Satisfactory Clinical Response Research Articles

Satisfactory Clinical Response to Erlotinib in a Patient Diagnosed with Olmsted Syndrome.

Olmsted syndrome is a rare congenital keratinization disorder characterized by mutilating palmoplantar keratoderma (PPK), often accompanied by flexion deformity, periorificial keratotic plaques, and hair abnormalities. The majority of Olmsted syndrome cases are attributed to mutations in the TRPV3 (Transient receptor potential vanillin 3) gene(1). Herein, we aim to present a sporadic case of Olmsted syndrome with a recurrent c1717G>T p.Gly573Cys variant in the TRPV3 gene, demonstrating clinical improvement with the epidermal growth factor inhibitor Erlotinib.

“Mechanic’s Hand” with Polyarthralgia and Transient Autoimmune Features after COVID Vaccination

Abstract Autoimmune diseases are now well reported with COVID vaccination. Rheumatological, neurological, cardiac, and hematological adverse events are observed globally. Dermatological adverse events are reported in a few cases but dermatological with rheumatological manifestation with reversible autoimmune phenomenon after COVID vaccination is not reported commonly in literature. “Mechanic’s hands” is blackish discoloration of palmar aspects of both hands and knuckles commonly reported in rheumatological autoimmune condition such as dermatomyositis. In this case report, a 28-year-old male presented with polyarthralgia with myalgia and fatigability after 1 month of COVID vaccination. His joint pain symptoms worsened over 4 weeks and developed blackish pigmentation of both hands predominantly involving palms to present as mechanic’s hands. Vasculitis workup was inconclusive and rheumatologic workup documented raised antinuclear antibody titers and rheumatoid factor. We have started him on steroid and hydroxychloroquine and observed satisfactory clinical response with near complete resolution of “mechanic’s hands” in 24 weeks. Mechanic’s hands with rheumatological syndrome which is a rare vaccine-related adverse event, reversible, and easily treatable with routinely available medicines, and importantly it is having excellent prognosis. Mechanic’s hand is first time reported in medical literature after COVID vaccination. Minimal systemic adverse events are known to occur with all viral vector vaccines, but its occurrence is rare and it should not impact on routine vaccinations, as vaccination is a key step in this pandemic to protect humankind.

Sugamadex na reversão da anafilaxia induzida por rocurônio em paciente pediátrico: relato de caso e revisão de literatura

INTRODUCTION: Among neuromuscular blockers (NMB), rocuronium is the most notably cited as a cause of anaphylactic reaction. Rocuronium-induced anaphylaxis is a serious and potentially fatal complication, requiring immediate and effective management. The advent of the specific antagonist, sugammadex, has widely spread its use because it reduces the incidence of residual neuromuscular blockade and is indicated in the protocol for the treatment and reversal of refractory anaphylaxis. This study reports an episode of anaphylaxis induced by rocuronium and successfully reversed after administration of sugammadex. CASE REPORT: A 6-year-old child, weighing 30 kg, scheduled for video-assisted thoracoscopy under general anesthesia presented with tachycardia, severe hypotension, and diffuse skin rash after induction of general anesthesia and administration of rocuronium. All therapeutic measures were immediately taken for the treatment of a severe allergic reaction, however there was no clinical improvement, and the patient progressed to sinus bradycardia. At this point, cardiopulmonary resuscitation maneuvers were initiated, and adrenaline was administered, but without satisfactory clinical response. In this context, the possibility of the causative agent being rocuronium was raised. Sugammadex was administered 16mg/kg, and the patient immediately returned to sinus rhythm and later presented a favorable clinical evolution and no sequelae. DISCUSSION: Sugammadex is a molecule that encapsulates rocuronium and removes it from both plasma and neuromuscular junction, and then excretes it inertly in the urine. Some authors suggest that sugammadex removes rocuronium molecules from the circulation, whether free or IgE-bound. This mechanism is extremely important, especially in grade III and IV anaphylactic reactions, which can lead to death. In view of the scarcity of publications, this report showed the role of sugammadex in the reversal of rocuronium-induced anaphylaxis, refractory to conventional treatment.

