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Sedky M, Gohar S, Ahmed S, Zaky I, Salama A, Hassanein O, Maher E, ElHaddad A. Pediatric pulmonary multisystem langerhans cell histiocytosis: does lung lesion severity affect the outcome? Orphanet J Rare Dis 2023; 18:361. [PMID: 37978394 PMCID: PMC10655418 DOI: 10.1186/s13023-023-02970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The pediatric pulmonary multisystem Langerhans cell histiocytosis (PPM LCH) is associated with either low risk or high risk organ(s). The nodulo-cystic lung lesions although pathognomonic, yet are very variable in severity and remain a source of controversy in certifying pulmonary LCH diagnosis. The study aimed to examine the prognostic value of clinical respiratory manifestations and radiological lung lesions severity. This is through associating a CT chest triad of bilateral, extensive and diffuse lesions. It is a retrospective study of 350 LCH patients who received systemic treatment at Children's Cancer Hospital Egypt during the period from 2007 to 2020. RESULTS Sixty-seven patients (67/350-19.1%) had PPM LCH at presentation. Severe lung lesions were present in 24 of them. The median follow-up period was 61 months (IQR: 3.4-8.3). The 5-year overall survival (OS) and event free survival (EFS) was 89% and 56.6% respectively. The EFS, for severe radiological lesions triad was 38% ± 20.7 versus 66% ± 16.2 for non-severe lesions triad p 0.002, while for presence of chest X-ray changes 27% ± 22.344 versus absence of chest X ray changes 66% ± 14.7 p 0.001, for clinical respiratory manifestations 13% ± 13.9 versus none 62% ± 22.9 p < 0.001, for RO- with severe lung lesions 47% ± 30.4 versus RO- without severe lung lesions 69% ± 5.9 p 0.04. There was a tendency for the independent prognostic impact of severe lung involvement; aHR = 1.7 (95% CI 0.92-3.13, p = 0.09). CONCLUSION Although the lung is a low -risk organ per se in LCH, our study demonstrates a non negligeable prognostic impact of severe lung involvement in the risk stratification of pediatric LCH. This warrants further study and external validation.
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Affiliation(s)
- Mohamed Sedky
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt.
- Department of Pediatrics, National Research Centre, Cairo, Egypt.
| | - Seham Gohar
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
- Department of Pediatric Oncology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Zaky
- Department of Radiology, Children Cancer Hospital Egypt 57357 (11617), Cairo, Egypt
- Department of Radiology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Asmaa Salama
- Department of Pathology, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
- Department of Pathology National Cancer Institute, Cairo University, Cairo, Egypt
| | - Omayma Hassanein
- Department of Clinical Research, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
| | - Eslam Maher
- Department of Clinical Research, Children's Cancer Hospital 57357 (11617), Cairo, Egypt
| | - Alaa ElHaddad
- Department of Pediatric Oncology, Children Cancer Hospital Egypt 57357 1 (11617), Sekket Al-Imam St., Al Sayyeda Zeinab, Cairo, 11617, Egypt
- Department of Pediatric Oncology National Cancer Institute, Cairo University, Cairo, Egypt
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Zhang XY, Li J, Chen SL, Li Y, Wang H, He JH. Malakoplakia with aberrant ALK expression by immunohistochemistry: a case report. Diagn Pathol 2023; 18:97. [PMID: 37644531 PMCID: PMC10464214 DOI: 10.1186/s13000-023-01383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Malakoplakia is a rare inflammatory disease of the urogenital tract. There have been no reports of malakoplakia expressing anaplastic lymphoma kinase (ALK) to date. Here, we present one case of malakoplakia with aberrant ALK expression by immunohistochemistry and discuss the clinical significance. CASE PRESENTATION A 65-year-old Chinese woman with a history of diabetes presented with solid masses in the liver and kidney and elevated lesions on the mucosal surface of the colon. Right nephrectomy and partial liver resection were performed. Microscopically, sheets of histiocytes with poor intercellular adhesion were seen, with Michaelis-Gutmann bodies present in both the intracellular and extracellular interstitium. CD10-, CD68-, and