1
|
Nirmal C, Jayarajah U, Wijesinghe H, Fernandopulle N, Subasinghe D. Atypical hepatic metastases of pancreatic adenocarcinoma unveiled through persistent and unresolved pyrexia: Case report. SAGE Open Med Case Rep 2024; 12:2050313X241264952. [PMID: 39071196 PMCID: PMC11282560 DOI: 10.1177/2050313x241264952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024] Open
Abstract
Diagnosing neoplastic fever requires excluding identifiable causes, making it a diagnostic challenge. Fever as a primary manifestation of pancreatic adenocarcinoma is uncommon with few cases reported in the literature. Here we present an unusual case of metastatic pancreatic adenocarcinoma primarily manifesting as pyrexia of unknown origin. A 63-year-old Sri Lankan male, a non-smoker who was diagnosed with diabetes, hypertension and dyslipidaemia presented with a history of fever, anorexia and weight loss for 2 months. Despite the completion of treatment for positive serology for paratyphi, his symptoms and inflammatory markers remained elevated while the rest of the infectious screening was negative. On further evaluation, the patient was found to have a hypodense distal pancreas with ring-enhancing multiple liver lesions on imaging. Histology confirmed pancreatic adenocarcinoma with liver metastasis. Atypical liver metastases may present with evidence of ring enhancement in computed tomography imaging; thus, the biopsy is mandatory for diagnosis and decision-making. Usually, tumours of the pancreatic tail are resectable but if they are associated with liver metastatic disease, surgical resection is not recommended because it is not potentially curative. Therefore, in the context of metastatic pancreatic adenocarcinoma, palliative chemotherapy and pharmacological management of fever are required.
Collapse
Affiliation(s)
- Chamod Nirmal
- University Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Umesh Jayarajah
- University Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Harshima Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nilesh Fernandopulle
- University Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Duminda Subasinghe
- University Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
2
|
Kang S, Zheng R. Distribution of the causes of fever of unknown origin in China, 2013-2022. J Transl Int Med 2024; 12:299-307. [PMID: 39081273 PMCID: PMC11284625 DOI: 10.2478/jtim-2024-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Background and Objectives Fever of unknown origin (FUO) has long been a cause for concern among clinicians, and its spectrum has evolved with progress in medicine. This study aimed to investigate the distribution of causes of FUO in China between 2013 and 2022 to facilitate the clinical understanding of the etiology of FUO. Materials and Methods Case series of FUO in China published between 2013 and 2022 were retrieved from PubMed, Wanfang Data, and CNKI databases and retrospectively analyzed. The rates of different causes of FUO were calculated, and these data were compared with previously published distributions of causes of FUO in China. Results The causes of FUO with the highest rates from the 51 identified case series (n = 19,874) were infectious, autoimmune, and neoplastic diseases (59.6%, 14.3%, and 7.9%, respectively). A comparison of a subset (43 case series subdivided by disease category, n = 16,278) with previously reported data revealed an increased rate of FUO attributed to infectious diseases in the past decade, with a significantly higher rate attributed to bloodstream infections (10.0% vs. 4.8%) and a significantly lower rate attributed to tuberculosis (9.3% vs. 28.4%), compared with the rates from the previous period. In contrast, the rates of FUO attributed to both autoimmune and neoplastic diseases decreased, with significantly decreased rates attributed to adult-onset Still's disease among autoimmune diseases (4.6% vs. 8.5%) and lung cancer among neoplastic diseases (0.6% vs. 1.6%). Conclusion Despite an overall increase in the rate attributed to infectious diseases, that attributed to tuberculosis has decreased. The rates attributed to both autoimmune and neoplastic diseases have also decreased.
Collapse
Affiliation(s)
- Sihan Kang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Rui Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| |
Collapse
|
3
|
Bu Z, Xu Y, Zhou X, Wang X, Liu S, Wang L, Yang B, Zhou X, Lu G, Liu J, Liu Z. Exploring the therapeutic potential of "Xiaochaihu Decoction": a systematic review and meta-analysis on the clinical effectiveness and safety in managing cancer-related fever. Front Pharmacol 2024; 15:1359866. [PMID: 38803432 PMCID: PMC11128760 DOI: 10.3389/fphar.2024.1359866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Objective: This study aimed to conduct the first meta-analysis to comprehensively evaluate the clinical effectiveness and safety of Xiaochaihu Decoction in treating Cancer-related Fever (CRF). Methods: Eight databases were systematically searched in September 2023. The risk of bias (ROB) 2.0 tool recommended by Cochrane Handbook was applied to evaluate the ROB of the included randomized controlled trials (RCTs). Additionally, the quality of evidence was assessed using the Grading of recommendations assessment, development and evaluation (GRADE) tool. Results: We included 18 RCTs involving 1,424 patients. Compared to Western medicine or Xinhuang Tablets, Xiaochaihu Decoction significantly improved clinical effectiveness in CRF patients (risk ratio [RR] = 1.24, 95% confidence interval [CI]: 1.17, 1.32) and expedited the normalization of body temperature (mean difference [MD] = -5.29, 95%CI: -5.59, -4.99). It also demonstrated a reduction in tumor necrosis factor-α (TNF-α) levels (MD = -0.63, 95%CI: -0.84, -0.41) and an increase in IL-2 levels (MD = 1.42, 95%CI: -1.09, 1.74). Analysis of Karnofsky Performance Status (KPS) scores showed that the use of Xiaochaihu Decoction improved the quality of life in CRF patients (RR = 1.57, 95%CI: 1.11, 2.22) and reduced the incidence of adverse events. However, it is important to note that the majority of included studies showed "some concerns" in risk of bias based on ROB 2.0, and the evidence quality assessed by GRADE method was rated as "low". Conclusion: While this study suggests the clinical effectiveness and safety of Xiaochaihu Decoction in treating patients with CRF, confirming these findings will necessitate additional high-quality, large-scale RCTs in future research. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023484068.