“Mechanics hand” as vaccine related adverse event after COVID-19 vaccination

ABSTRACT Autoimmune diseases are now well reported with COVID-19 vaccination. Rheumatological, neurological, cardiac and hematological adverse events are observed globally. Dermatological adverse events are reported in few cases but dermatological with rheumatological manifestation with reversible autoimmune phenomenon after COVID-19 vaccination is not reported commonly in literature. “Mechanics hands” is blackish discoloration of palmar aspects of both hands and knuckles commonly reported in rheumatological autoimmune condition such as dermatomyositis. In this case report, 28-year male, presented with polyarthralgia with myalgia and fatigability after 1 month of COVID-19 vaccination. His joint pain symptoms worsened over 4 weeks and developed blackish pigmentation of both hands predominantly involving palms to present as mechanics hands. Vasculitis works up was inconclusive and rheumatologic workup documented raised antinuclear antibody (ANA) titers and rheumatoid factor. We have started him on steroid and hydroxychloroquine and observed satisfactory clinical response with near complete resolution of “mechanics hands” in 24 weeks. Mechanics hands with rheumatological syndrome which is a rare vaccine related adverse event (VRAE), reversible and easily treatable with routinely available medicines and importantly it is having excellent prognosis. Mechanics hand is first time reported in medical literature after COVID-19 vaccination. Minimal systemic VRAEs are known to occur with all viral vector vaccines, but its occurrence is rare and it should not impact on routine vaccinations; as vaccination is a key step in this pandemic to protect mankind.

Biologic anti-IL17 drugs in erythrodermic psoriasis

BackgroundErythrodermic psoriasis (EP) is a potentially life-threatening disease, and there is currently no consensus regarding its optimal treatment. Biological drugs approved for Psoriasis Vulgaris treatment have been used as alternatives to traditional medications. ObjectiveTo evaluate the clinical response and tolerability of anti-IL17 biologic drugs during a 2-year-follow-up. MethodsThis was a retrospective prospective study. EP cases, defined as >75% body surface area involvement, in patients ≥18 years old treated with anti-IL17 for at least six consecutive months were enrolled and then followed until 104 weeks. Patient characteristics, overall clinical responses, PASI score changes, and adverse events were analyzed. ResultsSixteen patients met the criteria, of which 50% had achieved the PASI 100 response at week 12 and in 93.7% at week 24. In the prospective observation of the cohort, 87.5% were still in remission at week 52 and 81.25% at 104 weeks, without adverse events. The three patients in whom the treatment was interrupted lost efficacy and were switched to other therapies. LimitationsOnly descriptive analysis was conducted due to the limited number of patients. ConclusionsA satisfactory long-term clinical response without adverse effects was observed in this case series, suggesting the interest of anti-IL17 in EP treatment.

Positive Vasoreactivity Testing in Pulmonary Arterial Hypertension: Therapeutic Consequences, Treatment Patterns, and Outcomes in the Modern Management Era.

