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Atypical agents

Tomohiro Muronoi, Akihiko Kidani, Eiji Hira, Kayo Takeda, Shunsuke Kuramoto, Kazuyuki Oka, Yoshihide Shimojo, Hiroaki Watanabe
INTRODUCTION: Mediastinal and subcutaneous emphysema usually result from spontaneous rupture of the alveolar wall. We present an extremely rare case of massive mediastinal, retroperitoneal, and subcutaneous emphysema due to the penetration of the colon into the mesentery. PRESENTATION OF CASE: A 57-year-old man presented to our institution with a history of chest pain. The patient's medical history included malignant rheumatoid arthritis during the use of steroids and an immunosuppressive agent...
February 10, 2019: International Journal of Surgery Case Reports
Raluca Grădinaru, Nicoleta Andreescu, Laura Nussbaum, Liana Suciu, Maria Puiu
BACKGROUND: Treatment with atypical antipsychotics is today the election therapy for different types of psychosis, but there is a high incidence of endocrine and metabolic disturbances. One of the major enzymes involved in the metabolism of antipsychotics is CYP2D6. Depending on the existing CYP2D6 alleles, the metabolic capacity of the enzyme may vary from very low to very high, so that patients can be grouped into four phenotypic groups: slow, intermediate, extensive (normal), and fast metabolizers...
February 15, 2019: Irish Journal of Medical Science
Carine Mekoguem, Cécile Triboulet, Alexandre Gouveia
BACKGROUND: Mycetoma is a neglected infectious disease caused by a fungus (eumycetoma) or bacteria (actinomycetoma); it is characterized by chronic local inflammation with sinus formation and purulent discharge. Its course can be quite devastating because of the difficulty in diagnosing the infection and in eliminating the causative agent. Although endemic in many countries in the tropics and subtropics, the migration of Africans to Europe may increase the presence of this neglected disease in European countries...
February 12, 2019: Journal of Medical Case Reports
Malgorzata Mikulska, Elisa Furfaro, Elena De Carolis, Enrico Drago, Ilaria Pulzato, Maria Lucia Borghesi, Emanuela Zappulo, Anna Maria Raiola, Carmen Di Grazia, Valerio Del Bono, Giuseppe Cittadini, Emanuele Angelucci, Maurizio Sanguinetti, Claudio Viscoli
Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE®) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia®, cutoff: 0...
February 7, 2019: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Clara Westwell-Roper, S Evelyn Stewart
Obsessive-compulsive disorder (OCD) affects 1%-3% of children worldwide and has a profound impact on quality of life for patients and families. Although our understanding of the underlying etiology remains limited, data from neuroimaging and genetic studies as well as the efficacy of serotonergic medications suggest the disorder is associated with the fundamental alterations in the function of cortico-striato-thalamocortical circuits. Significant delays to diagnosis are common, ultimately leading to more severe functional impairment with long-term developmental consequences...
January 2019: Indian Journal of Psychiatry
Abel Thamby, T S Jaisoorya
Most studies suggest that obsessive-compulsive disorder runs a chronic course. Only 40%-70% of patients respond to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). The most common pharmacological strategy used in clinical practice for partial responders to SSRIs is augmentation with an atypical antipsychotic. This article aims to review the efficacy, tolerability, and comparative efficacy of antipsychotics as augmenting agents in patients who showed inadequate response to SSRIs. In addition to case reports and case series, 15 randomized controls trials, 6 meta-analyses, and 3 expert guidelines have been examined...
January 2019: Indian Journal of Psychiatry
Osamu Kinoshita, Moyu Dohi, Yusuke Horii, Atsushi Ikai, Tomohito Kitamori, Tetsuro Yamashita
BACKGROUND: Metastases to the stomach or gallbladder from any malignancy is rarely noted, and simultaneous metastases to both organs are atypical. We present a unique case of simultaneous multifocal metastases of the stomach and gallbladder from renal cell carcinoma (RCC). CASE PRESENTATION: The case involved a 60-year-old man, with a past history of RCC (clear cell type, G2, T1b N0 M0 Stage I) treated by a right nephrectomy. Three years after the nephrectomy, a routine gastrointestinal endoscopy found an ulcerative lesion in the greater curvature of the gastric body...
