Positive Clinical Improvement Research Articles

Cannabinoids for behavioral symptoms in severe dementia: Safety and feasibility in a long-term pilot observational study in nineteen patients.

ContextThe management of behavioral symptoms and rigidity in patients with dementia constitutes a significant challenge. Short-term studies suggest an interest in the use of medical cannabis, but long-term data are lacking.ObjectivesThe objective of this study was to investigate the feasibility and long-term safety of administering tetrahydrocannabinol/cannabidiol (THC/CBD) treatment as an additional drug to a poly medicated population with severe dementia, evaluate clinical improvements, and collect information on the pharmacokinetics of cannabinoids and possible drug–drug interactions.MethodsA prospective observational study of patients with severe dementia living in a long-term care home to whom the physicians had prescribed a medical cannabis treatment. Data were collected over 2 years. We assessed the changes in medical cannabis dosages, safety parameters, variations in neuropsychiatric problems, agitation, rigidity, the most invalidating daily activity, and disabling behavior trouble scores. We evaluated the pharmacokinetics of cannabinoids by measuring plasma levels and analyzing the enzymatic activity.ResultsWe assessed 19 patients (81.4 years—17 women and two men) receiving an average of 12.4 mg THC/24.8 mg CBD per day for up to 13 months, with no reported problems related to the treatment and limited adverse drug reactions. Clinical scores showed a marked improvement that was stable over time, deprescription of other medications, and care facilitated. The pharmacokinetic evaluation showed an expected slight reduction in the enzymatic activity of CYP1A2 and CYP2C19.ConclusionA long-term THC/CBD (1:2) medication can be administered safely and with overall positive clinical improvement to poly medicated older adults with severe dementia and associated problems. The results must be confirmed in a randomized trial.

Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

BackgroundExtracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines.MethodsThis controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH).ResultsFive men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60% ± 3.94% and increased to 92.13% ± 3.28% after them (p < 0.001). Serum IL-6 showed a reduction from 139.70 ± 105.62 to 72.06 ± 65.87 pg/mL (p = 0.073); and c-reactive protein decreased from 136.25 ± 84.39 to 78.25 ± 38.67 mg/L (P = 0.016).ConclusionsExtracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients.Trial registrationThe research protocol has been registered in the website of Iranian Registry of Clinical Trials with the reference number IRCT20150704023055N2.

COMPARISON OF CLINICAL IMPROVEMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO WITH AND WITHOUT HYPERTENSION

Background: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. Several studies have shown that comorbid hypertension can affect the prognosis of BPPV. This study aims to assess the comparison of clinical improvement in BPPV patients with and without hypertension. Method: This research is an analytical study with a cohort design. The research was conducted at the Neurology Polyclinic of RSUP Haji Adam Malik Medan for the period of October 1, 2019 to December 1, 2019. A total of 40 BPPV patients with and without hypertension were taken into the study sample, using consecutive sampling technique. For 7 days recurrence was recorded and on the 7th day, BPPV symptoms were reassessed with the Dix-Hallpike maneuver. Furthermore, statistical analysis was performed using the Mann Whitney U test and Kruskall Wallis test. Result: Of the 40 research subjects, there were 29 more women (72.5%) and the highest age was in the range&gt; 40 - 60 years as many as 23 subjects (57.5%). It was found that 6 people (30.0%) BPPV patients with hypertension and 17 people (85.0%) BPPV patients without hypertension experienced positive clinical improvement, while 14 people (70.0%) BPPV patients with hypertension and 3 people (15 , 0%) BPPV patients without hypertension experienced negative clinical improvement (p = 0.001). Conclusion: There is a significant difference in clinical improvement between BPPV patients with and without hypertension.

Use of complement monoclonal antibody eculizumab in Shiga toxin producing Escherichia coli associated hemolytic uremic syndrome: A review of current evidence.

Complement activation plays an important role in the pathogenesis of atypical hemolytic uremic syndrome.Eculizumab is a monoclonal antibody that blocks complement activity and has been approved for use in the treatment of atypical hemolytic uremic syndrome (HUS).Less well appreciated is the role of complement in Shiga toxin-induced HUS (Shiga toxin producing Escherichia coli [STEC]-HUS). To a limited extent, eculizumab has been used off label in patients with severe STEC-HUS with neurological involvement.Through a systematic search of available databases, we identified 16 reports describing the use of eculizumab in STEC-HUS (eight case reports/series, seven retrospective studies, and one prospective cohort study). All studies described its use in severe STEC-HUS with neurological or multiorgan dysfunction; none were randomized or blinded. Four studies used the control groups. Although the overall quality of evidence is low, some published studies showed positive clinical improvement after treatment with eculizumab in severe STEC-HUS with progressive neurological involvement.

