Browsing by Issue Date, starting with "2020-01"
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- SAPHO: Has the Time Come for Tailored Therapy?Publication . Figueiredo, AS; Oliveira, AL; Caetano, A; Moraes-Fontes, MFSAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome is a heterogeneous condition combining osteoarticular and cutaneous manifestations. Conventional treatments are mostly ineffective. We hereby report two patients, the first with an aggressive form of disease and the second with an incomplete response to two different anti-TNF-α agents. Both were successfully treated with tocilizumab and ustekinumab, respectively, over a long period of time. A narrative review of a biological therapy in SAPHO syndrome yielded very little information on the specific use of these agents. We highlight the advantages of personalising therapy and describe emerging promising treatments for this disease.
- Delayed-Interval Delivery in Dichorionic Twin Pregnancies: A Case Report of 154 Latency DaysPublication . Soares de Frias, C; Queirós, A; Simões, HTPremature delivery often complicates multifetal pregnancies, placing neonates at risk of serious morbidity and mortality. In select cases, preterm birth of one sibling may not require delivery of the remaining fetus(es), which may remain in utero for a delayed-interval delivery, consequently improving neonatal morbidity and mortality. Currently, there is no consensus on the best protocol for the optimal management of these cases. We report one case of delayed-interval delivery of a dichorionic pregnancy assisted in our center. In this case, prophylactic cerclage, tocolytic therapy and administration of broad-spectrum prophylactic antibiotics enabled delivery at 37 weeks, corresponding to 154 days of latency, which is, to our knowledge, the longest interval described in the literature. The attempt to defer the delivery of the second fetus in peri-viability is an option that should be offered to parents after counseling, providing that the clinical criteria of eligibility are fulfilled. The correct selection of candidates, combined with the correct performance of procedures, as well as fetal and maternal monitoring and early identification of complications increase the probability of success of this type of delivery.
- Labyrinthine Enhancement on 3D Black Blood MR Images of the Brain As an Imaging Biomarker for Cisplatin Ototoxicity in (Lung) Cancer PatientsPublication . Veiga, M; Kuhweide, R; Demaerel, V; De Pauw, R; De Foer, B; Casselman, JPurpose: Cancer patients treated with platinum-based chemotherapy can present with ototoxicity symptoms. The purpose of this work is to report the imaging features related to cisplatin ototoxicity. Methods: Between December 2015 and March 2019, a cohort of 96 consecutive patients with lung cancer was selected. Only patients who received cisplatin chemotherapy and underwent an imaging protocol consisting of a Gd-enhanced 3D-BB and 3D-T1W sequence, as well as T2W sequence to exclude metastases, were included. Labyrinthine enhancement was assessed, and all findings regarding the auditory and vestibular function were retrieved from the clinical files. Results: Twenty-one patients met the inclusion criteria. The Gd-enhanced 3D-BB images were used to divide them into the labyrinth enhancement group (LEG) and the labyrinth non-enhancement group (LNEG). None of these patients demonstrated enhancing regions on the 3D-T1W images. The labyrinthine fluid remained high on the T2 images in all patients, excluding metastases. The LEG consisted of 6 patients. The cochlea and semicircular canals were the most frequently affected regions. All the LEG patients that presented with hearing loss (4/6) had cochlear enhancement. Patients with normal hearing had no cochlear enhancement. Five patients (5/6) showed vestibular enhancement. Four of these patients had vestibular symptoms. Conclusion: Labyrinthine enhancement as an imaging feature related to cisplatin ototoxicity is unreported. This study demonstrates a correlation between hearing loss and cochlear enhancement and also between vestibular impairment and vestibular/semicircular enhancement on 3D-BB images, which remained invisible on the 3D-T1W images. The labyrinthine enhancement on 3D-BB images in the presence of normal signal intensity of the intralabyrinthine fluid can be used as an imaging biomarker for cisplatin toxicity in daily clinical practice and should not be mistaken for intralabyrinthine metastases.