Among patients with pulmonary arterial hypertension (PAH), acute vasoreactivity testing during right heart catheterization may identify acute vasoresponders, for whom treatment with high-dose calcium channel blockers (CCBs) is recommended. However, long-term outcomes in the current era remain largely unknown. We sought to evaluate the implications of acute vasoreactivity response for long-term response to CCBs and other outcomes. Patients diagnosed with PAH between January 1999 and December 2018 at 15 pulmonary hypertension centers were included and analyzed retrospectively. In accordance with current guidelines, acute vasoreactivity response was defined by a decrease of mean pulmonary artery pressure by ≥10 mm Hg to reach <40 mm Hg, without a decrease in cardiac output. Long-term response to CCBs was defined as alive with unchanged initial CCB therapy with or without other initial PAH therapy and World Health Organization functional class I/II and/or low European Society of Cardiology/European Respiratory Society risk status at 12 months after initiation of CCBs. Patients were followed for up to 5 years; clinical measures, outcome, and subsequent treatment patterns were captured. Of 3702 patients undergoing right heart catheterization for PAH diagnosis, 2051 had idiopathic, heritable, or drug-induced PAH, of whom 1904 (92.8%) underwent acute vasoreactivity testing. A total of 162 patients fulfilled acute vasoreactivity response criteria and received an initial CCB alone (n=123) or in combination with another PAH therapy (n=39). The median follow-up time was 60.0 months (interquartile range, 30.8-60.0), during which overall survival was 86.7%. At 12 months, 53.2% remained on CCB monotherapy, 14.7% on initial CCB plus another initial PAH therapy, and the remaining patients had the CCB withdrawn and/or PAH therapy added. CCB long-term response was found in 54.3% of patients. Five-year survival was 98.5% in long-term responders versus 73.0% in nonresponders. In addition to established vasodilator responder criteria, pulmonary artery compliance at acute vasoreactivity testing, low risk status and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels at early follow-up correlated with long-term response and predicted survival. Our data display heterogeneity within the group of vasoresponders, with a large subset failing to show a sustained satisfactory clinical response to CCBs. This highlights the necessity for comprehensive reassessment during early follow-up. The use of pulmonary artery compliance in addition to current measures may better identify those likely to have a good long-term response.

Management of Acute Organic Change of Character cases by Liaison Psychiatry Unit

IntroductionThe Acute Organic Change of Character (AOCC) is an organic mental disorder subtype in which perception, thought, mood and personality impairment predominate. It consists in a change in the individual’s general behaviour or attitude, which is shown to be closely associated with or caused by an underlying organic process, and which is rapidly resolved when the organic noxious agent is eliminated (Pintor et al. Journal of Psychiatry and Psychiatric Disorders 4 (2020): 354-358).ObjectivesTo describe the importance of taking AOCC diagnosis into consideration and the role of liaison psychiatrists in AOCC management by presenting two AOCC cases admitted to the Hospital Clinic of Barcelona.MethodsWe retrospectively reviewed two AOCC cases in patients followed by our hospital’s liaison psychiatry unit during the summer of 2023. We also searched for previous case reports of AOCC using a PubMed query.ResultsCase 1: A 50-year-old male who suffered a polytrauma with diffuse axonal injury (DAI). His relatives and the referring medical team observed a change in his behaviour consisting in irritability, suspicion, hostility and impatience. No cognitive impairment nor fluctuation in the described symptoms were observed. At the time of discharge character changes were still present due to DAI slow and unpredictable clinical course. Symptomatic treatment with risperidone 6mg/day and quetiapine 100mg/day was administered achieving a satisfactory clinical response.Case 2: A 47-year-old woman with type 2 diabetes who suffered an infectious cellulitis that spread causing sepsis. The patient began to appear disruptive with verbose and tangential speech during her admission. No cognitive impairment nor fluctuation in the described symptoms were observed. Symptomatic treatment with risperidone 10mg/day and olanzapine 5mg/day was administered achieving a satisfactory clinical response. At the time of discharge character changes described before were almost resolved.ConclusionsThe clinical presentation of both cases suggested organic mental disorders in which a change in general behaviour predominates. Liaison psychiatrists play a key role in AOCC management by recognizing the clinical pattern, helping if needed with psychopharmacological treatment and ensuring a good understanding of the disorder both by the referring medical team and the patient’s relatives. To our knowledge, it would be of great importance to achieve a better understanding of this clinical condition which to date we consider to be underdiagnosed.Disclosure of InterestNone Declared

Intrapleural injection of brucea javanica oil emulsion provided a long-term benefits in patient with malignant pleural effusion from pleural mesothelioma: A case report

