Pub Date : 2019-03-12DOI: 10.24983/SCITEMED.CMT.2019.00106
C. Kuo
Epistaxis (i.e., nosebleed) is a common otolaryngologic emergency; however, it is seldom life-threatening and most minor nosebleeds stop on their own or under primary care from medical staff. Nonetheless, cases of recurrent epistaxis should be checked by an otolaryngologist, and severe nosebleeds should be referred to the emergency department to avoid adverse consequences, including hypovolemic shock or death. This paper reviews current advances in our understanding of epistaxis as well as updated treatment algorithms to assist clinicians in optimizing outcomes.
{"title":"Updates on the Management of Epistaxis","authors":"C. Kuo","doi":"10.24983/SCITEMED.CMT.2019.00106","DOIUrl":"https://doi.org/10.24983/SCITEMED.CMT.2019.00106","url":null,"abstract":"Epistaxis (i.e., nosebleed) is a common otolaryngologic emergency; however, it is seldom life-threatening and most minor nosebleeds stop on their own or under primary care from medical staff. Nonetheless, cases of recurrent epistaxis should be checked by an otolaryngologist, and severe nosebleeds should be referred to the emergency department to avoid adverse consequences, including hypovolemic shock or death. This paper reviews current advances in our understanding of epistaxis as well as updated treatment algorithms to assist clinicians in optimizing outcomes.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"140 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77674020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-09DOI: 10.24983/SCITEMED.CMT.2019.00105
C. Kuo
Stephen Hawking died in Cambridge on March 14, 2018 at the age of 76. He has been described as one of the greatest scientific minds in history and the most popular scientific figure since Albert Einstein. He is also a symbol of human courage and persistence, having continued in his work for decades in spite of a debilitating disease that left him confined to a wheelchair. Hawking was diagnosed with amyotrophic lateral sclerosis (ALS) in his early twenties. This rare disease leads to gradual decline of the brain’s ability to control muscles. Doctors predicted that he would live for only a few years, but the advance of the disease was slower than expected, thereby allowing him to pursue an illustrious career articulating theories of the cosmos and bringing science to the forefront of popular culture.
{"title":"How Stephen Hawking Defied Amyotrophic Lateral Sclerosis for Five Decades","authors":"C. Kuo","doi":"10.24983/SCITEMED.CMT.2019.00105","DOIUrl":"https://doi.org/10.24983/SCITEMED.CMT.2019.00105","url":null,"abstract":"Stephen Hawking died in Cambridge on March 14, 2018 at the age of 76. He has been described as one of the greatest scientific minds in history and the most popular scientific figure since Albert Einstein. He is also a symbol of human courage and persistence, having continued in his work for decades in spite of a debilitating disease that left him confined to a wheelchair. Hawking was diagnosed with amyotrophic lateral sclerosis (ALS) in his early twenties. This rare disease leads to gradual decline of the brain’s ability to control muscles. Doctors predicted that he would live for only a few years, but the advance of the disease was slower than expected, thereby allowing him to pursue an illustrious career articulating theories of the cosmos and bringing science to the forefront of popular culture.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84723842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-12DOI: 10.24983/SCITEMED.CMT.2018.00085
J. P. Ospina, Franklin King, Elizabeth N Madva, C. Celano
Delirium is an acute disorder of arousal and attention that is commonly encountered, incompletely understood, and associated with adverse outcomes including increased morbidity and mortality, reduced health-related quality of life, and increased healthcare costs. In this narrative review, authors examine the epidemiology, potential pathophysiological mechanisms, assessment, prevention, and treatment of this cognitive disorder.
{"title":"Epidemiology, Mechanisms, Diagnosis, and Treatment of Delirium: A Narrative Review","authors":"J. P. Ospina, Franklin King, Elizabeth N Madva, C. Celano","doi":"10.24983/SCITEMED.CMT.2018.00085","DOIUrl":"https://doi.org/10.24983/SCITEMED.CMT.2018.00085","url":null,"abstract":"Delirium is an acute disorder of arousal and attention that is commonly encountered, incompletely understood, and associated with adverse outcomes including increased morbidity and mortality, reduced health-related quality of life, and increased healthcare costs. In this narrative review, authors examine the epidemiology, potential pathophysiological mechanisms, assessment, prevention, and treatment of this cognitive disorder.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78206257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-07DOI: 10.24983/SCITEMED.CMT.2018.00073
J. Finsterer, S. Zarrouk-Mahjoub
In a recent article, Reda et al. reported about a 41-year-old patient with a classical mitochondrial multiorgan disorder syndrome, manifesting as stroke-like episodes, epilepsy, ataxia, migraine, cognitive impairment, brain atrophy, hypoacusis, short stature, hypertrophic cardiomyopathy, heart failure, renal impairment, anemia, gout, and hyperlipidemia. The authors have some comments and concerns.
