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Mahla H, Rhoul A, Gartit M, Yachaoui S, El Oumri AA. Hypertonia of the Big Toe Revealing Parkinson's Disease: A Case Report. Cureus 2024; 16:e58203. [PMID: 38741846 PMCID: PMC11090378 DOI: 10.7759/cureus.58203] [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] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Despite being less commonly discussed than other motor symptoms such as tremors and bradykinesia, hypertonia of the hallux holds diagnostic and prognostic significance in Parkinson's disease (PD). This motor anomaly is dissected within the context of the broader clinical spectrum of PD symptoms, emphasizing its importance alongside its cardinal symptoms. This case report underscores the importance of accurate clinical assessment especially thorough neurological evaluation in discerning hallux hypertonia, potentially enabling early disease recognition and intervention. By synthesizing these clinical insights, we trust that this case report contributes to an enhanced understanding of hypertonia of the hallux as a distinctive clinical presentation in PD fostering improved diagnostic precision.
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Affiliation(s)
- Houssam Mahla
- Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Oujda, MAR
- Medicine and Pharmacy, Mohamed I University, Oujda, MAR
| | - Abdelilah Rhoul
- Medicine and Pharmacy, Mohamed I University, Oujda, MAR
- Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Oujda, MAR
| | - Mohammed Gartit
- Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Oujda, MAR
| | | | - Ahmed Amine El Oumri
- Medicine, Mohamed I University, Oujda, MAR
- Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Oujda, MAR
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Rhoul A, Boubcher M, Gartit M, Noumairi M, Mahla H, Allam AES, El Oumri AA. Post-traumatic radial nerve neuroma: A case report. Trauma Case Rep 2023; 47:100913. [PMID: 37601552 PMCID: PMC10436167 DOI: 10.1016/j.tcr.2023.100913] [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: 08/13/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Radial nerve neuromas (RNNs) are mostly post-traumatic conditions that occur after a complete or partial section of a nerve. Here we report a case of post-traumatic RNN with good functional progression after intense physical rehabilitation. Case presentation A 49 years old patient with a post-complete section of the radial nerve underwent intensive physical rehabilitation with two sessions of ultrasound-guided injections of 10 % glucose saline around the neuroma. 12 months later, the patient improved his wrist and hand finger extension functions. Conclusion Several surgical and non-surgical therapies have been proposed for the treatment of neuromas. However, no consensus currently exists, and management is frequently adapted to each patient.
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Affiliation(s)
- Abdelilah Rhoul
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Mohammed Boubcher
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Orthopaedics Trauma, Mohammed VI University Hospital Oujda, Morocco
| | - Mohammed Gartit
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Mohammed Noumairi
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Houssam Mahla
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Abdallah El-Sayed Allam
- Faculty of Medicine, Tanta University, Egypt
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University, Egypt
| | - Ahmed Amine El Oumri
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
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Hilal FM, Bashawyah A, Allam AES, Lam KHS, El Oumri AA, Galluccio F, AlKharabsheh A, Kaye AD, Salti A, Varrassi G. Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis. Pain Physician 2022; 25:325-337. [PMID: 35901473] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local anesthetics (LAs) and steroids, epidural injection, botulinum toxin (BT) injection, and surgery. OBJECTIVES To investigate the efficacy of BT, LA, and corticosteroid (CS) injections in relieving pain in patients affected by PS. STUDY DESIGN This systematic review and meta-analysis was conducted according to the "Cochrane Handbook for Systematic Reviews of Interventions" and the "Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA)" guidelines. METHODS A systematic search was conducted through PubMed, Cochrane, Web of Science, and Scopus through April 2021 for studies investigating the efficacy of BT, LA, or CS injection in improving pain in patients with PS. After screening retrieved studies, data were extracted from included studies and pooled. Overall results were reported as standardized mean difference (SMD) and 95% confidence interval (CI). Analysis was performed using RevMan software version 5.4. RESULTS Sixteen studies were included in this systematic review, and 12 of them were included in the quantitative synthesis. The pain scores decreased significantly after treatment with BT (SMD = -2.00; 95% CI [-2.84, -1.16], P < 0.001), LA and CS (SMD = -4.34; 95% CI [-5.77, 2.90], P < 0.001), LA (SMD = -3.73; 95% CI [-6.47, -0.99], P = 0.008), CS (SMD = -2.78; 95% CI [-3.56, -2.00], P < 0.001), and placebo injection (SMD = -0.04; 95% CI [-0.07, -0.01], P = 0.002). BT injection was less effective than LA and CS together (P = 0.006), more effective than placebo (P = 0.001), and similar to LA (P = 0.24) and CS (P = 0.18), when injected alone. LIMITATIONS A wide variety of study designs were utilized to obtain the largest sample size available. Many of the included studies lack randomization, and some are retrospective in nature. These limitations may introduce bias into the analyzed data and affect the results. Many studies had a low sample size and are of moderate quality, limiting the generalizability of the results. Also, we could not conduct a direct meta-analysis due to the lack of sufficient double-arm studies comparing different types of injection therapies. CONCLUSIONS In patients with PS, satisfactory pain improvement can be obtained by BT, LA plus CS, LA, or CS injection therapy. Injection of LA plus CS showed the best efficacy.