Malignant pleural mesothelioma (MPM) is a severe form of cancer that originates from mesothelium cells. Around 54–90% of mesotheliomas are associated with pleural effusions. Brucea Javanica Oil Emulsion (BJOE) is the processed oil derived from the seeds of Brucea javanica, which has shown potential as a treatment option for several types of cancer. Here, we present a case study of a MPM patient with malignant pleural effusion who received intrapleural injection of BJOE. The treatment resulted in the complete response of pleural effusion and chest tightness. While the precise mechanisms underlying the therapeutic effects of BJOE for pleural effusion are not yet fully understood, it has demonstrated a satisfactory clinical response without significant adverse effects.

Study of tumor necrosis factor receptor in the inflammatory bowel disease.

Ulcerative colitis (UC) and Crohn's disease (CD) are part of Inflammatory Bowel Diseases (IBD) and have pathophysiological processes such as bowel necrosis and enteric neurons and enteric glial cells. In addition, the main inflammatory mediator is related to the tumor necrosis factor-alpha (TNF-α). TNF-α is a me-diator of the intestinal inflammatory processes, thus being one of the main cytokines involved in the pathogenesis of IBD, however, its levels, when measured, are present in the serum of patients with IBD. In addition, TNF-α plays an important role in promoting inflammation, such as the production of interleukins (IL), for instance IL-1β and IL-6. There are two receptors for TNF as following: The tumor necrosis factor 1 receptor (TNFR1); and the tumor necrosis factor 2 receptor (TNFR2). They are involved in the pathogenesis of IBD and their receptors have been detected in IBD and their expression is correlated with disease activity. The soluble TNF form binds to the TNFR1 receptor with, and its activation results in a signaling cascade effects such as apoptosis, cell proliferation and cytokine secretion. In contrast, the transmembrane TNF form can bind both to TNFR1 and TNFR2. Recent studies have suggested that TNF-α is one of the main pro-inflammatory cytokines involved in the pathogenesis of IBD, since TNF levels are present in the serum of both patients with UC and CD. Intravenous and subcutaneous biologics targeting TNF-α have revolutionized the treatment of IBD, thus becoming the best available agents to induce and maintain IBD remission. The application of antibodies aimed at neutralizing TNF-α in patients with IBD that induce a satisfactory clinical response in up to 60% of patients, and also induced long-term maintenance of disease remission in most patients. It has been suggested that anti-TNF-α agents inactivate the pro-inflammatory cytokine TNF-α by direct neutralization, i.e., resulting in suppression of inflammation. However, anti-TNF-α antibodies perform more complex functions than a simple blockade.

Evaluation of patients treated by telemedicine in the beginning of the COVID-19 pandemic in São Paulo, Brazil: A non-randomized clinical trial preliminary study

We performed a pilot open-label, non-randomized controlled clinical trial in a clinic in São Paulo, Brazil in the beginning of the COVID-19 pandemic.“This medical pilot project was carried out during the pandemic of a new and unknown agent. It was necessary to find a new and safe therapeutic approach for pathogens with high potential for severity and contamination. The repositioning of safe and accessible pre-existing and approved medications and the telemedicine approach improved treated covid patients’ symptoms and reduced the risk of disease transmission. The emergency application of a new medical technology was the major limitation of the study. This innovative care model is a low-cost safe strategy, and we understand that applicability can be expanded to other regions in emergency situations.”The 187 patients of the study (mean age of 37.6 ± 15,6 years) were divided into four groups: (1) asymptomatic, (2) mild symptoms, (3) moderate symptoms and (4) severe symptoms and were followed up for five days. A drug intervention was performed in group 3 and the patients of Group 4 were oriented to seek hospital care. Of all the patients, 23.0% were asymptomatic, 29.4% reported mild symptoms, 43.9% moderate symptoms and 3.7% severe symptoms. Three patients were hospitalized and discharged after recovery. Our results indicate that the use of telemedicine with diagnosis and drug treatment is a safe and effective strategy to reduce overload of health services and the exposure of healthcare providers and the population. The patients that initiated the treatment in the early stages of the disease presented satisfactory clinical response, reducing the need of face-to-face consultations and hospitalizations. The patients who followed the protocol treatment for COVID-19 with hydroxychloroquine and azithromycin for five days presented statistically significant improvement of clinical symptoms when compared to moderate patients who opted for not following the protocol (p < 0.05) and to all no treatment patients (p < 0.001).

