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Frontiers in Microbiology 2015Filoviruses are virulent human pathogens which cause severe illness with high case fatality rates and for which there are no available FDA-approved vaccines or... (Review)
Review
Filoviruses are virulent human pathogens which cause severe illness with high case fatality rates and for which there are no available FDA-approved vaccines or therapeutics. Diagnostic tools including antibody- and molecular-based assays, mass spectrometry, and next-generation sequencing are continually under development. Assays using the polymerase chain reaction (PCR) have become the mainstay for the detection of filoviruses in outbreak settings. In many cases, real-time reverse transcriptase-PCR allows for the detection of filoviruses to be carried out with minimal manipulation and equipment and can provide results in less than 2 h. In cases of novel, highly diverse filoviruses, random-primed pyrosequencing approaches have proved useful. Ideally, diagnostic tests would allow for diagnosis of filovirus infection as early as possible after infection, either before symptoms begin, in the event of a known exposure or epidemiologic outbreak, or post-symptomatically. If tests could provide an early definitive diagnosis, then this information may be used to inform the choice of possible therapeutics. Several exciting new candidate therapeutics have been described recently; molecules that have therapeutic activity when administered to animal models of infection several days post-exposure, once signs of disease have begun. The latest data for candidate nucleoside analogs, small interfering RNA (siRNA) molecules, phosphorodiamidate (PMO) molecules, as well as antibody and blood-product therapeutics and therapeutic vaccines are discussed. For filovirus researchers and government agencies interested in making treatments available for a nation's defense as well as its general public, having the right diagnostic tools to identify filovirus infections, as well as a panel of available therapeutics for treatment when needed, is a high priority. Additional research in both areas is required for ultimate success, but significant progress is being made to reach these goals.
PubMed: 25750638
DOI: 10.3389/fmicb.2015.00108 -
Journal of Neural Transmission (Vienna,... Jun 2023The worldwide prevalence of Parkinson's disease (PD) has been constantly increasing in the last decades. With rising life expectancy, a longer disease duration in PD... (Review)
Review
The worldwide prevalence of Parkinson's disease (PD) has been constantly increasing in the last decades. With rising life expectancy, a longer disease duration in PD patients is observed, further increasing the need and socioeconomic importance of adequate PD treatment. Today, PD is exclusively treated symptomatically, mainly by dopaminergic stimulation, while efforts to modify disease progression could not yet be translated to the clinics. New formulations of approved drugs and treatment options of motor fluctuations in advanced stages accompanied by telehealth monitoring have improved PD patients care. In addition, continuous improvement in the understanding of PD disease mechanisms resulted in the identification of new pharmacological targets. Applying novel trial designs, targeting of pre-symptomatic disease stages, and the acknowledgment of PD heterogeneity raise hopes to overcome past failures in the development of drugs for disease modification. In this review, we address these recent developments and venture a glimpse into the future of PD therapy in the years to come.
Topics: Humans; Parkinson Disease; Dopamine; Disease Progression
PubMed: 37147404
DOI: 10.1007/s00702-023-02641-6 -
Neurology Mar 1992Pharmacotherapy is the mainstay for patients with persistent headaches. When simple analgesics can no longer be used, combination analgesics are prescribed. Symptomatic... (Review)
Review
Pharmacotherapy is the mainstay for patients with persistent headaches. When simple analgesics can no longer be used, combination analgesics are prescribed. Symptomatic medications also include antiemetics, ergot derivatives, corticosteroids, neuroleptics, and narcotics. Nonsteroidal anti-inflammatory drugs are commonly used both symptomatically and prophylactically, and are the treatment of choice for menstrual migraine. Exertional migraine, benign orgasmic cephalalgia, chronic paroxysmal hemicrania, cough headache, and "ice-pick" headache are treated with indomethacin. Ergotamine tartrate is often recommended when simple or combination analgesics do not relieve headaches. Dihydroergotamine (DHE) is effective for treating intractable headache; because it has fewer side effects than ergotamine, it is tolerated by patients unable to tolerate other ergotamine preparations. DHE is administered IM and, for occasional use, patients can be taught self-injection. Repetitive IV DHE therapy for chronic severe headaches requires hospitalization; most patients become headache-free within 3 days. Patients who refuse hospitalization, do not respond to the drug, or are not suitable candidates for DHE therapy may receive a short course of a corticosteroid, a neuroleptic or, rarely, a narcotic. For frequent headaches, prophylactic treatment usually begins with a tricyclic antidepressant or a beta blocker.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Dihydroergotamine; Drug Therapy, Combination; Ergot Alkaloids; Headache; Humans; Migraine Disorders
PubMed: 1557187
DOI: No ID Found -
The Journal of Pain Nov 2022Pain is a common symptom reported in COVID-19 patients. Impaired endogenous pain-modulatory mechanisms such as conditioned pain modulation (CPM), and exercise-induced...