Collapse
Affiliation(s)
- Zhijun Bu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yaoyu Xu
- The First Clinical College, Hubei University of Traditional Chinese Medicine, Wuhan, China
| | - Xian Zhou
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Xuefeng Wang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shuyuan Liu
- School of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Linyan Wang
- School of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Bei Yang
- Acupuncture and Bone Injury College, Hubei University of Traditional Chinese Medicine, Wuhan, China
| | - Xiaodie Zhou
- The First Clinical College, Hubei University of Traditional Chinese Medicine, Wuhan, China
| | - Guanhang Lu
- School of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhaolan Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
4
|
Ghaffari K, Falahati V, Motallebirad T, Safarabadi M, Tashakor AH, Azadi D. Microbiological and Molecular Study of Paranasal Sinus Infections of Children with Malignancy and Unknown Origin Fever in Markazi Province, Iran. CURRENT THERAPEUTIC RESEARCH 2024; 100:100745. [PMID: 38617893 PMCID: PMC11015527 DOI: 10.1016/j.curtheres.2024.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/13/2024] [Indexed: 04/16/2024]
Abstract
Background Children with malignancies are vulnerable to various infections, including sinus infections. Sinusitis is primarily caused by bacterial infections, followed by fungal infections. Due to this, evaluating the occurrence, diversity, and antibiotic susceptibility patterns of bacterial species that cause paranasal sinus infections in children with malignancy and unexplained fever is important. Objective To investigate the bacterial species accountable for sinusitis in children with malignancy and unexplained fever, and determine their susceptibility to antibiotics. Methods The study involved collecting 90 sinus samples from children aged 5 to 15 years with malignancy in Arak City, Iran. The isolates were identified using a combination of phenotypic, biochemical, and molecular techniques, including specific polymerase chain reaction and 16S ribosomal RNA gene sequencing. Drug susceptibility testing was performed following the Clinical & Laboratory Standards Institute 2021 guidelines. Results A total of 36 isolates (40%) were obtained, including 4 isolates of Nocardia (11.12%), 4 isolates of Escherichia coli (11.12%), 3 isolates of Klebsiella pneumoniae (8.33%), 5 isolates of Pseudomonas aeruginosa (13.88%), 3 isolates of Acinetobacter baumannii (8.33%), 4 isolates of Staphylococcus aureus (11.12%), 3 isolates of Staphylococcus epidermidis (8.33%), 5 isolates of Streptococcus agalactiae (13.88%), 2 isolates of Streptococcus pneumoniae (5.55%), and 3 isolates of Enterococcus faecium (8.33%). The isolates showed the most sensitivity to imipenem and trimethoprim-sulfamethoxazole and the least sensitivity to erythromycin and tetracycline. Conclusions The findings of the study indicate that sinusitis can contribute to fever of unknown origin in patients with cancer. Therefore, it is recommended to use a combination of molecular and phenotypic methods for accurate identification of isolates. This approach can provide more reliable and precise results, leading to better diagnosis and treatment of sinusitis infections in children with malignancy.
Collapse
Affiliation(s)
- Kazem Ghaffari
- Department of Basic Sciences, Khomein University of Medical Sciences, Khomein, Iran
- Student Research Comittee, Khomein University Of Medical Sciences, Khomein, Iran
| | - Vahid Falahati
- Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
| | - Tahereh Motallebirad
- Department of Basic Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Mahdi Safarabadi
- Department of Nursing, Khomein University of Medical Sciences, Khomein, Iran
| | - Amir Hossein Tashakor
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Azadi
- Department of Basic Sciences, Khomein University of Medical Sciences, Khomein, Iran
| |
Collapse
|
5
|
Cajanding RJM. Current State of Knowledge on the Definition, Pathophysiology, Etiology, Outcomes, and Management of Fever in the Intensive Care Unit. AACN Adv Crit Care 2023; 34:297-310. [PMID: 38033217 DOI: 10.4037/aacnacc2023314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Fever-an elevated body temperature-is a prominent feature of a wide range of disease conditions and is a common finding in intensive care, affecting up to 70% of patients in the intensive care unit (ICU). The causes of fever in the ICU are multifactorial, and it can be due to a number of infective and noninfective etiologies. The production of fever represents a complex physiological, adaptive host response that is beneficial for host defense and survival but can be maladaptive and harmful if left unabated. Despite any cause, fever is associated with a wide range of cellular, local, and systemic effects, including multiorgan dysfunction, systemic inflammation, poor neurological recovery, and an increased risk of mortality. This narrative review presents the current state-of-the-art knowledge on the definition, pathophysiology, etiology, and outcomes of fever in the ICU and highlights evidence-based findings regarding the management of fever in the intensive care setting.
Collapse
Affiliation(s)
- Ruff Joseph Macale Cajanding
- Ruff Joseph Macale Cajanding is a Critical Care Senior Charge Nurse, Adult Critical Care Unit, St Bartholomew's Hospital, Barts Health NHS Trust, King George V Building, West Smithfield EC1A 7BE London, United Kingdom
| |
Collapse
|
6
|
Escobar Gil T, Echavarria Cross A, Valencia Barrera S, Bustamante Omaña A. Cardiac Myxomas As Chameleons: A Scoping Review of Their Paraneoplastic Presentations. Cureus 2023; 15:e37558. [PMID: 37197119 PMCID: PMC10184748 DOI: 10.7759/cureus.37558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
This scoping review aims to explore the relationship between cardiac myxomas (CMs) and paraneoplastic syndromes (PS). CMs are the most common tumors in the heart, with the majority located in the left atrium, and are often associated with a triad of obstructive, embolic, and constitutional symptoms. However, they can also present with unrelated symptoms that are part of a PS. This study performed a thorough literature search of 11 databases and included 12 papers in the final review. All of the patients were diagnosed with atrial myxoma, which initially presented as a PS. Surgery was the curative measure in all cases and resulted in remission in every case, with patients reporting resolution of symptoms at follow-up. The majority of patients in the study were female, with comorbid rheumatologic conditions often present. This study highlights the heterogeneity of presentations of CMs and their associated PS.
