Clinical medicine & research
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Nearly 6,750,000 people suffer moderate to severe cancer-related pain each year. Unfortunately, 10% to 15% of these patients fail to achieve acceptable pain relief with conventional management. Spinal cord stimulation (SCS) has been used with increased frequency for successful treatment of intractable cancer pain. ⋯ Case 1 reports a 51-year-old male with burning pain at the left groin site of inguinal metastases, post-surgical and intraoperative radiation therapy for treatment of squamous cell carcinoma of the anus. Case 2 reports a 43-year-old woman with intractable, burning, throbbing, and shooting pain, post-debulking followed by radiation of a metastatic colon carcinoma. In both cases SCS implantation provided 90% to 100% pain relief, improved functioning and sleep, and discontinuation of pain medications, sustained through 12 months.
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Voriconazole is a broad-spectrum triazole antifungal agent indicated for invasive aspergillosis, refractory Candida infections, and other emerging invasive fungal infections. Adverse cutaneous reactions associated with voriconazole therapy occur in fewer than 10% of treated patients and range from mild erythematous eruptions to life-threatening reactions such as the Stevens-Johnson syndrome and toxic epidermal necrolysis. Photosensitivity reactions are an uncommon but characteristic dermatitis in voriconazole recipients, particularly following chronic administration. We report a case of voriconazole-induced phototoxicity in a 50-year-old male with Candida parapsilosis endocarditis that reversed on discontinuation of the drug.
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Familial amyloid polyneuropathy (FAP) is rare and most commonly caused by the Val30Met mutation of the transthyretin (TTR) gene. Beside polyneuropathy, other complications due to amyloid deposits occur, but may vary in phenotype. The mutation tends to occur in endemic clusters. ⋯ Nerve biopsy showed amyloid deposits, staining with TTR-antibodies on immunohistochemistry. After DNA-sequencing of the TTR gene, the diagnosis of FAP Val30Met was made. Late-onset FAP Val30Met is a progressive and fatal disorder with varying penetrance, and may occur in non-endemic areas and cases without a family history.
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The use of organophosphorus pesticides results in toxicity risk to non-target organisms. Organophosphorus compounds share a common mode of action, exerting their toxic effects primarily via acetylcholinesterase (AChE) inhibition. Consequently, acetylcholine accumulates in the synaptic clefts of muscles and nerves, leading to overstimulation of cholinergic receptors. ⋯ An oxime HLö-7 seems to be an efficient reactivator of AChE inhibited by any of the four organophosphorus warfare agents. According to the available literature, the oximes LüH-6 and TMB-4, although relatively toxic, are the most potent to induce reactivation of AChE inhibited by the majority of organophosphorus pesticides. Since there are no reports of controlled clinical trials on the use of TMB-4 in human organophosphate pesticide poisoning, LüH-6 may be a better option.
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Multicenter Study Clinical Trial
Innate immunity SNPs are associated with risk for severe sepsis after burn injury.
To analyze allelic association with clinical outcome in a cohort of burn patients. ⋯ Carriage of variant alleles at immune response genes were associated with increased risk for severe sepsis after burn injury.