Successful Course Of Treatment Research Articles

Pediatric Intraocular Foreign Bodies

Pediatric posterior segment intraocular foreign bodies (IOFB) are clinical conditions that can lead to serious complications in children and should be carefully managed. Children are more vulnerable to ocular trauma due to their carelessness and lack of awareness of the dangers of certain objects. Such injuries are an important cause of childhood vision loss and can lead to various complications such as mechanical damage, chemical reactions and infections in the delicate tissues of the eye due to trauma. In this review, the diagnosis, imaging, treatment and follow-up of IOFB cases in pediatric patients are discussed. Studies have shown that early diagnosis and appropriate treatment strategies improve visual prognosis. In our study, it was emphasized that the timing of surgery in such cases should be determined on a case-specific basis. In addition, complications such as retinal detachment, proliferative vitreoretinopathy (PVR) and endophthalmitis were emphasized. In conclusion, pediatric posterior segment IOFBs have unique clinical features depending on the type of injury and the composition of the IOFB. Early intervention and protection of the fellow eye are essential for a successful treatment course. Although the overall visual prognosis is favorable, management and monitoring of complications is of paramount importance.

Skin Care Experience of a Case of Multiple Organ Failure Caused by High-Voltage Electrical Injury

Background: High-voltage electrical burns are caused by the direct transmission of electric current through the body and the conversion of electric energy into heat energy, which directly heats the tissues and leads to organ function damage. Especially after high-voltage electric burns (more than 1000W), it can not only cause coagulation necrosis of the skin and even carbonization, but also cause serious deep tissue damage .The degree of tissue damage depends on the type of current, the magnitude of current, the frequency, the voltage, the resistance of the tissue, the skin humidity, the duration, the contact area, and other factors. Low voltage and low frequency electric shock mainly affect the heart and respiration, which can lead to insignificant soft tissue damage. High voltage electric shock mainly causes serious soft tissue damage, which can be accompanied by changes in the circulatory system and respiratory system.[1] Subject and Method: We collected the data of a case of multiple organ failure caused by high-voltage electricity that was successfully treated in July 2023.In the course of this patient's successful treatment, The main nursing measures were analyzed: The intake and output volume were actively controlled. Albumin supplementation, Debridement and dressing change were performed daily, Covered with nano-silver ion dressing, Try to ensure a sterile environment during operation, Maintain ambient temperature and humidity. Results: Twenty days later,the skin damage caused by electric burns was reduced from 30% to 1%. Conclusion: These are very important links: The intake and output volume were actively controlled, The balance of intake and output was maintained for 24 hours, and lactic acid was less than 2mmol/L. Albumin supplementation Controlled above 30g/L, Debridement and dressing change were performed daily, Covered with nano-silver ion dressing, Try to ensure a sterile environment during operation, Maintain ambient temperature 28~30℃ and humidity 40%~50%.

Risk Factors and Characteristics of Recalcitrant Osteomyelitis Following Initial Surgical and Antibiotic Treatment.

To evaluate the injury, patient, and microbiological characteristics that place patients at risk for recalcitrant fracture related infection and osteomyelitis despite appropriate initial treatment. Retrospective Chart Review. Three level I trauma centers. Two hundred and fifty-seven patients undergoing surgical debridement and antibiotic therapy for osteomyelitis from 2003 to 2019. Patients were categorized as having undergone serial bone debridement if they had two separate procedures a minimum of six weeks apart with a full course of appropriate antibiotics in between. Patient records were reviewed for age, injury location, body mass index (BMI), smoking status, comorbidities, and culture results including the presence of multidrug resistant organisms (MDRO) and culture-negative osteomyelitis. A total of 257 patients were identified; 49% (n=125) had a successful single course of treatment, and 51% (n=132) required repeat debridement for recalcitrant osteomyelitis. At the index treatment for osteomyelitis, the most common organisms in both groups were Methicillin-resistant (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA). There was no significant difference in incidence of polymicrobial infection between the two groups (25% vs 20%, p=0.49). The most common organisms cultured at the time of repeat saucerization remained MRSA and MSSA, however, the same organism was cultured from both the index and repeat procedure in only 28% (n=37) of cases. Diabetic patients, IVDU, delay to diagnosis, and open fractures of the lower leg are independent risk factors for failure of initial treatment of post-traumatic osteomyelitis. Successful eradication of fracture related infection and post-traumatic osteomyelitis is difficult and fails 51% of the time despite standard surgical and antimicrobial therapy. While MRSA and MSSA remain the most common organisms cultured, patients who fail initial treatment for osteomyelitis often do not culture the same organisms as those obtained at the index procedure.