Collapse
Affiliation(s)
- Tomas Escobar Gil
- Internal Medicine, The University of New Mexico School of Medicine, Albuquerque, USA
| | | | | | | |
Collapse
|
7
|
Muacevic A, Adler JR. Fever of Unknown Origin and Atrial Fibrillation: A Case Report. Cureus 2022; 14:e32472. [PMID: 36644072 PMCID: PMC9835392 DOI: 10.7759/cureus.32472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Fever of unknown origin describes a temperature greater than 100.9°F which is present on multiple instances for a period over three weeks with no confirmed diagnosis despite a minimum of three outpatient visits, three days of inpatient testing, or one week of extensive outpatient testing. This diagnosis presents challenges in clinical management due to the unknown etiology. This case highlights a fever of unknown origin presenting with new-onset atrial fibrillation in a patient with no previous cardiac history. A 62-year-old Caucasian male presented to the ED with a nine-day history of intermittent fevers and chills. He returned from a rafting trip in North Carolina two weeks ago but reported no tick bites, animal encounters, or river water ingestion. Further evaluation was significant for an elevated white blood cell count and elevated inflammatory markers. Laboratory and radiologic testing for a wide array of infectious and malignant etiologies were unremarkable. Soon after hospital presentation, he developed a fever of 102.9°F with new onset palpitations and chest tightness due to atrial fibrillation. Episodes of atrial fibrillation continued for his seven-day hospital course with more severe symptoms in the evenings. He was administered broad-spectrum antibiotics and tested extensively with no definitive etiology. His fever curve downtrended with max temperatures below 100.9°F on hospital days six and seven with asymptomatic episodes of atrial fibrillation, prompting discharge. He continued to have low-grade fevers measured below 100.9°F for several days post-discharge with no associated symptoms, resulting in a diagnosis of fever of unknown origin following the 21st day. Fever of unknown origin is a clinical challenge, particularly in cases with no diagnosis discovered and cases with potentially life-threatening complications such as atrial fibrillation. This patient had multiple potential etiologies for his condition, but none had sufficient evidence for diagnosis, resulting in uncertainty regarding the ideal management. As a result, constant monitoring with supportive treatments and broad-spectrum antibiotics was utilized. These measures allowed for symptom remission and hospital discharge for outpatient follow-up. This case highlights a rare presentation of fever of unknown origin with new-onset atrial fibrillation in an otherwise healthy adult.
Collapse
|
8
|
Isaza E, Huppert LA, Lai AR, Brondfield S. Tumor Fever Due to Metastatic Esophageal Squamous Cell Carcinoma. Am J Med 2022; 135:e294-e295. [PMID: 35367183 DOI: 10.1016/j.amjmed.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Andrew R Lai
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Sam Brondfield
- Division of Hematology/Oncology, Department of Medicine.
| |
Collapse
|
9
|
Abstract
RATIONALE Cancer is a well-recognized cause of fever, which is related to cytokines produced by malignant cells. Prostate cancer presenting with fever and other inflammatory markers as a paraneoplastic syndrome rarely occurs. PATIENTS CONCERNS AND DIAGNOSES We describe the case of high fever and lower-urinary tract symptoms that progressed 1 month prior to presentation. A 78-year-old man had been diagnosed with prostate cancer 8 months ago. He received androgen deprivation therapy with leuprolide acetate 22.5 mg for every 3 months. Castration-resistant prostate cancer was diagnosed due to elevated prostate specific antigen (1639 ng/mL) and cancer fever. INTERVENTION The patient received docetaxel-based systemic chemotherapy 50 mg/mm2 biweekly. Naproxen 500 mg was administered twice a day. OUTCOMES After one cycle of systemic chemotherapy, the patient had no major side effects, no more fever was observed, and the systemic condition improved. CONCLUSION Differentiating cancer-related fever from infection-related fever is important for appropriate patient management. In this case, fever appeared as the first symptom of castration-resistant prostate cancer and was managed by naproxen and resolved with systemic chemotherapy.
Collapse
Affiliation(s)
- Tae Hoon Oh
- Department of Urology, Wonkwang University Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Seung Chol Park
- Department of Urology, Wonkwang University Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
- *Correspondence: Seung Chol Park, Department of Urology, Wonkwang University Hospital, 895 Muwang-Ro, Iksan 54538, Korea (e-mail: )
| |
Collapse
|
10
|
Fever as an evolutionary agent to select immune complexes interfaces. Immunogenetics 2022; 74:465-474. [PMID: 35545703 PMCID: PMC9094598 DOI: 10.1007/s00251-022-01263-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
We herein analyzed all available protein–protein interfaces of the immune complexes from the Protein Data Bank whose antigens belong to pathogens or cancers that are modulated by fever in mammalian hosts. We also included, for comparison, protein interfaces from immune complexes that are not significantly modulated by the fever response. We highlight the distribution of amino acids at these viral, bacterial, protozoan and cancer epitopes, and at their corresponding paratopes that belong strictly to monoclonal antibodies. We identify the “hotspots”, i.e. residues that are highly connected at such interfaces, and assess the structural, kinetic and thermodynamic parameters responsible for complex formation. We argue for an evolutionary pressure for the types of residues at these protein interfaces that may explain the role of fever as a selective force for optimizing antibody binding to antigens.
Collapse
|
11
|
Wei P, Gao Y, Zhang J, Lin J, Liu H, Chen K, Lin W, Wang X, Wang C, Liu C. Diagnosis of lung squamous cell carcinoma based on metagenomic Next-Generation Sequencing. BMC Pulm Med 2022; 22:108. [PMID: 35346137 PMCID: PMC8958490 DOI: 10.1186/s12890-022-01894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The clinical treatment of patients suspected of pulmonary infections often rely on empirical antibiotics. However, preliminary diagnoses were based on clinical manifestations and conventional microbiological tests, which could later be proved wrong. In this case, we presented a patient whose initial diagnosis was lung abscess, but antibiotic treatments had no effect, and metagenomic Next-Generation Sequencing (mNGS) indicated presence of neoplasm.
Case presentation A 62-year-old female was diagnosed with lung abscess at three different health facilities. However, mNGS of bronchoalveolar lavage fluid did not support pulmonary infections. Rather, the copy number variation analysis using host DNA sequences suggested neoplasm. Using H&E staining and immunohistochemistry of lung biopsy, the patient was eventually diagnosed with lung squamous cell carcinoma. Conclusions mNGS not only detects pathogens and helps diagnose infectious diseases, but also has potential in detecting neoplasm via host chromosomal copy number analysis. This might be beneficial for febrile patients with unknown or complex etiology, especially when infectious diseases were initially suspected but empirical antibiotic regimen failed.
