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Dec 2022 DOI 10.14302/issn.2574-4526.jddd-22-4151
Steroid cell tumors of the ovary are particularly rare, secreting sex hormones, characterized by steroid cell proliferation and represent only 0.1% of all ovarian tumors. They are classified into three subtypes according to their cell of origin: stromal luteoma, Leydig cell tumors and a third subtype of unknown lineage corresponds to a not specified steroid cell tumor (SCT-NOS). This third subtype accounts for 60% of steroid cell tumors. The clinical manifestations of SCT-NOS can take many forms, including pain, abdominal distension, but perhaps the most visible presentations are those related to hormonal activity and virilization of the tumor. We present a rare case of a 48-year-old woman with vaginal bleeding and a history of trunk obesity, hirsutism for 2 years and hypothyroidism with hormone replacement therapy. Clinical examination revealed a characteristic of obesity, virilization. Serum testosterone was 3.62 µg / L and CA-125 was 40.67. Magnetic resonance imaging identified a left ovarian solid mass and histopathology confirmed a steroid cell tumor not specific. The patient underwent exploratory laparotomy and left salpingoophorectomy. Macroscopically, the mass is well circumscribed, solid, homogeneous and yellowish. Microscopically, the tumor is mainly composed of eosinophilic or vacuolar granular cytoplasm. Immunohistochemistry showed that the tumor cells were strongly positive for inhibin. The postoperative period was uneventful. Through this rare observation, we will discuss the aspects that characterize this type of tumor and present some guidelines to be used in the differential diagnosis, as well as the difficulties encountered in the clinical, radiological and therapeutic fields.
Sep 2020 DOI 10.14302/issn.2470-0436.jos-20-3400
Aim To compare the efficacy of combined anti-VGEF (IVB) with steroids versus pure anti-VEGF for the treatment of macular edema secondary to retinal vein occlusion (RVO). Methods In this prospective study, 51 eyes were randomized into 2 groups according to treatment of clinically identified macular edema secondary to retinal vein occlusion within 4 weeks of onset: Group 1 (19 eyes) was given intravitreal Bevacizumab (IVB) (1.25mg/.05ml) + Triamcinolone (IVTA) (2mg/.05ml); Group 2 (22 eyes) was given pure intravitreal Bevacizumab (IVB) (1.25mg/.05ml) at baseline, at month 1, and at month 2. The outcome of the study represented the EDRTS letters gain, IOP change and (CRT) by using Spectral domain optical coherence tomography (OCT) at month 1, 2, 3 and 6 in each group. Both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) patients with at least 6 months FU were enrolled in the study. Results EDRTS letters gain was (20.37±15.28, 28.05±16.68, 35.16±17.12, 36.47±18.17) in group1 and (14.50±14.56, 18.41±14.56, 20.59±16.13, 21.06±15.72) in group2 at month 2,3 and 6 p value (0.18, .04, 0.004, 0.002). Mean IOP pre-injection (14.00±2.67) in group 1 and (13.5±5.89) in group 2. Group 1 has transient increase in IOP at month 1 and then return to baseline over 6 months. CRT from baseline to final FU decrease by 264.82 (µm) ±147.66 in group 1 and 308.42(µm) ±226.78 in group 2 with no significant difference between two group p value 0.57. There was no significant difference in EDRTS letters gain between CRVO patients and BRVO patients at month 1, 2, 3 and 6 p values (0.83, 0.23, 0.29, 0.13). Conclusion Early treatment macular edema in RVO patients by combined anti-VGEF+ steroid effectively improve functional outcome better than pure anti-VGEF injection.
Mar 2018 DOI 10.14302/issn.2575-1212.jvhc-18-2012
Bisphenol A (BPA) is an endocrine disruptor with a weak estrogenic effect used in industry as a component of food cans. We aimed to study the toxic effects of BPA on mRNA expression of steroidogenic genes and testicular structure in mature male rats. Animals were divided into 3 groups: vehicle control rats as first group, while second group received 10 µg/kg BW and third group received BPA 15 µg/kg BW orally every alternate day for a period of 105 successive days. Serum testosterone level, mRNA expression of genes related to steroid synthesis, histopathological examination, spermatogenesis index and number of Leydig cells were evaluated in this study. Lower serum hormone levels were observed in both BPA-treated groups as compared to the control group. The gene expression patterns of steroidogenic acute regulatory protein (StAR), cytochrome P450 17a(CYP17a) and 3β-Hydroxysteroid dehydrogenase (3β-HSD) were significantly down-regulated in BPA-treated rats compared to control group. Meanwhile, the expression of aromatase (CYP19) and lutinizing hormone receptor (LHR) was significantly up-regulated. Histopathological lesions were observed in the testes and epididymis of BPA-treated rats. Spermatogenesis index and the number of Leydig cells were significantly decreased in BPA-treated groups compared with the control group. This study highlights negative effect of BPA on steroidogenic genes and testicular structure in male rats.
