a teenage male patient with non-ischaemic cardiomyopathy to improve pulmonary hypertension secondary to severe functional mitral regurgitation (FMR) to defer anticipated heart transplantation. A 19-year-old patient with previous history of fulminant myocarditis followed by markedly left ventricular dysfunction presented with severe mitral regurgitation 3 years after initial recovery. Slightly over time, deterioration of FMR was associated with gradual increase in pulmonary artery pressures despite optimal medical therapy...
January 18, 2018: ESC Heart Failure
https://www.readbyqxmd.com/read/29344476/acute-angle-closure-precipitated-by-hemorrhage-and-necrosis-of-a-large-uveal-melanoma-in-the-setting-of-systemic-immunomodulatory-therapy
#5
Chau M Pham, Krishna Kalyam, Bradley T Smith, Justin Floyd, John B Holds
Management of nonmetastatic uveal melanoma has been well studied and a large body of work has been published by the Collaborative Ocular Melanoma Study (amongst many others). Management of uveal melanoma that is found to be metastatic upon initial diagnosis, however, is less well defined. We report an interesting case of acute angle closure caused by necrosis and hemorrhage into a large uveal melanoma occurring shortly after initiation of immunomodulatory therapy with ipilimumab and nivolumab for metastatic disease...
November 2017: Ocular Oncology and Pathology
https://www.readbyqxmd.com/read/29344340/assessment-and-management-of-sexual-dysfunction-in-the-context-of-depression
#6
REVIEW
Pratap R Chokka, Jeffrey R Hankey
Sexual dysfunction (SD) is pervasive and underreported, and its effects on quality of life are underestimated. Due in part to its bidirectional relationship with depression, SD can be difficult to diagnose; it is also a common side effect of many antidepressants, leading to treatment noncompliance. While physicians often count on patients to spontaneously report SD, treatment is optimized when the clinician instead performs a thorough assessment of sexual functioning before and during drug therapy using a standardized questionnaire such as the Arizona Sexual Experiences Scale (ASEX)...
January 2018: Therapeutic Advances in Psychopharmacology
https://www.readbyqxmd.com/read/29343970/a-retrospective-examination-of-the-us-food-and-drug-administration-s-clinical-pharmacology-reviews-of-oncology-biologics-for-potential-use-of-therapeutic-drug-monitoring
#7
Brett Fleisher, Sihem Ait-Oudhia
Background: Biologics have gained traction for use in oncology, but have demonstrate clinical variability for efficacy and safety. Therapeutic drug monitoring (TDM) can benefit patients' outcomes from a biologic therapy when the latter has a defined therapeutic window. A clinically relevant therapeutic window may exist for biologics with established exposure-response (E-R) relationships for efficacy and/or safety and a documented maximum tolerated dose (MTD). Additionally, the inter-individual variability (IIV) on the clearance (CL) parameter could determine risks for patients falling outside the proposed therapeutic window...
2018: OncoTargets and Therapy
https://www.readbyqxmd.com/read/29343908/pet-ct-and-pet-mr-in-urological-cancers-other-than-prostate-cancer-an-update-on-state-of-the-art
#8
REVIEW
Abdul Razik, Chandan Jyoti Das, Sanjay Sharma
Hybrid positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (PET/MRI) have enabled the combination of morphologic and functional imaging with the promise of providing better information in guiding therapy. Further advance has been made in the past decade with the development of newer radiotracers and optimization of the technical aspects. We performed a search in PubMed, Scopus, and Google Scholar for peer-reviewed literature concerning the advances and newer developments in the imaging of nonprostate urologic cancers between 2005 and 2017...
January 2018: Indian Journal of Urology: IJU: Journal of the Urological Society of India
https://www.readbyqxmd.com/read/29340850/drug-related-problems-among-community-dwelling-older-adults-in-mainland-china
#9
Jiadan Yang, Long Meng, Yu Liu, Liping Lv, Shusen Sun, Rui Long, Xuefeng Shan, Jie Song, Feng Qiu
Background Little is known about the extent of drug-related problems (DRPs) in community-dwelling older adult patients with chronic diseases in mainland China. Setting A medication therapy review service at a community health center in Chongqing, China. Objective To identify and categorize DRPs along with pharmacists' recommendations in addressing the DRPs identified. Method The study was conducted between May 2015 and July 2016. A total of 102 community-dwelling older adults were included. MTR was carried out by clinical pharmacists...