- The child and adolescent psychiatry: study of training in Europe (CAP-STATE)Publication . Barrett, E; Jacobs, B; Klasen, H; Herguner, S; Agnafors, S; Banjac, V; Bezborodovs, N; Cini, E; Hamann, C; Huscsava, MM; Kostadinova, M; Kramar, Y; Maravic, VM; McGrath, J; Molteni, S; Moron-Nozaleda, MG; Mudra, S; Nikolova, G; Vorkas, KP; Prata, AT; Revet, Al; Joseph, JR; Serbak, R; Tomac, A; Van den Steene, H; Xylouris, G; Zielinska, A; Hebebrand, JThere is great cultural diversity across Europe. This is reflected in the organisation of child and adolescent mental health (CAMH) services and the training of the respective professionals in different countries in Europe. Patients and their parents will want a high quality, knowledgeable, and skillful service from child and adolescent psychiatrists (CAPs) wherever they see them in Europe. A European comparison of training programs allows all stakeholders in different European countries to assess the diversity and to initiate discussions as to the introduction of improvements within national training programs. Major issues to be addressed in comparing child and adolescent psychiatric training programs across Europe include: (1) formal organisation and content of training programs and the relationship to adult psychiatry and paediatrics; (2) flexibility of training, given different trainee interests and that many trainees will have young families; (3) quality of governance of training systems; (4) access to research; and (5) networking. The Child and Adolescent Psychiatry-Study of Training in Europe (CAP-State) is a survey of training for child and adolescent psychiatrists (CAPs) across European countries. It aims to revisit and extend the survey carried out in 2006 by Karabekiroglu and colleagues. The current article is embedded in a special issue of European Child + Adolescent Psychiatry attempting to for the first time address training in CAP at the European and global levels. Structured information was sought from each of 38 European and neighboring countries (subsequently loosely referred to as Europe) and obtained from 31. The information was provided by a senior trainee or recently qualified specialist and their information was checked and supplemented by information from a senior child and adolescent psychiatry trainer. Results showed that there is a very wide range of provision of training in child and adolescent psychiatry in different countries in Europe. There remains very substantial diversity in training across Europe and in the degree to which it is subject to national oversight and governance. Some possible reasons for this variation are discussed and some recommendations made.
- The Child and Adolescent Psychiatry: Study of Training in Europe (CAP-STATE)Publication . Barrett, E; Jacobs, B; Klasen, H; Herguner, S; Agnafors, S; Banjac, V; Bezborodovs, N; Cini, E; Hamann, C; Huscsava, MM; Kostadinova, M; Kramar, Y; Maravic, VM; McGrath, J; Molteni, S; Moron-Nozaleda, MG; Mudra, S; Nikolova, G; Vorkas, KP; Prata, AT; Revet, A; Joseph, JR; Serbak, R; Tomac, A; Van den Steene, H; Xylouris, G; Zielinska, A; Hebebrand, JThere is great cultural diversity across Europe. This is reflected in the organisation of child and adolescent mental health (CAMH) services and the training of the respective professionals in different countries in Europe. Patients and their parents will want a high quality, knowledgeable, and skillful service from child and adolescent psychiatrists (CAPs) wherever they see them in Europe. A European comparison of training programs allows all stakeholders in different European countries to assess the diversity and to initiate discussions as to the introduction of improvements within national training programs. Major issues to be addressed in comparing child and adolescent psychiatric training programs across Europe include: (1) formal organisation and content of training programs and the relationship to adult psychiatry and paediatrics; (2) flexibility of training, given different trainee interests and that many trainees will have young families; (3) quality of governance of training systems; (4) access to research; and (5) networking. The Child and Adolescent Psychiatry-Study of Training in Europe (CAP-State) is a survey of training for child and adolescent psychiatrists (CAPs) across European countries. It aims to revisit and extend the survey carried out in 2006 by Karabekiroglu and colleagues. The current article is embedded in a special issue of European Child + Adolescent Psychiatry attempting to for the first time address training in CAP at the European and global levels. Structured information was sought from each of 38 European and neighboring countries (subsequently loosely referred to as Europe) and obtained from 31. The information was provided by a senior trainee or recently qualified specialist and their information was checked and supplemented by information from a senior child and adolescent psychiatry trainer. Results showed that there is a very wide range of provision of training in child and adolescent psychiatry in different countries in Europe. There remains very substantial diversity in training across Europe and in the degree to which it is subject to national oversight and governance. Some possible reasons for this variation are discussed and some recommendations made.
- Mycobacterium Tuberculosis Prosthesis Joint InfectionPublication . Ribeiro, AF; Inacio Oliveira, M; Jordão, P; Tavares, D; Varandas, L; Gouveia, C
- Current Evidence on the Impact of Medication Optimization or Pharmacological Interventions on Frailty or Aspects of Frailty: a Systematic Review of Randomized Controlled TrialsPublication . Pazan, F; Petrovic, M; Cherubini, A; Onder, G; Cruz-Jentoft, A; Denkinger, M; van der Cammen, T; Stevenson, J; Ibrahim, K; Rajkumar, C; Bakken, M; Baeyens, JP; Crome, P; Frühwald, T; Gallaghar, P; Guðmundsson, A; Knol, W; O’Mahony, D; Pilotto, A; Rönnemaa, E; Serra-Rexach, JA; Soulis, G; van Marum, R; Ziere, G; Mair, A; Burkhardt, H; Neumann-Podczaska, A; Wieczorowska-Tobis, K; Fernandes, MA; Gruner, H; Dallmeier, D; Beuscart, J; van der Velde, N; Wehling, MBackground: Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. Methods: A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019. Results: Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty. Conclusion: So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.