SEGAN-BASED LESION SEGMENTATION AND OPTIMIZED RideNN FOR DIABETIC RETINOPATHY CLASSIFICATION

The most significant issue with diabetes is diabetic retinopathy (DR), which is the primary cause of blindness. DR typically develops no symptoms at the beginning of the disease, thus numerous physical examinations, including pupil dilation and a visual activity test, are necessary for DR identification. Due to the differences and challenges of DR, it is more challenging to identify it during the manual assessment. For DR patients, visual loss is prevented thanks to early detection and accurate therapy. Therefore, it is even more necessary to classify the severity levels of DR in order to provide a successful course of treatment. This study develops a deep learning method based on chronological rider sea lion optimization (CRSLO) for the classification of DR. The segmentation process divides the image into multiple subgroups, which is necessary for the appropriate detection and classification procedure. For the efficient identification of DR and classification of DR severity, the deep learning approach is used. Additionally, the CRSLO scheme is used to train the deep learning technique to achieve higher performance. With respect to testing accuracy, sensitivity, and specificity of 0.9218, 0.9304 and 0.9154, the newly introduced CRSLO-based deep learning approach outperformed other existing DR classification techniques like convolutional neural networks (CNNs), deep convolutional neural network (DCNN), synergic deep learning (SDL), HPTI-V4 and DR[Formula: see text]GRADUATE. The Speech Enhancement Generative Adversarial Network (SEGAN) model in use also produced increased segmentation accuracy of 0.90300.

Pharmacological ascorbate potentiates combination nanomedicines and reduces cancer cell stemness to prevent post-surgery recurrence and systemic metastasis

Conventional chemotherapy targets proliferative cancer cells to halt tumor progression or regress tumors. However, the plasticity of tumor cells enables their phenotypical changes to acquire chemo-resistance, leading to treatment failure or tumor recurrence after a successful treatment course. Here, we report the use of high-dose pharmacologic ascorbate to potentiate treatment efficacy of nanoscale coordination polymers (NCPs) delivering two clinical combinations of chemotherapeutics, carboplatin/docetaxel and oxaliplatin/SN38, and to target metabolic plasticity of tumor cells. Combination treatments of high-dose ascorbate and NCPs overcome multi-drug resistance by significantly reducing the abundance of cancer stem cells (CSCs) in solid tumors, as evidenced by reduced expression of tumor pluripotency factors. The clearance of CSCs inhibits post-surgery recurrence and systemic metastasis in multiple mouse models of cancer.

Is history of abuse predictive of eating disorders with binge-eating episodes through an effect mediated by impulsivity? A French longitudinal study.

In recent years, many studies have explored the associations among impulsivity, history of abuse, the emergence of eating disorders with episodes of binge eating (EDBE) and their severity. Nevertheless, factors associated with successful clinical outcomes of EDBE are still unknown. Our study aimed to test the hypothesis that a history of abuse is associated with unsuccessful clinical outcomes of EDBE through an effect mediated by impulsivity. We assessed patients older than 15 years, 3 months with EDBE at inclusion and at 1 year. Recovery was defined as the absence of eating disorders at 1 year. A mediation analysis was performed by means of structural equation modelling. We included 186 patients in our analyses (54% bulimia nervosa, 29% anorexia nervosa binge eating/purging type and 17% binge-eating disorder); 179 (96%) were female. One-third (n = 63) of patients reported a history of abuse, and recovery was observed for 20% of the sample (n = 38). Contrary to our assumption, a history of abuse was not associated with the absence of recovery of EDBE at 1 year. Factors unfavourable for achieving recovery were anxiety disorders (odds ratio [OR] 0.41), vomiting (OR 0.39), physical hyperactivity (OR 0.29), negative urgency and a lack of perseverance (OR 0.85 for both). Only positive urgency was positively associated with recovery (OR 1.25). We excluded 219 patients lost to the 1-year follow-up. Our findings may help to deconstruct the empirical belief that traumatic events may interfere with the successful course of treatment for eating disorders. A high level of positive urgency may be associated with more receptivity to care.

Uncommon Petaloid Form of Seborrheic Dermatitis Seen in Fitzpatrick Skin Types V-VI.

