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Hypoglycemia Following Antifungal Tx in Affected person With Kind 1 Diabetes

Posted in News on 8th November 2018
Micafungin is a member of the echinocandin class of antifungal agents

Micafungin is a member of the echinocandin class of antifungal agents

A recent report published in The Journal of Clinical Endocrinology and Metabolism, describes the case of a patient with type 1 diabetes mellitus (T1DM) who developed hypoglycemia following antifungal therapy for a severe infection.

The 29-year-old female patient had a long history of uncontrolled T1DM and was diagnosed with cervical necrotizing fasciitis with mediastinal spread after presenting for evaluation of worsening dysphagia and dyspnea. Several debridement surgeries as well as broad spectrum antibiotics and antifungal therapy were required to treat her. At admission, she had an HbA1c of 13.4%; due to worsening infection, continuous tube feeds, and multiple surgeries, her insulin needs subsequently increased.

To provide broader antimicrobial coverage, micafungin, a member of the echinocandin class of antifungal agents, was initiated. After administration of micafungin, the patient’s insulin requirement dropped to 0 for more than 48 hours. Upon discontinuing micafungin and switching to a different antifungal, her insulin needs increased again.

“This is the first report of decreased insulin requirements in a patient with T1DM correlating with micafungin administration,” noted the authors. While the exact mechanism by which micafungin induces hypoglycemia has yet to be established, they hypothesized that the agent reduces blood glucose levels through inhibition of sodium-glucose transporter-1 (SGLT1) function.

FDA Clears Affected person Controller Platform for Stimwave’s Neuromodulation Machine

Posted in News on 5th November 2018
WaveCrest Mobile allows a patient to use an iPhone, iPod touch, or Apple Watch to adjust their pain relief therapy

WaveCrest Mobile allows a patient to use an iPhone, iPod touch, or Apple Watch to adjust their pain relief therapy

The Food and Drug Administration has cleared the WaveCrest Mobile iOS Platform for patients with Stimwave’s Wireless Freedom Spinal Cord Stimulator (SCS) System, allowing them to control their pain relief therapy through an iPhone or Apple Watch. 

The Stimwave SCS System utilizes a tiny injectable microchip device that sends small pulses of energy to electrodes near surrounding nerves. This elicits a reaction that allows the remapping of specific pain signals, thus resulting in pain relief. The device is implanted under the skin in an outpatient procedure. “The Freedom System not only is the smallest option available for patients eliminating the complexities of an implanted lithium ion battery, but offers a wide variety of advanced programming features that the patient can choose through their mobile device,” said Dr. Ellen Lin, MD, medical director of San Antonio’s Advanced Spine and Pain Center.

The new software enables patients to fine-tune the power level and modify programs that were pre-programmed by their clinician to control pain. 

First-of-its-kind examine to check a personalised vaccine in most cancers affected person

Posted in News on 17th October 2018

Tamara Strauss has been residing with high-grade, stage IV pancreatic neuroendocrine most cancers for greater than three years. Present therapies, though efficient for her, are extremely poisonous. Tamara enrolled in a first-of-its-kind, pilot examine at Moores Most cancers Heart at UC San Diego Well being to check a personalised vaccine utilizing her distinctive most cancers mutations to spice up an anti-tumor immune response.

Led by Stephen Schoenberger, PhD, professor of immunology on the La Jolla Institute for Allergy and Immunology (LJI), and Ezra Cohen, MD, professor of drugs at College of California San Diego College of Medication, scientists and clinicians have developed a know-how that reliably defines the neoantigens — overseas protein fragments acknowledged by the immune system — in a affected person’s most cancers.

With neoantigens recognized, the group can determine peptides — strings of amino acids — that can be utilized to create a vaccine to stimulate a protecting immune system response. Basically, the data in a affected person’s most cancers is used to spice up the immune system to provoke a stronger response from each cytotoxic and “helper” T cells — white blood cells that collaborate to destroy most cancers cells.

“T cells want to acknowledge a most cancers cell as being totally different earlier than they’ll produce a response to destroy a affected person’s tumor,” mentioned Cohen, affiliate director for translational science at Moores Most cancers Heart and an internationally acknowledged physician-scientist who focuses on novel most cancers therapies. “It is a sophisticated course of to harness this energy right into a vaccine. We’re creating an extremely personalised and exact remedy that’s primarily based on what that particular person’s most cancers and immune system are telling us. Every vaccine we develop solely applies to a particular particular person.”