Sep 2017 DOI 10.14302/issn.2471-2175.jdrt-17-1774
Topical corticosteroids are main therapeutic agents for the treatment of a wide variety of dermatological disorders. Three cases of chronic cutaneous ulceration affecting the skin of the breasts that were caused presumably by previous and continued use of potent topical corticosteroids for the treatment of psoriasis and/or intertrigo lesions were reported here. These three cases were presented to emphasize the potential serious local side effects of topical steroids even progressing to ulceration in breast' skin. These cases highlight the importance of appropriate use of topical corticosteroids, necessity of a strict follow up for adverse effects and the need of warning every patient about possible side effects of topical corticosteroids
Jan 2015 DOI 10.14302/issn.2471-7061.jcrc-14-394
This review synthesizes evidence on NSAIDs and colorectal cancer prevention. It balances chemopreventive efficacy against gastrointestinal and cardiovascular risks, and considers selective COX‑2 inhibitors, dosing, and candidate populations for risk‑benefit.
May 2025 DOI 10.14302/issn.2694-2283.jsem-25-5529
Background Septic arthritis is a potentially limb or life-threatening joint infection that requires prompt recognition and intervention to reduce morbidity and mortality. While intra-articular joint injections are commonly performed for osteoarthritis and other arthropathies, they carry a rare but significant risk of iatrogenic infection, particularly when performed in the presence of unrecognized joint or periarticular infection. Case Presentation We report a case of a 52-year-old female with a history of traumatic brain injury and chronic right knee pain who developed severe knee swelling, pain, and systemic symptoms following an intra-articular corticosteroid injection performed without ultrasound evaluation/guidance. Post-procedure, she presented with fever, elevated inflammatory markers, and purulent knee effusion. Operative washout revealed a purulent tract extending from the knee joint capsule to the lateral thigh. Cultures from joint aspiration and intraoperative samples grew Streptococcus dysgalactiae. Blood cultures were negative. The patient reported frequent cat scratches to the affected knee and described an unusual sensation of the injection needle tracking laterally during the joint injection. She was treated with surgical drainage and a four-week course of amoxicillin, with full clinical recovery. Discussion This case highlights an unusual presentation of septic arthritis with extra-capsular extension likely due to iatrogenic needle tracking during joint injection. The causative organism, S. dysgalactiae, is an uncommon pathogen in septic arthritis, and the presumed source was contiguous spread from untreated cellulitis, possibly related to cat scratches/bites. The absence of predisposing comorbidities and negative blood cultures further support a local rather than hematogenous source. The case emphasizes the importance of thorough clinical evaluation and consideration of infection prior to joint injections, as well as the potential benefits of ultrasound guidance to minimize procedural complications. Conclusion Careful history, physical examination, and appropriate imaging are essential prior to joint interventions to avoid iatrogenic complications. This case illustrates the rare but serious risk of extra-capsular extension of septic arthritis following intra-articular injection and emphasizes the need for vigilance in identifying underlying infection before proceeding with invasive procedures.
May 2024 DOI 10.14302/issn.2379-7835.ijn-24-5098
This prospective randomized double-blinded multicentric study aimed to assess the efficacy of a new nutraceutical in controlling itch and skin lesions caused by flea allergy dermatitis (FAD) and compare it with another oral product of proven efficacy. Forty-three dogs, of different age, breed and sex, with FAD were included and divided into two groups: 24 received product A and 19 product B. Both groups received the same antiparasitic treatment. A modified canine atopic lesion index (mCADLI) and pruritus visual analogic scale (pVAS) were recorded at days 0, 30 and 60. pVAS was evaluated both by the examining veterinarian (vpVAS) and the owner (opVAS). Results obtained were compared between the two groups at each time point. In both groups of dogs, a significant decrease of mCADLI, vpVAS and opVAS at day 30 and 60, compared to day 0, was observed. At baseline, the mCADLI scores of Group B were significantly higher than Group A (95% CI: -4.0 to 0.0, p < 0.05), with no differences at D30 and D60 (not significant, p > 0.05). In Group B, significantly lower values of vpVAS were observed at D30 compared to Group A (95% CI: -2.5 to 0.0, p < 0.05), but not at D60 (not significant, p > 0.05). The median values of pVAS in Group B were lower compared to Group A at both D30 (95% CI: -2.5 to 0.4, p < 0.01) and D60 (95% CI: -3.0 to 0.3, p < 0.05). Both nutraceuticals can be useful to control discomfort, skin lesions and pruritus due to flea allergy dermatitis and can be a valuable replacement for antipruritic drugs antihistamines, steroids or Il-31 inhibitors.
