The prevalence of obesity is increasing worldwide. Bioactive phytochemicals in food supplements are a trending approach to facilitate dieting and to improve patients’ adherence to reducing food and caloric intake. The aim of this systematic review was to assess efficacy and safety of the most commonly used bioactive phytochemicals with appetite/hunger-suppressing and/or satiety/fullness-increasing properties. To be eligible, studies needed to have included at least 10 patients per group aged 18 years or older with no serious health problems except for overweight or obesity. Of those studies, 32 met the inclusion criteria, in which 27 different plants were tested alone or as a combination, regarding their efficacy in suppressing appetite/hunger and/or increasing satiety/fullness. The plant extracts most tested were derived from Camellia sinensis (green tea), Capsicum annuum, and Coffea species. None of the plant extracts tested in several trials showed a consistent positive treatment effect. Furthermore, only a few adverse events were reported, but none serious. The findings revealed mostly inconclusive evidence that the tested bioactive phytochemicals are effective in suppressing appetite/hunger and/or increasing satiety/fullness. More systematic and high quality clinical studies are necessary to determine the benefits and safety of phytochemical complementary remedies for dampening the feeling of hunger during dieting.
BACKGROUND Immune checkpoint inhibitors (ICIs) can cause a wide spectrum of immune-related adverse events, including encephalitis. To date, no prospective randomised controlled trials examining the patient characteristics, treatment and outcomes of ICI-associated encephalitis have been published. Therefore, we aimed to review case reports and to provide recommendations for the management of ICI-associated encephalitis. METHODS A literature search using Google Scholar and PubMed was performed in December 2019. Published case reports and case series of ICI-associated encephalitis were reviewed, and a case series from the Limmattal Hospital in Schlieren, Switzerland was added. The results are presented as numbers and medians (ranges). RESULTS Five different ICIs caused encephalitis in the 47 patients included in this case series. Nivolumab was the most frequently involved drug (27/47, 57%). The median time between treatment and onset of symptoms was 65 (4–630) days. Patients presented with rapidly evolving confusion, reduced level of consciousness, headache, seizures and focal neurological deficits. A total of 19 out of the 44 (43%) magnetic resonance imaging (MRI) scans performed revealed findings suggestive of encephalitis. No specific electroencephalogram (EEG) pattern consistent with encephalitis was found, but epileptiform discharges were detected in 7/20 (35%) of all tested patients. Typical findings of cerebrospinal fluid (CSF) analysis were pleocytosis, elevated protein levels and normal glucose concentrations. Forty-four out of 47 (94%) patients received corticosteroids. Intravenous immunoglobulins (IVIG), rituximab and plasma exchange therapy were less frequently prescribed. Nine out of 47 (19%) patients died during the index hospitalisation. CONCLUSIONS Encephalitis should be suspected in patients treated with ICIs who present with rapidly evolving confusion. Blood tests, CSF analysis, cerebral MRI and an EEG should be performed. Therapy with intravenous corticosteroids is recommended. Steroid unresponsiveness is rare and should lead to a review of the diagnosis. Alternative treatment options are IVIG, plasma exchange therapy and rituximab.
OBJECTIVES: We present a patient with bifacial weakness and paraesthesia subtype of Guillain-Barré syndrome (GBS), which occurred 1 month after a SARS-CoV-2 infection. While GBS as complication of SARS-CoV-2 infection has been described many times, only a few cases of post-COVID-19 bifacial weakness and paraesthesia are known to date. RESULTS: A 59-year-old man presented with thoracoradicular pain, paraesthesias of hands and feet, as well as progressive bilateral facial palsy. Neurological examination revealed a hyporeflexia of his lower limbs and hypoaesthesia of his hands and feet. Clinical and electrophysiological findings as well as CSF analysis were consistent with bifacial weakness and paraesthesia. The patient’s condition improved promptly after 5 days of intravenous immunoglobulin therapy. DISCUSSION: We suspect bifacial weakness and paraesthesia to be a possible post-infectious complication of COVID-19. Hence, it is a differential diagnosis of facial nerve palsy in association with SARS-CoV-2 infection. Considering the rarity of GBS and bifacial weakness and paraesthesia, it appears unlikely that bigger trials elucidating the causal relation between them and SARS-CoV-2 infection will be available in the future.
A 51-year-old woman with fever and malaise was diagnosed with coronavirus disease 19. Two weeks later, the patient was admitted with acute onset of severe epigastric pain and abdominal tenderness. Blood tests revealed high levels of D-dimer with normal values of C-reactive protein. A computed tomography (CT) of the abdomen showed a large (63 3 25 3 49 mm) fatty encapsulated mass with soft-tissue stranding and moderate ascites (a, b). No obstructions of the supplying arteries or veins were detectable. Diagnosis of an infarction of the greater omentum was made. The patient required intravenous analgesia and received dalteparin 5000E subcutaneously for 5 days. Nine weeks later, the patient was pain-free and in good condition. In the follow-up CTscan, the infarction of the greater omentum and the ascites had completely resolved (C). In summary, the infarction of the greater omentum is a rare cause of an acute abdomen in patients with severe acute respiratory syndrome coronavirus type 2, which improves with analgesia and thrombosis prophylaxis. (Informed consent was obtained from the patient to publish these images.
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