Aintree – A Meta-Analysis of Survival Factors in Rhino-Orbital-Cerebral Mucormycosis-Has Anything Changed in the Past 20 Years?

Author(s): Vaughan C.; Bartolo A.; Vallabh N.; Leong S.C.

Source: Clinical Otolaryngology; Dec 2018; vol. 43 (no. 6); p. 1454-1464

Publication Date: Dec 2018

Publication Type(s): Article

PubMedID: 29947167

Available  at Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery –  from Wiley Online Library Full Collection

Abstract:Background: Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon yet potentially lethal fungal infection. Although most cases originate from developing countries, an ageing population and increased prevalence of chronic illness may mean some clinicians practicing in developed countries will encounter ROCM cases in their careers. Yohai et al published a systematic review of 145 case reports from 1970 to 1993 assessing prognostic factors for patients presenting with ROCM. We present an updated review of the literature and assess whether survival outcomes have changed in the two decades since that seminal paper. Search strategy: An extensive Medline literature search was performed for case reports published between 1994 and 2015. Result(s): In total, 210 published cases were identified from the literature review, of which 175 patients from 140 papers were included in this review. Fifty-five were female, with an overall mean age of 43 years. Overall survival rate was 59.5%, which was not significantly better than the previous series reported (60%) reported by Yohai et al. Survival rates in patients with chronic renal disease had improved, from 19% to 52%, and in patients with leukaemia (from 13% to 50%). Facial necrosis and hemiplegia remained poor prognostic indicators (33% and 39% survival rates, respectively). Early commencement of medical treatment related to better survival outcomes (61% if commenced within first 12 days of presentation, compared to 33% if after 13 days). Timing of surgery had less of an effect on overall survival. However, in 28 cases that did not receive any surgical treatment, survival was only 21%. Conclusion(s): Although overall survival rates have not improved, survival in patients with renal disease were better, potentially due to the introduction of liposomal amphotericin B which is less nephrotoxic. Prompt recognition of ROCM, reversal of predisposing co-morbidities and aggressive medical treatment remain the cornerstone of managing this highly aggressive disease.

Copyright © 2018 John Wiley & Sons Ltd

Database: EMBASE

Aintree – Coagulopathy, Cryoprecipitate and CRYOSTAT-2: Realising the Potential of a Nationwide Trauma System for A National Clinical Trial

Author(s): Marsden M.; Brohi K.; Rossetto A.; Davenport R.; Benger J.; Stanworth S.; Foley C.; Lucas J.; Green L.; Thomas H.; Curry N.; Howes N.; Foukaneli D.; Philpott K.; Aylwin C.; Chowdhury F.; Moss P.; Wiltshire S.; Keep J.; Umlauft B.; Thornley J.; Karakantza M.; Hussain G.; Procter R.; Elliott C.; Shelton J.; Smithson G.; Sattout A.; Gorry J.; Challen K.; Noyon A.; Carley S.; Trimble T.; Horner D.; Baxter L.; Darwent M.; Hemmatpour S.; Kellett S.; Dowling K.; Kong R.; Coles J.; Kendall J.; Wreford-Bush T.; Kehoe T.; Binney M.; Mahmood A.; Morton S.; Lowe G.; Leech C.; Mushkbar M.; Hall R.; Graham J.; Brooks A.; Chang C.; Townend W.; Bryan M.; Elshaw R.; Squires J.; Taylor B.; Akhtar A.

Source: British Journal of Anaesthesia; 2018

Publication Date: 2018

Publication Type(s): Article In Press

Database: EMBASE

Aintree – An Anatomic Study of the Naviculocuneiform Ligament and Its Possible Role Maintaining the Medial Longitudinal Arch

Authors: Swanton E, Fisher L, Fisher A, Molloy A, Mason L.

Source: Foot Ankle Int. 2018 Nov 22:1071100718811638.

doi: 10.1177/1071100718811638. [Epub ahead of print]

PMID: 30466312 [PubMed – as supplied by publisher]

Aintree – Guidelines for the Diagnosis and Management of Primary Central Nervous System Diffuse Large B-Cell Lymphoma.

Authors: Fox CP, Phillips EH, Smith J, Linton K, Gallop-Evans E, Hemmaway C, Auer DP, Fuller C, Davies AJ, McKay P, Cwynarski K; British Society for Haematology.