Collapse
Affiliation(s)
- Ping Wei
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.,The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China
| | - Yang Gao
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jing Zhang
- The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China
| | - Jianlong Lin
- The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China
| | - Huibin Liu
- The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China
| | - Keqiang Chen
- The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China
| | - Weikai Lin
- The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China
| | - Xiaojia Wang
- Hangzhou Matridx Biotechnology Co., Ltd, Bd 2-4, 2073 Jinchang Rd, Hangzhou, 311100, Zhejiang, China
| | - Chune Wang
- The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350003, Fujian, China. .,Director of Respiratory Department, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350108, Fujian, China.
| | - Chao Liu
- Hangzhou Matridx Biotechnology Co., Ltd, Bd 2-4, 2073 Jinchang Rd, Hangzhou, 311100, Zhejiang, China. .,Director of Medical Department, Hangzhou Matridx Biotechnology Co., Ltd, Hangzhou, 311100, China.
| |
Collapse
|
12
|
Khanna P, Malluru N, Pyada R, Gupta M, Akkihal K, Varkey TC. Fever of Unknown Origin: The Workup and Diagnosis of Pel-Ebstein Fever. Cureus 2022; 14:e21959. [PMID: 35282507 PMCID: PMC8903813 DOI: 10.7759/cureus.21959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/06/2022] Open
Abstract
The clinical and diagnostic workup of fever of unknown origin (FUO) is key in the treatment of patients on the internal medicine service. In this article, the authors present a case of fever of unknown origin, walk through the differential diagnosis, explain the laboratory testing ordered in the workup of the patient as well as the resulting values of said testing, and discuss the pathophysiology and diagnostic criteria for the diagnosis of Pel-Ebstein fever. The authors also discuss a clinical pearl when working with electronic health records to ensure that the needs of the patient in question are met.
Collapse
|
13
|
Prommee N, Itharat A, Thisayakorn K, Sukkasem K, Inprasit J, Tasanarong A, Löbenberg R, Somayaji V, Davies NM, Ooraikul B. Investigations of the antipyretic effect and safety of Prasachandaeng, a traditional remedy from Thailand national list of essential medicines. Biomed Pharmacother 2022; 147:112673. [PMID: 35123231 DOI: 10.1016/j.biopha.2022.112673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/02/2022] Open
Abstract
Prasachandaeng (PSD) remedy from the Thailand National List of Essential Medicines (NLEM) has been used as an antipyretic for chronic fever in both adults and children for centuries. Its therapeutic effect in treating fever and its safety have not been studied in animal models. We evaluated its antipyretic activity on lipopolysaccharide (LPS)-induced fever and safety in the liver in comparison with acetaminophen (ACP). Correlation between biochemistry of liver function and the level of cytochrome P450 (CYP2E1) was also evaluated using an ELISA kit. All doses of PSD powder (PSDP) and a 95% ethanol extract of PSD (PSDE) (50, 200, and 400 mg/kg) showed a significant antipyretic effect (* p < 0.05) as compared to ACP. We investigated clinical biochemistry of liver and kidney functions, histopathology, and concentrations of CYP2E1. All treatment groups demonstrated a normal range of clinical biochemistry of liver and kidney functions in comparison with ACP on days 1, 3, 7, and 10. Serum AST, ALP, and LDH levels of PSDE and PSDP showed mean values less than that of ACP on the corresponding days (* p < 0.05). None of the treatment groups showed evidence of hepatocellular damage, nor did they affect CYPE21. The results of histopathology on liver tissue correlated with the biochemistry of liver functions which indicated no hepatotoxicity effect in liver tissue during the seven day treatment. These findings suggest that both forms of PSD remedy possessed marked antipyretic activity and were not hepatotoxic during the seven days of administration in rats.
Collapse
Affiliation(s)
- Nuntika Prommee
- Department of Applied Thai Traditional Medicine and Center of Excellence in Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University (Rangsit campus), Klong Luang, Pathum Thani 12120, Thailand.
| | - Arunporn Itharat
- Department of Applied Thai Traditional Medicine and Center of Excellence in Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University (Rangsit campus), Klong Luang, Pathum Thani 12120, Thailand.
| | - Krittiya Thisayakorn
- Researcher, Department of Pharmaceuticals and Natural Products, Thailand Institute of Scientific and Technology Research (TISTR), Techno Polis, Pathum Thani 12120, Thailand.
| | - Kanmanee Sukkasem
- Department of Applied Thai Traditional Medicine and Center of Excellence in Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University (Rangsit campus), Klong Luang, Pathum Thani 12120, Thailand.
| | - Janjira Inprasit
- Department of Applied Thai Traditional Medicine and Center of Excellence in Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University (Rangsit campus), Klong Luang, Pathum Thani 12120, Thailand.
| | - Adis Tasanarong
- Chulabhorn International College of Medicine, Thammasat University (Rangsit Campus), Klong Luang, Pathum Thani 12120, Thailand; Nephrology Unit, Faculty of Medicine, Thammasat University, Thammasat University (Rangsit Campus), Klong Luang, Pathum Thani 12120, Thailand.
| | - Raimar Löbenberg
- Faculty of Pharmacy and Pharmaceutical Sciences, Katz Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - Vijay Somayaji
- Faculty of Pharmacy and Pharmaceutical Sciences, Katz Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - Neal M Davies
- Faculty of Pharmacy and Pharmaceutical Sciences, Katz Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - Buncha Ooraikul
- Professor Emeritus, Department of Agricultural food and Nutritional Science, Faculty of Agricultural Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
14
|
Griffin CP, Paul CL, Alexander KL, Walker MM, Hondermarck H, Lynam J. Postmortem brain donations vs premortem surgical resections for glioblastoma research: viewing the matter as a whole. Neurooncol Adv 2022; 4:vdab168. [PMID: 35047819 PMCID: PMC8760897 DOI: 10.1093/noajnl/vdab168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There have been limited improvements in diagnosis, treatment, and outcomes of primary brain cancers, including glioblastoma, over the past 10 years. This is largely attributable to persistent deficits in understanding brain tumor biology and pathogenesis due to a lack of high-quality biological research specimens. Traditional, premortem, surgical biopsy samples do not allow full characterization of the spatial and temporal heterogeneity of glioblastoma, nor capture end-stage disease to allow full evaluation of the evolutionary and mutational processes that lead to treatment resistance and recurrence. Furthermore, the necessity of ensuring sufficient viable tissue is available for histopathological diagnosis, while minimizing surgically induced functional deficit, leaves minimal tissue for research purposes and results in formalin fixation of most surgical specimens. Postmortem brain donation programs are rapidly gaining support due to their unique ability to address the limitations associated with surgical tissue sampling. Collecting, processing, and preserving tissue samples intended solely for research provides both a spatial and temporal view of tumor heterogeneity as well as the opportunity to fully characterize end-stage disease from histological and molecular standpoints. This review explores the limitations of traditional sample collection and the opportunities afforded by postmortem brain donations for future neurobiological cancer research.