Seborrheic dermatitis (SD) is an inflammatory disease that has a papulosquamous morphology in areas rich in sebaceous glands such as the scalp, face, and body folds. Petaloid SD is an uncommon presentation found in patients with dark skin (Fitzpatrick Skin type V-VI). This form of SD can appear as pink or hypopigmented polycyclic coalescing rings or scaly macules and patches in the typical areas SD appears, which can mimic other conditions including lupus erythematosus. There is significant disproportion in the representation of darker skin types in dermatological textbooks and scarce literature on petaloid SD. This case demonstrates the presentation of the petaloid SD in an African American patient to contribute to the limited literature on dermatological conditions within this population. A 25-year-old African American female with a history of mild hidradenitis suppurativa and asthma who presented with asymptomatic hypopigmented rashes throughout her face, scalp, and chest. She was diagnosed with the petaloid form SD and treated with ketoconazole shampoo once weekly, ketoconazole cream 1-2x daily, and hydrocortisone 2.5% ointment twice daily as needed. At six-week post-treatment follow-up, the patient's rashes significantly improved. The petaloid form of SD is commonly experienced in dark-skinned patients. While common treatments for SD are effective in this form of SD, special consideration of skin types, skincare habits, and haircare in the African American population should be explored. This case report demonstrates how this uncommon skin condition presents in patients of Fitzpatrick skin type V-VI and a successful treatment course.

Case report on the interaction between furosemide and digoxin that caused digoxin toxicity

Toxicity from digitalis is a typical clinical issue. In this case, the interaction of digoxin and furosemide is becoming more widely recognised as a major cause of digitalis toxicity. We present an abnormal ECG that demonstrates digoxin-induced cardiotoxicity. We report a case of a Digoxin toxicity in a 79-year-old male patient admitted with complains of nausea, increase frequency of micturition, decrease appetite, increase nocturia, shortness of breathing. The patient is taking furosemide and digoxin as past medication for Heart block and Chronic kidney disease treatment. In patient, Serum digoxin level is high due to hypokalemia because of digoxin and furosemide drug interaction. The Electrocardiogram interpretation shows sinus bradycardia, ST segment depression, and T wave inversion which mainly due to digoxin toxicity. So for the management digoxin is omitted from the current treatment. The patient needs to be constantly monitored since digitalis poisoning is deadly. A digoxin-binding antibody is the only treatment for digoxin overdose that can reverse its effects by its antidote but it’s not available. So, the most successful course of treatment is symptomatic or efficient methods of extracorporeal drug removal.
 Keywords: Digoxin toxicity, furosemide, hypokalemia, cardiotoxicity, complete heart block, ST segment depression.

Mycological Profile of Acute Invasive Fungal Rhinosinusitis during COVID-19 Pandemic at a Tertiary Care Hospital

Introduction: During the coronavirus disease-19 (COVID-19) pandemic, a surge in acute invasive fungal rhinosinusitis (AIFRS) cases with high mortality was reported in India. Objective: The objective was to study the spectrum of fungus associated with AIFRS during the pandemic of COVID-19. Materials and Methods: A total of 51 patients who were clinically diagnosed as cases of acute invasive rhinosinusitis in the department of ear, nose and throat (ENT) were included in the study. The clinical data along with demographic details were noted, and fungal identification was done using a conventional method. Results: Out of 51 patients, 66.6% were males and 33.4% females. Predominantly affected age group was 41–50 years. Out of 51 patients, 92.15% (47/51) had suffered from COVID-19 and 7.8% (4/51) did not have COVID-19 infection previously. Thirty-seven patients out of 51 (72.54%) were diabetics. Out of 51 samples collected from patients, 94.11% (48/51) were fungal culture-positive and only 5.8% (3/51) were culture-negative. A total of 52 fungi were isolated from the 48 culture-positive samples. Mucormycetes were predominantly isolated from the samples followed by Aspergillus species and Candida species. Among mucormycetes, Rhizopus species was the predominantly isolated. Conclusion: Patients with COVID-19, especially those at high risk, need to undergo an ENT examination once they recover because an early identification of AIFRS and a strong clinical suspicion of the disease are crucial for a successful course of treatment and to improve patient prognosis.

Perioperative Management of an Adolescent Fontan Patient with Narrowing of the Aortopulmonary Space for Posterior Scoliosis Surgery

Congenital cardiac patients who received neonatal reconstructive aortic arch surgery are at risk of aortopulmonary space narrowing with compression of the left pulmonary artery and left main bronchus (LMB) later in life. We discuss a challenging adolescent single ventricle patient who presented for surgical treatment of a non-idiopathic thoracic scoliosis (posterior spinal fusion) with severe stenosis of the LMB and left pulmonary artery due to a narrow aortopulmonary space. Careful preoperative imaging, evaluation, and decision making resulted in successful surgical treatment and uneventful perioperative course.

