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Mild COVID-19 Infection in a Patient with Multiple Sclerosis, while Taking Fingolimod: A Case Report 多发性硬化症患者服用芬戈莫德并发轻度COVID-19感染1例
Pub Date : 2021-01-01 DOI: 10.36648/2171-6625.12.2.355
M. Mohammadpour, M. Fattahi, M. Sahraian, A. Moghadasi, S. Navardi
Background: Fingolimod, as an immunosuppressive drug, is used in the treatment of patients with Multiple Sclerosis. During recent pandemic, several controversies raised to stop or continue immunosuppressive drugs such as fingolimod in patients who developed coronavirus disease 2019. In this regard, most of consensuses advised to stop the consumption of this drug, but try to re-initiate before 6-8 weeks to prevent the disease’s activity or occurrence of rebound phenomenon. Case presentation: we report a 40-year old female patient with Multiple Sclerosis receiving fingolimod. Having peripheral lymphopenia, she developed coronavirus disease 2019 symptoms, tested for polymerase chain reaction of coronavirus, and the result was positive. Afterward, she stayed at home and did not stop fingolimod. However, her symptoms have improved and she did not need hospitalization for the entire course of coronavirus disease 2019 infection. Conclusion: The effects of the treatment with fingolimod on a patient infected by coronavirus disease 2019 are complex. On one hand, fingolimod withdrawal can increase the number of circulating lymphocytes, which consequently improves body defense against viral infections. On the other hand, it can also increase the risk of cytokine storm, which could be harmful. Therefore, further studies needed to find the risks and beneficial effects of fingolimod on coronavirus disease 2019 patients.
背景:芬戈莫德是一种免疫抑制药物,用于多发性硬化症患者的治疗。在最近的大流行期间,对2019年冠状病毒病患者停用或继续使用芬戈莫等免疫抑制药物引发了一些争议。对此,多数共识建议停止使用该药,但尽量在6-8周之前重新开始,以防止疾病的活动或反弹现象的发生。病例介绍:我们报告一位40岁多发性硬化症女性患者接受芬戈莫德治疗。由于周围淋巴细胞减少,她出现了2019冠状病毒病的症状,并进行了冠状病毒聚合酶链反应检测,结果为阳性。之后,她呆在家里,并没有停止服用芬戈莫德。然而,她的症状有所改善,在2019冠状病毒感染的整个过程中,她不需要住院治疗。结论:芬戈莫德治疗1例新型冠状病毒感染患者疗效复杂。一方面,停药可以增加循环淋巴细胞的数量,从而提高身体对病毒感染的防御能力。另一方面,它也会增加细胞因子风暴的风险,这可能是有害的。因此,需要进一步研究芬戈莫德对2019冠状病毒病患者的风险和有益影响。
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引用次数: 3
Safety of Endovascular Thrombectomy in Anticoagulated Patients with Acute Ischaemic Stroke: A Systematic Review and Meta-Analysis 急性缺血性脑卒中抗凝患者血管内取栓术的安全性:系统回顾和荟萃分析
Pub Date : 2021-01-01 DOI: 10.36648/2171-6625.21.10.374
Jake Hindmarch
Intravenous tissue plasminogen activator (IV-tPA) is first line treatment for acute ischaemic stroke (AIS). After AIS, many patients are anticoagulated, which is a contraindication to IV-tPA. Endovascular thrombectomy (EVT) provides an alternative treatment for AIS patients who have contraindications for IV-tPA. Limited data exists regarding the safety of EVT in anticoagulated patients. We aim to determine the safety of EVT in anticoagulated patients through comparing the rates of symptomatic intracranial haemorrhage (sICH) in anticoagulated and nonanticoagulated patients. Furthermore, we aim to compare differences in functional outcome and mortality after EVT in both patient groups. A meta-analysis of 10 studies was performed to assess the risk of developing sICH in anticoagulated patients who underwent EVT to treat AIS. Odds ratios and 95% confidence intervals were extracted from the studies. Meta-analysis showed no difference in the rate of sICH between anticoagulated patients and those with normal haemostasis (OR =1.21; 95% C.I.: 0.88, 1.67). Ninety-day mortality was similar among both groups. Most authors report similar rates of good functional outcome at 90-days between patient groups. EVT appears to be a safe treatment option in patients who are therapeutically anticoagulated.