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Affiliation(s)
- Faisal M Hilal
- Saudi Board of Anesthesia SPA, Ministry of Health King Fahad General Hospital, Jeddah, Kingdome of Saudi Arabia
| | - Ahmed Bashawyah
- Anesthesiology Department, College of Medicine and King Abdulaziz University Hospital, Jeddah, Kingdome of Saudi Arabia
| | - Abdallah El-Sayed Allam
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University, Egypt; Morphological Madrid Research Center (MoMaRC), Madrid, Spain
| | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong; Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ahmed Amine El Oumri
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda , Immuno-Hematology and Cellular Therapy Laboratory, Mohammed First University of Oujda, Morocco
| | - Felica Galluccio
- Morphological Madrid Research Center (MoMaRC), Madrid, Spain; Rheumatology, Medical-Geriatric Department, University Hospital AOU Careggi, Florence, Italy
| | - Abdullah AlKharabsheh
- King Abdullah University Hospital, Jordan University of Science and Technology, Jordan
| | | | - Ammar Salti
- Consultant Anesthesia and Interventional Pain Medicine, Cleveland Clinic, Abu Dhabi, United Arab Emirates; Clinical Associate Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Elmir S, Jabi R, Noumairi M, Gartit M, El Bekkaoui M, Skiker I, Housni B, Bouziane M, El Oumri AA. An Exceptional Clinical Presentation associating an occipital stroke, a Superior and Inferior Mesenteric Thrombosis following Covid 19 disease, case report. Ann Med Surg (Lond) 2021; 72:103082. [PMID: 34868574 PMCID: PMC8632876 DOI: 10.1016/j.amsu.2021.103082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction The Covid 19 pandemia since the first reported case in 2019 had a direct socioeconomic impact related to morbi-mortality and indirect in response to protection and isolation strategies. To our knowledge thrombo-embolic complications can be a mode of revelation complicating the management. Case presentation We present an exceptional case of a patient with a history of Covid 19,admitted 21 days later for disturbed consciousness, in whom an ischemic occipital stroke ,intestinal and colonic ishemia had been objectified. Our objective through this presentation is to remind the thrombo-embolic particularity of Covid 19, to take the viral attack as a serious antecedent in the periods following theinfection and to put the point on the primordial place of early rehabilitation in patients with stroke. Discussion and Conclusion We discuss through this report the recommendations of anticoagulation in Covid 19 patients and the place of early rehabilitation in patients with stroke. We also report a new case among the rare cases described in the literature that associates several thrombo-embolic manifestations secondary to Covid 19, in particular the neurological and digestive association. Exceptional Clinical Presentation associating an occipital Stroke, a Superior and Inferior Mesenteric Thrombosis following Covid 19 Disease. We propose take to the viral attack as a serious antecedent. This manuscript can add new perspectives to the management practice of this very rare presentation.