Collapse
Affiliation(s)
- Cassandra P Griffin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Biobank: NSW Regional Biospecimen and Research Services, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, New South Wales, Australia
- Priority Research Centre Health Behaviour, University of Newcastle, New South Wales, Australia
| | - Kimberley L Alexander
- Neurosurgery Department, Chris O’Brien Lifehouse, Camperdown, New South Wales, Australia
- Brainstorm Brain Cancer Research, Brain and Mind Centre, The University of Sydney, New South Wales, Australia
- Neuropathology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Hubert Hondermarck
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - James Lynam
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, New South Wales, Australia
| |
Collapse
|
15
|
Teng TZJ, Chua BQY, Shelat VG. Carcinosarcoma of gallbladder: A world review. World J Clin Oncol 2021; 12:1244-1263. [PMID: 35070742 PMCID: PMC8716988 DOI: 10.5306/wjco.v12.i12.1244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/14/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallbladder carcinosarcoma is a rare hepatobiliary tumor comprising of both carcinomatous and sarcomatous components. Due to its rarity, the literature with regards to the topic is scarce and currently lacking, spanning less than 100 cases.
AIM To summarize the current literature on gallbladder carcinosarcoma.
METHODS A literature review was performed on the PubMed database using the keywords “Gallbladder” AND “Carcinosarcoma” from 1970 to 2021. Additionally, similar searches were performed on MEDLINE and Web of Science.
RESULTS Risk factors noted include female gender, gallstones and chronic cholecystitis. In the absence of any diagnostic biochemical testing or tumor markers, imaging modality serves as the key initial impression tool, which can be histologically confirmed only post-resection. While surgery is the only curative option, the use of adjunctive chemotherapy has been considered on top of excision in recent years, with some success.
CONCLUSION While this study has taken steps to bridge the gap in the literature, more cases should be reported to further ascertain the current associations and management potential for gallbladder carcinosarcoma.
Collapse
Affiliation(s)
- Thomas Zheng Jie Teng
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Branden Qi Yu Chua
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| |
Collapse
|
16
|
Lee S, Heo J. COVID-19 pandemic: a new cause of unplanned interruption of radiotherapy in breast cancer patients. Med Oncol 2021; 39:5. [PMID: 34739633 PMCID: PMC8569493 DOI: 10.1007/s12032-021-01604-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/27/2021] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients undergoing radiotherapy by comparing the patterns of unplanned radiotherapy interruption before and after the COVID-19 pandemic. We enrolled patients who received their first dose of radiotherapy for breast cancer between January 28 and July 31, 2019 and between January 28, 2020, and July 31, 2020. We compared the radiotherapy interruption patterns in 2019 with those in 2020 to analyze the impact of the COVID-19 pandemic on treatment interruption. Between January 28 and July 31, 2019, 287 patients with breast cancer received radiotherapy. Among them, 19 patients (6.6%) experienced treatment interruption; the reasons for treatment interruption were radiotherapy-related side effects (10 patients, 52.6%), other medical reasons (three patients, 15.8%), and personal reasons (six patients, 31.6%). Between January 28 and July 31, 2020, 279 patients with breast cancer received radiotherapy. Among them, 23 patients (8.2%) experienced treatment interruption; the reasons for treatment interruption were radiotherapy-related side effects (eight patients, 35%) and COVID-19 screening clinic-related reasons (six patients, 26.1%). Among the six patients with screening clinic-related causes of radiotherapy interruption, five had asymptomatic fever and one had mild cold-like symptoms. The duration of treatment interruption was longer in patients with screening clinic-related interruptions than in those with interruptions because of other causes (p = 0.019). Multivariate analysis showed that cancer stage and radiotherapy volume did not significantly affect treatment interruption. The radiotherapy of certain patients was suspended despite the lack of a confirmed COVID-19 diagnosis. Precise and systematic criteria for the management of patients with suspected COVID-19 are needed, and the opinion of radiation oncologist in charge of the patient must also be considered.
Collapse
Affiliation(s)
- Shiho Lee
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
| |
Collapse
|
17
|
Lee IH, Koh SA, Lee SJ, Lee SA, Cho YY, Lee JY, Kim JY. Treatment decision for cancer patients with fever during the coronavirus disease 2019 (COVID-19) pandemic. Yeungnam Univ J Med 2021; 38:344-349. [PMID: 34420277 PMCID: PMC8688784 DOI: 10.12701/yujm.2021.01144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background Cancer patients have been disproportionally affected by the coronavirus disease 2019 (COVID-19) pandemic, with high rates of severe outcomes and mortality. Fever is the most common symptom in COVID-19 patients. During the COVID-19 pandemic, physicians may have difficulty in determining the cause of fever (COVID-19, another infection, or cancer fever) in cancer patients. Furthermore, there are no specific guidelines for managing cancer patients with fever during the COVID-19 pandemic. Thus, this study evaluated the clinical characteristics and outcomes of cancer patients with fever during the COVID-19 pandemic. Methods This study retrospectively reviewed the medical records of 328 cancer patients with COVID-19 symptoms (fever) admitted to five hospitals in Daegu, Korea from January to October 2020. We obtained data on demographics, clinical manifestations, laboratory test results, chest computed tomography images, cancer history, cancer treatment, and outcomes of all enrolled patients from electronic medical records. Results The most common COVID-19-like symptoms were fever (n=256, 78%). Among 256 patients with fever, only three (1.2%) were diagnosed with COVID-19. Most patients (253, 98.8%) with fever were not diagnosed with COVID-19. The most common solid malignancies were lung cancer (65, 19.8%) and hepatobiliary cancer (61, 18.6%). Twenty patients with fever experienced a delay in receiving cancer treatment. Eighteen patients discontinued active cancer treatment because of fever. Major events during the treatment delay period included death (2.7%), cancer progression (1.5%), and major organ dysfunction (2.7%). Conclusion Considering that only 0.9% of patients tested for COVID-19 were positive, screening for COVID-19 in cancer patients with fever should be based on the physician’s clinical decision, and patients might not be routinely tested.