CD163-positive cells were present, with Michaelis-Gutmann bodies confirmed by staining with Alcian blue, periodic acid-Schiff (PAS), periodic acid-Schiff with diastase, Von Kossa, and Prussian blue. Aberrant ALK1 and ALK (D5F3) expression was observed in the cytoplasm and nucleus of cells. However, ALK gene mutation was not detected by fluorescence in situ hybridization or whole exome next-generation sequencing. NGS revealed nine individual somatic gene mutations: GOT1L1, GLIS2, SPOUT1, TMEM97, MUC3A, NSD2, SFXN5, ADAD1 and RAD50. The significance of the somatic gene mutations detected in this study is not clear, and the relationship between them and malakoplakia cannot be clarified by existing scientific studies. The pathological diagnosis was malakoplakia with aberrant ALK expression by immunohistochemistry. The antibiotics imipenem and vancomycin were started based on the results of drug sensitivity analysis and the patient was subsequently discharged. She experienced no discomfort during 30 months of follow-up. CONCLUSION This is the first reported case of malakoplakia with aberrant ALK expression, it should be differentiated from ALK-positive histiocytosis to avoid misdiagnosis.
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Affiliation(s)
- Xiao-Ying Zhang
- Department of Pathology, Panyu District Central Hospital, Guangzhou, China
| | - Jun Li
- Department of Urology, Panyu District Central Hospital, Guangzhou, China
| | - Shui-Lian Chen
- Department of Pathology, Panyu District Central Hospital, Guangzhou, China
| | - Ying Li
- Department of Pathology, Panyu District Central Hospital, Guangzhou, China
| | - Hao Wang
- Department of Pathology, Panyu District Central Hospital, Guangzhou, China
| | - Jin-Hua He
- Department of Laboratory Medicine, Panyu District Central Hospital, Guangzhou, China.
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Bartley EJ, Makhoul M, Palit S, Robinson ME, Fillingim RB. Examining Physical and Cognitive Function in Chronic Low Back Pain Through the Use of a Multisystem Resilience Framework. Pain Med 2023; 24:547-555. [PMID: 36269196 PMCID: PMC10406157 DOI: 10.1093/pm/pnac156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/02/2022] [Accepted: 10/06/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Chronic pain results in significant impairment in older adults, yet some individuals maintain adaptive functioning. Limited research has considered the role of positive resources in promoting resilience among older adults. Likewise, these factors have largely been examined independently. We aimed to identify resilience domains based on biopsychosocial factors and explore whether resilience phenotypes vary across sleep disturbance, fatigue, and cognitive function. METHODS Sixty adults (ages ≥60 years) with chronic low back pain completed measures of psychological, health, and social functioning. On the basis of previously published analyses, principal-components analysis was conducted to create composite domains for these measures, followed by cluster analysis to identify phenotypes. RESULTS Four profiles emerged: Cluster 1, with high levels of psychosocial and health-related functioning; Cluster 2, with high health-related functioning and low psychosocial functioning; Cluster 3, with high psychosocial functioning and poorer health; and Cluster 4, with low levels of functioning across all domains. Significant differences across cluster membership emerged for sleep disturbance (ηp2 = 0.29), fatigue (ηp2 = 0.29), and cognitive abilities (ηp2 = 0.47). Individuals with the highest levels of resilience demonstrated more optimal outcomes in sleep and fatigue (P values ≤0.001) than did individuals with a less resilient phenotype. Furthermore, the High-Resilience group (Cluster 1) and the High Psychosocial / Low Health group (Cluster 3) had lower cognitive impairment than did the High Health / Low Psychosocial group (Cluster 2) and the Low-Resilience group (Cluster 4) (P values ≤0.009). CONCLUSIONS A higher array of protective resources could buffer against the negative sequelae associated with chronic low back pain. These exploratory findings support the multidimensional nature of resilience and suggest that targeting resilience from a multisystem perspective might help to optimize interventions for older adults with chronic pain.
