scholarly journals Pyoderma Gangrenosum and Interleukin Inhibitors: A Semi-Systematic Review

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Hakim Ben Abdallah ◽  
Karsten Fogh ◽  
Christian Vestergaard ◽  
Rikke Bech
Keyword(s):  
Pyoderma Gangrenosum ◽  
Case Reports ◽  
Response Rates ◽  
Complete Response ◽  
Underlying Disease ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Treatment Groups ◽  
Search Terms ◽  
Interleukin Inhibitors

<b><i>Background:</i></b> Pyoderma gangrenosum (PG) is a rare ulcerating skin disease associated with multiple comorbidities and increased mortality. In recent decades, newer biologics such as interleukin inhibitors have been used to treat PG; however, the literature is scarce, consisting predominantly of case reports and caseseries. The aim of our review was to evaluate the effectiveness and safety of interleukin inhibitors for the treatment of PG in adults. <b><i>Summary:</i></b> A literature search was conducted using search terms related to PG and interleukin inhibitors in databases such as PubMed, Embase, Scopus, Web of Science, and Cochrane Library. The study eligibility criteria included patients diagnosed with PG, over the age of 18, and treated with an interleukin inhibitor. Our study included 60 papers describing 81 patients fulfilling the eligibility criteria. The treatment with interleukin inhibitors resulted in 70% (95% CI 59–80%) response and 57% (95% CI 45–68%) complete response rates, and few (4%) mild adverse events, hence supporting the off-label use for the treatment of recalcitrant PG in adults. The response and complete response rates were 59% (17/29) and 38% (11/29) for anakinra, 64% (7/11) and 55% (6/11) for canakinumab, and 79% (27/34) and 71% (24/34) for ustekinumab, respectively. Limitations include publication bias that might have overestimated the efficacy as successful cases responding to treatment are more likely to be reported than nonresponding cases. Additionally, the heterogeneity of the treatment groups does not allow conclusions of superiority or inferiority of the different interleukin inhibitors to be drawn. Further studies are needed to investigate the efficacy of the different interleukin inhibitors and to investigate the importance of underlying disease for treatment response.

Neuroleptic malignant syndrome in patients with cancer: a systematic review

2020 ◽  
Vol 10 (3) ◽  
pp. 265-270
Author(s):  
Izumi Sato ◽  
Hideki Onishi ◽  
Chiaki Kawanishi ◽  
Shuhei Yamada ◽  
Mayumi Ishida ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neuroleptic Malignant Syndrome ◽  
High Mortality ◽  
Case Reports ◽  
Healthcare Providers ◽  
D2 Receptor ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Patients With Cancer ◽  
Low Incidence

BackgroundAntipsychotics potentially cause a low incidence of the side effect called neuroleptic malignant syndrome (NMS), which has a high mortality rate. However, few studies on NMS among patients with cancer exist.AimsWe aimed to examine the characteristics of antipsychotic-induced NMS among patients with cancer.MethodsWe conducted a systematic review of published reports on NMS described during the treatment of patients with any type of cancer. Articles were identified by a comprehensive search of PubMed, Web of Science, the Cochrane Library and reference lists from relevant articles published until 25 December 2019. Original articles or case reports on humans published in English were included. This review summarises the symptoms, characteristics, treatment course and prognosis of patients with cancer with NMS.ResultsEleven patients with various cancer types from ten case reports published from 1988 to 2013 met the eligibility criteria. Mean age of the 11 patients was 52.5 (range, 32–83) years. NMS developed mostly during the postoperative period, and haloperidol and D2 receptor antagonists were determined as the common causative drugs. Ten patients survived following treatment that mostly involved discontinuing the causative drugs and administering dantrolene, if necessary.ConclusionAlthough NMS intrinsically has a low incidence and high mortality, only few reports were available, with most patients surviving after early detection and appropriate treatment. Healthcare providers should consider NMS development while prescribing antipsychotics to ensure prompt recognition of the condition and rapid treatment for preventing unnecessary deaths.