Jan 2024 DOI 10.14302/issn.2694-1201.jsn-23-4829
Caudal injection is a type of epidural injection that is administered to the lower back to reduce pain and inflammation. The injection contains a steroid medication that is injected into the lower part of the epidural space, which surrounds the nerve roots in the lower back. The procedure is usually performed on an outpatient basis, and most patients experience relief from back pain within a few days. The sacral injection is another name for a caudal epidural injection. It is a type of spinal epidural injection that is administered to the sacral hiatus, which is the opening at the base of the spine near the tailbone. The injection is used to treat nerve pain and inflammation caused by conditions such as spinal canal stenosis, herniated disks, degenerative disk disease, sciatica, or radiculopathy.
Jun 2023 DOI 10.14302/issn.2377-2549.jndc-23-4615
A literature review was undertaken with a focus on 1) identifying the research gaps regarding CECs, 2) identifying the most common ones, and 3) identifying the typical analytical methods/technologies employed, for their analysis. A total of 214 papers were noted, with a total of 21 review articles (9.8%). Of this total, a surprisingly high number were from South Africa alone: 117 (54.7%), of which 44 (20.6%) reports were associated with South Africa’s Water Research Commission (WRC). The top three CECs research gaps were (decreasing rank: Number of “gaps”, %): 1) Toxicity/Risk/Impact (260, 21.5%), 2) Analysis/Tests/Methods (118, 9.8%) and 2) Future research/studies (118, 9.8%), and 3) Monitoring (89, 7.4%). The common classes of CECs that were reported on, were : (i) Chemical: pharmaceuticals, personal care products, steroids, chlorinated and brominated contaminants, PAHs, PCBs, phthalates, alkyl phenols, herbicides, organochlorine pesticides, engineered nanomaterials and (ii) “Microbiological”: antibiotic resistance genes, human enteric bacteria and viruses, microbial pathogens (e.g., E Coli, rotavirus, Crypto, etc.), infectious biological water contaminants (e.g., E Coli isolates), cyanobacterial blooms (Microcystis). Common test methods used for analysis of the chemical contaminants were found to be chromatography (gas, liquid)-mass spectrometry; for the microbial contaminants, they were culture-based methods, ELISA, fluorescence microscopy, qPCR, RT-qPCR, gel electrophoresis, Raman spectroscopy, and also chromatography (largely liquid)-mass spectrometry, were also used. Some proposals were additionally made to address the very common, significant research gaps noted in CECs research, especially the standardization of analytical chemical test methods, based on chromatography-mass spectrometry, for quantification.
Apr 2023 DOI 10.14302/issn.2474-7785.jarh-23-4550
Aim This review examines the research base concerning hand osteoarthritis and changes in muscle mass and quality known as sarcopenia and the possible use of vitamin-D supplementation for reducing this potentially adverse functionally disabling state. Methods Publications detailing a possible link between hand osteoarthritis manifestations and sarcopenia, plus those discussing vitamin D as a possible intervention strategy for minimizing sarcopenia in the older adult were systematically sought and reviewed. Results Collectively, data reveal hand osteoarthritis in the older population is common, and is possibly affected by age as well as disease associated muscle mass declines. Vitamin D, a powerful steroid required by the body to foster many life affirming physiological functions may help reduce the degree of any prevailing sarcopenia and thereby some degree of hand osteoarthritis disability. Conclusions Older individuals with hand osteoarthritis, as well as healthy older adults at risk for sarcopenia are likely to benefit physically from efforts to clarify the extent of this association and if indicated, to examine and intervene thoughtfully to maximize muscle composition as well as safe vitamin D levels where subnormal. Researchers can make highly notable impacts in multiple spheres in this regard and are encouraged to do so.
Sep 2022 DOI 10.14302/issn.2641-4538.jphi-22-4238
The safety of cyclooxygenase (COX)-2 inhibitors has been tested in patients who had cross-reactive hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs). However, these studies have been mainly done before the current classification of NSAID hypersensitivity and cross-reaction between COX-2 inhibitors has been rarely reported.We aimed to assess tolerability of COX-2 inhibitors and to evaluate the cross-reactivity between them in cross-reactive phenotype of NSAID hypersensitivity. The diagnosis was based on clinical features, reliable history of HSRs to at least two chemically different NSAIDs, and/or positive provocation tests with implicated NSAIDs in 151 patients. Single-blind, oral challenges with 1/4 and 3/4 divided doses of placebo, nimesulide, meloxicam, and celecoxib, as COX-2 inhibitors, were performed. The most common cross-reactive phenotype was NSAID-induced urticaria/angioedema (56.3%). Positive reactions to meloxicam, nimesulide, and celecoxib challenges were observed in 23/140 (16.4%), 7/33 (21.2%), and none of six patients, respectively. Overall, 24 patients were tested with two, one was tested with three COX-2 inhibitors. Six (31.6%) of 19 patients with meloxicam intolerance reacted to nimesulide provocation. Nimesulide, meloxicam, and celecoxib appeared safe alternatives in cross-reactive phenotypes of NSAID hypersensitivity. Although celecoxib has the most favorable tolerability, cross-reactivity among COX-2 inhibitors seems to be possible.