February 4, 2019: Surgical Case Reports
Akihiro Ohmoto, Shinichi Yachida, Chigusa Morizane
Pancreatic cancer (PC) is one of the most devastating malignancies; it has a 5-year survival rate of only 9%, and novel treatment strategies are urgently needed. While most PC cases occur sporadically, PC associated with hereditary syndromes or familial PC (FPC; defined as an individual having two or more first-degree relatives diagnosed with PC) accounts for about 10% of cases. Hereditary cancer syndromes associated with increased risk for PC include Peutz-Jeghers syndrome, hereditary pancreatitis, familial atypical multiple mole melanoma, familial adenomatous polyposis, Lynch syndrome and hereditary breast and ovarian cancer syndrome...
January 29, 2019: International Journal of Molecular Sciences
De Godoy Natalia Souza DE, Aiello Vera Demarchi, de Souza Regina Maia, Okay Thelma, Braz Lucia Maria Almeida
Patients coinfected with Leishmania /HIV can develop atypical forms of visceral leishmaniasis (VL), making it indispensable to identify the etiological agent. We are presenting a post-mortem specie definition by ITS1-PCR-RFLP in a larynx tissue of a patient presented coinfection Leishmania /HIV. This patient was from a leishmaniasis endemic region in São Paulo (SP), Brazil, and was diagnosed clinically with mucocutaneous leishmaniasis. Before a rK39 immunochromatographic test positive, a tiny stored paraffin-embedded larynx tissue was obtained post-mortem and submitted to 3 conventional PCR assays: kDNA (K20/K22 and RV1/RV2), and ITS1 (LITSR/L5...
October 2018: Iranian Journal of Parasitology
S Jo Moore, Jodi D Smith, Jürgen A Richt, Justin J Greenlee
Prion diseases are neurodegenerative diseases characterized by the accumulation of misfolded prion protein (PrPSc ) in the brain and other tissues. Animal prion diseases include scrapie in sheep, chronic wasting disease (CWD) in cervids, and transmissible mink encephalopathy (TME) in ranch-raised mink. We investigated the susceptibility of raccoons to various prion disease agents and compared the clinicopathologic features of the resulting disease. Raccoon kits were inoculated intracranially with the agents of raccoon-passaged TME (TMERac ), bovine-passaged TME (TMEBov ), hamster-adapted drowsy (TMEDY ) or hyper TME (TMEHY ), CWD from white-tailed deer (CWDWtd ) or elk (CWDElk ), or atypical (Nor98) scrapie...
January 29, 2019: Journal of Veterinary Diagnostic Investigation
Linda A Hershey, Rhonda Coleman-Jackson
Dementia with Lewy bodies (DLB) is a complex disease that involves a variety of cognitive, behavioral and neurological symptoms, including progressive memory loss, visual hallucinations, parkinsonism, cognitive fluctuations and rapid eye movement sleep behavior disorder (RBD). These symptoms may appear in varying combinations and levels of severity in each patient who is seen in the clinic, making diagnosis and treatment a challenge. DLB is the third most common of all the neurodegenerative diseases behind both Alzheimer's disease and Parkinson's disease (PD)...
January 25, 2019: Drugs & Aging
Xiaomei I Liu, Paul Schuette, Gilbert J Burckart, Dionna J Green, Julie La, Janelle M Burnham, Natella Rakhmanina, Adelaide Robb, Shiew Mei Huang, John N van den Anker
OBJECTIVE: To examine the differences in the adverse drug reaction (ADR) profile of antipsychotic and antidepressant agents between pediatric and adult patients in studies submitted to the Food and Drug Administration (FDA) during the drug development process. STUDY DESIGN: Clinical trials in adult and pediatric patients were conducted by sponsors as part of the drug development programs for antipsychotic and antidepressant agents, and ADR information was collected as part of those trials and submitted to the FDA...
January 21, 2019: Journal of Pediatrics
Kasia Gustaw Rothenberg, Ryan Rajaram
PURPOSE OF THE REVIEW: Psychosis is broadly defined as a disengagement from reality. It describes syndromes that impair both thought content and thought process. Psychosis negatively impacts an individual's quality of life, in addition to the families caring for them. Psychosis with different types of hallucinations and delusions occurs in the context of delirium. Neuropsychiatric symptoms (NPS) are almost universal in the course of common neurodegenerative disorders (NDD) like Alzheimer's disease (AD) or Parkinson's disease (PD)...
January 23, 2019: Current Treatment Options in Neurology
E A Newberry, B Babu, P D Roberts, N S Dufault, E M Goss, J B Jones, M L Paret
From 2013 to 2014, bacterial leaf spot epidemics incited by Pseudomonas syringae pv. syringae affected an estimated 3,000 ha of watermelon and squash in Florida, and caused foliar blighting and transplant losses in severely affected fields. To investigate the diversity of the causal agent, we isolated 28 P. syringae strains from diseased plants grown in 10 Florida and Georgia counties over the course of 2 years. Strains were confirmed as P. syringae through sequence analysis of the 16S ribosomal RNA, phenotypic, and biochemical profiling; however, 20 displayed an atypical phenotype by exhibiting nonfluorescent activity on King's medium B agar and being negative for ice-nucleating activity...