Collapse
Affiliation(s)
- In Hee Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sung Ae Koh
- Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Soo Jung Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sun Ah Lee
- Department of Oncology/Hematology, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon Young Cho
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Shcool of Medicine, Daegu, Korea
| | - Ji Yeon Lee
- Department of Infectious Diseases, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin Young Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| |
Collapse
|
18
|
Aermes C, Hayn A, Fischer T, Mierke CT. Cell mechanical properties of human breast carcinoma cells depend on temperature. Sci Rep 2021; 11:10771. [PMID: 34031462 PMCID: PMC8144563 DOI: 10.1038/s41598-021-90173-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/30/2021] [Indexed: 12/21/2022] Open
Abstract
The knowledge of cell mechanics is required to understand cellular processes and functions, such as the movement of cells, and the development of tissue engineering in cancer therapy. Cell mechanical properties depend on a variety of factors, such as cellular environments, and may also rely on external factors, such as the ambient temperature. The impact of temperature on cell mechanics is not clearly understood. To explore the effect of temperature on cell mechanics, we employed magnetic tweezers to apply a force of 1 nN to 4.5 µm superparamagnetic beads. The beads were coated with fibronectin and coupled to human epithelial breast cancer cells, in particular MCF-7 and MDA-MB-231 cells. Cells were measured in a temperature range between 25 and 45 °C. The creep response of both cell types followed a weak power law. At all temperatures, the MDA-MB-231 cells were pronouncedly softer compared to the MCF-7 cells, whereas their fluidity was increased. However, with increasing temperature, the cells became significantly softer and more fluid. Since mechanical properties are manifested in the cell's cytoskeletal structure and the paramagnetic beads are coupled through cell surface receptors linked to cytoskeletal structures, such as actin and myosin filaments as well as microtubules, the cells were probed with pharmacological drugs impacting the actin filament polymerization, such as Latrunculin A, the myosin filaments, such as Blebbistatin, and the microtubules, such as Demecolcine, during the magnetic tweezer measurements in the specific temperature range. Irrespective of pharmacological interventions, the creep response of cells followed a weak power law at all temperatures. Inhibition of the actin polymerization resulted in increased softness in both cell types and decreased fluidity exclusively in MDA-MB-231 cells. Blebbistatin had an effect on the compliance of MDA-MB-231 cells at lower temperatures, which was minor on the compliance MCF-7 cells. Microtubule inhibition affected the fluidity of MCF-7 cells but did not have a significant effect on the compliance of MCF-7 and MDA-MB-231 cells. In summary, with increasing temperature, the cells became significant softer with specific differences between the investigated drugs and cell lines.
Collapse
Affiliation(s)
- Christian Aermes
- Biological Physics Division, Faculty of Physics and Earth Science, Peter Debye Institute of Soft Matter Physics, University of Leipzig, Linnéstr. 5, 04103, Leipzig, Germany
| | - Alexander Hayn
- Biological Physics Division, Faculty of Physics and Earth Science, Peter Debye Institute of Soft Matter Physics, University of Leipzig, Linnéstr. 5, 04103, Leipzig, Germany
| | - Tony Fischer
- Biological Physics Division, Faculty of Physics and Earth Science, Peter Debye Institute of Soft Matter Physics, University of Leipzig, Linnéstr. 5, 04103, Leipzig, Germany
| | - Claudia Tanja Mierke
- Biological Physics Division, Faculty of Physics and Earth Science, Peter Debye Institute of Soft Matter Physics, University of Leipzig, Linnéstr. 5, 04103, Leipzig, Germany.
| |
Collapse
|
19
|
Zandstra J, Jongerius I, Kuijpers TW. Future Biomarkers for Infection and Inflammation in Febrile Children. Front Immunol 2021; 12:631308. [PMID: 34079538 PMCID: PMC8165271 DOI: 10.3389/fimmu.2021.631308] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/12/2021] [Indexed: 01/08/2023] Open
Abstract
Febrile patients, suffering from an infection, inflammatory disease or autoimmunity may present with similar or overlapping clinical symptoms, which makes early diagnosis difficult. Therefore, biomarkers are needed to help physicians form a correct diagnosis and initiate the right treatment to improve patient outcomes following first presentation or admittance to hospital. Here, we review the landscape of novel biomarkers and approaches of biomarker discovery. We first discuss the use of current plasma parameters and whole blood biomarkers, including results obtained by RNA profiling and mass spectrometry, to discriminate between bacterial and viral infections. Next we expand upon the use of biomarkers to distinguish between infectious and non-infectious disease. Finally, we discuss the strengths as well as the potential pitfalls of current developments. We conclude that the use of combination tests, using either protein markers or transcriptomic analysis, have advanced considerably and should be further explored to improve current diagnostics regarding febrile infections and inflammation. If proven effective when combined, these biomarker signatures will greatly accelerate early and tailored treatment decisions.
Collapse
Affiliation(s)
- Judith Zandstra
- Division Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Ilse Jongerius
- Division Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
- Division Research and Landsteiner Laboratory, Department of Blood Cell Research, Sanquin Blood Supply, Amsterdam UMC, Amsterdam, Netherlands
| |
Collapse
|
20
|
Aladily TN, Khader M, Bustami N, Samara OA. Papillary thyroid carcinoma in a 5-year old child, mimicking lymphoma in presentation. Avicenna J Med 2021; 11:103-106. [PMID: 33996648 PMCID: PMC8101645 DOI: 10.4103/ajm.ajm_288_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thyroid cancer is very rare in children and papillary thyroid carcinoma (PTC) represents the most common type. Patients are frequently in the second decade of life and complain of painless enlargement of the gland. Pediatric PTC has unique clinicopathologic characteristics that make it different from the adult counterpart. The biologic behavior tends to be aggressive and patients frequently present with advanced disease. Herein, we report a case with an unusual presentation. A 5-year-old child manifested with fever, night sweats, cervical lymphadenopathy, and weight loss for 2 months. He also complained of mild cough and shortness of breath. Clinical suspicion of tuberculosis or lymphoma was raised, but laboratory workup was unremarkable. Cervical lymph node excision was done, and the histopathologic examination showed metastatic PTC. The patient underwent surgical and radioactive therapy and remained in complete remission for 5 years. Unfortunately, the disease ultimately relapsed with disseminated metastasis and the patient passed away.