Feb 2022 DOI 10.14302/issn.2470-5020.jnrt-22-4092
Acute disseminated encephalomyelitis (ADEM) is a monophasic, multifocal, demyelinating, autoimmune disease that affects the central nervous system (CNS). It usually occurs after a systemic infection, usually viral, including certain coronavirus infections. A 27-year-old girl presented with complaints of left interscapular pain, paresthesias and weakness in the ipsilateral upper limb. These symptoms followed paresthesias on the fingertips of her right hand the day before her admission. she was treated two weeks earlier for pneumonia with COVID-19. Her clinical pattern resulted in a moderate weakness of the left limbs associated with tactil and algic hypoesthesia in the lower left limb ascending until the C4 level in the left side. Magnetic resonance imaging (MRI) of the brain and spinal cord showed diffuse spontaneous hypersignals on fluid-attenuated inversion recovery (FLAIR) images at the cerebral level and on T2-weighted images at the spinal level. These imaging lesions coupled with the medical history of a recent COVID-19 infection led to the diagnosis of acute disseminated encephalomyelitis (ADEM) post covid-19. The clinical condition improved rapidly with intravenous (IV) corticosteroid therapy and IV immunoglobulin combined with physiotherapy. ADEM is a demyelinating autoimmune disease which is increasingly reported during this current corona virus pandemic.
Dec 2020 DOI 10.14302/issn.2474-7785.jarh-20-3650
Background The coronavirus Covid-19 strain that emerged in December 2019, continues to produce a widespread and seemingly intractable negative impact on health and longevity in all parts of the world, especially, among older adults, and those with chronic health conditions. Aim The first aim of this review article was to examine, summarize, synthesize, and report on the research base concerning the possible use of vitamin-D supplementation for reducing both Covid-19 risk and severity, especially among older adults at high risk for Covid-19 infections. A second was to provide directives for researchers or professionals who work or are likely to work in this realm in the future. Methods All English language relevant publications detailing the possible efficacy of vitamin D as an intervention strategy for minimizing Covid-19 infection risk published in 2020 were systematically sought. Key words used were: Vitamin D, Covid-19, and Coronavirus. Databases used were PubMed, Scopus, and Web of Science. All relevant articles were carefully examined and those meeting the review criteria were carefully read, and described in narrative form. Results Collectively, these data reveal vitamin D is a powerful steroid like compound that is required by the body to help many life affirming physiological functions, including immune processes, but its deficiency may seriously impact the health status and well being of the older adult and others. Since vitamin D is not manufactured by the body directly, ensuring those who are deficient in vitamin D may prove a helpful overall preventive measure as well as a helpful treatment measure among older adults at high risk for severe Covid-19 disease outcomes. Conclusions Older individuals with chronic health conditions, as well as healthy older adults at risk for vitamin D deficiency are likely to benefit physically as well as mentally, from efforts to foster adequate vitamin D levels. Geriatric clinicians can expect this form of intervention to reduce infection severity in the presence of Covid-19 infection, regardless of health status, and subject to careful study, researchers can make a highly notable impact in this regard.
Nov 2020 DOI 10.14302/issn.2470-5020.jnrt-20-3596
Background Reversible posterior encephalopathy syndrome (RPE) is a clinical and radiological entity characterized by the acute or subacute fitting of symptoms covering headache, vomiting, visual disturbances, seizures and impairment of consciousness. The pathophysiology of RPE syndrome is poorly described. RPE syndrome is characterized by a reversible cerebral edema of often posterior topography in magnetic resonance imagery (MRI). Cases Presentation We consider RPE syndrome four cases under various conditions that are known as airplane flight, hypertension, non-steroidal anti-inflammatory medication, pregnancy and oldness with several pathologies. The RPE was described with several symptoms like headaches, vomiting, focal motor deficit, paresthesia, seizures, disorders of consciousness and photophobia. The imagery findings were varying from cortical hypersignals in Flair sequences to edema of both cortex and sub cortex. The outcome was good with a complete regression of symptoms and imagery lesions. Conclusion The pathophysiological mechanism of RPE syndrome remains unknown. High blood pressure, renal failure and drugs (anti-depressants, NSAIDs, immunosuppressants) are the most etiological factors. The diagnosis is based on clinical arguments and brain MRI. The main location is posterior. The clinical outcome was good with all the patients in our study, no recurrence was noted.