Safe shortening of antibiotic treatment duration for complicated Staphylococcus aureus bacteraemia (SAFE trial): protocol for a randomised, controlled, open-label, non-inferiority trial comparing 4 and 6 weeks of antibiotic treatment

IntroductionA major knowledge gap in the treatment of complicated Staphylococcus aureus bacteraemia (SAB) is the optimal duration of antibiotic therapy. Safe shortening of antibiotic therapy has the potential to reduce...

Vulvovaginal erosive lichen planus refractory to topical therapies: What's next? A case report

A 60-year-old woman was referred for progressive and severe vulvovaginal pain characterized by erosions and Wickham's stria for the past 7months. Her condition had not responded to oral fluconazole, topical estrogen cream, and topical clobetasol cream. Vulvar and vaginal biopsies were obtained under general anesthesia to verify the diagnosis of erosive lichen planus given the failed response to ultrapotent topical steroids. Tacrolimus cream was added but not tolerated. Oral and cutaneous lesions of lichen planus also developed. In the absence of evidence-based guidelines, three different systemic treatments were administered sequentially (hydroxychloroquine, mycophenolate, and finally cyclosporin) before a satisfactory, well-tolerated, and sustained clinical response was obtained. Topical betamethasone ointment in a taper was continued to assist in sustaining a vulvovaginal response after cyclosporin was discontinued.

Criptococose cutânea: doença sistêmica ou localizada?

Cutaneous cryptococcosis is a fungal infection that can manifest as localized or disseminated disease in both immunocompetent and immunocompromised patients. The present report describes a case of an 81-year-old man from the rural area of Bahia, with the cutaneous form of the disease. Initially the patient was considered to have primary cryptococcosis and was treated with fluconazole. However, in order to rule out disseminated disease, the patient underwent chest tomography, which showed pulmonary nodules that, associated with positive antigenemia, justified the change to liposomal amphotericin B. There was a satisfactory clinical response with no evident complications related to the treatment, but a late metastatic prostate cancer diagnosis allowed to question the supposed fungal infection spread. The differentiation between localized and disseminated cryptococcosis is difficult, but it is fundamental for the proper direction of treatment.

Monoclonal antibodies in the management of asthma: Dead ends, current status and future perspectives.

Patients with moderate-to-severe asthma may now be treated using a variety of monoclonal antibodies that target key inflammatory cytokines involved in disease pathogenesis. Existing clinical data on anti-IgE, anti-IL-5 and other immunological pathways indicate these therapies to offer reduced exacerbation rates, improved lung function, greater asthma control and better quality of life. However, as several patients still do not achieve satisfactory clinical response with the antibodies available, many more biologics, aiming different immunological pathways, are under evaluation. This review summarizes recent data on existing and potential monoclonal antibodies in asthma. Recent advances have resulted in the registration of a new antibody targeting TSLP (tezepelumab), with others being under development. Some of the researched monoclonal antibodies (e.g. anti-IL-13 tralokinumab and lebrikizumab or anti-IL-17A secukinumab) have shown optimistic results in preliminary research; however, these have been discontinued in asthma clinical research. In addition, as available monoclonal antibody treatments have shown little benefit among patients with T2-low asthma, research continues in this area, with several antibodies in development. This article summarizes the available pre-clinical and clinical data on new and emerging drugs for treating severe asthma, discusses discontinued treatments and outlines future directions in this area.

Electrochemotherapy with bleomycin as an effective local treatment for Kaposi's sarcoma: a case report.