静脉注射组织型纤溶酶原激活剂(IV-tPA)是急性缺血性脑卒中(AIS)的一线治疗方法。AIS后,许多患者抗凝,这是IV-tPA的禁忌症。血管内血栓切除术(EVT)为有IV-tPA禁忌症的AIS患者提供了另一种治疗方法。关于EVT在抗凝患者中的安全性的数据有限。我们的目的是通过比较抗凝和非抗凝患者的症状性颅内出血(sICH)发生率来确定EVT在抗凝患者中的安全性。此外,我们的目的是比较两组患者EVT后功能结局和死亡率的差异。对10项研究进行荟萃分析,以评估接受EVT治疗AIS的抗凝患者发生sICH的风险。从研究中提取优势比和95%置信区间。荟萃分析显示抗凝血患者与正常止血患者的sICH发生率无差异(OR =1.21;95% ci: 0.88, 1.67)。两组的90天死亡率相似。大多数作者报告了患者组之间90天良好功能结果的相似比率。EVT似乎是治疗抗凝患者的一种安全的治疗选择。
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引用次数: 0
Isolated Orthopnea in Myasthenia Gravis 重症肌无力的孤立性直鼻气
Pub Date : 2021-01-01 DOI: 10.36648/2171-6625.21.12.356
J. Mathew
Isolated Orthopnea due to neuromuscular factors in a patient known to have myasthenia gravis is very unusual. Past history of operated thymoma in such a patient may have specific implications with regard to its etiology and is discussed.
孤立的矫形呼吸由于神经肌肉因素在病人已知有重症肌无力是非常罕见的。过去的历史手术胸腺瘤在这样的病人可能有特定的含义,关于其病因和讨论。
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引用次数: 0
Potential Role of MRI in Reducing the Cost Burden of Stroke Mimic Patients MRI在减少脑卒中模拟患者费用负担中的潜在作用
Pub Date : 2021-01-01 DOI: 10.36648/2171-6625.12.1.347
Ehsan Esmaili Sh, Iz, C. Bertmar, S. Day, D. Griffiths, E. O. 'Brien, M. Krause
Introduction: Diagnostic uncertainty results in admission and unnecessary treatment of stroke mimics (SMs), leading to substantial expenditure of limited existing resources. We investigated the costs of admitting SMs compared to the cost of MR imaging in the acute setting. Methods: In this retrospective cross-sectional study, we analyzed all suspected stroke admissions from January 2016 until July 2018. We evaluated the costs of admission of SMs to the stroke unit and compared it with the cost assumption of having performed MR instead of CT imaging in all patients who presented with stroke symptoms. Findings: A total of 1745 patients presenting with stroke symptoms was included. 1108 (63%) were diagnosed as ischemic strokes, 321 (18%) with intracranial haemorrhage and 316 (18%) with SMs. The calculated cost of the initial neuroimaging studies for all patients was A$631,291. The cost of performing MRI for these patients would have been A$657,167. Accordingly, the excess cost of performing MRI instead of CT scan in the acute setting would have been A$25,876.00. This is significantly lower than the costs of stroke admission of SMs (A$1,255,373). Conclusion: Unnecessary admission and stroke investigations for SM patients can impose huge expenses on health care system. Since MRI is highly sensitive and specific in diagnosis of acute stroke, utilizing it as the first imaging modality in diagnosis of acute stroke would reduce the cost of stroke admission of SMs.
