Overview Of Treatment Options Research Articles

Cenobamate in refractory epilepsy: Overview of treatment options and practical considerations.

Management of drug resistant epilepsy (DRE) represents a challenge to the treating clinician. This manuscript addresses DRE and provides an overview of treatment options, medical, surgical, and dietary. It addresses treatment strategies in polytherapy, then focuses on the role cenobamate (CNB) may play in reducing the burden of DRE while providing practical advice for its introduction. CNB is a recently approved, third generation, anti-seizure medication (ASM), a tetrazole-derived carbamate, thought to have a dual mechanism of action, through its effect on sodium channels as well as on GABAA receptors at a non-benzodiazepine site. CNB, having a long half-life, is an effective add-on ASM in refractory focal epilepsy with a higher response rate and a higher seizure-freedom rate than is usually seen in regulatory clinical trials. Experience post-licensing, though still limited, supports the findings of clinical trials and is encouraging. Its spectrum of action in relation to generalized epilepsies and seizures remains to be established, and there are no data on its efficacy in monotherapy. At the time of writing, CNB has been prescribed for some 50 000 individuals with DRE and focal epilepsy. A larger number is needed to fully establish its safety profile. It should at all times be introduced slowly to minimize the risk of serious allergic drug reactions. It has clinically meaningful interactions which must be anticipated and managed to maximize tolerability and likelihood of successful treatment. Despite the above, it may well prove to be of major benefit in the treatment of many patients with drug resistant epilepsy.

Stage III Non-Small-Cell Lung Cancer: An Overview of Treatment Options

Lung cancer is the second-most commonly diagnosed cancer and the leading cause of cancer death worldwide. The most common histological type is non-small-cell lung cancer, accounting for 85% of all lung cancer cases. About one out of three new cases of non-small-cell lung cancer are diagnosed at a locally advanced stage-mainly stage III-consisting of a widely heterogeneous group of patients presenting significant differences in terms of tumor volume, local diffusion, and lymph nodal involvement. Stage III NSCLC therapy is based on the pivotal role of multimodal treatment, including surgery, radiotherapy, and a wide-ranging option of systemic treatments. Radical surgery is indicated in the case of hilar lymphnodal involvement or single station mediastinal ipsilateral involvement, possibly after neoadjuvant chemotherapy; the best appropriate treatment for multistation mediastinal lymph node involvement still represents a matter of debate. Although the main scope of treatments in this setting is potentially curative, the overall survival rates are still poor, ranging from 36% to 26% and 13% in stages IIIA, IIIB, and IIIC, respectively. The aim of this article is to provide an up-to-date, comprehensive overview of the state-of-the-art treatments for stage III non-small-cell lung cancer.

Carbon monoxide poisoning: Recommendations for neuropsychological assessment

Carbon monoxide poisoning is potentially significant in terms of mortality rates, and survivors can have serious deleterious neurological consequences. Diagnosis may be hampered because of symptoms that are similar to other benign conditions. Neuropsychological assessment is complicated due to the need to assess potentially global brain dysfunction. Assessment recommendations are presented and discussed together with an overview of treatment options.

Acute thrombectomy for saddle pulmonary embolus: Case presentation and review of management

Pulmonary embolism is the third leading cause of cardiovascular death after myocardial infarction and stroke [1,2,4,5]. Anticoagulation is the primary choice of treatment for the majority of patients presenting with acute pulmonary embolism [2,4]. However, a greater risk of mortality in patients with right ventricular (RV) dysfunction may open the door to more aggressive treatment modalities [2]. We present the case of a patient who was diagnosed with a post-operative saddle pulmonary embolus that failed initial treatment with anticoagulation and required emergency thrombectomy to prevent mortality. A brief overview of treatment options is highlighted.

Ruptured Bilobed Basilar Artery Fenestration Aneurysm Treated with a WEB Device.

To describe the technique of using a Woven Endo Bridge (WEB) device to treat a ruptured bilobed blister-like aneurysm (BLA) at the basilar artery (BA) fenestration. A previously healthy 66-year-old female presented at the emergency room with subarachnoid hemorrhage (SAH), centered around the brainstem. Unenhanced CT and CT angiography showed a BLA of a basilar fenestration limb. The angiogram confirmed the diagnosis. A WEB device was chosen to treat this rare and challenging aneurysm. In this article, we describe the successful endovascular treatment of a SAH patient with a ruptured BLA at the basilar artery fenestration using a WEB device. And an overview of treatment options is provided.