January 16, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29339168/selection-of-p2y12-inhibitor-in-percutaneous-coronary-intervention-and-or-acute-coronary-syndrome
#10
REVIEW
Udaya Tantry, Eliano P Navarese, Aung Myat, Paul Gurbel
The P2Y12 receptor plays a critical role in the amplification of platelet aggregation in response to various agonists and stable thrombus generation at the site of vascular injury leading to deleterious ischemic complications. Therefore, treatment with a P2Y12 receptor blocker is a major effective strategy to prevent ischemic complications in high -risk patients with acute coronary syndrome (ACS) and patients undergoing percutaneous coronary intervention (PCI). The determination of optimal platelet inhibition is based on maximizing antithrombotic properties while minimizing bleeding risk and is critically dependent on individual patient's propensity for thrombotic and bleeding risks...
January 12, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29338602/sequential-drug-treatment-algorithm-for-agitation-and-aggression-in-alzheimer-s-and-mixed-dementia
#11
Simon Jc Davies, Amer M Burhan, Donna Kim, Philip Gerretsen, Ariel Graff-Guerrero, Vincent L Woo, Sanjeev Kumar, Sarah Colman, Bruce G Pollock, Benoit H Mulsant, Tarek K Rajji
INTRODUCTION: Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge...
January 1, 2018: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/29336905/getting-a-good-night-sleep-the-importance-of-recognizing-and-treating-nocturnal-hypokinesia-in-parkinson-s-disease
#12
REVIEW
Roongroj Bhidayasiri, Claudia Trenkwalder
When Parkinson's disease (PD) patients are asked about the quality of their sleep, their answers are dominated by difficulties associated with impaired mobility in bed, medically referred to as nocturnal hypokinesia. Nocturnal hypokinesia is symptomatic from the mid-stage of the disease, affecting up to 70% of PD patients, and contributes to poor sleep quality, and increased carer burden. Here we explore four areas of nocturnal hypokinesia that are relevant to clinical practice, namely: manifestations and definition; clinical assessment and objective monitoring; etiologies and contributing factors; and evidence-based therapeutic approaches...
January 5, 2018: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/29335863/integrative-medicine-on-optimizing-clopidogrel-and-aspirin-therapy
#13
REVIEW
Hui Chen
This article reviews the available published data on optimizing clopidogrel and aspirin therapy using translational and integrative medicine. Translational and evidence-based medical studies show that the CYP2C19 gene mutation (CYP2C19*2 and CYP2C19*3) could affect > 50% of the Chinese population, and that this mutation is closely associated with clopidogrel resistance and an increased risk of major adverse cardiovascular events, particularly stent thrombosis in patients following percutaneous coronary intervention (PCI)...
January 15, 2018: Chinese Journal of Integrative Medicine
https://www.readbyqxmd.com/read/29332075/patient-evaluation-and-selection-for-movement-disorders-surgery-the-changing-spectrum-of-indications
#14
Steffen Paschen, Günther Deuschl
This report summarizes the state-of-the-art and controversies around patient selection for deep brain stimulation (DBS) for various conditions. Parkinson's disease (PD): several class I studies have shown superiority of DBS over best medical treatment for advanced PD with fluctuations and further inclusion criteria. One class I study suggests that PD patients with early motor complications might gain more quality of life if operated within 3 years after the onset of fluctuations. The subthalamic nucleus (STN) is still the standard target...
2018: Progress in Neurological Surgery
https://www.readbyqxmd.com/read/29331943/modern-management-of-perianal-fistulas-in-crohn-s-disease-future-directions
#15
REVIEW
Paulo Gustavo Kotze, Bo Shen, Amy Lightner, Takayuki Yamamoto, Antonino Spinelli, Subrata Ghosh, Remo Panaccione
Perianal fistulae in patients with Crohn's disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%...