Serotonin Syndrome

2013 ◽  
Vol 27 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Susie H. Park ◽  
Robin C. Wackernah ◽  
Glen L. Stimmel
Keyword(s):  
Drug Interaction ◽  
Serotonin Syndrome ◽  
Tricyclic Antidepressants ◽  
Case Reports ◽  
Antidepressant Drugs ◽  
Cochrane Library ◽  
Search Terms ◽  
Potential Risk Factors ◽  
Therapeutic Doses ◽  
P450 2D6

Background: There is a warning associated with all serotonergic antidepressants and its concomitant use with tramadol due to the concern for a drug–drug interaction resulting in serotonin syndrome (SS). The prescribing of antidepressants with tramadol may be unnecessarily restricted due to fear of causing this syndrome. Objectives: There are 3 objectives of this review. To (1) review case reports of SS associated with the combination of tramadol and antidepressant drugs in recommended doses, (2) describe the mechanisms of the drug interaction, and (3) identify the potential risk factors for SS. Methods: Case reports of SS associated with tramadol and antidepressants were identified via Cochrane Library, PubMed, and Ovid (through October 2012) using search terms SS, tramadol, antidepressants, fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram, venlafaxine, desvenlafaxine, duloxetine, mirtazapine, milnacipran, trazodone, vilazodone, and bupropion. Cases involving monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants were excluded. Results: Nine articles were identified describing 10 cases of suspected SS associated with therapeutic doses of tramadol combined with an antidepressant. Mechanisms of the drug–drug interactions involve pharmacodynamic, pharmacokinetic, and possible pharmacogenetic factors. Conclusions: Review of the available case reports of tramadol combined with antidepressant drugs in therapeutic doses indicates caution in regard to the potential for SS but does not constitute a contraindication to their use. Tramadol is only contraindicated in combination with MAOIs but not other antidepressants in common use today. These case reports do suggest several factors associated with a greater risk of SS, including increased age, higher dosages, and use of concomitant potent cytochrome P450 2D6 inhibitors. Tramadol can be safely combined with antidepressants; however, monitoring and counseling patients are prudent when starting a new serotonergic agent or when doses are increased.

scholarly journals P-OGC51 A Review of Post-Oesophagectomy Benign Anastomotic Strictures

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Aya Musbahi ◽  
Arul Immanuel
Keyword(s):  
Risk Factors ◽  
Balloon Dilatation ◽  
English Language ◽  
Case Reports ◽  
Cochrane Library ◽  
Search Terms ◽  
Anastomotic Strictures ◽  
Included Review ◽  
Incidence Risk ◽  
Specific Search

Abstract Background Benign anastomotic strictures (BAS) are a known risk of oesophageal resection, leading to significant post-operative morbidity and a reported incidence of BAS varies widely from 8.83% to 42.38%. This review aims to assess incidence, risk factors for development as well as treatment.  Methods An electronic search using specific search terms using Medline, Embase and the Cochrane Library to identify all articles studying the development of BAS in adults post oesophagectomy was carried out. Inclusion criteria were patients who underwent any form of oesophagectomy for malignant disease (Ivor Lewis, McKeown, thoracoabdominal, transhiatal,minimally invasive); patients in study &gt;18-year-old; study reported only benign anastomotic strictures and any study design with a minimum of 6 patients. Only articles published in the English language were included. Review articles, case reports and conference abstracts were all excluded Results Seven studies reported on the incidence of BAS and an average of 34.1% was found. Cervical anastomosis, anastomotic leak development. Cardiovascular disease, diabetes and gastric conduit and smaller gun size in a stapled anastomosis were also found to be associated with BAS. Hypertension, neoadjuvant chemotherapy, transhiatal oesophagectomy or transthoracic were not found to be associated with BAS. The mainstay of management appears to be endoscopic balloon dilatation with adverse reported outcomes related to stent management. Conclusions BAS after oesophagectomy is common. Several risk factors have been identified and balloon dilatation appears to be the mainstay of treatment.

scholarly journals The Behavior of Patients with Obsessive-Compulsive Disorder in Dental Clinics

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hala M. Elkamash ◽  
Hatem M. Abuohashish
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Case Reports ◽  
Research Question ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Obsessive Compulsive ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Compulsive Disorder