Response Inhibition and Predicting Response to Pharmacological and Cognitive Behavioral Therapy Treatments for Major Depressive Disorder: A Canadian Biomarker Integration Network for Depression Study

BackgroundMajor depressive disorder (MDD) is associated with various cognitive impairments, including response inhibition. Deficits in response inhibition may also underlie poor antidepressant treatment response. Recent studies revealed that the neurobiological correlates of response inhibition can predict response to pharmacological treatments. However, the generalizability of this finding to first-line nonpharmacological treatments, particularly cognitive behavioral therapy, remains to be investigated. MethodsData from two independent treatment protocols were combined, one in which 65 patients with MDD underwent treatment with escitalopram, and the other in which 41 patients with MDD underwent a course of cognitive behavioral therapy. A total of 25 healthy control subjects were also recruited. Neural correlates of response inhibition were captured by participants completing a Go/NoGo task during electroencephalography recording. Response inhibition–related measures of interest included the amplitudes of the N2 and P3 event-related potentials. ResultsPretreatment P3 amplitude, which has been linked to both the motor and cognitive aspects of response inhibition, was a significant predictor of change in depressive symptoms following escitalopram and cognitive behavioral therapy treatment. A greater pretreatment P3 amplitude was associated with a greater reduction in depressive severity. In addition, the pretreatment P3 amplitude was found to be significantly greater at baseline in remitters than in nonremitters and healthy control subjects. ConclusionsThe integrity of response inhibition may be critical for a successful course of pharmacological or psychological treatment for MDD. Electrophysiological correlates of response inhibition may have utility as a general prognostic marker of treatment response in MDD. Future studies may investigate the benefit of preceding first-line treatments with interventions that improve response inhibition in MDD.

Itopride in treatment of laryngopharyngeal symptoms of gastroesophageal reflux disease.

In everyday otolaryngological and gastroenterological practice, the diagnosis and treatment of extraesophageal forms of gastroesophageal reflux disease are often challenging. It is sometimes the case that treatment ordered by other specialists proves ineffective or even worsens the symptoms. There is no golden standard of diagnosis for otolaryngological forms of GERD, and currently used tools (gastroscopy, laryngoscopy, impedance and pH testing) have low sensitivity and specificity. After finishing a course of successful treatment, the patients often come back to our offices with the very same symptoms. In order to improve the efficacy of treatment, a prokinetic agent can be added to the standard proton pump inhibitor therapy.

Therapie des komplexen regionalen Schmerzsyndroms im Handbereich aus Sicht der Physiotherapie

Successful treatment of complex regional pain syndrome (CRPS) depends mainly on an early diagnosis and an adequate treatment concept with active participation of the patient. Diagnostics and treatment recommendation of CRPS with localization on the hand. Presentation and research of studies on treatment recommendations and the CRPS guidelines. The early diagnosis of CRPS, adequate pain therapy and treatment of CRPS based on the CRPS guidelines favor the successful course of treatment. Graded motor imagery training is the treatment of choice, especially in the acute phase and is essential for improving cortical representation, reducing pain and reintegration into the body image. Good patient education regarding the clinical picture and course of the disease form the basis for the treatment of CRPS. The patient should always be considered holistically and treated correspondingly by amultiprofessional team. Active involvement of the patient in the treatment from the beginning is always essential.

