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Medicine Jan 2022Pyomyositis is characterized by an insidious and multifactorial inflammatory process, which is often caused by hematogenous pathogen. Predisposing risk factors include...
RATIONALE
Pyomyositis is characterized by an insidious and multifactorial inflammatory process, which is often caused by hematogenous pathogen. Predisposing risk factors include immunodeficiency, diabetes, malignancy, or trauma. The spectrum of clinical presentation depends on disease severity, typically presented by fever and hip pain. We hereby present a case with extensive pyomyositis secondary to chronic paronychia infection.
PATIENT CONCERNS
A 14-year-old immunocompetent male presented with fever and hip pain. The patient was initially surveyed for common infectious etiologies prior to the presentation of acute limping, which led to image confirmation of extensive pyomyositis.
DIAGNOSIS
The patient presented with acute pain in the right hip accompanied by headache, myalgia of the right leg, and intermittent fever for a week. Physical examination disclosed limping gait, limited range of motion marked by restricted right hip flexion and right knee extension, and chronic paronychia with a nail correction brace of the left hallux. Diagnosis of pyomyositis was confirmed by magnetic resonance image. Methicillin-resistant strains of Staphylococcus aureus was isolated from the patient's blood and urine cultures within 2 days of collection. The same strain was also isolated from the pus culture collected via sonography-guided aspiration.
INTERVENTIONS
Antibiotics treatment with oxacillin, teicoplanin, daptomycin, and fosfomycin were administered. Sonography-guided aspiration and computed tomography-guided pigtail drainage were arranged, along with nail extraction of his left hallux paronychia prior to discharge. Oral antibiotics fusidic acid was prescribed. Total antibiotics course of treatment was 4 weeks.
OUTCOMES
The patient gradually defervesced and was afebrile after drainage. Followed limb doppler sonography showed regression of the abscess at his right lower limb. Gait and range of motion gradually recovered without sequelae.
LESSONS
Ambulation and quality of life are greatly affected by the inflammatory process of pyomyositis. Detailed evaluation of predisposing factors should be done, even in immunocompetent individuals. Timely diagnosis is vital to successful treatment.
Topics: Adolescent; Anti-Bacterial Agents; Arthralgia; Fever; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Paronychia; Pyomyositis; Staphylococcal Infections
PubMed: 35029183
DOI: 10.1097/MD.0000000000028431 -
Journal of Neuro-oncology Sep 2020A hallmark of pediatric low-grade glioma (pLGG) is aberrant signaling of the mitogen activated protein kinase (MAPK) pathway. Hence, inhibition of MAPK signaling using...
INTRODUCTION
A hallmark of pediatric low-grade glioma (pLGG) is aberrant signaling of the mitogen activated protein kinase (MAPK) pathway. Hence, inhibition of MAPK signaling using small molecule inhibitors such as MEK inhibitors (MEKi) may be a promising strategy.
METHODS
In this multi-center retrospective centrally reviewed study, we analyzed 18 patients treated with the MEKi trametinib for progressive pLGG as an individual treatment decision between 2015 and 2019. We have investigated radiological response as per central radiology review, molecular classification and investigator observed toxicity.
RESULTS
We observed 6 partial responses (PR), 2 minor responses (MR), and 10 stable diseases (SD) as best overall responses. Disease control rate (DCR) was 100% under therapy. Responses were observed in KIAA1549:BRAF- as well as neurofibromatosis type 1 (NF1)-driven tumors. Median treatment time was 12.5 months (range: 2 to 27 months). Progressive disease was observed in three patients after cessation of trametinib treatment within a median time of 3 (2-4) months. Therapy related adverse events occurred in 16/18 patients (89%). Eight of 18 patients (44%) experienced severe adverse events (CTCAE III and/or IV; most commonly skin rash and paronychia) requiring dose reduction in 6/18 patients (33%), and discontinuation of treatment in 2/18 patients (11%).
CONCLUSIONS
Trametinib was an active and feasible treatment for progressive pLGG leading to disease control in all patients. However, treatment related toxicity interfered with treatment in individual patients, and disease control after MEKi withdrawal was not sustained in a fraction of patients. Our data support in-class efficacy of MEKi in pLGGs and necessity for upfront randomized testing of trametinib against current standard chemotherapy regimens.