Objectives. This review documents published obsessive-compulsive disorder (OCD) cases with dental and oral conditions with potential impact on the dental procedure. The research question was, what are the psychiatric and behavioral features of people with OCD that might affect dental sessions? Methods. This review followed the PRISMA guidelines (PROSPERO registration No. CRD42020212371). Six databases (PubMed, Scopus, Web of Science, LILACS, Cochrane Library, and PsycINFO) were screened for published clinical studies that report dental patients with obsessions or compulsions behaviors as identified by National Institute of Mental Health (NIMH). Inclusion of the studies was performed according to the eligibility criteria. The quality evaluation was carried out using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist. The results were qualitatively assessed for synthesis. Results. After elimination of duplication, 530 articles were screened, and 35 articles were evaluated for eligibility. 17 studies met the inclusion criteria (8 case reports, 5 cross-sectional studies, 1 longitudinal cohort study, and 3 case-control studies) and were included in the review. All case reports demonstrated symptoms of obsessions or compulsions such as fear of germs and contamination, aggressive thoughts, having things symmetric in perfect order, excessive cleaning or handwashing, repeatedly checking things, and compulsive counting. OCD-related behavior was assessed in the included clinical investigations using standardized protocols such as Florida Obsessive-Compulsive Inventory, Symptom Checklist-90-Revised, 4-item Corah Dental Anxiety Scale, Diagnostic and Statistical Manual of Mental Disorders, and the Crown Crisp Experimental Index. Quality assessment of the 17 included articles revealed 14 articles with low risk of bias and 3 articles with moderate risk of bias. Conclusion. The reported OCD symptoms may implement psychological difficulties during dental procedures without affecting the outcome. Although there was no contraindication for planning or performing dental treatments for a patient with OCD, dental-related procedures and protocols might be modified for successful dental appointments.

scholarly journals Effectiveness of Canal Occlusion for Intractable Posterior Canal Benign Paroxysmal Positional Vertigo: A Systematic Review

2019 ◽  
Vol 162 (1) ◽  
pp. 40-49 ◽  
Author(s):  
Britta D. P. J. Maas ◽  
Hester J. van der Zaag-Loonen ◽  
Peter Paul G. van Benthem ◽  
Tjasse D. Bruintjes
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Case Reports ◽  
Vestibular Function ◽  
Cochrane Library ◽  
Posterior Semicircular Canal ◽  
Eligibility Criteria ◽  
Posterior Canal ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Objectives A last resort for therapy for intractable benign paroxysmal positional vertigo (BPPV) is mechanical occlusion of the posterior semicircular canal. The aim of this review was to assess the effect of posterior canal occlusion for intractable posterior canal BPPV on vertigo and to determine the risk of loss of auditory or vestibular function. Data Sources A systematic literature search according to the PRISMA statement was performed on PubMed, the Cochrane Library, Embase, Web of Science, and CINAHL. The last search was conducted in June 2018. Review Methods Cohort studies with original data and case reports describing >5 cases were included if they analyzed the effect of posterior semicircular canal obliteration in adults with intractable posterior BPPV on vertigo. Two authors screened titles and abstracts for eligibility. The first author screened full texts and analyzed the data. Results Eight retrospective studies met the eligibility criteria. The quality of all individual studies was rated fair. Canal occlusion was performed on 196 patients. All studies reported complete resolution of BPPV in all patients (100%). Among postoperatively tested patients, total loss of auditory function and vestibular function was reported in 2 of 190 (1%) and 9 of 68 (13%), respectively. Conclusion Posterior semicircular canal plugging resulted in 100% resolution of BPPV in patients with intractable BPPV in all studies. However, the strength of evidence was weak. Potential serious complications, such as deafness and loss of vestibular function, should be taken into account.

scholarly journals Melphalan as a Promising Treatment for BRCA-Related Ovarian Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Vincenza Conteduca ◽  
Emanuela Scarpi ◽  
Alberto Farolfi ◽  
Nicole Brighi ◽  
Lorena Rossi ◽  
...  
Keyword(s):  
Clinical Benefit ◽  
Case Reports ◽  
Previous Treatment ◽  
Progression Free Survival ◽  
Complete Response ◽  
Disease Recurrence ◽  
Clinical Activity ◽  
Eligibility Criteria ◽  
Platinum Resistant ◽  
Platinum Based Chemotherapy