A Rare Case of Metastatic Transformation to Pituitary Carcinoma

Background: Pituitary carcinomas are rare and comprise less than 0.5% of pituitary tumors and frequently arise from previously resected and/or radiated infiltrating adenomas.1 Radiation therapy is used to prevent regrowth but does not have significant data supporting improved prognosis.2 True pituitary carcinomas requires the presence of craniospinal and/or systemic metastases. Here, we present a case of benign pituitary adenoma that had progressed to a metastatic tumor and responded to radiation therapy. Clinical Case: Our patient was first diagnosed in 1982 with a pituitary mass after undergoing an MRI due to right eye blindness. He ultimately had a transcranial resection of the tumor and post-operative external radiation to residual tumor. Final pathology was consistent with a nonsecretory tumor. Additionally, he was diagnosed with panhypopituitarism and he was treated accordingly. Due to barriers of patient adherence, only one post-operative MRI was obtained, and he was lost to endocrine follow up. In 2007, he was again referred to endocrinology for new vision loss in the left eye. An MRI revealed a 3.0 x 3.8 x 4.4 cm tumor that compressed the optic chiasm. Additionally, multiple lesions were seen within the dural and leptomeningeal extra-axial areas including the largest left frontal lesion of 2.4 cm and a 1.7 cm lesion posterior to the cord within the foramen magnum. The patient underwent endonasal transsphenoidal resection of the sellar mass and biopsy of the frontal lesion in October 2007. Pathology showed pituitary adenocarcinoma in both the sellar and frontal lesions and immunoperoxidase staining was negative for all hormones. He completed salvage radiation to the sellar and craniospinal lesions in December 2007. MRI scans completed 7 months later showed stable residual pituitary and metastatic lesions. The patient received 6-month MRI screening exams for the first 2 years and then annually thereafter, as well as PET scanning, without significant progression or new metastatic lesions. Conclusion: We present a case of benign pituitary adenoma which transformed following resection to a malignant tumor with metastatic lesions in the brain and spinal cord that was treated with radiation with relative success. Despite the often-aggressive nature of these metastatic tumors, the patient has experienced a successful treatment course with minimal side effects and without progression 13 years after initial treatment of the metastatic pituitary carcinoma.

Neonatal lupus with left bundle branch block and cardiomyopathy: a case report

BackgroundCardiac manifestations of neonatal lupus include an array of structural and conduction abnormalities due to placental transference of maternal anti-SSA/Ro and anti-SSB/La autoantibodies. Late-onset neonatal lupus cardiomyopathies, occurring outside the neonatal period, is an infrequently reported manifestation with unknown pathophysiology and poorly defined treatment regimens. Due to the rarity of this condition, additional studies and case reports are required to better understand and manage late-onset neonatal lupus cardiomyopathies.Case presentationA 4-week-old female, born to a mother with known anti-SSA/Ro and anti-SSB/La autoantibodies, presents with classic cutaneous manifestations for neonatal lupus and is found to have left bundle branch block, severely dilated cardiomyopathy with an ejection fraction of 25%, and a thin echogenic dyskinetic ventricular septum. Weekly second trimester and 30-week fetal echocardiograms showed no signs of structural or conduction abnormalities. There were no histologic signs of inflammation on cardiac tissue biopsy. After a complicated hospital course, she was successfully treated with biventricular pacemaker, intravenous immunoglobulin, and plasmapheresis.ConclusionsWe present a case of late-onset neonatal lupus with severe dilated cardiomyopathy, a dyskinetic ventricular septum, and left bundle branch block. To our knowledge, the dyskinetic ventricular septum has never been reported and left bundle branch block is rarely reported in NL. This case further validates the need for long term cardiac follow up for patients born with NL, even if lacking cardiac manifestations in the peripartum period. We characterize a unique presentation of a rare clinical entity, highlighting the diagnostic challenges, and describe a successful treatment course.

3221 A Rare Case of Collagenous Sprue

INTRODUCTION: Collagenous Sprue (CS) is a rare clinicopathological malabsorptive disorder characterized by mucosal villi atrophy and sub-epithelial collagen deposition. It is very important to consider the possibility of CS in patients diagnosed with celiac disease not improving on the gluten-free diet. CASE DESCRIPTION/METHODS: We present an elderly caucasian male with clinicopathological manifestations of Collagenous Sprue, as well as the successful treatment course that he underwent. DISCUSSION: Collagenous Sprue (CS) is a rare clinicopathological malabsorptive disorder characterized by mucosal villi atrophy which was first described in 1947. Approximately 60 cases have been reported so far in the medical literature. Replacement of the crypts with subepithelial collagen deposition in the small intestine made some experts believe CS to be a histopathologic variant of celiac disease with a poorer outcome. Although it's not true in all patients, diagnosis of CS should be considered in a patient whose symptoms are not getting better despite a gluten-free diet. Unlike in celiac disease, the collagenous deposits in CS doesn't regress with a gluten-free diet. Thus far, the etiology of CS is not clearly understood and it is very essential to initiate treatment at an early stage of the sprue to prevent fibrotic progression. Multiple treatment strategies were advised in the past but there is no standard therapy.

