1
|
Ayub N, Braat AJAT, Timmers HJLM, Lam MGEH, van Leeuwaarde RS. Challenges in Von Hippel-Lindau's disease: PRRT in patients on hemodialysis. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0195. [PMID: 35319492 PMCID: PMC9002207 DOI: 10.1530/edm-21-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/08/2022] Open
Abstract
Summary Von Hippel-Lindau's disease (VHL) is a hereditary tumor syndrome characterized by its prototype lesions, hemangioblastomas, and renal cell carcinomas. Treatment for renal cell carcinomas can ultimately result in long-term dialysis. Pancreatic neuroendocrine tumors (pNET) can also occur in the course of the disease. Currently, peptide receptor radionuclide therapy (PRRT) is the standard treatment for progressive neuroendocrine tumors. However, little is known about treatment with PRRT in patients on dialysis, an infrequent presentation in patients with VHL. We present a 72-year-old man with VHL on hemodialysis and a progressive pNET. He received four cycles of PRRT with a reduced dose. Only mild thrombopenia was seen during treatments. The patient died 9 months after the last PRRT because of acute bleeding in a hemangioblastoma. Hemodialysis is not a limiting factor for PRRT treatment and it should be considered as it seems a safe short-term treatment option for this specific group. Learning points Von Hippel-Lindau disease (VHL) is a complex disease in which former interventions can limit optimal treatment for following VHL-related tumors later in life. Metastasized pancreatic neuroendocrine tumors occur as part of VHL disease. Peptide receptor radionuclide therapy seems a safe short-term treatment option in patients on hemodialysis.
Collapse
Affiliation(s)
- N Ayub
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H J L M Timmers
- Departments of Endocrinology and Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Kartsios C, Lokare A, Osman H, Perrin D, Razaq S, Ayub N, Daddar B, Fair S. Diagnosis, management, and outcomes of venous thromboembolism in COVID-19 positive patients: a role for direct anticoagulants? J Thromb Thrombolysis 2021; 51:947-952. [PMID: 32910408 PMCID: PMC7481340 DOI: 10.1007/s11239-020-02257-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of thromboembolic complications due to systemic coagulation activation. Little is known about the role of direct anticoagulants (DOACs) in COVID-19 related thrombosis. In this audit we sought to distinguish COVID-19 hospitalised patients with a diagnosis of venous thromboembolism (VTE) and record their outcomes over a period of 3 months (01/02/2020–30/04/2020). A total of 1583 patients were diagnosed with laboratory proven COVID-19 disease. Amongst them, 38 patients (0.82%) suffered VTE (median age 68 years, male/female: 20/18). VTE was the presenting symptom on admission in 71%. Pulmonary embolism was diagnosed in 92% of patients; 5 patients required intensive care and 3 underwent thrombolysis. 27 patients received initial treatment with unfractionated heparin/low molecular weight heparin (LMWH) while 10 were treated with direct anticoagulants (DOACs). After a median follow up of 25 days, 29 (76%) patients were alive while 5 were still hospitalised. Most patients (83%) were discharged on DOACs, no VTE recurrence or bleeding was recorded post-discharge. Our results suggest that direct anticoagulants could be a safe and effective treatment option in selected COVID-19 positive patients who have suffered venous thromboembolism.
Collapse
Affiliation(s)
- Charalampos Kartsios
- Department of Haematology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK.
| | - Anand Lokare
- Department of Haematology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Husam Osman
- Department of Virology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Damian Perrin
- Department of Acute Medicine, Good Hope Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Shahzad Razaq
- Department of Pharmacy, University Hospitals Birmingham, Birmingham, UK
| | - Namrah Ayub
- Department of Pharmacy, University Hospitals Birmingham, Birmingham, UK
| | - Bobby Daddar
- Department of Pharmacy, University Hospitals Birmingham, Birmingham, UK
| | - Susan Fair
- Department of Acute Medicine, Good Hope Hospital, University Hospitals Birmingham, Birmingham, UK
| |
Collapse
|
3
|
Sokolov E, Abdoul Bachir DH, Sakadi F, Williams J, Vogel AC, Schaekermann M, Tassiou N, Bah AK, Khatri V, Hotan GC, Ayub N, Leung E, Fantaneanu TA, Patel A, Vyas M, Milligan T, Villamar MF, Hoch D, Purves S, Esmaeili B, Stanley M, Lehn-Schioler T, Tellez-Zenteno J, Gonzalez-Giraldo E, Tolokh I, Heidarian L, Worden L, Jadeja N, Fridinger S, Lee L, Law E, Fodé Abass C, Mateen FJ. Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea. Eur J Neurol 2020; 27:1570-1577. [PMID: 32359218 DOI: 10.1111/ene.14291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Epilepsy is most common in lower-income settings where access to electroencephalography (EEG) is generally poor. A low-cost tablet-based EEG device may be valuable, but the quality and reproducibility of the EEG output are not established. METHODS Tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEG twice (EEG1 and EEG2), separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology as to data quality and clinical utility. RESULTS There were 149 participants (41% female; median age 17.9 years; 66.6% ≤21 years of age; mean seizures per month 5.7 ± SD 15.5). The mean duration of EEG1 was 53 ± 12.3 min and that of EEG2 was 29.6 ± 12.8 min. The mean quality scores of EEG1 and EEG2 were 6.4 [range, 1 (low) to 10 (high); both medians 7.0]. A total of 44 (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.8%) had EDs at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. A total of 39 (26.2%) were recommended for neuroimaging after EEG1 and 22 (14.8%) after EEG2. Of participants without EDs at EEG1 (n = 53, 55.8%), seven (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n = 23, 24.2%), 12 (52.1%) did not have EDs at EEG2. CONCLUSIONS Tablet-based EEG had a reproducible quality level on repeat testing and was useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.