Pain is a common symptom reported in COVID-19 patients. Impaired endogenous pain-modulatory mechanisms such as conditioned pain modulation (CPM), and exercise-induced hypoalgesia (EIH) have been found in chronic pain conditions but is often overlooked in acute conditions that evoke painful symptoms, such as COVID-19. The purpose was to compare pressure-pain sensitivity, CPM, and EIH function among individuals who previously had COVID-19, both symptomatically and asymptomatically, and a healthy control group. Pressure pain thresholds of 59 participants were assessed in the forearm and leg using a pressure algometer before and after 1) submersion of their dominant foot in cold water (2°C) for 1min; and 2) isometric knee extension performed to task-failure at 25% of their maximal contraction. The CPM response was attenuated in individuals who were infected with symptomatic COVID-19 (N = 26) compared to asymptomatic COVID-19 (N = 13) in arm (-1.0% ± 20.3 vs 33.3% ± 26.2; P < .001) and leg (12.8% ± 22.0 vs 33.8% ± 28.2; P = .014) and compared to controls (N = 20) in arm only (-1.0% ± 26.2 vs 23.4% ± 28.2; P = .004). The EIH response was not different between groups. CPM was impaired in individuals who had symptomatic COVID-19, which may have long-term implications on pain modulation. PERSPECTIVE: This study reveals that CPM was impaired in individuals who had symptomatic COVID-19 during the first wave of COVID-19, pre vaccine. These findings present a preliminary motive to study the long-term implications of COVID-19 and its effects on pain modulation.
Topics: Humans; Young Adult; Isometric Contraction; COVID-19; Exercise; Pain Threshold; Chronic Pain; Chronic Disease
PubMed: 35872293
DOI: 10.1016/j.jpain.2022.06.010 -
Current Gastroenterology Reports Jan 2020Meckel's diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications... (Review)
Review
PURPOSE OF REVIEW
Meckel's diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications associated with the condition. We aim to review the many faces with which a Meckel's diverticulum may present, either symptomatically or as an incidental finding.
RECENT FINDINGS
Due to its rarity, recent studies mainly include small retrospective series or case reports. Emphasis in the recent literature is on clinical presentation, the pathology of symptomatic cases, management options and risks of neoplasia. Symptoms are mainly caused by obstruction, bleeding or diverticulitis. Cross-sectional imaging is unspecific, although capsule endoscopy is reported of use in case series. Meckel's diverticulum presents with clinical features that are age-specific. Complicated Meckel's diverticulum is treated by resection. Optimal treatment of incidental cases remains debated. Meckel's diverticulum usually stays asymptomatic, and decision-making for management should be based on patient-specific factors. Use of minimal invasive techniques mandates refinement of the optimal treatment.
Topics: Humans; Incidental Findings; Meckel Diverticulum; Retrospective Studies
PubMed: 31930430
DOI: 10.1007/s11894-019-0742-1 -
Cancer Causes & Control : CCC Dec 2021Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and...
