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Khan MZ, Mahapatra SS, Patel T, Razzaq W, Khawaja UA. Presentation of Dyke-Davidoff-Masson Syndrome in a 32-Year-Old Female: Report of a Rare Case With a Literature Review. Cureus 2023; 15:e41101. [PMID: 37519523 PMCID: PMC10382186 DOI: 10.7759/cureus.41101] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Dyke-Davidoff-Masson syndrome (DDMS) is a rare congenital or acquired neurological disorder that most commonly affects the pediatric population but is also rarely reported in adults. DDMS results from brain injury in the intrauterine or early years of life. It is characterized by prominent cortical sulci, hyperpneumatization of the frontal sinus, unilateral cerebral hemiatrophy with ventricular dilation, and associated bony thickness of the cranial vault. Seizures and asymmetric hemiparesis are the most consistent findings in DDMS with facial asymmetry and mental retardation widely reported. Herein, we report a case of a 32-year-old female patient with DDMS presenting with a history of seizure and right-sided hemiparesis. Neuroimaging findings showed asymmetric cerebral encephalomalacia and gliosis with ex vacuo ventricular dilatation and calvarial diploic space widening. Our case report is unique in the sense that our patient presented with DDMS in adulthood with no signs of mental retardation or history of seizures during childhood and well-controlled seizures on monotherapy. Given the adult presentation of DDMS is unusual and rarely reported in the medical literature, our case report will help physicians to keep DDMS high on differential diagnoses in such cases. Awareness of the clinical features of DDMS on imaging can facilitate a timely and accurate diagnosis, thereby enabling appropriate and prompt management.
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Affiliation(s)
| | | | - Tirath Patel
- Department of Medicine, American University of Antigua, St. John's, ATG
| | - Waleed Razzaq
- Department of Internal Medicine, Services Hospital, Lahore, PAK
| | - Uzzam Ahmed Khawaja
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
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Jogie JA. Acute Upper Respiratory Infection in a Pediatric Patient During the COVID-19 Pandemic: A Case Report. Cureus 2023; 15:e39057. [PMID: 37378231 PMCID: PMC10292066 DOI: 10.7759/cureus.39057] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Upper respiratory infections (URIs) are a frequent presentation of the COVID-19 pandemic, which has had a major detrimental impact on the pediatric population. In this case report, we detail the pandemic-related treatment of a five-year-old patient who had an acute upper respiratory illness. The case report begins with an overview of the COVID-19 pandemic, then discusses the difficulties in identifying and treating pediatric patients with respiratory illnesses in the current setting. In this report, we describe the case of a five-year-old child who originally displayed signs and symptoms of a viral URI that, with further investigation, proved unrelated to COVID-19. Treatment for the patient included symptom control, monitoring, and ultimately recovery. This study stresses the necessity for adequate diagnostic testing, individualized treatment plans, and ongoing surveillance for respiratory infections in pediatric patients during the COVID-19 pandemic.
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Affiliation(s)
- Joshua A Jogie
- Department of Medical Sciences, University of the West Indies, St. Augustine, TTO
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Talvacchio S, Nazari MA, Pacak K. Supportive management of patients with pheochromocytoma/paraganglioma undergoing noninvasive treatment. Curr Opin Endocrinol Diabetes Obes 2022; 29:294-301. [PMID: 35621181 PMCID: PMC9205066 DOI: 10.1097/med.0000000000000724] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Many publications review perioperative management of pheochromocytomas/paragangliomas (PPGLs); however, a large population, including 10-20% of metastatic PPGL patients, have inoperable disease. This has necessitated the development of noninvasive treatments (e.g., radio/chemotherapy), which, in affording disease-modification, have led to an ever-growing population of surviving patients with inoperable PPGL. These patients experience debilitating symptoms arising from discomforts related to the masses themselves (e.g., pain from osseous metastasis) and symptoms from tumoral catecholamine production and release. Unfortunately, management of these conditions is not yet well-defined. Adding further insult-to-injury, these noninvasive treatments can trigger catecholamine release, worsening catecholamine-induced symptoms. Herein, we detail these ailments and their management, especially while patients receive these noninvasive treatments. RECENT FINDINGS Improved diagnostic evaluations have allowed for earlier detection of PPGL, prolonging survival in patients with inoperable PPGLs. Accordingly, noninvasive treatment strategies have rapidly evolved alongside state-of- the-art theranostics and genetic testing, which inform ongoing management and therapeutic response. SUMMARY While treatments afford improved survival, there must be a corresponding attention to quality-of-life. This is ensured by employing supportive management, which mitigates debilitating symptoms. This is best accomplished with a multidisciplinary approach and familiarity with genetic and biochemical determinants which guide patient education and management.