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Affiliation(s)
- Emily J Bartley
- Correspondence to: Emily J. Bartley, PhD, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, 1329 SW 16 St., Suite 5192, Gainesville, FL 32610, USA. Tel: 352-273-8934; Fax: 352-273-5985; E-mail:
| | - Melissa Makhoul
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Shreela Palit
- Nemours Children’s Health, Center for Healthcare Delivery Science, Jacksonville, Florida, USA
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
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Pham HT, Bendezú JJ, Wadsworth ME. HPA-SAM co-activation among racially diverse, economically disadvantaged early adolescents: Secondary analysis with a preliminary test of a multisystem, person-centered approach. Biol Psychol 2023; 179:108546. [PMID: 36990378 PMCID: PMC10175235 DOI: 10.1016/j.biopsycho.2023.108546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Investigating the co-activation of hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenomedullary (SAM) responses to acute stress can provide insight into how risk might become biologically embedded during early adolescence and improve understanding of what distinguishes physiological dysregulation from normative/expected physiological responses to stress. Evidence has thus far been mixed as to whether symmetric or asymmetric co-activation patterns are associated with higher exposure to chronic stress and poorer mental health outcomes during adolescence. This study expands on a prior multisystem, person-centered analysis of lower-risk, racially homogenous youth by focusing on HPA-SAM co-activation patterns in a higher-risk, racially diverse sample of early adolescents from low-income families (N = 119, Mage=11.79 years, 55.5% female, 52.7% mono-racial Black). The present study was conducted by performing secondary analysis of data from the baseline assessment of an intervention efficacy trial. Participants and caregivers completed questionnaires; youth also completed the Trier Social Stress Test-Modified (TSST-M) and provided six saliva samples. Multitrajectory modeling (MTM) of salivary cortisol and alpha-amylase levels identified four HPA-SAM co-activation profiles. In accordance with the asymmetric-risk model, youth exhibiting Low HPA-High SAM (n = 46) and High HPA-Low SAM (n = 28) profiles experienced more stressful life events, posttraumatic stress, and emotional and behavioral problems relative to Low HPA-Low SAM (n = 30) and High HPA-High SAM (n = 15) youth. Findings highlight potential differences in biological embedding of risk during early adolescence based on individuals' exposure to chronic stress and illustrate the utility of multisystem and person-centered approaches in understanding how risk might get "underneath the skin" across systems.
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Affiliation(s)
- Holly T Pham
- Department of Psychology, 234 Moore Building, The Pennsylvania State University, University Park, PA 16802, United States.
| | - Jason José Bendezú
- Department of Psychology, 234 Moore Building, The Pennsylvania State University, University Park, PA 16802, United States
| | - Martha E Wadsworth
- Department of Psychology, 234 Moore Building, The Pennsylvania State University, University Park, PA 16802, United States
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Shantzer LB, Dougherty SC, Bolte F, Melson JW, Reed DR, Lynch AC, Gentzler RD, Novicoff W, Hall RD. Immune-Related Adverse Events in Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibition in Combination With Chemotherapy: A Brief Report. Clin Lung Cancer 2023; 24:e60-e64. [PMID: 36526550 DOI: 10.1016/j.cllc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Lindsey B Shantzer
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Sean C Dougherty
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Fabian Bolte
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA
| | - John W Melson
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Daniel R Reed
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Alia C Lynch
- Department of Pharmacy, University of Virginia Health System, Charlottesville, VA
| | - Ryan D Gentzler
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Wendy Novicoff
- Department of Public Health Sciences and Orthopaedic Surgery, HSC, University of Virginia Health System, Charlottesville, VA
| | - Richard D Hall
- Department of Medicine, Division of Hematology-Oncology, University of Virginia Health System, Charlottesville, VA.