PURPOSE
Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and many women are diagnosed at advanced stages. Little is known about the degree to which U.S. women may begin their diagnostic workup for cervical cancer in Emergency Departments (ED). We sought to quantify the proportion of women presenting symptomatically in the ED prior to their diagnosis with cervical cancer and to describe their characteristics and outcomes.
METHODS
We identified women diagnosed from 2006 to 2017 with cervical cancer in the California Cancer Registry. We linked this cohort to statewide ED discharge records to determine ED use and symptoms present at the encounter. Multivariable logistic regression models examined associations with ED use and multivariable Cox proportional hazards regression models examined associations with survival.
RESULTS
Of the more than 16,000 women with cervical cancer in the study cohort, 28% presented symptomatically in the ED prior to diagnosis. Those presenting symptomatically were more likely to have public (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.06-1.27) or no insurance (OR 4.81; CI 4.06-5.71) (vs. private), low socioeconomic status (SES) (OR 1.76; CI 1.52-2.04), late-stage disease (OR 5.29; CI 4.70-5.96), and had a 37% increased risk of death (CI 1.28-1.46).
CONCLUSION
Nearly a third of women with cervical cancer presented symptomatically, outside of a primary care setting, suggesting that many women, especially those with low SES, may not be benefiting from screening or healthcare following abnormal results.
Topics: California; Emergency Service, Hospital; Female; Humans; Mass Screening; Odds Ratio; Uterine Cervical Neoplasms
PubMed: 34424442
DOI: 10.1007/s10552-021-01489-z -
Journal of Neurosurgery Aug 1992In the past, intention tremor has responded well to selected neuroablative procedures; however, objective symptomatic and functional outcomes of ventralis lateralis (VL)... (Review)
Review
In the past, intention tremor has responded well to selected neuroablative procedures; however, objective symptomatic and functional outcomes of ventralis lateralis (VL) thalamotomy specifically for intention tremor in the post-computerized tomography era has rarely been reported. This series explored the symptomatic and functional impact of VL thalamotomy on 14 patients presenting at the Mayo Clinic with severe, refractory intention tremor due to multiple sclerosis (five patients), trauma (four patients), or stroke (five patients). General neurological examinations, psychometric evaluations, speech pathology assessments, and neuroradiological scans were performed. Pre- and postoperative disability were graded according to a modified form of an established rating scale for tremor. All patients received VL radiofrequency thalamotomies utilizing neurophysiological recording and stimulation control. Contralateral targeted upper-extremity tremor remained symptomatically absent or markedly reduced in 81.8% of cases (mean follow-up period 23.4 months). The median disability score was reduced by 12 points (0.02 less than p less than 0.05). Persistent surgical morbidity was limited to two patients with mild, nondisabling dysarthrias. One elderly patient died of pulmonary complications 2 weeks postoperatively. There were no reported surgically induced exacerbations in multiple sclerosis; however, some of these patients exhibited difficulties with electrophysiological localization. These results compare favorably with those reported in the literature and confirm that stereotactic VL thalamotomy for debilitating intention tremor carries a low surgical risk and can be an effective treatment option for properly selected patients.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Morbidity; Stereotaxic Techniques; Thalamus; Tremor
PubMed: 1625009
DOI: 10.3171/jns.1992.77.2.0223 -
BMJ Open May 2021The aim of this study was to determine the relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals based on a scoping... (Review)
Review
OBJECTIVES
The aim of this study was to determine the relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals based on a scoping review of available literature.
DESIGN
Rapid scoping review of peer-reviewed literature from 1 January to 5 December 2020 using the LitCovid database and the Cochrane library.
SETTING
International studies on the infectiousness of individuals infected with SARS-CoV-2.
PARTICIPANTS
Studies were selected for inclusion if they defined asymptomatics as a separate cohort distinct from presymptomatics and if they provided a quantitative measure of the infectiousness of asymptomatics relative to symptomatics.