{"title":"Multiorgan Disorder Suggests Mitochondrial Disease","authors":"J. Finsterer, S. Zarrouk-Mahjoub","doi":"10.24983/SCITEMED.CMT.2018.00073","DOIUrl":"https://doi.org/10.24983/SCITEMED.CMT.2018.00073","url":null,"abstract":"In a recent article, Reda et al. reported about a 41-year-old patient with a classical mitochondrial multiorgan disorder syndrome, manifesting as stroke-like episodes, epilepsy, ataxia, migraine, cognitive impairment, brain atrophy, hypoacusis, short stature, hypertrophic cardiomyopathy, heart failure, renal impairment, anemia, gout, and hyperlipidemia. The authors have some comments and concerns.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82297901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-18DOI: 10.24983/SCITEMED.CMT.2018.00062
C. Kuo
The clinical significance of otitis media with effusion (OME), a complication associated with cleft lip/palate (CLP), is often overlooked in children. The author reviews the pathogenesis, clinical manifestations, and diagnoses of OME in children with CLP as well as the controversies surrounding treatment. He also provides a flowchart to guide the management of OME in children with CLP.
{"title":"Glue Ear in Children with Cleft Lip and Palate: An Update","authors":"C. Kuo","doi":"10.24983/SCITEMED.CMT.2018.00062","DOIUrl":"https://doi.org/10.24983/SCITEMED.CMT.2018.00062","url":null,"abstract":"The clinical significance of otitis media with effusion (OME), a complication associated with cleft lip/palate (CLP), is often overlooked in children. The author reviews the pathogenesis, clinical manifestations, and diagnoses of OME in children with CLP as well as the controversies surrounding treatment. He also provides a flowchart to guide the management of OME in children with CLP.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81458609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) stage III and IV with vitamin D sterols is useful to maintain optimal parathyroid hormone (PTH) levels and thereby, reduces the severity of bone abnormalities caused by high PTH levels. However, it should be borne in mind that serum calcium (Ca) levels may easily increase as bone turnover is easily suppressed due to diffuse or early nodular parathyroid tissue in these patients. Furthermore, an elevated risk of cardiovascular disease due to advanced atherosclerosis associated with both secondary hyperparathyroidism and the administration of vitamin D sterols has been reported in patients with moderate to severe CKD, resulting in a high mortality in these patients. In order to control serum Ca levels, therefore, additional use of cinacalcet hydrochloride may be useful. However, acute reduction of serum Ca levels and chronic hyperphosphatemia should be avoided; therefore, the doses of phosphorus (P) binders should be increased or the initiation of low doses of vitamin D sterols may be favorable in patients with stage III and IV CKD receiving cinacalcet hydrochloride. The phosphaturic effect of FGF-23 after treatment with cinacalcet is estimated to be small as compared with that of vitamin D in moderate to severe CKD patients, therefore, evaluation of osteocytes should be performed in patients with secondary hyperparathyroidism treated with cinacalcet hydrochloride.
{"title":"Efficacy and Safety of Cinacalcet in Chronic Kidney Disease Stage III and IV","authors":"A. Yajima, A. Pasch, K. Nitta","doi":"10.4137/CMT.S3189","DOIUrl":"https://doi.org/10.4137/CMT.S3189","url":null,"abstract":"Treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) stage III and IV with vitamin D sterols is useful to maintain optimal parathyroid hormone (PTH) levels and thereby, reduces the severity of bone abnormalities caused by high PTH levels. However, it should be borne in mind that serum calcium (Ca) levels may easily increase as bone turnover is easily suppressed due to diffuse or early nodular parathyroid tissue in these patients. Furthermore, an elevated risk of cardiovascular disease due to advanced atherosclerosis associated with both secondary hyperparathyroidism and the administration of vitamin D sterols has been reported in patients with moderate to severe CKD, resulting in a high mortality in these patients. In order to control serum Ca levels, therefore, additional use of cinacalcet hydrochloride may be useful. However, acute reduction of serum Ca levels and chronic hyperphosphatemia should be avoided; therefore, the doses of phosphorus (P) binders should be increased or the initiation of low doses of vitamin D sterols may be favorable in patients with stage III and IV CKD receiving cinacalcet hydrochloride. The phosphaturic effect of FGF-23 after treatment with cinacalcet is estimated to be small as compared with that of vitamin D in moderate to severe CKD patients, therefore, evaluation of osteocytes should be performed in patients with secondary hyperparathyroidism treated with cinacalcet hydrochloride.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"69 1","pages":"1661-1666"},"PeriodicalIF":0.0,"publicationDate":"2009-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90856567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence has accumulated indicating that proinflammatory cytokines play critical roles in the pathogenesis of RA. Recent clinical studies demonstrate that blockade of IL-6 signaling with tocilizumab, a recombinant humanized anti-interleukin-6 receptor antibody, is a new therapeutic option for the treatment of patients with RA refractory to conventional DMARD therapy and anti-TNF-α therapy. This paper discusses possible mechanisms of action, reviews the results of clinical trials, and discusses the place of tocilizumab in RA treatment.