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Finsterer J. C19orf12 mutation carriers and their first-degree relatives require prospective clinical and genetic work-up. Parkinsonism Relat Disord 2021; 89:118-119. [PMID: 34274621 DOI: 10.1016/j.parkreldis.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/11/2021] [Indexed: 11/18/2022]
Affiliation(s)
- J Finsterer
- Klinik Landstrasse, Messerli Institute, Postfach 20 1180, Vienna, Austria.
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Rudd KL, Bush NR, Alkon A, Roubinov DS. Identifying profiles of multisystem physiological activity across early childhood: Examining developmental shifts and associations with stress and internalizing problems. Psychoneuroendocrinology 2021; 128:105196. [PMID: 33765640 PMCID: PMC8188642 DOI: 10.1016/j.psyneuen.2021.105196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Physiological regulation is an important predictor of health across the lifespan. Regulation occurs across multiple collaborative systems, yet few empirical studies explore multisystem activity and how this collaborative regulation develops early in life. The current study used latent profile analysis to evaluate multisystem regulation in the autonomic nervous system and hypothalamic pituitary adrenal (HPA) axis in 150 racially/ethnically diverse, low-income children at 18- and 36-months. At both timepoints, profiles of generally moderate activity (Moderate Arousal) and heightened baseline activity (Anticipatory Arousal) emerged. A profile of typically adaptive patterns across all systems (Active Copers) emerged at 18-months and a profile of heightened HPA Axis activity (HPA-axis Responders) emerged at 36-months. Persistent membership in the Anticipatory Arousal profile across time was associated with exposure to greater maternal stress at 18-months and child internalizing problems at 36-months. These findings highlight early multisystem profile development and suggest associations with stress and later behavior problems.
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Affiliation(s)
- Kristen L. Rudd
- University of California, San Francisco; Department of Psychiatry and Behavioral Sciences; San Francisco, CA
| | - Nicole R. Bush
- University of California, San Francisco; Department of Psychiatry and Behavioral Sciences; San Francisco, CA,University of California, San Francisco; Department of Pediatrics; San Francisco, CA,University of California, San Francisco; Weill Institute for Neurosciences; San Francisco, CA
| | - Abbey Alkon
- University of California, San Francisco; School of Nursing; San Francisco, CA
| | - Danielle S. Roubinov
- University of California, San Francisco; Department of Psychiatry and Behavioral Sciences; San Francisco, CA,University of California, San Francisco; Weill Institute for Neurosciences; San Francisco, CA
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8
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Finsterer J. Perampanel may be beneficial in Leigh syndrome by its anti-oxidative but not anti-epileptic effect. Brain Dev 2021; 43:360. [PMID: 32893077 DOI: 10.1016/j.braindev.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Josef Finsterer
- Klinik Landstrasse, Messerli Institute, Postfach 20, 1180 Vienna, Austria.
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Gargan ML, Wong JL, Leidhin CN, Owens C, Byrne A. Langerhans cell histiocytosis in children under 12 months of age: The spectrum of imaging and clinical findings: Experience in an Irish tertiary referral centre. Eur J Radiol 2020; 134:109375. [PMID: 33261936 DOI: 10.1016/j.ejrad.2020.109375] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Langerhans cell histiocytosis is an uncommon condition and it is unusual for it to present in children under one year of age. Our aim is to review the clinical presentation, and present the radiologic findings and clinical outcome in this particular cohort of patients and determine how this differs from the imaging features of older children presenting with LCH. MATERIALS AND METHODS A database of 17 patients with LCH who presented between 0 and 12 months of age was retrospectively reviewed. Radiologic findings, initial clinical presentation and ultimate clinical outcome were documented in table format. RESULTS Eight patients (47 %) initially presented with cutaneous stigmata, seven patients (41 %) had skeletal involvement, five patients (29 %) had splenic involvement, two patients (24 %) had central nervous system involvement either at presentation or at follow-up, three patients (18 %) had lymphadenopathy, two patients (12 %) had liver involvement, and two patients (12 %) had gastrointestinal (GI) involvement. Four patients (24 %) had multisystem involvement either at presentation or at follow-up. One patient died during follow-up. CONCLUSION LCH in children under one year of age is uncommon and may have an unusual clinical presentation. The radiologic findings are varied and may differ from the classical imaging appearance more commonly seen in the older age group, with multisystem involvement seen more readily in younger patients.