PRIMARY OUTCOME MEASURES
PCR result (PCR studies), the rate of infection (mathematical modelling studies) and secondary attack rate (contact tracing studies) - in each case from asymptomatic in comparison with symptomatic individuals.
RESULTS
There are only a limited number of published studies that report estimates of relative infectiousness of asymptomatic compared with symptomatic individuals. 12 studies were included after the screening process. Significant differences exist in the definition of infectiousness. PCR studies in general show no difference in shedding levels between symptomatic and asymptomatic individuals; however, the number of study subjects is generally limited. Two modelling studies estimate relative infectiousness to be 0.43 and 0.57, but both of these were more reflective of the infectiousness of undocumented rather than asymptomatic cases. The results from contact tracing studies include estimates of relative infectiousness of 0, but with insufficient evidence to conclude that it is significantly different from 1.
CONCLUSIONS
There is considerable heterogeneity in estimates of relative infectiousness highlighting the need for further investigation of this important parameter. It is not possible to provide any conclusive estimate of relative infectiousness, as the estimates from the reviewed studies varied between 0 and 1.
Topics: COVID-19; Cohort Studies; Contact Tracing; Humans; Mass Screening; SARS-CoV-2
PubMed: 33947725
DOI: 10.1136/bmjopen-2020-042354 -
World Neurosurgery Apr 2022Intraparenchymal cyst formation around a deep brain stimulation electrode is a rare complication. This is the first report of intraparenchymal cyst formation along a...
Intraparenchymal cyst formation around a deep brain stimulation electrode is a rare complication. This is the first report of intraparenchymal cyst formation along a deep cerebellar stimulation electrode in the posterior cranial fossa. The patient was a 27-year-old man with DYT-1 early-onset isolated dystonia who received bilateral deep cerebellar stimulation. He developed dizziness, nausea, and dysarthria 1 month following the deep cerebellar stimulation surgery. Head computed tomography revealed multiple cysts along the left electrode. The contrast medium of computed tomography did not enhance the appearance of the cystic lesions. We confirmed the absence of fever and sterile cerebrospinal fluid. Steroid therapy for 3 weeks was not radiologically and symptomatically useful. He underwent aspiration surgery. The cyst fluid was light yellow, sterile, and rich in protein. Despite substantial improvement in nausea and dysarthria within 1 week postoperatively, dizziness required 1 month to recover. Cystic formations gradually decreased with time.
Topics: Adult; Cerebellum; Cranial Fossa, Posterior; Cysts; Dystonia; Electrodes; Humans; Male
PubMed: 35033692
DOI: 10.1016/j.wneu.2022.01.039 -
Skeletal Radiology Dec 2015Symptomatic calcific discitis has been reported in the paediatric population but is a rare entity in adults with only eight cases reported in the English literature. We... (Review)
Review
Symptomatic calcific discitis has been reported in the paediatric population but is a rare entity in adults with only eight cases reported in the English literature. We present a case of adult calcific discitis presenting with acute onset back pain. Radiographs and CT demonstrated central T11-T12 disc calcification with diffuse marrow oedema on subsequent MRI. The patient was referred to our spinal oncology unit due to the extensive marrow oedema as a possible underlying primary bone tumour. Review of the CT confirmed an end-plate defect with herniated calcific nucleus pulposus with no underlying bone lesion. Features were in keeping with acute calcific discitis. The patient was treated symptomatically and made an uneventful recovery. We discuss the characteristic imaging features seen on radiograph, CT and MRI and review the current literature. Calcific discitis is a self-limiting pathology requiring symptomatic management only. Radiologists need to be aware of this rare entity as it can occur in adults and may be mistaken for a more sinister pathology such as infective discitis or a bone tumour and lead to further unnecessary imaging or invasive procedures.
Topics: Acute Disease; Calcinosis; Diagnosis, Differential; Discitis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Radiography; Thoracic Vertebrae
PubMed: 26160461
DOI: 10.1007/s00256-015-2213-6