scholarly journals Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review

Cureus ◽  
2021 ◽  
Author(s):  
Youngmin Cho ◽  
Erik W Anderson ◽  
Sara J Guevara ◽  
Santiago J Miyara ◽  
Naomi Maria ◽  
...  
Keyword(s):  
Case Series ◽  
Narrative Review ◽  
Diagnostic Dilemma

scholarly journals Topical Treatments and Their Molecular/Cellular Mechanisms in Patients with Peripheral Neuropathic Pain—Narrative Review

Pharmaceutics ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 450
Author(s):  
Magdalena Kocot-Kępska ◽  
Renata Zajączkowska ◽  
Joanna Mika ◽  
David J. Kopsky ◽  
Jerzy Wordliczek ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Management ◽  
Clinical Studies ◽  
Neuronal Cells ◽  
Case Series ◽  
Narrative Review ◽  
Peripheral Sensitization ◽  
Cellular Mechanisms ◽  
Peripheral Neuropathic Pain ◽  
Topical Treatments

Neuropathic pain in humans results from an injury or disease of the somatosensory nervous system at the peripheral or central level. Despite the considerable progress in pain management methods made to date, peripheral neuropathic pain significantly impacts patients’ quality of life, as pharmacological and non-pharmacological methods often fail or induce side effects. Topical treatments are gaining popularity in the management of peripheral neuropathic pain, due to excellent safety profiles and preferences. Moreover, topical treatments applied locally may target the underlying mechanisms of peripheral sensitization and pain. Recent studies showed that peripheral sensitization results from interactions between neuronal and non-neuronal cells, with numerous signaling molecules and molecular/cellular targets involved. This narrative review discusses the molecular/cellular mechanisms of drugs available in topical formulations utilized in clinical practice and their effectiveness in clinical studies in patients with peripheral neuropathic pain. We searched PubMed for papers published from 1 January 1995 to 30 November 2020. The key search phrases for identifying potentially relevant articles were “topical AND pain”, “topical AND neuropathic”, “topical AND treatment”, “topical AND mechanism”, “peripheral neuropathic”, and “mechanism”. The result of our search was 23 randomized controlled trials (RCT), 9 open-label studies, 16 retrospective studies, 20 case (series) reports, 8 systematic reviews, 66 narrative reviews, and 140 experimental studies. The data from preclinical studies revealed that active compounds of topical treatments exert multiple mechanisms of action, directly or indirectly modulating ion channels, receptors, proteins, and enzymes expressed by neuronal and non-neuronal cells, and thus contributing to antinociception. However, which mechanisms and the extent to which the mechanisms contribute to pain relief observed in humans remain unclear. The evidence from RCTs and reviews supports 5% lidocaine patches, 8% capsaicin patches, and botulinum toxin A injections as effective treatments in patients with peripheral neuropathic pain. In turn, single RCTs support evidence of doxepin, funapide, diclofenac, baclofen, clonidine, loperamide, and cannabidiol in neuropathic pain states. Topical administration of phenytoin, ambroxol, and prazosin is supported by observational clinical studies. For topical amitriptyline, menthol, and gabapentin, evidence comes from case reports and case series. For topical ketamine and baclofen, data supporting their effectiveness are provided by both single RCTs and case series. The discussed data from clinical studies and observations support the usefulness of topical treatments in neuropathic pain management. This review may help clinicians in making decisions regarding whether and which topical treatment may be a beneficial option, particularly in frail patients not tolerating systemic pharmacotherapy.

scholarly journals Brief Review on Metabolic Bone Disease

2018 ◽  
Vol 8 (3) ◽  
pp. 611-640 ◽  
Author(s):  
Dina el Demellawy ◽  
Jorge Davila ◽  
Ashley Shaw ◽  
Youssef Nasr
Keyword(s):  
Child Abuse ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Heterogeneous Group ◽  
Narrative Review ◽  
Common Denominator ◽  
Diagnostic Dilemma ◽  
Metabolic Bone ◽  
Broad Term ◽  
Bone Abnormalities

Metabolic bone disease (MBD) is a broad term that describes a clinically heterogeneous group of diseases that are only united by a common denominator of an aberrant bone chemical milieu leading to a defective skeleton and bone abnormalities. From a forensic pathologist’s perspective, MBDs create a challenging diagnostic dilemma in differentiating them from child abuse, particularly when the victim is an infant. Through this brief narrative review on MBD, bone pathophysiology and two relatively challenging pediatric MBDs will be discussed.