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Affiliation(s)
- Mary-Louise Gargan
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Jsun Loong Wong
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Caoilfhionn Ni Leidhin
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Cormac Owens
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
| | - Angela Byrne
- Children's Health Ireland at Crumlin, Dublin, Ireland; Children's Health Ireland, Cooley Road, Crumlin, Dublin, D12 N512, Ireland.
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Finsterer J. Phenotypic spectrum of variants in the beta-oxidation enoyl-CoA hydratase-1 (ECHS-1) gene. Eur J Paediatr Neurol 2020; 29:101-102. [PMID: 32988733 DOI: 10.1016/j.ejpn.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- J Finsterer
- Klinik Landstrasse, Messerli Institute, Postfach 20 1180, Vienna, Austria.
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Alnashri H, Aljohani N, Tayeb S, Rabie N, AlBenayan E, Alharthi A, Samannodi M. A challenging case of multisystem inflammatory syndrome in children related to coronavirus Disease-19 hospitalized under adult medical service. IDCases 2020; 22:e00957. [PMID: 32953455 PMCID: PMC7489252 DOI: 10.1016/j.idcr.2020.e00957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/01/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 12/27/2022] Open
Abstract
Data on multisystem inflammatory syndrome in children (MIS-C) related to coronavirus disease-19 (COVID-19) is increasing in the current COVID-19 pandemic. We present a 16 year old male who was hospitalized in July 2020 under adult medical service due to Kawasaki-like disease symptoms. Diagnosis of MIS-C related to COVID-19 was established by clinical features, elevated inflammatory markers, and positive SARS−COV 2 immunoglobulin G. We encourage all clinicians especially who practice adult medicine to be familiar with signs and symptoms of MIS-C to avoid delayed diagnosis and complications.
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Affiliation(s)
- Huda Alnashri
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Naif Aljohani
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Sarah Tayeb
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nada Rabie
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Eyad AlBenayan
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Adil Alharthi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohammed Samannodi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Yeo CJJ, Darras BT. Overturning the Paradigm of Spinal Muscular Atrophy as Just a Motor Neuron Disease. Pediatr Neurol 2020; 109:12-19. [PMID: 32409122 DOI: 10.1016/j.pediatrneurol.2020.01.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/23/2019] [Accepted: 01/05/2020] [Indexed: 12/31/2022]
Abstract
Spinal muscular atrophy is typically characterized as a motor neuron disease. Untreated patients with the most severe form, spinal muscular atrophy type 1, die early with infantile-onset progressive skeletal, bulbar, and respiratory muscle weakness. Such patients are now living longer due to new disease-modifying treatments such as gene replacement therapy (onasemnogene abeparvovec), recently approved by the US Food and Drug Administration, and nusinersen, a central nervous system-directed treatment which was approved by the US Food and Drug Administration three years ago. This has created an area of pressing clinical need: if spinal muscular atrophy is a multisystem disease, dysfunction of peripheral tissues and organs may become significant comorbidities as these patients survive into childhood and adulthood. In this review, we have compiled autopsy data, case reports, and cohort studies of peripheral tissue involvement in patients and animal models with spinal muscular atrophy. We have also evaluated preclinical studies addressing the question of whether peripheral expression of survival motor neuron is necessary and/or sufficient for motor neuron function and survival. Indeed, spinal muscular atrophy patient data suggest that spinal muscular atrophy is a multisystem disease with dysfunction in skeletal muscle, heart, kidney, liver, pancreas, spleen, bone, connective tissues, and immune systems. The peripheral requirement of SMN in each organ and how these contribute to motor neuron function and survival remains to be answered. A systemic (peripheral and central nervous system) approach to therapy during early development is most likely to effectively maximize positive clinical outcome.