��������������� ����� � ��������������� ���������� ��� ��������� (�� ������� C����-����������)

Introduction The incidence of compression spine injuries account for 0.49 % to 0.9 % of total pediatric trauma victims. Spine fractures constitute 7.5 % to 14.6 % of all inpatient hospital admissions and require conservative treatment. The aim of the study is to analyze the system of outpatient rehabilitation of pediatric compression vertebral fractures at follow-up care provided in St. Petersburg. Material and methods Medical records of 1230 children and adolescents who sustained compression fractures of the vertebral bodies and were followed up by orthopaedic surgeons in St. Petersburg between 2011 and 2017 have been reviewed. Results and discussion Pediatric bone fractures constituted 24.8 % of total injuries registered in St. Petersburg in 2017. From pediatric vertebral body victims, 53 % were boys and 47 % were girls. Vertebral fractures were most common in children aged nine, ten and eleven years (range, 13% - 14 %). A system of consistent non-operative treatment performed for the patients at trauma departments of children's hospitals, through inpatient and outpatient services of rehabilitation and restorative treatments, follow-up care in the outpatient setting is presented. Conclusion The incidence of pediatric bone injury and vertebral body compression fractures is higher in St. Petersburg than the average incidence reported in the Russian Federation. Questions of overdiagnosis of vertebral body compression fractures in pediatric population are considered to be important and relevant. An overview of treatment options and strategies, utilization of braces, follow-up term required for children with compression vertebral body fractures suggests revised approaches to treatment methods, length of inpatient management and follow-up care.

Constipation

This review presents an overview of the management of constipation. The review addresses the diagnosis of primary and secondary forms and then discusses in greater detail the investigative workup and modern management of chronic constipation (primary). The review addresses what simple and more advanced investigations are relevant for determining pathophysiology and gives an overview of treatment options, including pharmacologic, behavioral, and surgical approaches for thus defined subgroups of patients (evacuation disorder, slow transit constipation). This review contains 3 figures, 6 tables, and 89 references.

Constipation

This review presents an overview of the management of constipation. The review addresses the diagnosis of primary and secondary forms and then discusses in greater detail the investigative workup and modern management of chronic constipation (primary). The review addresses what simple and more advanced investigations are relevant for determining pathophysiology and gives an overview of treatment options, including pharmacologic, behavioral, and surgical approaches for thus defined subgroups of patients (evacuation disorder, slow transit constipation). This review contains 3 figures, 6 tables, and 89 references.

Focus Group Study to Examine Content of Family Meetings in Short-Term Substance Use Disorder Treatment

This study explores the content family members find helpful in family meetings that occur while patients are in short-term treatment for substance use disorders. Four focus groups were conducted: 3 with 23 family members and 1 with 10 patients who were asked to identify those topics that are helpful or unhelpful for families with and without prior treatment experiences. Families identified education about substance use disorders and an overview of treatment options as useful for family members new to treatment, and an emphasis on response to relapse and family supports as important for those with prior treatment experiences.

Abdominal desmoid-type fibromatosis – a case report and an overview of treatment options

Fibromatosis (desmoid, desmoid tumour) is a tumour belonging to the group of fibrous tissue proliferative diseases. Although the tumour cannot produce distant metastases, it shows local malignancy by invading adjacent tissues, as well as high recurrence rates after local resection. The incidence of fibromatosis is 2-4 cases per 1 million inhabitants per year. Three types of fibromatosis have been distinguished: extra-abdominal, abdominal wall and intra-abdominal type. Although the most common types are sporadic, coexistence with familial adenomatous polyposis (FAP), known as the Gardner’s syndrome, is observed. Available therapeutic options include surgical treatment, watchful waiting, hormone therapy, non-steroid anti-inflammatory drugs, chemotherapy and radiation therapy. This case report aims to draw attention to the difficulties in selecting an appropriate treatment option, limited surgical treatment, the psychological aspect of the disease, as well as the need to actively search for modern diagnostic and therapeutic solutions. We present a case of a 26-year-old patient who was ultimately diagnosed with a desmoid tumour invading the abdominal wall and internal abdominal organs. The patient presented to a county hospital due to suspected gastrointestinal obstruction. It was found from medical history that the patient had palpated a tumour of the abdominal wall 9 months before admission.

