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The Veterinary Clinics of North... Sep 2020Primary hyperaldosteronism, also known as Conn's syndrome, is the most common adrenocortical disease in cats. As in humans, this disease is underdiagnosed in cats. Cats... (Review)
Review
Primary hyperaldosteronism, also known as Conn's syndrome, is the most common adrenocortical disease in cats. As in humans, this disease is underdiagnosed in cats. Cats presenting with systemic arterial hypertension, hypokalemia, or both quite often are only treated symptomatically without further investigations. This practice may potentially exclude a significant number of cats from receiving appropriate treatment. It is therefore important for general practitioners to be aware of the disease. This article describes the (patho)physiology, clinical presentation, diagnostic approach, and treatment options of for feline primary hyperaldosteronism.
Topics: Animals; Cat Diseases; Cats; Hyperaldosteronism
PubMed: 32653266
DOI: 10.1016/j.cvsm.2020.05.007 -
Advances in Therapy Sep 2018Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen... (Review)
Review
Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man's risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.
Topics: Age Factors; Biopsy; Digital Rectal Examination; Genetic Predisposition to Disease; Humans; Incidence; Lower Urinary Tract Symptoms; Magnetic Resonance Imaging; Male; Primary Health Care; Prostate-Specific Antigen; Prostatic Neoplasms; Risk Factors
PubMed: 30097885
DOI: 10.1007/s12325-018-0766-1 -
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 -
Zeitschrift Fur Rheumatologie May 2022Immunoglobulin A vasculitis (IgAV) is a systemic vasculitis of the small vessels with formation of IgA immune complexes and a broad spectrum of clinical... (Review)
Review
Immunoglobulin A vasculitis (IgAV) is a systemic vasculitis of the small vessels with formation of IgA immune complexes and a broad spectrum of clinical constellations. Typical manifestations include purpura, arthralgia or arthritis, enteritis and glomerulonephritis. The IgAV is the most common vasculitis in childhood with a mostly uncomplicated and self-limiting course. In adults IgAV is much less frequent but the course can be more complicated, especially with renal or gastrointestinal manifestations. Various triggers of IgAV including infections have been described, whereby impaired glycosylation of IgA1 with subsequent exposure of binding sites for autoantibodies is a pathophysiological precondition for the vasculitis. Therapeutic strategies with immunosuppressants are so far supported by low evidence, take the severity of the organ manifestations into account and are oriented towards the recommendations for the treatment of other vasculitides of small vessels. Benign courses are treated symptomatically. The long-term prognosis of IgAV is determined by the renal manifestation.
Topics: Adult; Female; Glomerulonephritis; Humans; IgA Vasculitis; Immunoglobulin A; Kidney; Male; Vasculitis
PubMed: 35303751
DOI: 10.1007/s00393-022-01162-z -
Neurology(R) Neuroimmunology &... May 2023Among the glutamic acid decarboxylase (GAD)-antibody-spectrum disorders, the most common phenotypic subset is the stiff-person syndrome (SPS), caused by impaired... (Review)
Review
Among the glutamic acid decarboxylase (GAD)-antibody-spectrum disorders, the most common phenotypic subset is the stiff-person syndrome (SPS), caused by impaired GABAergic inhibitory neurotransmission and autoimmunity characterized by very high titers of GAD antibodies and increased GAD-IgG intrathecal synthesis. If not properly treated or untreated because of delayed diagnosis, SPS progresses leading to disability; it is therefore fundamental to apply the best therapeutic schemes from the outset. This article is focused on the rationale of specific therapeutic strategies based on the SPS pathophysiology targeting both the impaired reciprocal GABAergic inhibition to symptomatically improve the main clinical manifestations of stiffness in the truncal and proximal limb muscles, gait dysfunction, and episodic painful muscle spasms and the autoimmunity to enhance improvement and slow down disease progression. A practical, step-by-step therapeutic approach is provided, highlighting the importance of combination therapies with the preferred gamma-aminobutyric acid-enhancing antispasmodic drugs, such as baclofen, tizanidine, benzodiazepines, and gabapentin, that provide the first-line symptomatic therapy, while detailing the application of current immunotherapies with intravenous immunoglobulin (IVIg) plasmapheresis, and rituximab. The pitfalls and concerns of long-term therapies in different age groups, including children, women planning pregnancy, and especially the elderly considering their comorbidities are emphasized, also highlighting the challenges in distinguishing the conditioning effects or expectations of chronically applied therapies from objective meaningful clinical benefits. Finally, the need for future targeted immunotherapeutic options based on disease immunopathogenesis and the biologic basis of autoimmune hyperexcitability are discussed, pointing out the unique challenges in the design of future controlled clinical trials especially in quantifying the extend and severity of stiffness, episodic or startle-triggered muscle spasms, task-specific phobias, and excitability.