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Affiliation(s)
- Crystal Jing Jing Yeo
- Department of Neurology, Neuromuscular Center and SMA Program, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Neuromuscular Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Translational Neuromuscular Medicine Laboratory, Institute of Molecular and Cell Biology, Singapore; Experimental Drug Development Center, Singapore.
| | - Basil T Darras
- Department of Neurology, Neuromuscular Center and SMA Program, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Abstract
In the context of rising disasters worldwide and the challenges of the COVID-19 pandemic, this commentary considers the implications of findings in resilience science on children and youth for disaster preparation and response. The multisystem challenges posed by disasters are illustrated by the COVID-19 pandemic. We discuss the significance of disasters in the history of resilience science and the emergence of a unifying systems definition of resilience. Principles of a multisystem perspective on resilience and major findings on what matters for young people in disasters are delineated with reference to the pandemic. Striking parallels are noted in the psychosocial resilience factors identified at the level of individual children, families, schools, and communities. These parallels suggest that adaptive capacities associated with resilience in these interacting systems reflect interconnected networks and processes that co-evolved and may operate in concert. As resilience science moves toward integrated theory, knowledge, and applications in practice, particularly in disaster risk reduction and resilience promotion, more focus will be needed on multisystem and multidisciplinary research, communication, training, and planning.
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Affiliation(s)
- Ann S. Masten
- University of Minnesota Twin Cities, Minneapolis, MN USA
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Finsterer J. Peculiarities of the m.3243A>G variant in MT-TL1 leave medicine unprecise. Mol Genet Metab Rep 2019; 21:100541. [PMID: 31788424 DOI: 10.1016/j.ymgmr.2019.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 11/20/2022] Open
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Abstract
Mitochondrial disorders are increasingly recognised world-wide and represent a diagnostic and therapeutic challenge. This is due to the peculiarities of mitochondrial genetics and the extreme genotypic and phenotypic heterogeneity of these disorders. Traditional time-consuming and expensive diagnostic steps are increasingly replaced by first-line genetic approaches. Despite recent advances in the treatment and prevention of mitochondrial disorders, therapeutic approaches are still limited mainly to non-invasive or invasive symptomatic measures.
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Finsterer J, Zarrouk-Mahjoub S. Infantile-onset deafness in m.7445A>G carriers may be multicausal. Int J Pediatr Otorhinolaryngol 2018; 111:192-193. [PMID: 29921456 DOI: 10.1016/j.ijporl.2018.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | - Sinda Zarrouk-Mahjoub
- University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunisia
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Finsterer J, Stöllberger C, Rauschka H, Gatterer E. Coronary ectasia in amyloid cardiomyopathy and neuropathy due to the transthyretin mutation c.323A>G. Heart Lung 2017; 47:127-129. [PMID: 29246775 DOI: 10.1016/j.hrtlng.2017.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/31/2017] [Accepted: 11/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND atrial fibrillation(AF) is a frequent manifestation of cardiac involvement in genetic and wild-type transthyretin-related familial amyloidosis(TTR-FA). However, ectasia of coronary arteries and ablation for AF have not been reported in TTR-FA. METHODS AND RESULTS A 65yo male developed progressive sensori-motor polyneuropathy since age 59y. At age 60y bifascicular block and myocardial thickening were recognised. At age 62y heart failure developed and work-up with cardiac MRI suggested amyloidosis but biopsy was non-informative. Coronary angiography revealed ectasias of the coronary arteries. At age 65y AF developed, neither responding to electrical cardioversion nor ablation. Work-up for polyneuropathy revealed the point mutation c.323A>G (p.His108Arg) in the TTR-gene. Tafamidis was started but did not exhibit a beneficial effect after 7 months. CONCLUSIONS TTR-FA may manifest in the coronary arteries with ectasia. Ablation for AF in TTR-FA may be unsuccessful. Tafamidis has been unsuccessful for cardiac or nerve involvement after the first seven months.