An elderly female patient with a long-standing history of Kaposi's sarcoma of the lower limbs was referred to the Surgical Department after the subsequential failure of multiple lines of systemic chemotherapy. The patient was also complaining of increasing symptoms including intractable pruritus, which negatively impacted her quality of life. She underwent palliative electrochemotherapy with bleomycin (15 g/m 2 ) on the sarcomatous lesions of the left foot and ankle, which lead to complete clinical response and resolution of symptoms; no adverse events were reported. Electrochemotherapy is a valid option in the palliative treatment of Kaposi's sarcoma, as it may lead to satisfactory clinical response and symptom control.

Efficacy of Dupilumab on Different Phenotypes of Adult with Moderate-to-Severe Atopic Dermatitis in Taiwan: A Real-World Study.

To determine phenotype-related dupilumab response in adult patients with atopic dermatitis (AD), this multicenter, retrospective study included 111 adults with moderate-to-severe AD in Taiwan, with median age of 31.5 years (18–87) and 71 (64.0%) males. Patients received dupilumab 300 mg per two to three weeks up to 12 months. We found a significant improvement after 4 and 16 weeks of treatment in all patients for all the assessed scores, including eczema area and severity index (EASI) improvement ≥50% (EASI-50) and 75% (EASI-75), EASI reaching minimal clinically important difference (MCID), and Investigator’s Global Assessment (IGA) improvement ≥2. Importantly, prior to asthma, early AD onset and 3-week drug intervals were significantly associated with a high proportion of EASI-75 at month 12, while prurigo and lichenoid phenotypes were associated with a lower proportion of EASI-75 at month 12. However, the majority of adverse events were mild in severity. In conclusion, our study results identify phenotype-related dupilumab response at month 12 in adults with moderate-to-severe AD, and we suggest that treatment should not be discontinued until reaching a satisfactory clinical response.

Mid-Term and Long-Term Outcomes of Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis.

Peroral endoscopic myotomy (POEM) achieves a satisfactory short-term clinical response in patients with achalasia. However, data on mid- and long-term clinical outcomes are limited. We aimed to assess the mid- and long-term efficacy and safety of POEM in achalasia patients. Using the pre-designed search strategy, we identified relevant studies that evaluated the efficacy and safety of POEM with a minimum of 2-year follow-up in the Embase, Cochrane, and PubMed databases from inception to January 2021. Primary outcome was pooled mid- and long-term clinical success rate based on the Eckardt score. Secondary outcome was pooled long-term reflux-related adverse events. A total of 21 studies involving 2,698 patients were included. Overall, the pooled clinical success rates with 2-, 3-, 4-, and 5-year follow-ups were 91.3% (95% confidence interval [CI] 88.4-93.6%), 90.4% (95% CI 88.1-92.2%), 89.8% (95% CI 83.6-93.9%), and 82.2% (95% CI 76.6-86.7%), respectively. Besides, the pooled long-term clinical success rates for type I, II, and III achalasia were 86.1% (95% CI 80.9-90.1%; I2 = 0%), 87.9% (95% CI 84.2-90.8%; I2 = 48.354%), and 83.9% (95% CI 72.5-91.2%; I2 = 0%), respectively. Moreover, the pooled incidence of symptomatic reflux and reflux esophagitis was 23.9% (95% CI 18.7-29.9%) and 16.7% (95% CI 11.9-23.1%), respectively. POEM is associated with a long-term clinical success of 82.2% after 5years of follow-up. Randomized control trials comparing POEM with laparoscopic Heller myotomy or pneumatic dilation with longer follow-up periods are needed to further demonstrate the long-term safety and efficacy of POEM.