Topics: Antineoplastic Agents; Child; Child, Preschool; Female; Follow-Up Studies; Glioma; Humans; Infant; Male; Prognosis; Pyridones; Pyrimidinones; Retrospective Studies
PubMed: 33026636
DOI: 10.1007/s11060-020-03640-3 -
Indian Journal of Dermatology,... 2022Background Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims In this study, risk factors for... (Observational Study)
Observational Study
Background Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation.
Topics: Braces; Humans; Nail Diseases; Nails; Nails, Ingrown; Retrospective Studies; Risk Factors
PubMed: 34245522
DOI: 10.25259/IJDVL_529_20 -
RSC Advances Jun 2021The chemical characterization of the extract of the aerial parts of afforded two oxetane containing lignans, paronychiarabicine A (1) and B (2), and one new...
The chemical characterization of the extract of the aerial parts of afforded two oxetane containing lignans, paronychiarabicine A (1) and B (2), and one new megastigmane, paronychiarabicastigmane A (3), alongside a known lignan (4), eight known phenolic compounds (5-12), one known elemene sesquiterpene (13) and one steroid glycoside (14). The chemical structures of the isolated compounds were constructed based upon the HRMS, 1D, and 2D-NMR results. The absolute configurations were established NOESY experiments as well as experimental and TDDFT-calculated electronic circular dichroism (ECD). Utilizing molecular docking, the binding scores and modes of compounds 1-3 towards the SARS-CoV-2 main protease (M), papain-like protease (PL), and RNA-dependent RNA polymerase (RdRp) were revealed. Compound 3 exhibited a promising docking score (-9.8 kcal mol) against SARS-CoV-2 M by forming seven hydrogen bonds inside the active site with the key amino acids. The reactome pathway enrichment analysis revealed a correlation between the inhibition of and genes (identified as the main targets of megastigmane treatment) and significant inhibition of SARS-CoV-1 viral replication in infected Vero E6 cells. Our results manifest a novel understanding of genes, proteins and corresponding pathways against SARS-CoV-2 infection and could facilitate the identification and characterization of novel therapeutic targets as treatments of SARS-CoV-2 infection.
PubMed: 35479905
DOI: 10.1039/d1ra02486h -
International Journal of Environmental... Mar 2023There are a few reports that focus on radiotherapy (RT) and cetuximab (CET) therapy exclusively for oral cancer. This retrospective study aimed to investigate the...
There are a few reports that focus on radiotherapy (RT) and cetuximab (CET) therapy exclusively for oral cancer. This retrospective study aimed to investigate the efficacy and safety of RT and CET therapy for locally advanced (LA) or recurrent/metastatic (R/M) oral squamous cell carcinoma (OSCC). Seventy-nine patients from 13 hospitals who underwent RT and CET therapy for LA or R/M OSCC between January 2013 and May 2015 were enrolled in the study. Response, overall survival (OS), disease-specific survival (DSS), and adverse events were investigated. The completion rate was 62/79 (78.5%). The response rates in patients with LA and R/M OSCC were 69% and 37.8%, respectively. When only completed cases were examined, the response rates were 72.2% and 62.9%, respectively. The 1- and 2-year OS were 51.5% and 27.8%, respectively (median, 14 months), for patients with LA OSCC, and 41.5% and 11.9% (median, 10 months) for patients with R/M OSCC. The 1- and 2-year DSS were 61.8% and 33.4%, respectively (median, 17 months), for patients with LA OSCC, and 76.6% and 20.4% (median, 12 months) for patients with R/M OSCC. The most common adverse event was oral mucositis (60.8%), followed by dermatitis, acneiform rash, and paronychia. The completion rate was 85.7% in LA patients and 70.3% in R/M patients. The most common reason for noncompletion was an inadequate radiation dose due to worsening general conditions in R/M patients. Although the standard treatment for LA or R/M oral cancer is concomitant RT with high-dose cisplatin (CCRT) and the efficacy of RT and CET therapy for oral cancer is not considered to be as high as that for other head and neck cancers, it was thought that RT and CET therapy could be possible treatments for patients who cannot use high-dose cisplatin.
Topics: Humans; Cetuximab; Carcinoma, Squamous Cell; Cisplatin; Retrospective Studies; Japan; Mouth Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Neoplasm Recurrence, Local; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms
PubMed: 36901553
DOI: 10.3390/ijerph20054545 -
Journal of Clinical Medicine Mar 2024: Plexiform neurofibromas (pNFs) are benign neoplasms, primarily originating from Schwann cells, posing challenges in patients with type 1 neurofibromatosis (NF1) due to...