IntroductionMelphalan, as a bifunctional alkylating agent has been shown to be selectively efficient in BRCA-deficient case reports of epithelial ovarian cancer (EOC). The clinical benefit of melphalan on unselected platinum-resistant EOC population and stratified by BRCA status has not been clearly elucidated. We aimed to determine the response to melphalan in patients with recurrent EOC after platinum-based therapy.Material and MethodsThis retrospective observational study included patients with recurrent EOC treated with melphalan between February 2007 to July 2020. Eligibility criteria included having a histological confirmation of EOC, previous treatment with carboplatin plus paclitaxel regimens, and disease recurrence during treatment with or within 6 months of the end of the platinum-based chemotherapy.ResultsA total of 75 platinum-resistant EOC patients were enrolled. Median age was 69 years (range 41-82). Median of previous therapies before melphalan was 4 (range 1-7). We observed a median follow-up of 32 months (range 1-62), progression-free survival (PFS) and overall survival (OS) of 3.6 months (range 2.9-4.7) and 9.5 months (range 8.0-14.1), respectively. In the whole population, 1 complete response, 6 partial responses and 37 stable diseases were registered with an overall clinical benefit rate of 58.7%. In BRCA1/2 mutant patients, we showed a significant longer PFS compared to BRCA1/2 wild type patients (6.2 versus 2.6 months; hazard ratio (HR) 0.25, 95% confidence interval (CI) 0.10-0.61; p=0.002). Moreover, a trend was seen for BRCA1/2 mutants to have a better OS (25.9 versus 8.0 months; HR 0.38; 95% CI 0.12-1.19; p=0.097).ConclusionsOur study represents the largest cohort of heavily-pretreated EOC patients receiving melphalan treatment. Here, we report a considerable clinical activity of melphalan chemotherapy, more evident in a subset of BRCA1/2 mutated patients. Prospective studies to validate these findings are warranted.

scholarly journals Prevalence of KRAS, PIK3CA, BRAF and AXIN2 gene mutations in colorectal cancer and its relationship with dental agenesis: a systematic review

2021 ◽  
Vol 71 (1) ◽  
pp. e95595
Author(s):  
Francisco Sir-Mendoza ◽  
Farith González-Martínez ◽  
Meisser Madera
Keyword(s):  
Colorectal Cancer ◽  
Scientific Evidence ◽  
Gene Mutations ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Kras Mutations ◽  
Search Terms ◽  
Clinical Biomarkers ◽  
Publication Language ◽  
Different Populations

Introduction: The study of allelic and genotypic frequencies contributes to determining the distribution of genetic variants in different populations and their possible association with biomarkers. This knowledge could improve the decision-making process regarding the management of some diseases such as colorectal cancer (CRC), in which the detection of clinical biomarkers such as dental agenesis could be crucial in clinical practice. Objective: To evaluate the available scientific evidence on the prevalence of KRAS, PIK3CA, BRAF and AXIN2 mutations and their possible association with dental agenesis in people with CRC. Materials and methods: A systematic search was conducted in PubMed, EMBASE and Cochrane Library databases using the following search strategy: type of studies: observational studies reporting the prevalence of KRAS, PIK3CA, BRAF and AXIN2 mutations in people diagnosed with CRC and their possible association with dental agenesis; publication language: English and Spanish; publication period: 2010-2020; search terms: “Genes”, “RAS”, “Kras”, “PIK3CA”, “BRAF”, “AXIN2”, “Mutation”, “Polymorphism”, “Colorectal Neoplasms”, “Colorectal Cancer”, used in different combinations (“AND” and “OR”).   Results: The initial search yielded 403 records, but only 30 studies met the eligibility criteria. Of these, 11, 5, 5 and 1 only reported the prevalence of PIK3CA, KRAS, BRAF and AXIN2 mutations, respectively; while 8 reported the prevalence of more than one of these mutations in patients with CRC. The prevalence of KRAS (p.Gly12Asp), PIK3CA (p.Glu545Lys), and BRAF (p.Val600Glu) mutations ranged from 20.5% to 54%, 3.5% to 20.2%, and 2.5% to 12.1%, respectively. There were no findings regarding the association between the occurrence of these mutations and dental agenesis.   Conclusions: KRAS mutations were the most prevalent; however, there is no evidence on the association between dental agenesis and the occurrence of KRAS, PIK3CA and BRAF germline mutations in individuals with CRC.