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Affiliation(s)
- Sara Talvacchio
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Matthew A. Nazari
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
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Ning N, Weng R, Zhang C, Wen L, Wang H, Ye J, Li J, Chen X, Cai Y. Cluster analysis for symptomatic management of Neisseria gonorrhoea and Chlamydia trachomatis in sexually transmitted infections related clinics in China. Front Public Health 2022; 10:1005481. [PMID: 36466460 PMCID: PMC9714346 DOI: 10.3389/fpubh.2022.1005481] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to perform a cluster analysis of symptoms linked with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and to identify which cluster of symptoms was associated with a higher risk of NG and CT. STUDY DESIGN From 15 April to 16 May 2018, a cross-sectional study was conducted, and patients attending sexually transmitted infections (STI) related clinics were recruited from 22 medical institutions in six districts of Shenzhen city. METHODS A structured questionnaire was used to collect social-demographic information as well as STI symptoms, and urine samples were collected for nucleic acid detection. Cluster analysis and logistic regression were applied. RESULTS Among 8,207 participants, the prevalence of CT and NG infection was 9.04% (742/8,207) and 2.36% (194/8,207), respectively. Among male outpatients, four clusters with distinct symptomatic patterns were identified. Unmarried, having casual sexual partners in the past 6 months, cluster 2 (OR = 6.70, 95% CI = 3.36-13.35) and cluster 4 (OR = 24.53, 95% CI = 12.96-46.44) were risk factors associated with NG infection. Unmarried, cluster 2 (OR = 2.54, 95% CI = 1.83-3.53) and cluster 4 (OR = 3.31, 95% CI = 2.37-4.61) were risk factors associated with CT infection. Among female outpatients, five clusters with distinct symptomatic patterns were identified. Aged 24 years or below and cluster 3 (OR = 3.68, 95% CI = 1.61-8.39) were risk factors associated with NG infection. Aged 24 years or below, unmarried, having a high school/secondary technical school education, and having junior high school or below education were risk factors associated with CT infection. CONCLUSION The cluster of symptoms integrated into risk assessment for CT and NG infections suggests a new strategy of symptomatic management. Healthcare providers in STI clinics and resource-limited places may use this strategy to identify more potential patients and deliver adequate, acceptable, and equitable STI care for outpatients with a high risk of STI.
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Affiliation(s)
- Ning Ning
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
- Shantou University Medical College, Shantou University, Shantou, China
| | - Rongxing Weng
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Chunlai Zhang
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Lizhang Wen
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Honglin Wang
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jianbin Ye
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jing Li
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Xiangsheng Chen
- Chinese Academy of Medical Sciences, Institute of Dermatology, Peking Union Medical College, Nanjing, China
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, China
| | - Yumao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
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Hautbergue GM, Cleary JD, Guo S, Ranum LPW. Therapeutic strategies for C9orf72 amyotrophic lateral sclerosis and frontotemporal dementia. Curr Opin Neurol 2021; 34:748-55. [PMID: 34392299 DOI: 10.1097/WCO.0000000000000984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW An intronic G4C2 expansion mutation in C9orf72 is the most common genetic cause of amyotrophic lateral sclerosis and frontotemporal dementia (C9-ALS/FTD). Although there are currently no treatments for this insidious, fatal disease, intense research has led to promising therapeutic strategies, which will be discussed here. RECENT FINDINGS Therapeutic strategies for C9-ALS/FTD have primarily focused on reducing the toxic effects of mutant expansion RNAs or the dipeptide repeat proteins (DPRs). The pathogenic effects of G4C2 expansion transcripts have been targeted using approaches aimed at promoting their degradation, inhibiting nuclear export or silencing transcription. Other promising strategies include immunotherapy to reduce the DPRs themselves, reducing RAN translation, removing the repeats using DNA or RNA editing and manipulation of downstream disease-altered stress granule pathways. Finally, understanding the molecular triggers that lead to pheno-conversion may lead to opportunities that can delay symptomatic disease onset. SUMMARY A large body of evidence implicates RAN-translated DPRs as a main driver of C9-ALS/FTD. Promising therapeutic strategies for these devastating diseases are being rapidly developed with several approaches already in or approaching clinical trials.
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Nicholson K, Murphy A, McDonnell E, Shapiro J, Simpson E, Glass J, Mitsumoto H, Forshew D, Miller R, Atassi N. Improving symptom management for people with amyotrophic lateral sclerosis. Muscle Nerve 2017; 57:20-24. [PMID: 28561886 DOI: 10.1002/mus.25712] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 07/19/2016] [Revised: 05/02/2017] [Accepted: 05/27/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Symptomatic management is the main focus of ALS clinical care. We aim to report the prevalence of ALS-related symptoms and characterize self-reported symptomatic management. METHODS A symptom management survey developed by the Muscular Dystrophy Association Clinical Research Network was completed by ALS registrants. Logistic regression identified potential predictors of symptom prevalence, severity, and treatment. RESULTS A total of 567 ALS participants reported fatigue (90%), muscle stiffness (84%), and muscle cramps (74%) as most prevalent symptoms. Fatigue (18%), muscle stiffness (14%), and shortness of breath (12%) were most bothersome. Although fatigue was the most prevalent symptom, it was also least treated (10%). Neither location of care nor disease duration was associated with symptom prevalence, severity, or probability of receiving treatment. DISCUSSION This large patient-reported symptom survey suggests that fatigue is the most prevalent, bothersome, and undertreated ALS symptom. Improving ALS symptom management is an unmet medical need and clinical trials of symptomatic treatments are needed. Muscle Nerve 57: 20-24, 2018.
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Affiliation(s)
- Katharine Nicholson
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA
| | - Alyssa Murphy
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA
| | - Erin McDonnell
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, USA
| | - Jordan Shapiro
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
| | - Ericka Simpson
- Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Jonathan Glass
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, Eleanor and Lou Gehrig MDA/ALS Research Center, Columbia University Medical Center, New York, New York, USA
| | - Dallas Forshew
- Department of Neurology, Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, San Francisco, California, USA
| | - Robert Miller
- Department of Neurology, Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, San Francisco, California, USA
| | - Nazem Atassi
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA
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Abstract
Frontotemporal lobar degeneration (FTLD) is a neurodegenerative disease that affects frontal and temporal regions of the brain. Two proteins indicated in the pathology are tau and the recently discovered TDP-43. Major manifestations include progressive aphasia and a disorder of social comportment. The diagnosis of a patient includes a detailed cognitive exam, clinical testing, and neuroimaging techniques. The current goal of therapy for FTLD is symptomatic management with medications borrowed from other conditions. Nonpharmacologic management such as behavioral interventions and environmental engineering are also efficacious in optimizing quality of life.
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Affiliation(s)
- Lauren Massimo
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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