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Affiliation(s)
- Siham Elmir
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Immunohematology/Cellular Therapy Laboratory Adults and Children(LIHTC), University Mohammed First Oujda, Morocco
| | - Rachid Jabi
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM),Mohammed Ist University, Oujda, Morocco
| | - Mohammed Noumairi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Immunohematology/Cellular Therapy Laboratory Adults and Children(LIHTC), University Mohammed First Oujda, Morocco
| | - Mohammed Gartit
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Immunohematology/Cellular Therapy Laboratory Adults and Children(LIHTC), University Mohammed First Oujda, Morocco
| | - Mehdi El Bekkaoui
- Department of Radiolgy, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM),Mohammed Ist University, Oujda, Morocco
| | - Imane Skiker
- Department of Radiolgy, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM),Mohammed Ist University, Oujda, Morocco
| | - Brahim Housni
- Department of Anaesthesia and Intensive Care, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM),Mohammed Ist University, Oujda, Morocco
| | - Mohammed Bouziane
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM),Mohammed Ist University, Oujda, Morocco
| | - Ahmed Amine El Oumri
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Immunohematology/Cellular Therapy Laboratory Adults and Children(LIHTC), University Mohammed First Oujda, Morocco
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El-azrak M, Noumairi M, Oulalite MA, El Mir S, Kachmar S, Bkiyar H, El Ouafi N, El Oumri AA, Bazid Z, Housni B. Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report. Ann Med Surg (Lond) 2021; 72:103076. [PMID: 34876979 PMCID: PMC8632830 DOI: 10.1016/j.amsu.2021.103076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk. CASE PRESENTATION We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom's onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels. CLINICAL DISCUSSION Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome. CONCLUSION SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.
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Affiliation(s)
- Mohammed El-azrak
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Mohammed Noumairi
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Mohammed Amine Oulalite
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Siham El Mir
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Safaa Kachmar
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Ahmed Amine El Oumri
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Brahim Housni
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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Nasb M, Shah SZA, Chen H, Youssef AS, Li Z, Dayoub L, Noufal A, Allam AES, Hassanien M, El Oumri AA, Chang KV, Wu WT, Rekatsina M, Galluccio F, AlKhrabsheh A, Salti A, Varrassi G. Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e17645. [PMID: 34646693 PMCID: PMC8486367 DOI: 10.7759/cureus.17645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient intervention for stroke patients to start synchronized motor function along with spasticity reduction. The current systematic review and meta-analysis were conducted in order to evaluate the available literature about the safety and efficacy of constraint-induced movement therapy (CIMT) combined with BTX in stroke patients with upper limb spasticity. Searches were conducted on WoS (Web of Science), Ovid, EBSCO-ASC&BSC, and PubMed for identifying relevant literature published from 2000-2020. Randomized Controlled Trials (RCTs) and Quasi-experimental studies were considered for inclusion. Rayyan (systematic review tool) QCRI (Qatar Computing Research Institute) was used for independent screening of the studies by two reviewers. For risk of bias and study quality assessment, Cochrane risk of bias tool (RoB 2) and Physiotherapy Evidence Database (PEDro) scales were used. Cochrane review manager was used to carry out the meta-analyses of the included studies. The search resulted in a total of 13065 references, of which 4967 were duplicates. After the title, abstract and full-text screening, two RCTs were deemed eligible for inclusion. Both the RCTs scored 8 on PEDro and were level evidence. The studies were heterogeneous. The findings of this meta-analysis in all the three joints post-stroke spasticity assessed on modified Ashworth scale (MAS) at four weeks post-injection aren't statistically significant (elbow P-value 0.74, wrist P-value 0.57, fingers P-value 0.42), however, according to one of the included studies the therapeutic efficacy of the combination of BTX-mCIMT injection assessed at four weeks post-injection in wrist and finger flexors was promising. The effectiveness of BTX-CIMT combination over conventional therapy (CT) for improving post-stroke spasticity still needs to be explored with long-term, multicenter rigorously designed RCTs having a good sample size. However, the BTX-CIMT combination is promising for enhancing motor function recovery and improving activities of daily living (ADLs).