Multi-resistant Gram negative Enterobactericeae in paediatrics: an infection prevention and control challenge

Abstract Antibiotic resistance is not new. However, the microbiological landscape is changing for paediatricians. Increasingly resistant Gram-negative bacteria such as Escherichia coli and Klebsiella spp. Have, historically, resulted in infections in children. More recently, carbapenem resistant Enterobacteriaceae (CRE) have emerged and they have become one of the greatest challenges for clinicians and public health. Since their discovery, the number of cases of colonisation and infection in adults and children have increased worldwide. Overall, the number of reported cases remains lower in paediatric and neonatal populations compared to adults. KPC and OXA-48 carbapenemase producing Enterobacteriaceae are the most common phenotypes seen in the United Kingdom both in adults and children. These plasmid mediated transmissible resistance genes pose the highest risk due to the potential of horizontal gene transfer amongst different Enterobacteriaceae . Combination broad-spectrum antibiotic therapy has proven effective. Antibiotic stewardship and good infection control are necessary to tackle this rising challenge in healthcare; to reduce significant morbidity and mortality. This article discusses the current epidemiology and offers an overview of treatment options.

Laser skin resurfacing: an overview of treatment options and outcomes

Considered the gold standard procedure for atrophic acne scarring, photoageing and dyspigmentation, laser resurfacing achieves more superior results than peels and has a safer profile than more traditional methods such as dermabrasion. Lisa Mason describes the mechanisms of action of various laser types, explores expected outcomes, and outlines short- and long-term complications

Laser skin resurfacing: an overview of treatment options and outcomes

Laser skin resurfacing: an overview of treatment options and outcomes

Canakinumab for the treatment of TNF-receptor associated periodic syndrome

ABSTRACTIntroduction: TNF-receptor-associated periodic syndrome is an autoinflammatory disorder caused by mutations in TNF receptor superfamily 1A gene. The molecular pathogenesis of TRAPS remains unclear; it is known that a key role is played by mutations in TNFRSF1A that induce the hypersecretion of pro-inflammatory cytokines as well as IL-1β, resulting in uncontrolled inflammatory reactions. Furthermore, TNFRSF1A gene mutations result in intracellular stress ultimately leading to increased production of interleukin-1β, but the exact mechanism referred to in the connection between TNFRSF1A mutation and increased release of IL-1β, is still under study. This explains why IL-1 inhibition treatment can be effective in treating TRAPS patients. The purpose of this review is to discuss the safety and efficacy of canakinumab, a high-affinity human monoclonal anti IL-1β antibody.Areas covered: The data obtained from case reports, case series, Phase II study and a phase III randomized, double-blind, placebo controlled trial have been analyzed. Efficacy and safety profiles of canakinumab are discussed.Expert commentary: Was discussed an overview of treatment options in TRAPS patients. The understanding of pathogenesis of TNF-receptor-associated periodic syndrome led to realize why TRAPS patients respond to IL-1 inhibition. Canakinumab became approved for the treatment in TRAPS patients very recently.

Emerging treatment options for myelofibrosis: focus on pacritinib.

Myelofibrosis (MF) is a myeloid malignancy associated with a heavy symptomatic burden that decreases quality of life and presents a risk for leukemic transformation. While there are limited curative treatments, the recent discovery of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway dysregulation has led to many clinical investigations for new treatment approaches. This review provides practical knowledge on the disease state, an overview of treatment options, and specifically focuses on the efficacy and safety of pacritinib in the management of MF. Pacritinib is a novel selective inhibitor of JAK2 and FMS-related tyrosine kinase 3 (FLT3) currently in Phase III trials for the treatment of MF. Thus far, studies have demonstrated clinical efficacy in reducing splenomegaly and constitutional symptoms. Common adverse events were gastrointestinal in nature, while hematologic toxicity was limited. However, it was announced that all ongoing clinical trials on pacritinib have been placed on hold by the US Food and Drug Administration in February 2016, due to concerns for increased intracranial hemorrhage and cardiac events. With comprehensive risk-benefit analysis of clinical trial data, the utility of pacritinib in the management of MF may be more clearly defined.

Demystifying the persistent pneumothorax: role of imaging.