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Affiliation(s)
| | - Claudia Stöllberger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | | | - Edmund Gatterer
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
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Abstract
Mitochondrial disorders (MIDs) are usually multisystem disorders (mitochondrial multiorgan disorder syndrome) either on from onset or starting at a point during the disease course. Most frequently affected tissues are those with a high oxygen demand such as the central nervous system, the muscle, endocrine glands, or the myocardium. Recently, it has been shown that rarely also the arteries may be affected (mitochondrial arteriopathy). This review focuses on the type, diagnosis, and treatment of mitochondrial vasculopathy in MID patients. A literature search using appropriate search terms was carried out. Mitochondrial vasculopathy manifests as either microangiopathy or macroangiopathy. Clinical manifestations of mitochondrial microangiopathy include leukoencephalopathy, migraine-like headache, stroke-like episodes, or peripheral retinopathy. Mitochondrial macroangiopathy manifests as atherosclerosis, ectasia of arteries, aneurysm formation, dissection, or spontaneous rupture of arteries. The diagnosis relies on the documentation and confirmation of the mitochondrial metabolic defect or the genetic cause after exclusion of non-MID causes. Treatment is not at variance compared to treatment of vasculopathy due to non-MID causes. Mitochondrial vasculopathy exists and manifests as micro- or macroangiopathy. Diagnosing mitochondrial vasculopathy is crucial since appropriate treatment may prevent from severe complications.
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Finsterer J, Zarrouk-Mahjoub S. Double trouble progressive external ophthalmoplegia and Huntington's disease. Mol Genet Metab Rep 2016; 7:77. [PMID: 27144127 PMCID: PMC4840427 DOI: 10.1016/j.ymgmr.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/01/2022] Open
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Affiliation(s)
| | - Claudia Stöllberger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
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Finsterer J, Frank M. Pregnancy and delivery under the MELAS mutation. Mitochondrion 2016; 27:39. [PMID: 26883957 DOI: 10.1016/j.mito.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/13/2015] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Affiliation(s)
| | - Marlies Frank
- First Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria
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22
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Duan MH, Han X, Li J, Zhang W, Zhu TN, Han B, Zhuang JL, Wang SJ, Cao XX, Cai HC, Chen M, Yang C, Zhou DB. Comparison of vindesine and prednisone and cyclophosphamide, etoposide, vindesine, and prednisone as first-line treatment for adult Langerhans cell histiocytosis: A single-center retrospective study. Leuk Res 2016; 42:43-6. [PMID: 26859782 DOI: 10.1016/j.leukres.2016.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/29/2015] [Accepted: 01/24/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We compared the efficacy and clinical outcomes of vindesine and prednisone (VP) and cyclophosphamide, etoposide, vindesine, and prednisone (CEVP) regimens as first-line treatment for multisystem (MS) or multifocal single system (SS-m) adult Langerhans cell histiocytosis (LCH). METHOD Clinical features, treatment response, and survival of adults with Langerhans cell histiocytosis treated at our center from January 2001 to January 2015 were reviewed retrospectively. RESULTS Forty-five adult MS or SS-m LCH patients were treated (N=31, CEVP group; N=14, VP group). Both treatment groups had similar gender distributions, patient ages, and extent of disease. The non-active disease rate for both groups was 70.0% and 64.3% (P=0.775), respectively. Median follow-up was 74.9 (range: 2.8-183.6) months and recurrence rates were 71.0% and 78.6% (P=0.593), respectively. The need for second-line therapy was 64.5% and 71.4% (P=0.649), respectively, and mortality rates were 9.7% and 15.4% (P=0.586), respectively. Neutropenia occurred in 48.4% of CEVP-treated patients and 7.1% of VP-treated patients (P=0.008). CONCLUSIONS CEVP or VP regimens for the treatment of adult SS-m or MS LCH showed similar efficacies, and both regimens were associated with high disease recurrence and the need for second-line therapy.