Tamara was chosen as the primary affected person for the trial as a result of, regardless of illness development, her physique stays robust, and is extra prone to reply positively to the experimental immunotherapy remedy.

Tamara’s mother and father, Iris and Matthew Strauss, donated $ 1 million to assist launch the scientific trial, hoping breakthrough remedy may assist sufferers like their daughter beat their illness. The household has already misplaced one daughter to ovarian most cancers.

After sequencing Tamara’s tumor and regular tissue, the group recognized mutations expressed solely by most cancers cells in her physique. Schoenberger and LJI’s Bjoern Peters, PhD, developed a novel algorithm to pick mutations which might be acknowledged by the immune system. This algorithm was deployed to acknowledge the neoantigens that generated the strongest T cell response from Tamara’s tissue samples. These neoantigens had been then offered to Tamara’s personal T cells and cultured over a two-week interval utilizing 50 milliliters of her blood to develop a personalised vaccine.

“It has been invention and new science each step of the way in which. This course of merely hasn’t existed till we tried to construct it right here,” mentioned Schoenberger. “By opening up our eyes and measuring what’s actually occurring with the most cancers cells and the immune system, somewhat than predicting what we hope is there, we may make the transformational step wanted to make this strategy potential.”

Tamara’s vaccine took eight weeks to provide. When it was prepared, Cohen took the vaccine crammed syringe and administered it in Tamara’s higher arm, like a easy flu vaccine. After receiving the injection, Tamara mentioned the liquid felt thick and heat, stinging only a bit greater than a typical vaccine.

The vaccine is a part of a one-two punch. Along with the vaccine, sufferers obtain pembrolizumab (Keytruda), a FDA-approved immune checkpoint blockade inhibitor that blocks irregular interplay between the molecule PD-1 on immune cells and the molecule PD-L1 on most cancers cells, permitting the immune cells to acknowledge and assault tumors. Mixed with the vaccine, the drug ought to unleash the total potential of T cells activated by the vaccine, mentioned Schoenberger.

Through the trial, contributors will return for 2 further vaccine doses and stay on pembrolizumab for as much as two years. Their well being shall be monitored for at least 5 years.

“As a lot I’d like to be cancer-free greater than something, I hope this vaccine really does work due to the immense impression it may make on serving to so many individuals, and easing the ache of what they undergo as a most cancers affected person, can be phenomenal,” mentioned Tamara.

The trial will enroll 10 contributors with strong tumors whose illness has not responded to or has stopped responding to straightforward therapies. Most cancers cells can adapt to remedy and develop into resistant, however inherent within the immune system is a strategy to forestall resistance, mentioned Cohen. The concept is that the vaccine and check-point inhibitor will stimulate the immune response and that the vaccine will assist the immune system to adapt with the most cancers to stop resistance from occurring.

“The at first factor that I need is scientific profit for these sufferers. I need their tumors to both cease rising or begin shrinking,” mentioned Schoenberger. “Scientifically, I need to have the ability to measure that the targets we’re figuring out are related, that we see a rise within the variety of T cells or of their purposeful capability. That can tell us we’re actually on to one thing. After which, I am hoping that we will discover the assets wanted to deal with extra sufferers so we will be sure that this strategy really works.”

Along with the philanthropic present from the Strauss household, preliminary giving from the Immunotherapy Basis created the infrastructure for the trial and funds raised by patient-advocates, Kristin and Wyatt Peabody helped launch the trial.

“Funding science that’s this new, this progressive is difficult, however they acknowledge that this can be a paradigm shift for the way in which we deal with most cancers and the way in which we view most cancers sooner or later,” mentioned Cohen. “If we’ll take the subsequent large step towards curing most cancers, we realized we’ve got to do it on an individualized and personalised strategy as a result of that is what most cancers is. Each particular person’s most cancers is totally different. We have to cease taking sufferers and attempt to match them to medication. We have to begin making medication and becoming them to what we’re seeing biologically in a affected person’s most cancers.”