Collapse
Affiliation(s)
- E Sokolov
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - F Sakadi
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - J Williams
- Department of Neurology, Mater Misericordiae University Hospital and Dublin Neurological Institute, Dublin, Ireland
| | - A C Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - N Tassiou
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - A K Bah
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - V Khatri
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - G C Hotan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Boston, MA, USA
| | - N Ayub
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - E Leung
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, USA.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, USA
| | - T A Fantaneanu
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - A Patel
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - M Vyas
- Division of Neurology, University of Toronto, Toronto, ON, USA
| | - T Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M F Villamar
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - D Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Purves
- University of British Columbia, Vancouver, BC, Canada
| | - B Esmaeili
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M Stanley
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - J Tellez-Zenteno
- University of Saskatchewan College of Medicine, Saskatoon, SK, Canada
| | | | - I Tolokh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - L Worden
- Children's Hospital of Philadelphia, PA, USA
| | - N Jadeja
- University of Massachusetts School of Medicine, Boston, MA, USA
| | - S Fridinger
- Children's Hospital of Philadelphia, PA, USA
| | - L Lee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Law
- University of Waterloo, Waterloo, ON, Canada
| | - C Fodé Abass
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - F J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Russell RK, Wilson ML, Loganathan S, Bourke B, Kiparissi F, Mahdi G, Torrente F, Rodrigues A, Davies I, Thomas A, Akobeng AK, Fagbemi A, Hyer W, Spray C, Vaish S, Rogers P, McGrogan P, Heuschkel RB, Ayub N, Fell JM, Afzal NA, Green M, Murphy MS, Rao P, Shah N, Ho GT, Naik S, Wilson DC. A British Society of Paediatric Gastroenterology, Hepatology and Nutrition survey of the effectiveness and safety of adalimumab in children with inflammatory bowel disease. Aliment Pharmacol Ther 2011; 33:946-53. [PMID: 21342211 DOI: 10.1111/j.1365-2036.2011.04603.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adalimumab is efficacious therapy for adults with Crohn's disease (CD). AIM To summarise the United Kingdom and Republic of Ireland paediatric adalimumab experience. METHODS British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) members with Inflammatory Bowel Disease (IBD) patients <18 years old commencing adalimumab with at least 4 weeks follow-up. Patient demographics and details of treatment were then collected. Response and remission was assessed using the Paediatric Crohn's Disease Activity Index (PCDAI)/Physicians Global Assessment (PGA). RESULTS Seventy-two patients [70 CD, 1 ulcerative colitis (UC), 1 IBD unclassified (IBDU)] from 19 paediatric-centres received adalimumab at a median age of 14.8 (IQR 3.1, range 6.1-17.8) years; 66/70 CD (94%) had previously received infliximab. A dose of 80 mg then 40 mg was used for induction in 41(59%) and 40 mg fortnightly for maintenance in 61 (90%). Remission rates were 24%, 58% and 41% at 1, 6 and 12 months, respectively. Overall 43 (61%) went into remission at some point, with 24 (35%) requiring escalation of therapy. Remission rates were higher in those on concomitant immunosuppression cf. those not on immunosuppression [34/46 (74%) vs. 9/24 (37%), respectively, (χ(2) 8.8, P=0.003)]. There were 15 adverse events (21%) including four (6%) serious adverse events with two sepsis related deaths in patients who were also on immunosuppression and home parenteral nutrition (3% mortality rate). CONCLUSIONS Adalimumab is useful in treatment of refractory paediatric patients with a remission rate of 61%. This treatment benefit should be balanced against side effects, including in this study a 3% mortality rate.
Collapse
|