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Affiliation(s)
- Mohammad Nasb
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Hong Chen
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Ahmed S Youssef
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Zhenlan Li
- Department of Rehabilitation Medicine and Physical Therapy, First Hospital of Jilin University, Jilin University, Changchun, CHN
| | - Lamis Dayoub
- Department of Physical Therapy, Albaath University, Homs, SYR
| | - Abdullah Noufal
- Department of Orthopedic Surgery, Al-Assad University Hospital, Damascus University, Damascus, SYR
| | - Abdallah El Sayed Allam
- Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals & Faculty of Medicine, Tanta University, Tanta, EGY
| | - Manal Hassanien
- Department of Rheumatology, Assiut University Hospital, Assiut, EGY
| | - Ahmed Amine El Oumri
- Immunohematology Cellular Therapy, Medical School Oujda / Mohammed VI University Hospital of Oujda, Oujda, MAR
| | - Ke-Vin Chang
- Physical Medicine and Rehabilitation, National Taiwan University Hospital Bei-Hu Branch, Taipei, TWN
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, TWN
| | - Martina Rekatsina
- Pain Management, Whipps Cross Hospital Barts Health National Health Service (NHS), London, GBR
| | - Felice Galluccio
- Medical-Geriatric Department, Rheumatology, University Hospital Azienda Ospedaliero Universitaria (AOU) Careggi, Florence, ITA
| | - Abdullah AlKhrabsheh
- King Abdullah University Hospital, Jordan University of Science and Technology, Amman, JOR
| | - Ammar Salti
- Anesthesia and Pain Medicine, Cleveland Clinic, Abu Dhabi, ARE
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Serraj K, Hamaz S, Alaoui H, Barrimi M, El Oumri AA. Practical Approach for the Management and Evaluation of Paraneoplastic Syndromes. Cureus 2020; 12:e11830. [PMID: 33409072 PMCID: PMC7781533 DOI: 10.7759/cureus.11830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Paraneoplastic syndromes (PNS) are conditions linked to the presence of tumors, most often malignant, without being the direct translation of a locoregional extension or distant metastases. They affect 10% to 15% of cancer patients, can appear before, after, or simultaneously with a cancer diagnosis, and primarily affect the nervous system, endocrine glands, and skin. The main tumors that provide PNS are lung cancer, gynecological tumors, and lymphomas. The diagnostic and therapeutic approaches are very heterogeneous due to the physiopathological specificities of each type of PNS. The main advances made in recent years have focused mainly on diagnostic tools, which have become more efficient in the diagnosis of PNS and underlying cancers.
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Affiliation(s)
- Khalid Serraj
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Siham Hamaz
- Infectious Diseases, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Habiba Alaoui
- Immunohematology Cellular Therapy, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Mohamed Barrimi
- immunohematology Cellular Therapy, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Ahmed Amine El Oumri
- Immunohematology Cellular Therapy, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
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Serraj K, Alaoui H, El Oumri AA, Barrimi M, Bachir H. Effective Voriconazole in an Immunocompetent Patient With Amphotericin B Resistant Systemic Cryptococcal Granulomatosis. Cureus 2020; 12:e11101. [PMID: 33240697 PMCID: PMC7681776 DOI: 10.7759/cureus.11101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The diagnostic management of systemic granulomatosis is a difficult clinical exercise. The most frequent etiologies are tuberculosis and sarcoidosis. However, it is important to search as well for the other causes of granulomas, especially infections and malignancies, the prognosis of which can be poor without adequate treatment. A 67-year-old immunocompetent patient presented with granulomatous adenitis without caseous necrosis. The etiological evaluation had revealed neurological, pulmonary and lymph node systemic cryptococcosis. Conventional antifungal therapy with the triple combination Amphotericin B - Flucytosine - Fluconazole has not been effective, indicating administration of voriconazole. The evolution was rapidly favorable with apyrexia after 48 hours, disappearance of clinical symptoms, normalization of biological parameters of cerebrospinal fluid (CSF) and major improvement of radiological abnormalities. This clinical case is original by the disseminated involvement, the patient's non-immunocompromised status and the primary resistance to amphotericin B. Our findings underline the importance of carrying out an exhaustive evaluation, reflecting on cryptococcosis in any systemic granulomatosis and knowing the various therapeutic alternatives, in particular, voriconazole if primary response to amphotericin B has not been obtained.