Collapse
Affiliation(s)
- Tariq N Aladily
- Department of Pathology, The University of Jordan, Amman, Jordan
| | - Majd Khader
- Department of Pathology, The University of Jordan, Amman, Jordan
| | - Nadwa Bustami
- Department of Pathology, The University of Jordan, Amman, Jordan
| | - Osama A Samara
- Department of Radiology and Nuclear Medicine, The University of Jordan, Amman, Jordan
| |
Collapse
|
21
|
Chen HMN, Morris M, Manders PM. Cabozantinib as the causative agent of high-grade fever in a patient with a background of metastatic clear cell renal cell carcinoma: a case report. J Med Case Rep 2020; 14:225. [PMID: 33213524 PMCID: PMC7678049 DOI: 10.1186/s13256-020-02560-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fever, as an adverse event, is well documented in a wide array of drugs including multiple tyrosine kinase inhibitors however, it is not a previously well described consequence of the novel multi-targeted tyrosine kinase inhibitor, cabozantinib. Case presentation In this paper we document the first detailed review of high-grade fevers in a 54 year old male (Caucasian) with a background of metastatic clear cell renal cell carcinoma recently commenced on cabozantinib. After detailed investigation, we exclude infection and other common causes of fever as the causative agent and further, definitively resolve the recurrent fever by ceasing cabozantinib and starting a short course of oral corticosteroids. Conclusions We have demonstrated that cabozantinib should always be considered in the aetiology of high-grade fever in relevant patients. Further, we demonstrate that temporary cessation of cabozantinib and a course of short-term steroids can induce resolution of fever and allow for recommencement of cabozantinib safely thereafter.
Collapse
Affiliation(s)
- H M N Chen
- Sunshine Coast University Hospital, 6 Doherty St, Birtinya, 4575, Australia
| | - M Morris
- Sunshine Coast University Hospital, 6 Doherty St, Birtinya, 4575, Australia
| | - P M Manders
- Sunshine Coast University Hospital, 6 Doherty St, Birtinya, 4575, Australia. .,Griffith University, Sunshine Coast Health Institute, 6 Doherty St, Birtinya, 4575, Australia.
| |
Collapse
|
22
|
Cortés-Hernández LE, Eslami-S Z, Dujon AM, Giraudeau M, Ujvari B, Thomas F, Alix-Panabières C. Do malignant cells sleep at night? Genome Biol 2020; 21:276. [PMID: 33183336 PMCID: PMC7659113 DOI: 10.1186/s13059-020-02179-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022] Open
Abstract
Biological rhythms regulate the biology of most, if not all living creatures, from whole organisms to their constitutive cells, their microbiota, and also parasites. Here, we present the hypothesis that internal and external ecological variations induced by biological cycles also influence or are exploited by cancer cells, especially by circulating tumor cells, the key players in the metastatic cascade. We then discuss the possible clinical implications of the effect of biological cycles on cancer progression, and how they could be exploited to improve and standardize methods used in the liquid biopsy field.
Collapse
Affiliation(s)
| | - Zahra Eslami-S
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, Montpellier, France
| | - Antoine M Dujon
- CREEC (CREES), Unité Mixte de Recherches, IRD 224-CNRS 5290-Université de Montpellier, Montpellier, France
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Victoria, Australia
| | - Mathieu Giraudeau
- CREEC (CREES), Unité Mixte de Recherches, IRD 224-CNRS 5290-Université de Montpellier, Montpellier, France
| | - Beata Ujvari
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Victoria, Australia
- School of Natural Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Frédéric Thomas
- CREEC (CREES), Unité Mixte de Recherches, IRD 224-CNRS 5290-Université de Montpellier, Montpellier, France
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, Montpellier, France.
- CREEC (CREES), Unité Mixte de Recherches, IRD 224-CNRS 5290-Université de Montpellier, Montpellier, France.
- Institut Universitaire de Recherche Clinique (IURC), 641, avenue du Doyen Gaston Giraud, 34093, Montpellier Cedex 5, France.
| |
Collapse
|
23
|
Depetri F, Tarsia P, Donato MF, Invernizzi F, Cugno M. A 5-month history of fever and dry cough in a 67-year-old man. Intern Emerg Med 2020; 15:1057-1060. [PMID: 31214884 DOI: 10.1007/s11739-019-02132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Federica Depetri
- Medicina Interna, Dipartimento Di Fisiopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milano, Italy
| | - Paolo Tarsia
- Dipartimento Di Pneumologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milano, Italy
| | - Maria Francesca Donato
- Unità Di Epatologia Dei Trapianti, Divisione Di Gastroenterologia Ed Epatologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milano, Italy
- Centro Per Lo Studio Delle Malattie del Fegato "A. M. E A. Migliavacca", Università Degli Studi Di Milano, Milano, Italy
| | - Federica Invernizzi
- Unità Di Epatologia Dei Trapianti, Divisione Di Gastroenterologia Ed Epatologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milano, Italy
- Centro Per Lo Studio Delle Malattie del Fegato "A. M. E A. Migliavacca", Università Degli Studi Di Milano, Milano, Italy
| | - Massimo Cugno
- Medicina Interna, Dipartimento Di Fisiopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milano, Italy.
| |
Collapse
|
24
|
Zhang H, Wu Y, Lin Z, Zhong X, Liu T, Huang Z, Yang Y. Naproxen for the treatment of neoplastic fever: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15840. [PMID: 31145329 PMCID: PMC6709302 DOI: 10.1097/md.0000000000015840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The effect of naproxen on the treatment of neoplastic fever is still unclear. A systematic review and meta-analysis were performed to investigate the effect of naproxen in the treatment of cancer fever or suspicion. Besides, the latest and most convincing evidence was provided for the earlier use of naproxen in treating cancer patients with fever of unknown origin. METHODS A literature review was conducted to identify all published studies on the naproxen for the treatment of neoplastic fever. Electronic databases (eg, PUBMED, EMBASE and the Cochrane Library) were searched until October 2018. Data were extracted, and the risk of bias was assessed by 2 authors independently. Standard meta-analyses on the rate of successful treatment were conducted using a random-effects model, and relative risks were calculated with 95% confidence intervals (CIs). RESULTS A total of 15 studies, recruiting 582 participants, were included, which were 1 randomized controlled trial (RCT), 1 non-RCT, 3 cross-sectional studies, and 10 case-series studies. The result of our meta-analysis revealed that the success rate on the treatment of neoplastic fever using naproxen was 94.1% (95% CI: 87.6%-97.3%). The success rate of the suspected neoplastic fever was 79.8%; for fever of unknown origin, it also reached 67.7%. In this meta-analysis, the success rate was 98.1% (95% CI: 95.0%-99.3%) in the dosage of 250 mg twice a day. Besides, a small dose of 125 mg naproxen, 375 mg twice a day and 250 mg 3 times a day were also useful. The result of the subgroup analysis revealed that the difference was not statistically significant in the treatment success rate for solid tumors and hematologic malignant. CONCLUSIONS The result of our meta-analysis suggested that naproxen exhibited a highly successful rate for the treatment of neoplastic fever. Besides, naproxen was also satisfactory in improving symptoms of suspected neoplastic fever and fever of unknown origin. The earlier use of naproxen might be able to mitigate cancer patient's suffering and enhanced their quality of life. These findings, however, rely primarily on observational data and should be interpreted rigorously. Further well-conducted trials are required to assess naproxen for the treatment of neoplastic fever.