Source: Br J Haematol. 2018 Nov 23.

doi: 10.1111/bjh.15661. [Epub ahead of print] No abstract available.

PMID: 30467845 [PubMed – as supplied by publisher]

Walton – The Adult Spasticity International Registry (ASPIRE) Study: Realworld Treatment Utilization and Effectiveness of Onabotulinumtoxina in Post-Stroke Patients Treated for Spasticity

Author(s): Bavikatte G.; Francisco G.E.; Bandari D.S.; Jost W.H.; Zuzek A.; Largent J.; Esquenazi A.

Source: International Journal of Stroke; Oct 2018; vol. 13 (no. 2); p. 17

Publication Date: Oct 2018

Publication Type(s): Conference Abstract

Abstract:Background: OnabotulinumtoxinA treatment for spasticity is individualized, variable, and dependent on numerous factors. This analysis examines onabotulinumtoxinA utilization and effectiveness for the treatment of spasticity in post-stroke patients. Method(s): An international, multicenter, prospective, observational registry (NCT01930786) examining adults with spasticity treated with onabotulinumtoxinA at the physician’s discretion. Assessments include onabotulinumtoxinA utilization (each visit) and physician (next visit)/patient (5+/-1 weeks posttreatment) satisfaction. Result(s): Patients (N=731) were on average 54 years old, majority female (52%) and continuing botulinum toxin treatment for spasticity (63%). The majority of patients (n=411; 56%) had spasticity resulting from stroke. Among stroke patients, the most common upper limb presentation was clenched fist (72%), with onabotulinumtoxinA doses ranging from 10-500U; flexor digitorum superficialis (86%) was the most commonly injected muscle. The most common lower limb presentation was equinovarus foot (56%), with onabotulinumtoxinA doses ranging from 15-630U; gastrocnemius (77%) was the most commonly injected muscle. Overall (N=731), the majority of patients (85%) and physicians (95%) reported extreme satisfaction/satisfaction that onabotulinumtoxinA treatment helped their spasticity. Patients (92%) and physicians (99%) reported they would definitely/probably continue onabotulinumtoxinA treatment for spasticity. Overall (N=731), 261 patients (36%) reported 831 adverse events (AEs), with 23 AEs in 20 patients (3%) considered treatment-related. 94 patients (13%) reported 195 serious AEs, with 3 serious AEs in 2 patients (0.3%) considered treatment-related. No new safety signals were identified. Conclusion(s): Real-world data from ASPIRE captured onabotulinumtoxinA treatment patterns in post-stroke patients treated for spasticity in clinical practice, while further demonstrating the effectiveness and safety of onabotulinumtoxinA for spasticity.

Database: EMBASE


Walton – Clinicopathological Case: Rapid Cognitive Decline and Myoclonus Associated with Fever, Arthropathy and Scleritis

Authors: Ellis RJB, Doran M, Jacob A, Ismail A, Davenport R.

Source: Pract Neurol. 2018 Nov 13. pii: practneurol-2018-002013.

doi: 10.1136/practneurol-2018-002013. [Epub ahead of print]

PMID: 30425126 [PubMed – as supplied by publisher]

Aintree – Characterisation of the NRF2 Transcriptional Network and its Response to Chemical Insult in Primary Human Hepatocytes: Implications for Prediction of Drug-Induced Liver Injury

Authors: Copple IM, den Hollander W, Callegaro G, Mutter FE, Maggs JL, Schofield AL, Rainbow L, Fang Y, Sutherland JJ, Ellis EC, Ingelman-Sundberg M, Fenwick SW, Goldring CE, van de Water B, Stevens JL, Park BK.

Source: Arch Toxicol. 2018 Nov 13.

doi: 10.1007/s00204-018-2354-1. [Epub ahead of print]

PMID: 30426165 [PubMed – as supplied by publisher]

Walton – Ketogenic Diets for Drug-Resistant Epilepsy

Author(s): Martin-Mcgill K.J.; Jackson C.F.; Bresnahan R.; Levy R.G.; Cooper P.N.