: Plexiform neurofibromas (pNFs) are benign neoplasms, primarily originating from Schwann cells, posing challenges in patients with type 1 neurofibromatosis (NF1) due to pain, disfigurement, compression of vital structures and potential for malignancy. Selumetinib, a MEK1/2 inhibitor, has shown promising results in treating inoperable pNFs, with clinical trials demonstrating tumor volume reduction and improved patient-reported outcomes. Despite its efficacy, dermatologic toxicities may impact the quality of life and treatment adherence. Evaluating the frequency and spectrum of such effects is crucial for effective management. : In a four-year retrospective and prospective study, pediatric NF1 patients with symptomatic, inoperable plexiform neurofibromas (pNFs) were treated with selumetinib. Eligibility criteria included significant morbidity, pNF size exceeding 3 cm or surgical inoperability, and performance status >70%. Hematological, liver, lung and cardiac assessments established baseline health. Selumetinib, orally administered at 25 mg/m twice, was administered for two years unless a response warranting extension occurred. Cutaneous AEs were documented and graded by severity according to CTCAE v5.0, with evaluations every three to six months. The impact on symptoms and pNF size was systematically recorded, and biopsies characterized histopathological features in those patients requiring surgery. : Twenty patients were enrolled, with an average age at therapy initiation of 11.6 years. Cutaneous side effects were common, with all patients experiencing at least one and a median of two per patient. Xerosis, paronychia and acneiform rash were prevalent. Notably, pre-pubertal individuals were more susceptible to xerosis. Acneiform rash had a higher incidence in older patients and those with skin phototypes II and III. Successful management involved tailored approaches, such as clindamycin for acneiform rash and topical agents for paronychia. Hair abnormalities, including color changes and thinning, occurred, with female patients at higher risk for the latter. Paronychia presented challenges, necessitating various interventions, including surgical approaches. AEs led to treatment suspension in 20% of patients, with tumor rebound observed in 75%. : According to our experience, successful management of selumetinib-induced cutaneous AEs requires tailored strategies including surgery. AEs might indirectly determine pNF regrowth due to therapy suspension. We thus emphasize the pivotal role of addressing cutaneous reactions for effective selumetinib management in pediatric patients.
PubMed: 38542016
DOI: 10.3390/jcm13061792 -
International Journal of Infectious... Sep 2023We evaluated the burden of noninvasive group A Streptococcus (GAS) infections in ambulatory pediatrics before and during the COVID-19 pandemic in France.
Surveillance of noninvasive group A Streptococcus infections in French ambulatory pediatrics before and during the COVID-19 pandemic: a prospective multicenter study from 2018-2022.
OBJECTIVES
We evaluated the burden of noninvasive group A Streptococcus (GAS) infections in ambulatory pediatrics before and during the COVID-19 pandemic in France.
METHODS
We analyzed data from a national network of ambulatory pediatricians between 2018 and 2022. Clinicians evaluating children ≤15 years old for tonsillopharyngitis, perianal infections, paronychia/blistering dactylitis, and scarlet fever were invited to perform a rapid antigen detection test (RADT) for GAS. Monthly incidence of noninvasive GAS infections per 10,000 visits was modeled using time series analysis, considering two breakpoints: March 2020 (first national lockdown) and March 2022 (end of mandatory mask-wearing in schools).
RESULTS
Over the study period, 125 pediatricians recorded 271,084 infectious episodes. GAS-related illnesses represented 4.3% of all infections. In March 2020, the incidence of GAS diseases decreased by 84.5% (P <0.001), with no significant trend until March 2022. After March 2022, the incidence significantly increased (+23.8% per month, P <0.001), with similar patterns across all monitored GAS-related diseases.
CONCLUSION
By using routine clinical data and RADTs, we have monitored changes in the incidence of noninvasive GAS infections in ambulatory pediatrics. COVID-19 mitigation measures have had a major impact on the epidemiology of noninvasive GAS infections, but their relaxation was followed by a surge above baseline levels.
Topics: Child; Humans; Adolescent; Streptococcus pyogenes; Prospective Studies; Pandemics; COVID-19; Communicable Disease Control; Streptococcal Infections; Pediatrics
PubMed: 37290573
DOI: 10.1016/j.ijid.2023.06.003 -
BMC Medicine Jul 2023Surgery is a common treatment strategy for patients with neurofibromatosis type 1 (NF1)-related plexiform neurofibroma (PN) and has limited efficacy. FCN-159 is a novel...