May 2020 DOI 10.14302/issn.2641-5518.jcci-20-3317
This case report describes facial nerve palsy due to Ramsay Hunt syndrome, highlighting otic vesicles, audiovestibular symptoms, and imaging considerations. Management with antivirals, corticosteroids, and supportive care is summarized. Early recognition can improve outcomes and limit sequelae.
Nov 2019 DOI 10.14302/issn.2641-5518.jcci-19-3098
Idiopathic retroperitoneal fibrosis also known as Ormonds disease is a rare disorder characterized by the development of fibrotic tissue in the retroperitoneum. The fibrotic tissue may compress ureters, leading to obstructive nephrouropathy and renal failure. A 58-year-old man with fatigue, loss of appetite and unable to urinate was admitted to our clinic. Because of the serum creatinine value of 5.3 mg/dl, urinary ultrasonography was performed and bilateral grade 3 hydronephrosis with moderate level urine in bladder was detected. Hydronephrosis did not regress by transurethral foley catheter and suspicious appearance in the retroperitoneal area was found in abdominal magnetic resonance imaging. Tru-cut biopsy result of the current lesion was finally reported as a connective tissue. Bilateral double j catheter insertion was performed and started to immunosuppression therapy with corticosteroid. Two months later, double j catheters were removed and hydronephrosis was not detected in follow-up. In this case report, we tried to explain that, retroperitoneal fibrosis should be considered in the differential diagnosis of postrenal acute renal failure, even in patients without a classic symptom such as pain. In addition, early surgical intervention should be avoided in such patients.
May 2019 DOI 10.14302/issn.2324-7339.jcrhap-19-2847
Background Carissa carandas L. is a well-known wild fruit plant distributed through-out the India and also present in other countries. The fruits are rich in nutrients and minerals. A number of medicinally important phytochemicals such as carrisone, carindone, carandinol, lupeol, scopoletin, stigmasterol, β-sitosterol, myo-inositol, β-amyrin, Des-n-methylnoracronycine etc. have been reported from the extract of this plant. Being safe and cost effective molecules, the activity of phytochemicals against HIV-1 enzymes needs to be screened. Objective The aim of this study was to screen the potent phytocompound of C. carandas against human immunodeficiency virus-1 using docking method. Methods Total nine compounds viz. carandinol, caridone, carrisone, lupeol, p-coumaric acid, gallic acid, rutin, scopoletin and ursolic acid were used for in-silico study towards drug development against human immunodeficiency virus-1 reverse transcriptase (HIV-1RT; PDB ID: 1REV) and human immunodeficiency virus-1 protease (PDB ID:1EBY) using Autodock software. Results The qualitative characterization of the extracts showed the presence of a number of phytochemicals such as phenolics, flavonoids, alkaloids, terepnoids, terpenes, steroids, glycosides etc. Carandinol was observed as most effective anti-HIV-1 molecule having lowest binding energy and small inhibition coefficient. Another compound, p-coumaric acid, showed least effectiveness against human immunodeficiency virus- 1 reverse transcriptase or human immunodeficiency virus-1 protease showing highest binding energy and inhibition coefficients among all the evaluated phytocompounds. Conclusion The in-silico study demonstrated that some phytoconstituents of C. carandas exhibit potential anti-human immunodeficiency virus -1 activity and hence can be optimized to develop as a drug candidate in future.
May 2019 DOI 10.14302/issn.2576-6694.jbbs-19-2791
Plants used for medicinal practices which were discovered since prehistoric stone ages are termed Medicinal plants, which are also referred to as medicinal herbs, since plants produces bioactive chemical compounds (phytochemicals), this research however, is concerned with the extraction using Soxhlet extraction technique, phytochemical screening using various test methods, which reveals the presence of anthraquinones (free anthraquinones and combined anthraquinones), carbohydrates, cardiac glycosides, glycosides, flavonoids, saponins, steroids/ terpenes, phenolic compounds and tannins, and absence of alkaloids for extracts of senna occidentalis and also, thin layer chromatography profiling which gives probable foundation for further structural elucidation amongst others. This research shows the presence of potent secondary metabolites present in the leaves of senna occidentalis (leaves).