Source: Cochrane Database of Systematic Reviews; Nov 2018; vol. 2018 (no. 11)

Publication Date: Nov 2018

Publication Type(s): Review

Available  at Cochrane Database of Systematic Reviews –  from Cochrane Collaboration (Wiley)

Abstract:Background: Ketogenic diets (KDs), being high in fat and low in carbohydrates, have been suggested to reduce seizure frequency in people with epilepsy. At present, such diets are mainly recommended for children who continue to have seizures despite treatment with antiepileptic drugs (AEDs) (drug-resistant epilepsy). Recently, there has been interest in less restrictive KDs, including the modified Atkins diet (MAD), and the use of these diets has extended into adult practice. This is an update of a review first published in 2003 and last updated in 2016. Objectives: To assess the effects of KDs for drug-resistant epilepsy by reviewing the evidence from randomised controlled trials. Search methods: For the latest update we searched the Cochrane Epilepsy Group’s Specialized Register (11 April 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 11 April 2017), MEDLINE (Ovid, 11 April 2017), (11 April 2017) and the WHO International Clinical Trials Registry Platform (ICTRP, 11 April 2017). We imposed no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies. Selection criteria: Randomised controlled trials or quasi-randomised controlled trials of ketogenic diets for people with drug-resistant epilepsy. Data collection and analysis: Two review authors independently applied predefined criteria to extract data and assessed study quality. Main results: We identified 11 randomised controlled trials (RCTs) that generated 15 publications. All trials applied an intention-to-treat analysis with varied randomisation methods. The 11 studies recruited 778 patients; 712 children and adolescents and 66 adults. We assessed all 11 studies to be at low to unclear risk of bias for the following domains: random sequence generation, allocation concealment and selective reporting. For the other domains (blinding, incomplete outcome data, other bias) assessments were varied (low, unclear and high risk of bias). We could not conduct a meta-analysis due to the heterogeneity of the studies and the quality of the evidence was low to very low (GRADE ratings). Reported rates of seizure freedom reached as high as 55% in a classical 4:1 KD group after three months and reported rates of seizure reduction reached as high as 85% in a classical 4:1 KD group after three months (GRADE rating low). One trial found no significant difference between the fasting-onset and gradual-onset KD for rates of seizure freedom, and reported a greater rate of seizure reduction in the gradual-onset KD group. Studies assessing the efficacy of the MAD reported seizure freedom rates of up to 25% and seizure reduction rates of up to 60% in children. One study used a simplified MAD (sMAD) and reported seizure freedom rates of 15% and seizure reduction rates of 56% in children. One study utilised a MAD in adults and reported seizure reduction rates of 35%, but no patients became seizure free (GRADE rating low). Adverse effects of the dietary interventions were experienced in all studies. The most commonly reported adverse effects were gastrointestinal syndromes. It was common that adverse effects were the reason for participants dropping out of trials (GRADE rating low). Other reasons for dropout included lack of efficacy and non-acceptance of the diet (GRADE rating low). Although there was some evidence for greater antiepileptic efficacy for a classical 4:1 KD over lower ratios, the classical 4:1 KD was consistently associated with more adverse effects. One study assessed the effect of dietary interventions on quality of life, cognition and behavioural functioning, reporting participants in the KD group to be more active, more productive and less anxious after four months, compared to the control group. However, no significant difference was found in quality-adjusted life years (QALYs) between the KD group and control group at four or 16 months (GRADE rating very low). Authors’ conclusions: The RCTs discussed in this review show promising results for the use of KDs in epilepsy. However, the limited number of studies, small sample sizes and the limited studies in adults, resulted in a low to very low overall quality of evidence. There were adverse effects within all of the studies and for all KD variations, such as short-term gastrointestinal-related disturbances and increased cholesterol. However, study periods were short, therefore the long-term risks associated with these adverse effects is unknown. Attrition rates remained a problem with all KDs and across all studies; reasons for this being lack of observed efficacy and dietary tolerance. Only one study reported the use of KDs in adults with epilepsy; therefore further research would be of benefit. Other more palatable but related diets, such as the MAD, may have a similar effect on seizure control as the classical KD, but this assumption requires more investigation. For people who have medically intractable epilepsy or people who are not suitable for surgical intervention, KDs remain a valid option; however, further research is required.

Copyright © 2018 The Cochrane Collaboration.

Database: EMBASE