Assessment of the safety and efficacy of a bipolar multi-frequency radiofrequency device in the treatment of skin laxity

This study assessed the safety and efficacy of a bipolar, multi-frequency, vacuum-assisted radiofrequency device in the temporary improvement of thigh skin laxity. A secondary outcome measure included the determination of patient tolerability. Fourteen female study subjects between the ages of 30 and 61 years with Fitzpatrick skin types I-V completed the study. Each subject underwent a single, bipolar, multi-frequency, vacuum-assisted radiofrequency treatment with frequencies ranging between 0.80 and 2.45 MHZ. Suction was applied adjustable up to 500 mbars and skin temperatures were maintained between 39 and 42o C. Eight out of the fourteen (57.14%) study subjects noted an improvement in the appearance of their skin from baseline compared to their three-month follow-up while the independent, blinded investigator noted an improvement in eleven out of the fourteen (78%) subjects. All treatments were well tolerated and side effects were minimal, consisting of mild intra-operative discomfort, transient erythema and slight post-procedure edema noted in a minority of study subjects.This study demonstrated that a single treatment with a novel, bipolar, multi-frequency radiofrequency device applied to thigh skin resulted in a positive clinical improvement in 78% of investigator-assessed subjects. Furthermore, this study proved that the treatment is tolerable and safe for all skin types.

A refractory case of chromoblastomycosis due to Fonsecaea monophora with improvement by photodynamic therapy

Chromoblastomycosis is one of the most frequently encountered mycoses in tropical and temperate regions caused by the implantation of the infectious structures and one which is associated with low cure and high relapse rates. The etiologic agents play a critical role affecting clinical outcome and in southern China, Fonsecaea pedrosoi and F. monophora are the main causative agents of chromoblastomycosis. We treated, for two years, a 55-year-old male patient with chromoblastomycosis caused by F. monophora with itraconazole and terbinafine, two antifungals recommend in earlier papers in the literature but without any positive response. As a result we introduced the photodynamic therapy (PDT) employing 5-aminolevulinic acid (ALA) irradiation. The lesions were improved after two periods of ALA-PDT treatment, each consisting of exposures at weekly intervals for 5 weeks but new lesions developed with the cessation of ALA-PDT treatment. Thereafter, positive clinical improvement was obtained when voriconazole at 200 mg was combined with terbinafine at 250 mg in treating the patient. The in vitro susceptibility of the F. monophora isolate to terbinafine, itraconazole, and voriconazole was assessed and the fungus was found to be sensitive to all three, with the minimal inhibitory concentrations of 0.125, 1, 0.0625 μg/ml, respectively. However, the determination of in vitro susceptibility profiles may not predict clinical response.

Trasplante de progenitores hematopoyéticos en la adrenoleucodistrofia ligada al X

Over 130 patients with adrenoleukodystrophy have received hematopoietic stem cell transplantation from normal donors. Without treatment, this disease has an inexorable fatal course. On the other hand, all of the engrafted hosts have had a remarkable positive clinical improvement in response to normalization of previously deficient enzymatic activity. The specific indications and methods for transplantation are also included in this article.

Bone marrow transplantation as effective treatment of central nervous system disease in globoid cell leukodystrophy, metachromatic leukodystrophy, adrenoleukodystrophy, mannosidosis, fucosidosis, aspartylglucosaminuria, Hurler, Maroteaux-Lamy, and Sly syndromes, and Gaucher disease type III.

Over 400 patients with lysosomal and peroxisomal storage diseases have received hematopoietic stem cell transplantation from normal donors. Without treatment, all of these diseases have an inexorable fate leading to central nervous system deterioration and early death. On the other hand, all of the engrafted hosts have had a remarkable positive clinical improvement in response to normalization of previously deficient enzymatic activity. Survival data for those engrafted indicates continued life-span as long as two decades beyond transplantation. The particular diseases treated in this way are included in this article. The specific indications and methods for transplantation are also included in this article.