January 13, 2018: Gut
https://www.readbyqxmd.com/read/29329796/the-evolving-face-of-myocardial-reperfusion-in-acute-coronary-syndromes-a-primer-for-the-internist
#16
REVIEW
R Jay Widmer, Peter M Pollak, Malcolm R Bell, Bernard J Gersh, Nandan S Anavekar
Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes...
January 9, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29325953/physical-risk-factors-of-hemorrhagic-complications-associated-with-angio-seal-closure-device-use-in-neurointerventional-procedures
#17
Yasuhiro Aida, Kouichi Misaki, Tomoya Kamide, Masanao Mohri, Naoyuki Uchiyama, Mitsutoshi Nakada
BACKGROUND: Few studies have demonstrated detailed physical risk factors of hemorrhagic complications (HC) associated with the Angio-Seal closure device. This retrospective study aimed to identify the risk factors of HC due to Angio-Seal use. METHODS: Data from 143 cases that underwent neurointerventional procedures that involved puncturing the femoral artery and that used an Angio-Seal to close the puncture site were reviewed. We divided these cases into HC and no HC groups and retrospectively compared age, sex, past medical and preference history, body mass index (BMI), femoral artery depth, dual antiplatelet therapy use, activated clotting time, general anesthesia use, sheath size, right femoral artery puncture, and treatment time...
January 8, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29325801/editorial-the-role-of-medical-physics-in-lung-sbrt
#18
EDITORIAL
Pietro Mancosu, Andrew Nisbet, Núria Jornet
Stereotactic body radiation therapy (SBRT) has become a standard treatment for non-operable patients with early stage non-small cell lung cancer (NSCLC). In this context, medical physics community has largely helped in the starting and the growth of this technique. In fact, SBRT requires the convergence of many different features for delivering large doses in few fractions to small moving target in an heterogeneous medium. The special issue of last month, was focused on the different physics challenges in lung SBRT...
January 9, 2018: Physica Medica: PM
https://www.readbyqxmd.com/read/29325435/early-stages-of-hiv-treatment-cascade-in-people-living-with-hiv-in-saint-petersburg-russia
#19
M V Vetrova, O V Aleksandrova, A E Paschenko, S E Toropov, V V Rassokhin, R A Abyshev, O S Levina, L M Niccolai, R Heimer
The proportion of people living with HIV (PLWH) in need of antiretroviral therapy (ART) is growing rapidly in Russia. Successful treatment outcomes reduces disease progression and contributes to HIV epidemic control. We conducted a pilot study following 100 PLWH newly found eligible for ART in St. Petersburg, Russia. We determined the proportion of PLWH who initiated ART, remained in treatment, and achieved an undetectable VL during 6-month follow up. Semi-structured interviews were conducted prior the initiation of ART and progress along the cascade was assessed through medical chart review...
January 11, 2018: AIDS Care
https://www.readbyqxmd.com/read/29324542/extramammary-paget-disease-of-the-vulva-a-case-series-examining-treatment-recurrence-and-malignant-transformation
#20
Roni Nitecki, Michelle Davis, Jaclyn C Watkins, Yiru E Wu, Allison F Vitonis, Michael G Muto, Ross S Berkowitz, Neil S Horowitz, Colleen M Feltmate
OBJECTIVES: Extramammary Paget disease (EMPD) of the vulva is a rare lesion with a high recurrence rate ranging from 12% to 61%. The rate of underlying adenocarcinoma varies, but in the largest series was reported at 4%. Given the rarity of the disease there is a paucity of data to optimize treatment. This study aims to describe the management and recurrence patterns in a tertiary care setting and to offer suggestions for management in a modern-day setting. METHODS: Patients with pathologically confirmed EMPD treated from 2000 to 2015 were retrospectively identified using an IRB approved database...
January 10, 2018: International Journal of Gynecological Cancer
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