Evaluation for pneumothorax is an important indication for obtaining chest radiographs in patients who have had trauma, recent cardiothoracic surgery or are on ventilator support. By definition, a persistent pneumothorax constitutes ongoing bubbling of air from an in situ chest drain, 48 h after its insertion. Persistent pneumothorax remains a diagnostic dilemma and identification of potentially treatable aetiologies is important. These may be chest tube related (kinks or malposition), lung parenchymal disease, bronchopleural fistula, or rarely, oesophageal-pleural fistula. Although radiographs remain the mainstay for diagnosis and follow up of pneumothorax, computed tomography (CT) is increasingly being used for problem solving. Aetiology of persistent air leak determines the optimal treatment. For some, a simple repositioning of the chest tube/drain may suffice; others may require surgery. In this pictorial review, we will briefly describe the physiology of pneumothorax, discuss imaging features of identifiable causes for persistent pneumothorax and provide a brief overview of treatment options. Specific aetiology of a persistent air leak may often not be immediately discernible, and will need to be carefully sought. Accurate interpretation of imaging studies can expedite diagnosis and facilitate prompt treatment.Key points• Persistent pneumothorax is defined as a leak persisting for more than 2 days.• Radiographs can identify chest-tube-related causes of pneumothorax.• CT is the most useful test to identify other causes.• Penetrating thoracic injury can cause fistulous communication resulting in a persistent pneumothorax.• Discontinuity of visceral pleura identified by CT may indicate a bronchopleural fistula.

Sleep and Schizophrenia

Schizophrenia is a chronic, disabling condition that significantly impacts social and occupational functioning. Sleep problems are common to the illness, but are often overlooked. Patients with schizophrenia often have a combination of subjective sleep complaints and objective findings on polysomnographic testing. As a group, people with schizophrenia have a higher prevalence of common sleep disorders. This article reviews sleep abnormalities and disorders in schizophrenia and provides an overview of treatment options. [ Psychiatr Ann . 2016;46(3):192–196.]

Aspergillosis in Birds: An Overview of Treatment Options and Regimens

Aside from the therapeutic advantages associated with antimycotic drugs, predisposing factors have to be considered when treating aspergillosis in an avian patient. Predisposing influences can be affected by improving management conditions, thus decreasing the amount of fungal spores in the environment. Moreover, a veterinarian often treats a chronic disease in most cases; therefore, the treatment regimen is typically for months sometimes. The route of administration for the selected therapeutic agent is of great importance and depends on the severity of the disease condition, among other factors. Furthermore, the side effects of the individual drugs may be reduced by selecting different routes of administration. To date, in clinically ill birds, oral or parenteral administration of the drug is performed regularly to achieve a systemic effect. In principle, it would be preferable to use long-term nebulization treatment; however, careful consideration is required when determining the composition of antimycotic formulation. All currently available antimycotic agents that are in the drug market have been developed for use in human medicine. Drug dosages that are recommended for avian medicine are frequently based on the experience of individual researchers or reference values that are derived from other species. Essentially, active substances within the azoles group, as well as some allylamines and polyene antibiotics, are prescribed to avian patients with aspergillosis, with most of the patients currently being treated with azoles. Systemic administration of these compounds is effective when treating most fungal infections that involve the respiratory tract. However, treatment difficulties often occur because of the limited tolerability and the high occurrence of side effects in avian patients who are administered antimycotic drugs.

Non-melanoma Skin Cancer in Canada Chapter 1: Introduction to the Guidelines.

Non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma, represents the most common malignancy. The aim of this document is to provide guidance to Canadian health care practitioners on NMSC management. After conducting a literature review, the group developed recommendations for prevention, management, and treatment of basal cell carcinomas, squamous cell carcinomas, and actinic keratoses. These tumour types are considered separately in the accompanying articles. The Grading of Recommendations Assessment, Development and Evaluation system was used to assign strength to each recommendation. This introduction describes the scope and structure of the guidelines and the methods used to develop them. The epidemiology of NMSC is reviewed, as are the pathophysiologic changes occurring with damage to the skin, which lead to the formation of actinic keratoses and invasive squamous or basal cell carcinomas. This introduction describes the need for primary prevention and offers an overview of treatment options that are discussed in later chapters of the guidelines.

Laser skin resurfacing: an overview of treatment options and outcomes

Laser resurfacing procedures have become increasingly popular as more and more patients are seeking out aesthetic treatments that produce dramatic results. Considered the gold standard procedure for atrophic acne scarring and skin regeneration, laser resurfacing achieves more superior results than chemical peels and has a safer profile than more traditional methods such as dermabrasion. In this article, the author will differentiate between the various laser resurfacing technologies available, describe the mechanisms of action for ablative and non-ablative lasers in both fractionated and unfractionated modalities, explore the expected treatment outcomes, and outline the short-term and long-term complications associated with each procedure.