{"title":"Pharmacotherapy Options in Rheumatoid Arthritis: Focus on Tocilizumab, a Recombinant Humanized Anti-Interleukin-6 Receptor Antibody","authors":"Y. Ohsugi, T. Kishimoto","doi":"10.4137/CMT.S2048","DOIUrl":"https://doi.org/10.4137/CMT.S2048","url":null,"abstract":"Evidence has accumulated indicating that proinflammatory cytokines play critical roles in the pathogenesis of RA. Recent clinical studies demonstrate that blockade of IL-6 signaling with tocilizumab, a recombinant humanized anti-interleukin-6 receptor antibody, is a new therapeutic option for the treatment of patients with RA refractory to conventional DMARD therapy and anti-TNF-α therapy. This paper discusses possible mechanisms of action, reviews the results of clinical trials, and discusses the place of tocilizumab in RA treatment.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"61 1","pages":"1677-1691"},"PeriodicalIF":0.0,"publicationDate":"2009-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74405131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/BIS suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider.
{"title":"Fospropofol Disodium Injection: A Review of its Use as a Sedative-hypnotic Agent for Monitored Anesthesia Care (MAC) Sedation in Adult Patients Undergoing Diagnostic or Therapeutic Procedures:","authors":"E. Harris, D. Lubarsky, K. Candiotti","doi":"10.4137/CMT.S2388","DOIUrl":"https://doi.org/10.4137/CMT.S2388","url":null,"abstract":"Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/BIS suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"38 1","pages":"1667-1675"},"PeriodicalIF":0.0,"publicationDate":"2009-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86989191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lapatinib is an oral dual inhibitor of epidermal growth factor receptor (HER1/ErbB1/EGFR) and human epidermal growth factor receptor 2 (HER2/ErbB2) which was approved for use in patients with metastatic breast cancer in 2007. In this review, we discuss the quality of life (QOL) results for patients on clinical trials of lapatinib. Six clinical trials, including 4 phase III and 2 phase II trials, were identified for which QOL outcomes have been reported. The trials generally showed stability of QOL during lapatinib therapy with no trial showing a detrimental effect of lapatinib on QOL. With these results, a discussion of the role of QOL assessments in patients with breast cancer is presented.
{"title":"A Review of the Impact of Lapatinib on Health-Related Quality of Life in the Management of Advanced Solid Tumors","authors":"J. Price, Q. Chu","doi":"10.4137/CMT.S3410","DOIUrl":"https://doi.org/10.4137/CMT.S3410","url":null,"abstract":"Lapatinib is an oral dual inhibitor of epidermal growth factor receptor (HER1/ErbB1/EGFR) and human epidermal growth factor receptor 2 (HER2/ErbB2) which was approved for use in patients with metastatic breast cancer in 2007. In this review, we discuss the quality of life (QOL) results for patients on clinical trials of lapatinib. Six clinical trials, including 4 phase III and 2 phase II trials, were identified for which QOL outcomes have been reported. The trials generally showed stability of QOL during lapatinib therapy with no trial showing a detrimental effect of lapatinib on QOL. With these results, a discussion of the role of QOL assessments in patients with breast cancer is presented.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"10 1","pages":"1653-1660"},"PeriodicalIF":0.0,"publicationDate":"2009-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75547367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psoriasis is a chronic inflammatory cell-mediated disease affecting skin and joints, histologically characterized by epidermal hyperplasia and abnormal differentiation of keratinocytes. Plaque psoriasis, which is the most prevalent form of the disease, is clinically characterized by raised, inflamed, erythematous lesions covered by white silvery scales, located on the elbows, knees, scalp, lower back, forearms, hands and feet. Several drugs are available for the management of moderate-to-severe plaque psoriasis, including topical and systemic treatments. Calcitriol (1,25 dihydroxyvitamin D3) is the most biologically active form of vitamin D3 and it can be used topically as both a primary and adjunctive therapy for psoriasis. Based on evidence that calcitriol inhibits proliferation and induces differentiation of epidermal cells, this hormone has been used successfully in the treatment of psoriasis. This article reviews the effectiveness and safety of calcitriol for the treatment of patients with psoriasis and recent findings related with the mechanism of action.
{"title":"calcitriol in the Management of Moderate to severe plaque psoriasis","authors":"R. Saraceno, S. Faleri, S. Chimenti","doi":"10.4137/CMT.S2540","DOIUrl":"https://doi.org/10.4137/CMT.S2540","url":null,"abstract":"Psoriasis is a chronic inflammatory cell-mediated disease affecting skin and joints, histologically characterized by epidermal hyperplasia and abnormal differentiation of keratinocytes. Plaque psoriasis, which is the most prevalent form of the disease, is clinically characterized by raised, inflamed, erythematous lesions covered by white silvery scales, located on the elbows, knees, scalp, lower back, forearms, hands and feet. Several drugs are available for the management of moderate-to-severe plaque psoriasis, including topical and systemic treatments. Calcitriol (1,25 dihydroxyvitamin D3) is the most biologically active form of vitamin D3 and it can be used topically as both a primary and adjunctive therapy for psoriasis. Based on evidence that calcitriol inhibits proliferation and induces differentiation of epidermal cells, this hormone has been used successfully in the treatment of psoriasis. This article reviews the effectiveness and safety of calcitriol for the treatment of patients with psoriasis and recent findings related with the mechanism of action.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"64 1","pages":"1629-1639"},"PeriodicalIF":0.0,"publicationDate":"2009-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85275774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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