May 2019 DOI 10.14302/issn.2329-9487.jhc-19-2787
Introduction Cardiac non-specific inflammatory pseudotumors (NSIPT) are exceptionally associated to Behçet's disease (BD) and represent a real diagnostic and therapeutic challenge. The meaning and the mechanisms of this association are not yet well understood. The purpose of this paper is to study the epidemiologic, therapeutic, and evolutionary characteristics of cardiac NSIPT during BD Methods Systemic review of all reported cases of cardiac NSIPT associated with BD. Results We found only 6 cases of NSIPT associated with BD. Of these six patients, 4 were men (66.66%) and 2 were women (33.33%): Sex ratio =2. The average age was 26.66 years (9-35 years). The pseudotumor was unique in all cases. The chronology of occurrence of these NSIPT compared to the underlying angiitis was variable: inaugural of the disease in 4 cases, and complicating a previously known BD in 2 cases. The surgery was performed in all cases. It was carried out for diagnostic purpose in 4 cases, and therapeutic in the other 2. Additional medical treatment based on systemic corticosteroids with or without immunosuppressants was indicated in 4 patients. The evolution was favorable in 5 cases and a single case was quickly fatal. Recurrence of NSIPT was reported in one patient (20%). Conclusion The results of this review suggest a very likely association between BD and cardiac NSIPT; especially because of the scarcity of these two conditions in the general population, and the epidemiological characteristics clearly different from those of cardiac NSIPTs in the general population. The pathogenic mechanisms common to these two conditions (immune, inflammatory, reactive, and vascular) reinforce this causal link. The main differential diagnoses of these pseudotumors during BD remain cancer and intracardiac thrombosis.
Nov 2018 DOI 10.14302/issn.2997-2086.jfs-18-2245
Congenital pulmonary airway malformation (CPAM) can often be noted on fetal ultrasound. When a CPAM is noted in the face of fetal hydrops, the outcome is dismal. Surgical interventions and administration of antenatal steroids can be considered for treatment, but in hydropic fetuses these interventions are not always successful. We present a case of CPAM with severe fetal hydrops that underwent steroid administration and multiple intrauterine surgical interventions, which resulted in an excellent neonatal outcome.
Apr 2018 DOI 10.14302/issn.2578-8590.ipj-18-2018
Objective: The purpose of this study is to evaluate the use of paralytic shellfish poisoning toxin in a patient with arthrofibrosis of the knee. Arthrofibrosis is a common complication of knee surgery that tends to manifest itself as a limitation of the musculoskeletal ranges. Paralytic shellfish poisoning toxin has been proposed as an alternative treatment for painful musculoskeletal pathologies. Subjects: Use of paralytic shellfish poisoning toxin in arthroscopic menisectomy. Case report. Methods: Three doses of paralytic shellfish poisoning toxin were administered in an intra-articular manner on different days. Functionality, musculoskeletal ranges, pain at rest and pain during motion were evaluated. Results: The current alternatives for management of arthrofibrosis include the use of oral steroids, physiotherapy, mobilization under anesthesia and the liberation of arthroscopic debris. This case is the first report of the use of paralytic shellfish poisoning toxin. The adverse effects the patient presented coincided with those described in the literature but without the presence of severe reactions. Improvement in functional tests, progress in musculoskeletal ranges and a decrease in the level of pain were achieved. Adverse effects included parenthesia and a feeling of weightlessness.
Feb 2018 DOI 10.14302/issn.2641-5518.jcci-17-1880
Objective: Presentation of rare case report of primary non-Hodgkin Lymphoma of temporal bone secondary to immunodeficiency after prolonged steroid administration in a diabetic patient. Then review the literature of similar case reports. Method: 49 years old female presented with hearing loss, facial paralysis and otalgia. Biopsy revealed high grade non Hodgkin’s B-lymphoma. She underwent chemotherapy and had remarkable response. Result: Rapidly progressive deafness, facial paralysis and otalgia are common presentations of external canal Non-Hodgkin lymphoma. The disease is common in middle age, females and has a fair response to chemotherapy, good to radiotherapy. Surgery is an alternative method in isolated lesions or recurrent cases. Conclusion: High dose steroid and type II diabetes are potential risks for acquired immunodeficiency. External Auditory canal lymphoma is uncommon sequel. Chemotherapy is very effective in treatment of isolated cases without B symptoms
Jan 2018 DOI 10.14302/issn.2470-5020.jnrt-17-1926
Since the first description in 2013, 39 cases of anti-DPPX-encephalitis have been described. Main features of this autoimmune encephalitis characterized by antibodies against the potassium-channel-associated regulatory protein DPPX are gastrointestinal symptoms, cognitive dysfunction and signs of CNS hyperexcitability. While the majority of patients responds to immunotherapy relapses are frequent and often successfully treated with rituximab. Here we report another case of anti-DPPX-encephalitis presenting with the above mentioned triad. However, this is the first case of anti-DPPX-encephalitis in the context of a connective tissue disease combined with cerebral arteriopathy along with brain parenchymal lesions that we interpreted as a secondary, CTD-associated cerebral vasculitis. While the latter resolved under immunosuppressive treatment, comprising glucocorticosteroids, cyclophosphamide, rituximab and plasmapheresis, deterioration of the CTD and multiple infectious complications finally led to the patient's death. As histological evidence for cerebral vasculitis is lacking, other differential diagnoses for the observed cerebral arteriopathy, especially reversible cerebral vasoconstriction syndrome, have to be considered.