Comparison of the Efficacy of Zolmitriptan and Sumatriptan: Issues in Migraine Trial Design

Cephalalgia ◽  
2000 ◽  
Vol 20 (1) ◽  
pp. 30-38 ◽  
Author(s):  
G Geraud ◽  
J Olesen ◽  
V Pfaffenrath ◽  
P Tfelt-Hansen ◽  
R Zupping ◽  
...  
Keyword(s):  
Active Treatment ◽  
Trial Design ◽  
Placebo Response ◽  
Response Rates ◽  
Complete Response ◽  
Normal Activity ◽  
Double Blind ◽  
Treatment Groups ◽  
Significant Difference ◽  
Secondary Endpoints

In this international, multicentre, double-blind, placebo-controlled, single attack study, ‘triptan naive’ migraine patients were randomized in an 8:8:1 ratio to receive zolmitriptan 5 mg, sumatriptan 100 mg or placebo. The all-treated analysis included 1058 patients who took study medication. The primary endpoint, complete headache response, was reported by 39%, 38% and 32% of patients treated with zolmitriptan, sumatriptan and placebo, respectively, with no significant difference between treatment groups. In patients with moderate headache at baseline, complete response was significantly greater following zolmitriptan than after placebo (48% vs. 27%; P = 0.01); there was no significant difference between sumatriptan and placebo groups (40% vs. 27%). In patients with severe baseline headache (where a greater reduction in headache intensity is required for a headache response), there was no significant difference between any groups in complete headache response rates. For secondary endpoints, active treatment groups were significantly superior to placebo for: 1-, 2- and 4-h headache response (e.g. 2-h headache response rates: zolmitriptan 59%; sumatriptan 61%; placebo 44%; P < 0.01 vs. placebo); pain-free response rates at 2 and 4 h; alleviation of nausea and vomiting; use of escape medication and restoration of normal activity. The incidence of adverse events was similar between zolmitriptan and sumatriptan groups but was slightly lower in the placebo group. The lack of difference between active treatments and placebo for complete response probably reflects the high placebo response obtained, which is probably a result of deficiencies in trial design. For example, the randomization ratio may result in high expectation of active treatment. Thus, while ethically patient exposure to placebo should be minimized, this must be balanced against the scientific rationale underpinning study design.

scholarly journals Should civilian pre-hospital emergency care provision include tourniquets for the management of uncontrolled traumatic haemorrhage?

2015 ◽  
Vol 12 (4) ◽  
Author(s):  
Georgia Wright ◽  
Samantha Mcdonald ◽  
Gavin Smith
Keyword(s):  
Literature Search ◽  
Case Reports ◽  
Effective Means ◽  
Major Haemorrhage ◽  
Cochrane Library ◽  
Care Provision ◽  
Hospital Emergency ◽  
Search Terms ◽  
Academic Search ◽  
And Training

IntroductionTourniquets are used extensively in military settings, where they have proven to be an effective means of controlling major traumatic haemorrhage. This review aims to determine the value of tourniquets in the civilian pre-hospital setting.MethodA literature search was performed using the following electronic databases from inception to June 2014: Medline, Academic Search Premier and Cochrane Library. Additional searches were conducted in the Victoria University Library search engine. Key search terms included pre-hospital, tourniquet, military, complications, failure, ischemia, metabolic changes, history, and paramedics. Using the search terms outlined above, 236 articles were identified. With further examination 220 were excluded, leaving 16 for review (dated from 1974 - 2014). Of the 16 articles, 2 were determined to be relevant, published and peer reviewed case reports whilst the other 14 were peer reviewed and published studies.ResultsTourniquet use for controlling major haemorrhage is more accepted for military rather than civilian applications. Factors contributing to this include: lack of education and training, variation and incidence of specific mechanisms of injury, complications such as ischemia, decreased civilian scene times, and decreased civilian transport times to definitive care. Civilian research was inhibited by study numbers, with much of the data emanating from military research.ConclusionTo date, there is little evidence of tourniquet use in civilian environments. They are considered controversial due to complications and shortfalls. These factors contribute to user apprehension.

Laser Influence on Dental Sensitivity Compared to Other Light Sources Used During In-office Dental Bleaching: Systematic Review and Meta-analysis

2020 ◽  
Vol 45 (6) ◽  
pp. 589-597
Author(s):  
BGS Casado ◽  
EP Pellizzer ◽  
JR Souto Maior ◽  
CAA Lemos ◽  
BCE Vasconcelos ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Color Change ◽  
Meta Analysis ◽  
Present Review ◽  
Cochrane Library ◽  
Light Sources ◽  
Eligibility Criteria ◽  
Tooth Color ◽  
Significant Difference ◽  
Meta Analyses

Clinical Relevance The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources. SUMMARY Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources. Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible. Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: −1.60; confidence interval [CI]: −3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: −2.22; CI: −6.36 to 1.93; p=0.29). Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.

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