Odontogenic Infections with Cutaneous Involvement in Children: a Case Series

Dental Update ◽  
2020 ◽  
Vol 47 (2) ◽  
pp. 144-148
Author(s):  
Joana Monteiro ◽  
Adèle Johnson ◽  
Pathanjali Kandiah ◽  
Prabhleen Anand ◽  
Stephen Fayle
Keyword(s):  
Case Series ◽  
Well Being ◽  
Skin Lesions ◽  
Diagnostic Dilemma ◽  
Odontogenic Infections ◽  
Cutaneous Involvement ◽  
Odontogenic Origin ◽  
Oral Symptoms ◽  
The Uk ◽  
Dental Professionals

Cutaneous involvement of dental sepsis is a rare occurrence in children. It often presents as a diagnostic dilemma, especially in the absence of oral symptoms, with initial presentation to non-dental professionals. This article discusses three cases of children presenting with cutaneous involvement of odontogenic origin to two paediatric dentistry departments in the UK. All cases had delayed presentations and were initially submitted to ineffective treatment, with significant impact on the children’s well-being. Final management included antibiotic therapy, drainage and extraction of the septic tooth. These three cases highlight the importance of considering a dental aetiology for localized inflammatory and purulent skin lesions of the mandible. Prompt diagnosis and early treatment are determinant for early resolution and avoidance of systemic or psychological complications. CPD/Clinical Relevance: This article discusses diagnosis and management of three different presentations of odontogenic sepsis with cutaneous involvement in children.

The Impact of Shift Work on Migraine: A Case Series and Narrative Review

2019 ◽  
Vol 59 (9) ◽  
pp. 1631-1640 ◽  
Author(s):  
Claire H. Sandoe ◽  
Sanskriti Sasikumar ◽  
Christine Lay ◽  
Valerie Lawler
Keyword(s):  
Shift Work ◽  
Case Series ◽  
Narrative Review ◽  
The Impact

scholarly journals Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 29S-35S ◽  
Author(s):  
Christopher D. Witiw ◽  
Jefferson R. Wilson ◽  
Michael G. Fehlings ◽  
Vincent C. Traynelis
Keyword(s):  
Health Care Providers ◽  
Spine Surgery ◽  
Cost Optimization ◽  
Safety Data ◽  
Case Series ◽  
Surgical Care ◽  
Narrative Review ◽  
Care Providers ◽  
Ambulatory Surgical Centers

Study Design: Narrative review with commentary. Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety. Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting. Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of “outpatient.” Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.

scholarly journals Tuberculous brain abscesses: Case series and review of literature

2011 ◽  
Vol 02 (02) ◽  
pp. 153-157 ◽  
Author(s):  
Sarala Menon ◽  
Renu Bharadwaj ◽  
A.S. Chowdhary ◽  
D.V. Kaundinya ◽  
D.A. Palande
Keyword(s):  
Brain Abscess ◽  
Mr Spectroscopy ◽  
Case Series ◽  
Final Diagnosis ◽  
Diagnostic Dilemma ◽  
Proton Mr Spectroscopy ◽  
Microbiological Culture ◽  
Brain Abscesses ◽  
Tuberculous Brain Abscess

ABSTRACT Introduction: Tuberculous brain abscess (TBA) is a rare but serious condition. It resembles a pyogenic brain abscess clinically and radiologically and poses a problem in diagnosis and treatment. A final diagnosis is established by smear or culture demonstration of acid fast bacilli (AFB) within the abscess. Here, we report four such cases in our fiveyear study on brain abscesses, along with the different diagnostic modalities used. Materials and Methods: A total of 75 brain abscess pus specimens were collected during neurosurgery, either by burr hole or by craniotomy. These specimens were further subjected to Gram stain, Ziehl-Neelsen (ZN) stain, and conventional microbiological culture. Only those cases which showed presence of AFB on ZN stain along with the growth of Mycobacterium tuberculosis were considered as TBAs. Such TBA cases were further presented along with their In vitro Proton Magnetic Resonance (MR) Spectroscopic findings. Results: Of these four patients, three were males. Though this condition is more commonly seen in immunocompromised patients, three of the patients in this study were immunocompetent. All the four pus specimens showed presence of AFB in the ZN stain. Three of them grew M. tuberculosis as sole isolate. The fourth case was of concomitant tuberculous and pyogenic brain abscess. In vitro Proton MR spectroscopy of the pus specimens showed absence of multiple amino acids at 0.9 ppm, which was found to be hallmark of TBA. One patient died of four. Conclusions: TBA always poses a diagnostic dilemma. ZN stain and conventional microbiological culture for Mycobacteria always help to solve this dilemma. In vitro Proton MR Spectroscopy also seems to have the diagnostic utility.

scholarly journals Head and Neck Schwannomas: A Surgical Challenge—A Series of 5 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Ishtyaque Ansari ◽  
Ashfaque Ansari ◽  
Arjun Antony Graison ◽  
Anuradha J. Patil ◽  
Hitendra Joshi
Keyword(s):  
Brachial Plexus ◽  
Head And Neck ◽  
Case Series ◽  
Neck Region ◽  
Anatomical Location ◽  
Diagnostic Dilemma ◽  
Neurogenic Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Formidable Challenge ◽  
Nerve Of Origin