Collapse
Affiliation(s)
- Hongliang Zhang
- Pharmacy Department
- Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Yuyong Wu
- Pharmacy Department, Yizhou District People's Hospital of Hechi, Hechi, China
| | | | - Xiaobin Zhong
- Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | | | | | | |
Collapse
|
25
|
Gong ZJ, Cheng JW, Gao PT, Huang A, Sun YF, Zhou KQ, Hu B, Qiu SJ, Zhou J, Fan J, Yang XR. Clinical Characteristics and Prognostic Factors of Patients with Intrahepatic Cholangiocarcinoma with Fever: A Propensity Score Matching Analysis. Oncologist 2019; 24:997-1007. [PMID: 30910867 DOI: 10.1634/theoncologist.2018-0268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with intrahepatic cholangiocarcinoma (ICC) rarely present fever as the initial symptom. We aimed to identify clinical characteristics and prognostic factors for these feverish patients. SUBJECTS, MATERIALS, AND METHODS This study retrospectively reviewed 31 patients with ICC with fever (≥38.0°C) treated at our hospital between January 2002 and December 2014. A propensity score was used to match patients with and without fever at a ratio of 1:2. RESULTS Patients with ICC with fever had higher serum γ-glutamyl transferase and carcinoembryonic antigen levels, larger tumors, poorer tumor differentiation, and worse prognosis (all p < .05) than those without fever. This was supported by propensity score matching (PSM) analysis. Univariate and multivariate analyses indicated that microvascular invasion, hilar lymph node metastasis, and temperature ≥ 38.6°C were related to prognosis. Patients with ICC with fever had higher levels of leucocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in peripheral blood before and after PSM analysis. Body temperature positively correlated with leucocytes (r = 0.599, p < .001), neutrophils (r = 0.644, p < .001), NLR (r = 0.681, p < .001), and PLR (r = 0.457, p = .010). CONCLUSION Patients with ICC with fever ≥38.0°C and ≥38.6°C had poor and extremely poor prognosis, respectively. Radical surgical treatment may improve the prognosis of patients with ICC with fever <38.6°C. However, systemic therapy (e.g., anti-inflammatory and immune therapy) may be preferable to surgery for these patients with fever ≥38.6°C. IMPLICATIONS FOR PRACTICE Patients with intrahepatic cholangiocarcinoma (ICC) with fever (≥38.0°C) as the initial symptom are extremely rare. Because their symptoms are similar to those of liver abscess, diagnosis is challenging, and most of these patients are already at an advanced stage at the time of diagnosis. Patients with ICC with fever had different clinical characteristics and worse prognosis than those without fever. The prognosis of those with temperature <38.6°C would be improved by timely surgical intervention. Those with fever ≥38.6°C had an extremely dismal outcome, although they all received radical surgical treatment. New therapeutic strategies are needed to improve survival for patients with ICC with temperature ≥38.6°C.
Collapse
Affiliation(s)
- Zi-Jun Gong
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
- Department of General Surgery, Zhongshan Hospital, Biliary Tract Diseases Institute, Fudan University, Shanghai, People's Republic of China
| | - Jian-Wen Cheng
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Pin-Ting Gao
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Ao Huang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Yun-Fan Sun
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Kai-Qian Zhou
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Bo Hu
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Shuang-Jian Qiu
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Jian Zhou
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Jia Fan
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Xin-Rong Yang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| |
Collapse
|
26
|
Abstract
The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic and HIV-related. This could be expanded to include the elderly as a fifth group. The causes are broadly divided into four groups: infective, inflammatory, neoplastic and miscellaneous. Increasing early use of positron emission tomography-computed tomography (PET-CT) and the development of new molecular and serological tests for infection have improved diagnostic capability, but up to 50% of patients still have no cause found despite adequate investigations. Reassuringly, the cohort of undiagnosed patients has a good prognosis. In this article we review the possible aetiologies of PUO and present a systematic clinical approach to investigation and management of patients, recommending potential second-line investigations when the aetiology is unclear.
Collapse
Affiliation(s)
- Cristina Fernandez
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital and Clinical Sciences Group, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
27
|
Wang H, Xiong L, Tang W, Zhou Y, Li F. A systematic review of malignancy-associated hemophagocytic lymphohistiocytosis that needs more attentions. Oncotarget 2017; 8:59977-59985. [PMID: 28938698 PMCID: PMC5601794 DOI: 10.18632/oncotarget.19230] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/29/2017] [Indexed: 12/11/2022] Open
Abstract
As an infrequent but potentially life-threatening hyperinflammatory syndrome, hemophagocytic lymphohistiocytosis (HLH) is clinically characterized with prolonged fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia, hyperferritinemia and hemophagocytosis in bone marrow, liver, spleen or lymph nodes. Malignancy-associated HLH (M-HLH), one type of acquired HLH, usually presents variable overlaps of symptoms with other types of HLH, thus resulting in higher incidence of misdiagnosis and mortality. In recent years, with the increasing awareness to this disease, the diagnosis and management of HLH have gained more and more attention, and improvements have been made accordingly. As a result, the survival of patients is greatly prolonged. However, there is still no consensus on the diagnostic criteria and treatment strategies due to lack of large samples or prospective clinical trials. In order to improve recognition and diagnosis, and provide guidance regarding the treatment of M-HLH, the Study Group in HLH Subtypes of the Histiocyte Society has developed consensus recommendations for the diagnosis and management of M-HLH in 2015. In the present article, we summarized and discussed some updated understandings in M-HLH.
Collapse
Affiliation(s)
- Hongluan Wang
- Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.,Medical College, Nanchang University, Nanchang, Jiangxi 330006, China.,Department of Respiratory, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, China
| | - Lixia Xiong
- Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.,Medical College, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Weiping Tang
- Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.,Medical College, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Ying Zhou
- Medical College, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Fei Li
- Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| |
Collapse
|