Sep 2017 DOI 10.14302/issn.2474-7785.jarh-17-1727
Background: Healthcare services provided to patients should vary depending on disease severity. However, disease severity bias, a type of selection bias, is a commonly encountered problem in administrative database studies. Herein, we selected chronic obstructive pulmonary disease (COPD), which commonly affects elderly Japanese citizens, for the development and validation of a severity classification system based on a health insurance claims database. Methods: Patients who received COPD-related diagnostic codes in 2011 were selected from a commercially based health insurance claims database. COPD patients were randomly divided into two groups to develop and validate severity scores. A principal component analysis was used to estimate factor loadings used to weight calculations of COPD severity scores. Score validity was evaluated using a linear trend test to predict COPD treatment costs and acute exacerbation events. Results: Using records from 880 patients, ten variables were created: acute exacerbation events, emphysema diagnoses, laboratory test and oxygen therapy procedures, prescribed anticholinergic, inhaled corticosteroid (ICS), short acting beta-agonist, and long acting bronchodilator (LABA) agents, asthma diagnosis and patient birth years. Factor loadings from LABA and ICS prescriptions had the strongest impacts on estimated severity scores (0.50 and 0.49, respectively). Among 300 validation group patients, scores were found to associate with increasing trends of median costs and exacerbation risks (p for trend < 0.05). Conclusions: Estimatedseverity scores would help to predict COPD-related medical costs and exacerbation events. For further clinical implementation, this classification system should be re-evaluated using clinical lung functions information indicative COPD severity and treatment choices.
Aug 2017 DOI 10.14302/issn.2470-0436.jos-17-1721
A 57-year-old Hispanic female presented with 3 days of blurry vision in the left eye. Eight years prior, she had a branch retinal artery occlusion in the right eye and a hematologic work-up revealed a 4G/4G polymorphism in plasminogen activator inhibitor-1. With the current episode, she was found to have bilateral branch retinal artery occlusions and mild vitritis in the left eye, simulating a toxoplasma infection. An infectious and inflammatory work up, however, was negative and the vitritis resolved after a short course of steroids. Plasminogen activator inhibitor-1 mutations may be associated with an increased risk of retinal vascular occlusions.
Aug 2017 DOI 10.14302/issn.2470-0436.jos-17-1666
Purpose: To evaluate early versus late immunomodulatory therapy (IMT) for patients following initial diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Methods: Retrospective review including all VKH patients seen 5/1/2014 to 4/1/2016 at LAC+USC. Early IMT was defined as starting an immunomodulatory agent within 3 months of corticosteroid initiation. Results: Twenty-seven patients were included, of whom 15 received early IMT and 8 received late IMT. Early IMT patients trended toward greater improvement in vision compared to late IMT (logMAR 0.59 vs. 0.11; p=0.14) with no differences in ocular complications including ocular hypertension (p=0.53) and cataract (p=1.0). Patients receiving early IMT averaged 0.93 recurrences versus 2.13 recurrences for late IMT (p=0.092). Of patients successfully taper off oral corticosteroids, the early IMT group was tapered in an average of 8.3 months versus 19.8 months for late IMT (p=0.0019). Conclusions: Early IMT in VKH may allow for shorter duration of corticosteroids with similar visual outcomes, ocular complications, and disease recurrences.
Feb 2017 DOI 10.14302/issn.2997-2086.jfs-16-1098
We report a twin gestation with one fetus afflicted by a left sided Extra-Lobar Sequestration (ELS) in a morbidly obese mother. The ELS was complicated by a left pleural effusion in the second trimester unresponsive to maternal steroid administration. We discuss the need for repeat shunt placement, in the setting of maternal morbid obesity and twin gestation. Shunt replacement was necessary secondary to dislodgement. Delivery at 34 weeks gestation was followed by successful surgical removal of the ELS. At one year follow up the infant has complete expansion of the left lung with no morbidity.
Jul 2016 DOI 10.14302/issn.2574-4526.jddd-16-1203
Background: Iron deficiency is a common reason for referral to a gastroenterologist. Objective: To identify predictors of colorectal cancer in patients referred to a gastroenterologist for iron deficiency. Methods: This was a retrospective review of consecutive patients referred to one of two gastroenterologists for assessment of iron deficiency. The office files and electronic health records were reviewed for all patients. Clinical data, such as hemoglobin level, and clinical symptoms were recorded. The final diagnosis was that of the attending gastroenterologist. Variables associated with a diagnosis of colorectal cancer by univariate analysis were entered into a multivariate logistic regression model to identify variables independently associated with the diagnosis of colorectal cancer. Results: Two hundred and seventy eight patients were included in this study. One hundred and fifty-eight (56.8%) were female. Mean age was 60.7 years (± 16.7 years). The most common causes of iron deficiency were: menorrhagia 16.2%, colorectal cancer 14%, use of aspirin or non-steroidal agents 11.2% and regular blood donation 7.2%. In 11.5% of patients, no cause was found. In univariate analysis, lower hemoglobin, greater age, shorter duration of iron deficiency, weight loss, symptoms from anemia and NSAID use were associated with colorectal cancer. In multivariate analysis, only older age (OR=1.06; 95% CI 1.04-1.09) and symptoms from anemia (OR=2.19; 95% CI 1.20-4.0) were independently associated with colorectal cancer. Conclusions: Colorectal cancer was found in 14% of patients referred to a gastroenterologist because of iron deficiency. Older age, and symptomatic anemia may help predict a diagnosis of colorectal cancer.