March 2018: Plant Disease
James E Frampton
Brexpiprazole (Rxulti® , Rexulti® ) is an oral atypical antipsychotic agent approved for the treatment of schizophrenia in the EU (in adult patients) and the USA, as well as in some other countries, including Japan. Like aripiprazole, it is a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2A receptors. However, brexpiprazole displays less intrinsic activity at D2 receptors and, coupled with actions at 5HT1A , 5HT2A and noradrenaline α1B receptors that are at least as potent as its action at D2 receptors, is predicted to demonstrate a lower propensity for activating adverse events and extrapyramidal symptoms than aripiprazole...
January 22, 2019: Drugs
Maria Eugênia Costa Queiroz, Mônia Aparecida Lemos Pinto, Jonas Carneiro Cruz, Juliana Mayumi Ushirohira, Isabella Caroline da Silva Dias, Jaime E Cecilio Hallak
Schizophrenia is one of the most debilitating and costly illnesses worldwide. First-generation antipsychotics such as chlorpromazine and haloperidol succeeded in controlling the positive symptoms of schizophrenia, but had significant extrapyramidal effects that led to the search for new agents and the release of second-generation (or atypical) antipsychotics. These drugs had a lower risk of adverse motor symptoms. Therapeutic drug monitoring has become a useful tool to optimize schizophrenia treatment and HPLC-MS/MS has been considered the primary technique to monitor antipsychotics...
January 21, 2019: Bioanalysis
Bingjian Lu, Haiyan Shi
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a highly aggressive cancer in young women. The histogenesis remains unclear although a potential origin of germ cells has been suggested recently. The high throughput next generation sequencing techniques have facilitated the identification of inactivating SMARCA4 mutations as the driver of SCCOHT. These findings may greatly impact on the prevention, diagnosis, molecular classification and treatment of SCCOHTs. The SMARCA4 mutations, typically associated with dual loss of BRG1 and BRM expression, are highly sensitive and specific for the diagnosis of SCCOHT...
2019: Journal of Cancer
Md Shafiullah Parvej, Hiromi Nakamura, Md Ashraful Alam, Lili Wang, Shaobo Zhang, Kazuo Emura, Eriko Kage-Nakadai, Takayuki Wada, Yukiko Hara-Kudo, Yoshikazu Nishikawa
Atypical enteropathogenic Escherichia coli (aEPEC) strains (36 Japanese and 50 Bangladeshi) obtained from 649 poultry fecal samples were analyzed by molecular epidemiological methods. Clermont's phylogenetic typing showed that group A was more prevalent (58%, 50/86) than B1 (31%, 27/86). Intimin type β1, which is prevalent among human diarrheal patients, was predominant in both phylogroups B1 (81%, 22/27) and A (70%, 35/50). However, about 95% of B1-β1 strains belonged to virulence group I, and 77% of them were Japanese strains, while 17% (6/35) of A-β1 strains did...
January 18, 2019: Applied and Environmental Microbiology
Dana Butnaru, Joab Chapman
The central nervous system (CNS) in neurodegenerative diseases is a battlefield in which microglia fight a highly atypical battle. During the inflammatory process microglia themselves become dysfunctional and even with all the available immune arsenal including cytokine or/and antibody production, the battle is eventually lost. A closer look into the picture will reveal the fact that this is mainly due to the atypical characteristics of the infectious agent. The supramolecular assemblies of misfolded proteins carry unique features not encountered in any of the common pathogens...
January 10, 2019: Autoimmunity Reviews
Juan Jiang, Chengping Hu, Yuanyuan Li, Pinhua Pan, Xiaoli Su, Pengbo Deng, Junpu Wang, Xiaoying Wu
BACKGROUND: Severe pneumonia is responsible for great mortality and morbidity worldwide, and early-applied effective anti-infective therapy can improve the prognosis of patients. However, identification of infectious agents in severe pneumonia remains a major challenge so far. In this study, the potential utility of transmission electron microscopy (TEM) in detecting nonbacterial pathogens in patients with severe pneumonia was retrospectively evaluated. MATERIALS AND METHODS: A total of 106 patients diagnosed with severe pneumonia at our hospital from September 2015 to December 2017 were included, and their baseline clinical characteristics were collected...
November 27, 2018: American Journal of the Medical Sciences
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