Supply:

https://ucsdnews.ucsd.edu/pressrelease/is_the_next_big_step_in_cancer_therapy_personalized_vaccines

Affected person Develops Glandular Tularemia After Taking Care of Sick Cat

Posted in News on 12th October 2018

October 11, 2018

A recent case published in the New England Journal of Medicine reports on a patient diagnosed with glandular tularemia, an infection that was likely transmitted by his cat.

The 68-year-old patient reported having a fever for 1 week followed by progressive, painful swelling on the right side of his neck for 2 months. The symptoms had started 2 days after his outdoor cat had died from what was believed to be feline leukemia, however laboratory testing had not been conducted to confirm the diagnosis.

Image courtesy of The New England Journal of Medicine ©2018.

During the physical examination, it was noted that the patient had 3 erythematous, tender lymph nodes. Serologic testing was conducted and revealed the patient was positive for Francisella tularensis, a Gram-negative coccobacillus that is transmitted to humans by infected animals. “Domestic cats can become infected through the consumption of infected prey and can transmit the bacteria to humans,” explained the authors. The patient reported he had been administering medication to his cat at the time of its illness.

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Depending on how the bacteria enter the body, the signs and symptoms of tularemia can vary and illness can range from mild to life-threatening. The most common form of tularemia is ulceroglandular, in which case a skin ulcer appears at the site of bacterial entry. Glandular tularemia is similar to ulceroglandular tularemia but without the presence of an ulcer. Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and ciprofloxacin.

Within 5 days of receiving doxycycline, the patient’s lesions improved; resolution of symptoms occurred within 3 weeks of treatment (the patient was treated for a total of 4 weeks).

For more information visit NEJM.org.

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Abuse of Antidepressant for Weight Loss Results in Seizures in Affected person With Bulimia Nervosa

Posted in News on 4th October 2018

October 03, 2018

Abuse should be considered among eating disorder patients who present with seizures

Abuse should be considered among eating disorder patients who present with seizures

A recently published report in the International Journal of Eating Disorders describes the case of a 22-year old female patient who abused bupropion XR for the purpose of appetite suppression and weight loss.

The patient, who was suffering from bulimia nervosa and complex post-traumatic stress disorder, was admitted to the Jerusalem Mental Health Center for inpatient treatment of abuse of bupropion XR as well as a suicide attempt. Her past medical history was significant for anorexia nervosa, major depression, self-mutilation, multiple suicide attempts, and attention-deficit/hyperactivity disorder. The authors also noted that the patient had a history of abusing several other medications including benzodiazepines, sleeping pills, levothyroxine, and methylphenidate.

According to the authors, the patient obtained prescriptions for bupropion XR from psychiatrists and primary care physicians who were not aware of her past medical history. The patient began taking 300-450mg of bupropion XR daily, which she gradually increased to 1200–1500mg per day. Despite experiencing 2 grand-mal seizures after 6 months of abuse, the patient increased her bupropion dose to as much as 3-4.5g per day. During her most frequent abuse period, the patient reported experiencing headaches, tachycardia, anxiety, and insomnia. 

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Following an attempted suicide 1 year after her bupropion XR abuse began, the patient received treatment for pancreatitis, as well as psychiatric and eating disorder management over a 3 month period. Phenytoin was also prescribed to prevent future seizures. The patient was discharged taking fluoxetine, quetiapine, and phenytoin, and followed-up with a dietitian twice weekly as well as a psychotherapist once weekly. After not taking bupropion XR for nearly 1 year, the patient was readmitted and reported initiating bupropion XR again.

This case report demonstrates that bupropion XR may be an attractive medication for patients interested in losing weight. “Clinicians are reminded to screen for anorexia nervosa and bulimia nervosa histories prior to prescribing this medication, and to consider its abuse among eating disorder patients presenting with seizures,” the authors write. They added, “For patients abusing this medication, motivational interviewing in the context of a strong, ongoing therapeutic relationship might help some abusers achieve sustained periods of abstinence.”

Reference:

Dagan Y, Yager J. Severe bupropion XR abuse in a patient with long‐standing bulimia nervosa and complex PTSD. 2018. Int. Journal of Eating Disorders. doi.org/10.1002/eat.22948

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