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Leonardi M, Lee H, van der Veen S, Maribo T, Cuenot M, Simon L, Paltamaa J, Maart S, Tucker C, Besstrashnova Y, Shosmin A, Cid D, Almborg AH, Anttila H, Yamada S, Frattura L, Zavaroni C, Zhuoying Q, Martinuzzi A, Martinuzzi M, Magnani FG, Snyman S, El Oumri AA, Sylvain N, Layton N, Sykes C, Saleeby PW, Winkler AS, de Camargo OK. Avoiding the Banality of Evil in Times of COVID-19: Thinking Differently with a Biopsychosocial Perspective for Future Health and Social Policies Development. ACTA ACUST UNITED AC 2020; 2:1758-1760. [PMID: 32905109 PMCID: PMC7462656 DOI: 10.1007/s42399-020-00486-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/01/2022]
Abstract
The COVID-19 pandemic provides the opportunity to re-think health policies and health systems approaches by the adoption of a biopsychosocial perspective, thus acting on environmental factors so as to increase facilitators and diminish barriers. Specifically, vulnerable people should not face discrimination because of their vulnerability in the allocation of care or life-sustaining treatments. Adoption of biopsychosocial model helps to identify key elements where to act to diminish effects of the pandemics. The pandemic showed us that barriers in health care organization affect mostly those that are vulnerable and can suffer discrimination not because of severity of diseases but just because of their vulnerability, be this age or disability and this can be avoided by biopsychosocial planning in health and social policies. It is possible to avoid the banality of evil, intended as lack of thinking on what we do when we do, by using the emergence of the emergency of COVID-19 as a Trojan horse to achieve some of the sustainable development goals such as universal health coverage and equity in access, thus acting on environmental factors is the key for global health improvement.
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Affiliation(s)
- Matilde Leonardi
- UOC Neurology, Public Health, Disability, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Sabina van der Veen
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Marie Cuenot
- School of public Health, École des hautes études en santé publique (EHESP), Rennes, France
| | - Liane Simon
- MSH Medical School Hamburg, Hamburg, Germany
| | | | - Soraya Maart
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carole Tucker
- College of Public Health, Temple University, Philadelphia, PA USA
| | - Yanina Besstrashnova
- Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, St. Petersburg, Russia
| | - Alexander Shosmin
- Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, St. Petersburg, Russia
| | - Daniel Cid
- Centre for Innovations and Development in Healthcare (CIDEAS), Santiago del Chile, Chile
| | | | - Heidi Anttila
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Lucilla Frattura
- Strategical Directorate, Classification Area, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Carlo Zavaroni
- Strategical Directorate, Classification Area, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Qiu Zhuoying
- Research Institute of Rehabilitation Information, China Rehabilitation Research Center/WHO-FIC CC China, Beijing, China
| | - Andrea Martinuzzi
- Department of Conegliano-Pieve di Soligo, IRCCS E. Medea Scientific Institute, Conegliano, Italy
| | | | - Francesca Giulia Magnani
- UOC Neurology, Public Health, Disability, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Stefanus Snyman
- Centre for Community Technologies, Nelson Mandela University, Port Elizabeth, South Africa
| | - Ahmed Amine El Oumri
- Mohammed VI University Hospital of Oujda, Faculty of Medicine of Oujda, Mohammed First University of Oujda, Oujda, Morocco
| | | | - Natasha Layton
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Victoria Australia
| | | | - Patricia Welch Saleeby
- Department of Sociology, Criminology, and Social Work, Bradley University, Peoria, IL USA
| | - Andrea Sylvia Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olaf Kraus de Camargo
- CanChild - Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario Canada
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