Topics: Child; Humans; Female; Aged; Stiff-Person Syndrome; Autoantibodies; Autoimmunity; Baclofen; Spasm
PubMed: 37059468
DOI: 10.1212/NXI.0000000000200109 -
Ugeskrift For Laeger Oct 2022Congenital hydrops fetalis describes an abnormal accumulation of fluid in two or more compartments in a fetus. The disease is categorized based on the aetiology: immune-... (Review)
Review
Congenital hydrops fetalis describes an abnormal accumulation of fluid in two or more compartments in a fetus. The disease is categorized based on the aetiology: immune- and non-immune hydrops fetalis. Today, the non-immune form is the most common. Once born, the child is initially handled symptomatically and will often need intensive care and treatment. Even though approximately one in five cases is still idiopathic, genetic diagnostic tools have become increasingly important in the diagnostic process. The prognosis depends on the aetiology and the gestational age when diagnosed and at birth, as argued in this review.
Topics: Infant, Newborn; Female; Child; Humans; Hydrops Fetalis; Gestational Age; Prognosis
PubMed: 36331166
DOI: No ID Found -
Revista de Neurologia Aug 2021Early diagnosis based on clinical findings, neurophysiological studies and serum antibody titres allows early initiation of symptomatic treatment and oncological...
INTRODUCTION
Early diagnosis based on clinical findings, neurophysiological studies and serum antibody titres allows early initiation of symptomatic treatment and oncological screening. Reports of patients with LEMS in Latin America are scarce.
AIM
This article aims to describe the characteristics of patients with LEMS from a private centre in Buenos Aires, Argentina, and to compare them with those of other series that have been published.
PATIENTS AND METHODS
The medical records of 13 patients with LEMS with clinical findings, compatible electromyogram and/or positive antibodies were reviewed. Follow-up was performed until associated neoplasia was ruled out or confirmed according to the recommended algorithms.
RESULTS
Four patients were diagnosed with T-LEMS, two of them with small-cell lung carcinoma. Of the nine patients with NT-LEMS, five had a DELTA-P score of 3 and 4. Nine patients presented with the classic clinical triad from the onset of the disease. All patients had electromyogram findings compatible with presynaptic neuromuscular plaque defect. Of the total, 70% improved symptomatically with pyridostigmine.
CONCLUSIONS
The clinical findings, together with compatible neurophysiological studies, are sufficient for the diagnosis of LEMS. The relationship between the DELTA-P score and the risk of small-cell lung carcinoma could not be replicated. Symptomatic treatment with pyridostigmine represents an effective therapeutic alternative.
Topics: Adolescent; Adult; Aged; Argentina; Carcinoma, Small Cell; Electromyography; Female; Humans; Immunoglobulins, Intravenous; Lambert-Eaton Myasthenic Syndrome; Lung Neoplasms; Male; Middle Aged; Neuromuscular Junction; Pyridostigmine Bromide; Retrospective Studies; Symptom Assessment; Young Adult
PubMed: 34291446
DOI: 10.33588/rn.7303.2021140