Pulmonary Artery Denervation for Pulmonary Arterial Hypertension: A Sham-Controlled Randomized PADN-CFDA Trial

BackgroundWorld Health Organization (WHO) group 1 pulmonary arterial hypertension (PAH) is a progressive, debilitating disease. Previous observational studies have demonstrated that pulmonary artery denervation (PADN) reduces pulmonary artery pressures in PAH. However, the safety and effectiveness of PADN have not been established in a randomized trial. ObjectivesThe aim of this study was to determine the treatment effects of PADN in patients with group 1 PAH. MethodsPatients with WHO group 1 PAH not taking PAH-specific drugs for at least 30 days were enrolled in a multicenter, sham-controlled, single-blind, randomized trial. Patients were assigned to receive PADN plus a phosphodiesterase-5 inhibitor or a sham procedure plus a phosphodiesterase-5 inhibitor. The primary endpoint was the between-group difference in the change in 6-minute walk distance from baseline to 6 months. ResultsAmong 128 randomized patients, those treated with PADN compared with sham had a greater improvement in 6-minute walk distance from baseline to 6 months (mean adjusted between-group difference 33.8 m; 95% CI: 16.7-50.9 m; P < 0.001). From baseline to 6 months, pulmonary vascular resistance was reduced by −3.0 ± 0.3 WU after PADN and −1.9 ± 0.3 WU after sham (adjusted difference −1.4; 95% CI: −2.6 to −0.2). PADN also improved right ventricular function, reduced tricuspid regurgitation, and decreased N-terminal pro–brain natriuretic peptide. Clinical worsening was less (1.6% vs 13.8%; OR: 0.11; 95% CI: 0.01-0.87), and a satisfactory clinical response was greater (57.1% vs 32.3%; OR: 2.79; 95% CI: 1.37-5.82) with PADN treatment during 6-month follow-up. ConclusionsIn patients with WHO group 1 PAH, PADN improved exercise capacity, hemodynamic status, and clinical outcomes during 6-month follow-up. (Safety and Efficacy of Pulmonary Artery Denervation in Patients With Pulmonary Arterial Hypertension [PADN-CFDA]; NCT03282266)

Endoscopic septum division of tubular esophageal duplication in two children and systematic review

Tubular esophageal duplication is a rare congenital malformation The surgical treatment of this lesion can be challenging. We aimed to present our experience in two cases with tubular esophageal duplication. Both cases were endoscopically treated by a dual knife. The first patient underwent a single, while the second patient required three sessions of endoscopic septum division using an electrosurgical knife. Both showed satisfactory clinical, radiological and endoscopic response to treatment. Moreover, a systematic literature review has been performed. To identify all available studies, a detailed search on tubular esophageal duplication was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Tubular esophageal duplication was reported in 16 pediatric cases in 14 studies in the literature. Surgery was applied to 10 of these cases and endoscopic treatment was applied to two of them. In the follow-up, nine patients who underwent surgical treatment and two patients who underwent endoscopic treatment were uneventful. Tubular esophageal duplications can be successfully treated endoscopically. Endoscopic septum division is a minimally invasive procedure that allows full anatomical recovery and satisfactory therapeutic response.

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AimTo evaluate the sociodemographic and clinical profile of patients with Bipolar affective disorder who received ECT during the period of 2016-2020.MethodologyThe ECT register of the department was used to screen the patients of Bipolar affective disorder who received ECT during the period of 2016 to 2020.Treatment records of patients were reviewed to evaluate the sociodemographic and clinical profile of patients with Bipolar affective disorder who received ECT. During the period of 2016 to 2020, 1187 patients received ECT, out of which 178 (15%) patients were diagnosed with Bipolar affective disorder. Out of 178 patients with Bipolar affective disorder, 113 (63.5%) had Bipolar depression and rest of the patients had manic or mixed episode. Out of 178 patients of Bipolar affective disorder who received ECT, 62 (34.8%) had psychotic symptoms. Majority of patients received 6-10 ECTs and showed satisfactory clinical response, very few patients developed complications.Conclusion:ECT is more often used for bipolar depression than manic episodes. ECT is effective in management of both the acute phases of illness in patients with bipolar disorder.