Phase 1 dose-escalation study to evaluate the safety, tolerability, pharmacokinetics, and anti-tumor activity of FCN-159 in adults with neurofibromatosis type 1-related unresectable plexiform neurofibromas.
BACKGROUND
Surgery is a common treatment strategy for patients with neurofibromatosis type 1 (NF1)-related plexiform neurofibroma (PN) and has limited efficacy. FCN-159 is a novel anti-tumorigenic drug via selective inhibition of MEK1/2. This study assesses the safety and efficacy of FCN-159 in patients with NF1-related PN.
METHODS
This is a multicenter, open-label, single-arm, phase I dose-escalation study. Patients with NF1-related PN that was non-resectable or unsuitable for surgery were enrolled; they received FCN-159 monotherapy daily in 28-day cycles.
RESULTS
Nineteen adults were enrolled in the study, 3 in 4 mg, 4 in 6 mg, 8 in 8 mg, and 4 in 12 mg. Among patients included in dose-limiting toxicity (DLT) analysis, DLTs (grade 3 folliculitis) were reported in 1 of 8 patients (16.7%) receiving 8 mg and 3 of 3 (100%) patients receiving 12 mg. The maximum tolerated dose was determined to be 8 mg. FCN-159-related treatment-emergent adverse events (TEAEs) were observed in 19 patients (100%); most of which were grade 1 or 2. Nine (47.4%) patients reported grade 3 study-drug-related TEAEs across all dose levels, including four experiencing paronychia and five experiencing folliculitis. Of the 16 patients analyzed, all (100%) had reduced tumor size and six (37.5%) achieved partial responses; the largest reduction in tumor size was 84.2%. The pharmacokinetic profile was approximately linear between 4 and 12 mg, and the half-life supported once daily dosing.
CONCLUSIONS
FCN-159 was well tolerated up to 8 mg daily with manageable adverse events and showed promising anti-tumorigenic activity in patients with NF1-related PN, warranting further investigation in this indication.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT04954001. Registered 08 July 2021.
Topics: Humans; Adult; Neurofibromatosis 1; Neurofibroma, Plexiform; Protein Kinase Inhibitors
PubMed: 37400844
DOI: 10.1186/s12916-023-02927-2 -
Deutsches Arzteblatt International Feb 2021
Topics: Granulomatosis with Polyangiitis; Hemorrhage; Humans; Paronychia; Tongue; Ulcer
PubMed: 33785118
DOI: 10.3238/arztebl.m2021.0092 -
Orthopaedics & Traumatology, Surgery &... Sep 2021There is no consensus in the literature, or even within the same team, on the most appropriate treatment option for acute paronychia with abscess formation. The...
INTRODUCTION
There is no consensus in the literature, or even within the same team, on the most appropriate treatment option for acute paronychia with abscess formation. The performance of an evaluation of professional practices (EPP) using a clinical audit measures the quality of our practices with the aim of standardizing them. Therefore, the primary objective of this study was to develop a clinical pathway for the management of acute paronychia with abscess formation. The secondary objectives were to evaluate our professional practices using a clinical audit before and after the dissemination of the clinical pathway and then recommend strategies for improving our management of acute paronychia with abscess formation.
MATERIALS AND METHODS
A working group was established that designed an audit grid comprised of 15 items. Thirty patients (Group 1) who had an acute paronychia with abscess formation were included and their health records were analyzed using this audit grid. The working group then developed a clinical pathway for the management of acute paronychia with abscess formation. Thirty new patients (Group 2) were included after the dissemination of this clinical pathway and their records were analyzed using the same audit grid.
RESULTS
Our clinical pathway for the management of acute paronychia was validated by the local infectious disease committee of our university hospital center. The difference between groups 1 and 2 was significant (p<0.05) for eight items. There was no significant difference in the rate of surgical revision between the two groups.
DISCUSSION
This EPP enabled us to develop a clinical pathway that detailed the processes for managing acute paronychia with abscess formation, and in particular it provided indications for antibiotic therapy and its limitations.
LEVEL OF EVIDENCE
IV, retrospective study.
Topics: Abscess; Anti-Bacterial Agents; Humans; Paronychia; Professional Practice; Retrospective Studies
PubMed: 34102333
DOI: 10.1016/j.otsr.2021.102982