诊断的不确定性导致卒中模拟(SMs)的入院和不必要的治疗,导致有限的现有资源的大量消耗。我们调查了在急性情况下接受SMs的费用与MR成像的费用相比。方法:在这项回顾性横断面研究中,我们分析了2016年1月至2018年7月期间所有疑似卒中入院患者。我们评估了卒中单元接收SMs的成本,并将其与所有出现卒中症状的患者进行MR而不是CT成像的成本假设进行了比较。结果:共纳入1745例出现脑卒中症状的患者。1108例(63%)诊断为缺血性卒中,321例(18%)诊断为颅内出血,316例(18%)诊断为SMs。所有患者初始神经影像学研究的计算成本为631,291澳元。对这些患者进行核磁共振检查的费用为657,167澳元。因此,在急性情况下进行MRI而不是CT扫描的额外费用将为25,876.00澳元。这明显低于卒中住院费用(1,255,373澳元)。结论:SM患者不必要的住院和卒中调查给医疗卫生系统带来了巨大的开支。由于MRI对急性脑卒中的诊断具有高度的敏感性和特异性,因此将其作为急性脑卒中诊断的首选成像方式,可以降低卒中住院费用。
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引用次数: 0
Clobazam Efficacy as an Add-on Therapy for 121 Patients with Intractable Epilepsy 氯巴唑治疗顽固性癫痫121例疗效观察
Pub Date : 2021-01-01 DOI: 10.36648/2171-6625.21.12.357
A. Al-Sulami
Background: Clobazam is a novel 1,5-benzodiazepine that was initially developed as an antianxiety treatment designed to decrease adverse Effects associated with 1,4- benzodiazepines while maintaining efficacy. It was later found to have antiepileptic properties. Clobazam is well-tolerated and has shown efficacy as an adjunctive therapy for a variety of epilepsy types, including LGS. Studies have reported tolerance rates as high as 87%. Clobazam has an important antiepileptic effect and is less expensive than the new antiepileptic drugs, but still has not been considered as first- line drug in the treatment of epilepsy. Clobazam have been established as valuable addon medication for refractory epilepsy. Clobazam have been used in our institution for more than 15 years; with benefit observe in many patients. Methods and Results: Retrospective chart review of patient who were treated with Clobazam between 2008 and 2017 for treatment of intractable epilepsy. The following information were collected; age, sex, seizures type and frequency per month pre-and post Clobazam. Information was entered in Redcap database. 121 patients were reviewed to evaluate the response of seizures to the use of Clobazam. Age mean is 8 years old; male (73) and female (48). The median decrease in the average number of monthly seizures for all patients was 30. The seizures with highest response to Clobazam are myoclonic, atonic, infantile spasm more than generalized tonic clonic and partial seizures. The median decrease in the average monthly seizures following Clobazam was 30 among males and 40 among females no significant association between the sex and the decrease of average monthly seizures following Clobazam. Clobazam presented a stronger effect on younger children compared to the age above 15. Conclusions: Our study confirmed the efficacy of Clobazam for treatment of intractable epilepsy. Clobazam efficacy more superior in generalized seizures type i.e. myoclonic, atonic, infantile spasm than GTC and partial seizures. Younger children response better than older children.
背景:氯巴唑是一种新型的1,5-苯二氮卓类药物,最初是作为抗焦虑治疗而开发的,旨在减少与1,4-苯二氮卓类药物相关的不良反应,同时保持疗效。后来发现它有抗癫痫的特性。氯巴唑耐受性良好,作为一种辅助治疗多种癫痫类型(包括LGS)的疗效显著。研究报告耐受性高达87%。氯巴唑具有重要的抗癫痫作用,而且价格比新型抗癫痫药物便宜,但仍未被认为是治疗癫痫的一线药物。氯巴唑是治疗难治性癫痫的一种有价值的辅助药物。氯巴唑在我们机构已经使用超过15年;在许多患者中观察到良好效果。方法与结果:回顾性分析2008 - 2017年氯巴唑治疗难治性癫痫的病例。收集了以下信息:年龄,性别,发作类型和每月频率前后氯巴唑仑。信息已输入Redcap数据库。我们回顾了121例患者,以评估使用氯巴唑仑后癫痫发作的反应。平均年龄8岁;男(73)女(48)。所有患者平均每月癫痫发作次数的中位数下降为30次。对氯巴唑反应最高的癫痫发作是肌阵挛性、张力性、婴儿痉挛,而不是全身性强直性、阵挛性和部分性癫痫发作。氯巴唑仑后平均每月癫痫发作减少的中位数为男性30次,女性40次,性别与氯巴唑仑后平均每月癫痫发作减少之间无显著关联。与15岁以上的儿童相比,氯巴赞对年龄较小的儿童的效果更强。结论:本研究证实氯巴唑治疗顽固性癫痫的疗效。氯巴唑在全身性发作型(如肌阵挛性、张力性、婴儿痉挛)的疗效优于GTC和部分性发作。年幼的孩子比年长的孩子反应更好。
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引用次数: 0
Monocular pendular nystagmus in a patient with a dolichoectatic basilar artery 基底动脉过度扩张患者的单眼钟摆性眼球震颤
Pub Date : 2020-06-30 DOI: 10.33425/2692-7918.1005
Ioanna Alexandratou, Chara Zachariadi, V. Katsaros, S. Gatzonis