Background. Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. They originate from any nerve covered with schwann cell sheath. Schwannomas constitute 25–45% of tumors of the head and neck. About 4% of head and neck schwannomas present as a sinonasal schwannoma. Brachial plexus schwannoma constitute only about 5% of schwannomas. Cervical vagal schwannomas constitute about 2–5% of neurogenic tumors. Methods. We present a case series of 5 patients of schwannomas, one arising from the maxillary branch of trigeminal nerve in the maxillary sinus, second arising from the brachial plexus, third arising from the cervical vagus, and two arising from cervical spinal nerves. Result. Complete extracapsular excision of the tumors was achieved by microneurosurgical technique with preservation of nerve of origin in all except one. Conclusion. Head and neck schwannoma though rare should be considered as a differential diagnosis of a unilateral slow growing mass in the head and neck region, particularly in an adult. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time, and histopathology is the gold standard for diagnosis. As a rule, treatment is surgical and dictated by the location of the tumor and nerve of origin. Due to its rarity, complex anatomical location and morbidity risk postexcision, they can pose a formidable challenge to surgeons. This study aims to describe the presentation, workup, surgical technique, and outcome.

scholarly journals Delirium and Cognitive Impairment as Predisposing Factors of COVID-19 Infection in Neuropsychiatric Patients: A Narrative Review

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1244
Author(s):  
Michele Fabrazzo ◽  
Antonio Russo ◽  
Alessio Camerlengo ◽  
Claudia Tucci ◽  
Mario Luciano ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Case Reports ◽  
Neuropsychiatric Symptoms ◽  
Case Series ◽  
Potential Effect ◽  
Acute Onset ◽  
Predisposing Factors ◽  
Narrative Review ◽  
Predisposing Factor ◽  
Altered Level

SARS-CoV-2 neuroinvasive and neurotropic abilities may underlie delirium onset and neuropsychiatric outcomes. Only a limited number of studies have addressed the potential effect of SARS-CoV-2 infection on mental health so far. Most studies mainly reported the acute onset of mixed neuropsychiatric conditions in patients infected with SARS-CoV-2, characterized by agitated behavior, altered level of consciousness, and disorganized thinking, regardless of psychological or socioeconomic triggering factors. The present narrative review aims to analyze and discuss the mechanisms underlying the neuroinvasive/neurotropic properties of SARS-CoV-2 and the subsequent mental complications. Delirium appeared as a clinical manifestation of SARS-CoV-2 brain infection in some patients, without systemic or multiple organ failure symptoms. A small number of studies demonstrated that neuropsychiatric symptoms associated with COVID-19, initially presenting as a confused state, may subsequently evolve in a way that is consistent with the patients’ neuropsychiatric history. A literature analysis on this topic prevalently showed case reports and case series of patients presenting delirium or delirium-like symptoms as the main outburst of COVID-19, plus a cognitive impairment, from mild to severe, which pre-existed or was demonstrated during the acute phase or after infection. Dementia appeared as one of the most frequent predisposing factors to SARS-CoV-2 infection complicated with delirium. Instead, contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a neuropsychiatric history. Therefore, clinicians should contemplate the possibility that COVID-19 appears as delirium followed by a psychiatric exacerbation, even without other systemic symptoms. In addition, cognitive impairment might act as a predisposing factor for COVID-19 in patients with delirium.

scholarly journals UNILATERAL PROPTOSIS - A DIAGNOSTIC DILEMMA

2021 ◽  
Vol 71 (5) ◽  
pp. 1755-58
Author(s):  
Ubaid Ullah Yasin ◽  
Muhammad Amer Yaqub ◽  
Syed Abid Hassan Naqvi ◽  
Muhammad Shahid ◽  
Asad Habib ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Tertiary Care ◽  
Case Series ◽  
Armed Forces ◽  
Care Hospital ◽  
Diagnostic Challenge ◽  
Chi Square ◽  
Diagnostic Dilemma ◽  
Radio Imaging ◽  
Unilateral Proptosis

Objective: To study epidemiology, presentation and management of cases with unilateral proptosis presenting at a tertiary care hospital. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2016 to Dec 2017. Methodology: Retrospective analysis of hospital record of patients with unilateral proptosis was carried out. Data was entered and analyzed in SPSS version 22. Chi square test was used for statistical analysis. Results: Thirty-three cases of unilateral proptosis with a mean age of 41.79 ± 3.87 years were included in the study. Pain was the most common association. Proptosis was mild in 42.4%, moderate in 48.5% and severe in 9.1% cases. In 61% cases, diagnosis was made on excisional or incisional biopsy and on the basis of radio imaging in 39% cases. Most common cause of proptosis found was pleomorphic adenoma (12%). Patients with axial and non-axial proptosis were 48.5% and 51.5% respectively. Fourteen cases (42.5%) were managed surgically and 2 cases (6%) were observed. Total of 22 cases (67%) improved after treatment, 8 cases (24%) went into remission, 2 (6%) deteriorated, and 1 (3%) died in the study period. Conclusion: Unilateral proptosis is a diagnostic challenge. Pertinent history taking and detail examination is the key, but associated signs or symptoms not always point towards correct diagnosis. Tissue biopsy provides a conclusive diagnosis especially where radio imaging is doubtful.

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