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Affiliation(s)
- M-H Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - X Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - J Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - W Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - T-N Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - J-L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - S-J Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - X-X Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - H-C Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - D-B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Carroll JE, Seeman TE, Olmstead R, Melendez G, Sadakane R, Bootzin R, Nicassio P, Irwin MR. Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: pilot results from a randomized controlled comparative efficacy trial. Psychoneuroendocrinology 2015; 55:184-92. [PMID: 25770704 PMCID: PMC4422640 DOI: 10.1016/j.psyneuen.2015.02.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Sleep disturbances have been linked to increased morbidity and mortality, yet it is unknown whether improving sleep quality in older adult patients with insomnia alters biomarkers of diabetes and cardiovascular disease risk. OBJECTIVE Determine the comparative efficacy of cognitive behavioral therapy (CBT), tai chi chih (TCC), and a sleep seminar control (SS) to reduce multisystem biomarkers of disease risk in older adults with insomnia. DESIGN Randomized controlled comparative efficacy trial. SETTING Los Angeles community. PARTICIPANTS A population-based sample of 109 older adults with chronic and primary insomnia. INTERVENTION Random assignment to CBT, TCC, or SS for 2-h group sessions weekly over 4 months with a 16-month evaluation (1 year after follow-up). MAIN OUTCOME(S) AND MEASURE(S) Multisystem biological risk comprised of 8 biomarkers: high-density lipoprotein, low-density lipoprotein, triglycerides, hemoglobinA1c, glucose, insulin, C-reactive protein, and fibrinogen. Using clinical laboratory cutoffs defined as abnormal, a multisystem risk score was computed representing a sum of the deviation around the cutoffs across the 8 biomarkers. In addition, high risk grouping was classified if subjects exhibited 4 or more biomarkers in the abnormal laboratory range. RESULTS An interaction of time-by-treatment-by-high risk group was found (F(4, 197.2)=3.14, p=.02) in which both TCC (p=.04) and CBT (p=.001) showed significantly lower risk scores as compared to SS at 16-months. CBT reduced risk of being in the high risk group at 4-months (odds ratio [OR]=.21 [95% CI, .03-1.47], p<.10) and at 16-months (OR=.06 [95% CI, .005-.669]; p<.01). TCC reduced the risk at 16-months (OR=.10 [95% CI, .008-1.29]; p<.05) but not at 4 months. Of participants who were classified in the high risk category at baseline, improvements in sleep quality, as defined by a clinical severity threshold, reduced the likelihood of being in the high risk group at 16-months, OR=.08 (95% CI, .008-.78); p=.01. CONCLUSIONS AND RELEVANCE Participants classified as having high multisystem biological risk at entry and assigned to CBT or TCC show improvements in risk scores after one year follow-up. Given that these clinical biomarkers are associated with cardiovascular, metabolic, and inflammatory disease risk, improving sleep quality has the potential to reduce the risk of chronic disease in older adults with insomnia. Clinical Trial Registration # and name—ClinicalTrials.gov: NCT00280020, Behavioral Treatment of Insomnia in Aging
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Affiliation(s)
- Judith E Carroll
- University of California, Los Angeles-Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Teresa E Seeman
- University of California, Los Angeles, Division of Geriatrics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Richard Olmstead
- University of California, Los Angeles-Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Gerson Melendez
- University of California, Los Angeles-Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ryan Sadakane
- University of California, Los Angeles-Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Richard Bootzin
- University of Arizona, Department of Psychology, Tucson, AZ, USA
| | - Perry Nicassio
- University of California, Los Angeles-Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Michael R Irwin
- University of California, Los Angeles-Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA.
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