May 2016 DOI 10.14302/issn.2473-1005.jdoi-16-1059
Allergic angioedema of the airways is a potentially life-threatening condition. The allergen can be difficult to identify. Treatment in the acute phase comprises of antihistamines, steroids, adrenaline and in severe cases prophylactic intubation. Allergic angioedema can be encountered in all medical specialties including odontology. It can develop fast and emergency treatment is lifesaving. Knowledge of symptoms and emergency treatment is important. We present a case of a 33-year-old female physician who in a matter of hours developed first an atypical urticarial eruption followed by angioedema of the upper airways. She was treated with antihistamines, as she refused other treatments due to lactation. The patient also refused further investigations, however she has not had any further episodes after discontinuing the ingestion of organic tea. Allergic reactions are unpredictable and have a large variety of triggers. The most likely trigger in this case was fungicide in the organic tea.
Jan 2016 DOI 10.14302/issn.2379-8572.joa-15-814
Background and Objective: The etiological factors for nasal polyps include infection, inflammation or an imbalance of a metabolic pathway. This study was designed to compare serum Helicobacter pyloriantibodies and H. pylori–DNAs between cases of nasal polyp and controls (nasal fracture). Patients and Methods: This case control study was carried out in ENT Department of Rasul Hospital in Tehran (2007-2008), upon nasal polyp tissues in 62 cases and inferior nasal turbinate mucosa in 25 controls. H. pylori–DNAs were searched by qualitative polymerase chain reaction (PCR) and serum specific H. pylori antibodies (ELISA IgG and IgA). Comparative tests were performed for the 2 groups, and P value < 0.05 was considered as statistically significant. Results: The mean age of cases and controls were 37.5 ± 13.7 and 31 ± 11.5 years, respectively. H. pylori–DNA was found in 32.3% (20/62) of the cases and 4% (1/25) of the controls (P value = 0.005). Serum H. pylori antibody (IgA) was found in 14.5% (9/62) of the cases and 4% (1/25) of the controls (P value = 0.27). However, previous immunity (IgG) was higher in 71% of the cases and 32% of the controls (P = 0.001). Conclusion: H. pylori infection may play a key role in the formation of nasal polyps. We recommend the PCR as the best method of searching for H. pylori infection. However, from the data obtained in this investigation it could not be determined whether or not H. pylori play a pathogenic role. Long-term antibiotics treatment in cases with nasal polyp, especially in cases with severe chronic rhinosinusitis where patients do not respond to surgery or steroids, may be useful. More randomized controlled trial (RCT) studies are necessary to validate the role of H. pylori infection in nasal polyp and the effect of antibiotics for eradication of H. pylori infection.
Nov 2014 DOI 10.14302/issn.2379-8572.joa-14-429
Background: We reviewed the 2005-2011 ACS-NSQIP database to evaluate factors associated with adverse events (AE) after total laryngectomy (TL). Methods: All total laryngectomies performed from 2006 to 2011 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality. Results: 493 cases were identified. Complications of any category occurred in 189 cases (38.3%). Factors that were found to confer significant risk for medical complications were increased age (dds Ratio (OR) 1.03), prior PCI (OR 2.84), disseminated cancer (OR 2.47), chronic steroid/immunosuppresion use (OR 2.87), unintended weight loss > 10% over 6 months prior to surgery (OR 2.02), increasing work RVU total (OR 1.02), and increased anesthesia Z-score (OR 1.31). Only increased anesthesia Z-score (OR 1.27) was found to be a statistically significant risk factor for surgical complications. Chronic steroid/immunosuppression use (OR 3.16) and increased anesthesia Z-score (OR 1.29) were both found to be statistically significant risk factors of reoperation within 30 days. Conclusions: NSQIP is the only dataset that correctly discerns between minimally invasive and wide excision in laryngectomy. The use of the NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including fistula formation, are not tracked. In spite of this, our findings suggest avenues for improvement in the care of TL patients, and suggest directions for a laryngectomy-specific outcomes database.