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引用次数: 0
Right-to-left shunt and obstructive sleep apnea in cluster headache 丛集性头痛患者的左右分流与阻塞性睡眠呼吸暂停
Pub Date : 2020-06-30 DOI: 10.33425/2692-7918.1002
P. Damavandi, P. Rizzoli, M. Pecis, P. Bertora, M. Autunno, C. Lovati
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引用次数: 0
Inhibition of long-term kindled seizures induced alterations in the function of bone marrow cells by AC-31B (essential oil) from Allium cepa 大蒜精油AC-31B对长期点燃癫痫引起的骨髓细胞功能改变的抑制作用
Pub Date : 2020-06-30 DOI: 10.33425/2692-7918.1003
S. Simjee, Uzair Nisar, R. Khan, Warda Ainuddin, Iqra Mukhtar, M. Jamal, M. Azam, N. Rizvi, A. Salim, S. Anjum
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引用次数: 0
Malaria: pathology, immune response, and vaccine design: A mini review 疟疾:病理学、免疫反应和疫苗设计:小型综述
Pub Date : 2020-06-30 DOI: 10.33425/2692-7918.1001
Henry S. Pan, Haley O. Tucker
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引用次数: 0
The Efficacy of Anti-Inflammatory Medication in Postoperative Cognitive Decline: A Meta-Analysis 抗炎药治疗术后认知功能下降的疗效Meta分析
Pub Date : 2020-06-04 DOI: 10.36648/2171-6625.11.1.318
Lieke S. Jorna, J. Spikman, R. Schoemaker, B. Leeuwen, I. Sommer
Objective: Post-operative cognitive decline is a surgical complication involving chronic impairments in different cognitive domains. Although the exact mechanisms behind postoperative cognitive decline are still unknown, there is increasing evidence for a key role of neuroinflammation. This meta-analysis aims to investigate the efficacy of anti-inflammatory treatment on postoperative cognitive decline. Participants and Methods: An electronic search was performed using PubMed, Psychinfo, EmBase, Cochrane Database of Systematic Reviews and clinicaltrial.gov (until November 2019). No year or language restrictions were applied. Only randomized, double-blind, placebocontrolled studies that investigated clinical outcome in adult patients who underwent surgery under general anaesthesia (except brain surgery) were included. The search yielded 574 papers, of which nineteen fulfilled the inclusion criteria. Results: The current meta-analysis found a significant effect of different anti-inflammatory agents on the incidence of POCD (OR=0.67, p=0.010). Administration of COX-2 inhibitors (OR=0.31, p<0.0001), ketamine (OR=0.44, p=0.38) and lidocaine (OR=0.79, p=0.33) showed better results than placebo in a meta-analysis of at least two studies. Erythromycin (OR=0.14, p=0.006), erythropoietin (OR=0.15, p=0.07) and dexmedetomidine (OR=0.58, p=0.03) were significant in single studies. No beneficial effects on cognition were found for magnesium, 17β- estradiol, dexamethasone and melatonin. Conclusion: The results of this meta-analysis provide evidence for a potential efficacy of anti-inflammatory agents on POCD, but further research is necessary to determine which agents are most appropriate for clinical application.
目的:术后认知能力下降是一种涉及不同认知领域的慢性损伤的手术并发症。尽管术后认知能力下降的确切机制尚不清楚,但越来越多的证据表明神经炎症起着关键作用。本荟萃分析旨在研究抗炎治疗对术后认知能力下降的疗效。参与者和方法:使用PubMed、Psychinfo、EmBase、Cochrane系统评价数据库和clinicaltrial.gov进行电子搜索(至2019年11月)。没有年份或语言限制。仅纳入随机、双盲、安慰剂对照研究,这些研究调查了在全身麻醉下接受手术(脑手术除外)的成年患者的临床结果。搜索得到574篇论文,其中19篇符合入选标准。结果:目前的荟萃分析发现,不同抗炎药对POCD的发生率有显著影响(OR=0.67,p=0.010)。在至少两项研究的荟萃分析中,服用COX-2抑制剂(OR=0.31,p=0.0001)、氯胺酮(OR=0.44,p=0.038)和利多卡因(OR=0.79,p=0.033)的结果优于安慰剂。红霉素(OR=0.14,p=0.006)、红细胞生成素(OR=0.15,p=0.07)和右美托咪定(OR=0.58,p=0.03)在单一研究中具有显著性。镁、17β-雌二醇、地塞米松和褪黑激素对认知没有有益影响。结论:这项荟萃分析的结果为抗炎药对POCD的潜在疗效提供了证据,但需要进一步研究来确定哪些药物最适合临床应用。
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引用次数: 1
期刊
Journal of neurology and neuroscience
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