Disturbance of the Conformation of DNA Hairpin Containing the 5′-GT-3′ Binding Site Caused by Zn(II)bleomycin-A5 Studied through NMR Spectroscopy

The antibiotics known as bleomycins constitute a family of natural products clinically employed for the treatment of a wide spectrum of cancers. These antibiotics have the ability to chelate a metal center, most commonly Fe(II), and cause site-specific DNA cleavage upon oxidation. Bleomycin therapy is a successful course of treatment for some types of cancers. However, the risk of pulmonary fibrosis as an undesirable side effect, limits the use of the antibiotics in cancer chemotherapy. Bleomycins are differentiated by their C-terminal, or tail, regions, which have been shown to closely interact with DNA. Pulmonary toxicity has been correlated to the chemical structure of the bleomycin C-termini through biochemical studies performed in mice. In the present study, we examined the binding of Zn(II)Bleomycin-A5 to a DNA hairpin of sequence 5′-CCAGTATTTTTACTGG-3′, containing the 5′-GT-3′ binding site. The results were compared to those from a previous study that examined the binding of Zn(II)Bleomycin-A2 and Zn(II)Peplomycin to the same DNA hairpin. We provide evidence that, as shown for DNA hairpins containing the 5′-GC-3′ binding site, Zn(II)BLM-A5 causes the most significant structural changes to the oligonucleotide.

Using an Acceptance and Commitment Therapy Approach When Exposure and Cognitive Therapy Become Rituals in the Treatment of Obsessive-Compulsive Disorder.

Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the conceptual basis of ERP, and then present a client who relapsed after seemingly achieving substantial improvement following 11 sessions of ERP. Likely reasons for the relapse and strategies for enhancing ERP to achieve better long-term treatment outcomes are discussed from the perspective of acceptance and commitment therapy (ACT). These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the use of cognitive therapy for OCD.

Treatment responses in patients with vitiligo to very potent topical corticosteroids combined with vitaminotherapy in Madagascar

Vitiligo is a refractory disease in which treatment modalities are not yet established. We aim to assess results obtained 10years after the initiation ofa therapeutic protocol which combines very potent topical corticosteroids (TCS), vitaminotherapy (B12 and C), and suppression of microtraumas in the management of nonsegmental vitiligo in Madagascar. It was a prospective and descriptive study over a period of 6years (2011-2016) in the Department of Dermatology, Joseph Raseta Befelatanana, Antananarivo, Madagascar. The diagnosis of vitiligo was based on clinical data. Patients who agreed to follow the treatment protocol, which combined very potent TCS (two applications/day for 10days, and then one application/day for the following 10days), oral vitamin C 500mg/day for 20days, and oral vitamin B12 100mg/day for 20days, were included in the study. Two successive courses of treatment were made 10days apart. The details of 308 vitiligo patients were analyzed. The mean age of patients was 33.3years. There was a female preponderance (sex ratio: 0.6). The duration of treatment in our patients varied from 3 to 18months. Two hundred and thirty-nine patients had good therapeutic compliance and attended regular follow-up. Excellent repigmentation (more than 76% area repigmented) was noted in 50 patients (65.7%) less than 14yearsof age. Lesions evolving inless than 1year in 31 patients (36.9%) had excellent response to treatment. Localized lesions responded favorably to treatment with excellent repigmentation in 108 patients. These results show that therapeutic response is better in young people, lesions less than 1year of evolution, and for localization of vitiligo in the face and neck.

Continuation Electroconvulsive Therapy for Patients With Clozapine-Resistant Schizophrenia: A Pilot Study.

The risk of relapse after a successful acute course of treatment is a clinical challenge in electroconvulsive therapy (ECT) practice, particularly in patients with a history of marked resistance to previous treatments. Research suggests that a gradual decrease of ECT or its long-term continuation might be the best strategy. Notwithstanding, current studies do not address the role of continuation ECT in the truly refractory cases, that is, the clozapine-resistant patients. Our group published a randomized controlled trial of ECT augmentation of clozapine in clozapine-resistant patients with schizophrenia, where the augmentation was vastly superior in efficacy for the acute treatment. The aim of the current study is to evaluate the efficacy of continuation ECT for patients who showed response to the combination of acute ECT and clozapine for treatment-resistant schizophrenia. Continuation ECT was offered to all patients who completed the acute study and who met response criterion. We followed a tapered schedule of 4 weekly ECT sessions, followed by 4 ECT sessions every 2 weeks and 2 monthly ECT sessions for a total of 10 sessions. Patients sustained the gains achieved with the acute course of ECT, and no individual patient presented with clinically relevant worsening of symptoms. Moreover, the long-term use of ECT was not associated with added adverse effects. This is an open pilot study with a small sample size, and results should be interpreted accordingly, but this report offers a relevant starting point for much needed future studies.