Cowden syndrome (CS) is a rare, congenital disease with associated cancers, but in a neurosurgical context is typically considered part of Lhermitte-Duclos. This misrepresentation is the likely cause of under-diagnosis. Furthermore, the presence of meningiomata has been described in CS patients but its absence as part of the condition’s major criteria suggest the correlation requires greater documentation. A 41-year-old woman with multiple cancers and a familial circumambience of CS was reviewed in clinic where multiple meningiomata were incidentally identified on MRI. Despite a lack of neurological impairment, and the general reluctance in treating the meningiomas of congenital disease with radiotherapy (RT), the patient underwent stereotactic radio-surgery (SRS) and at one-year post-procedure has reported no side effects or toxicity.
Combined a-TST with QFTG testing gave 43% positivity among RA patients, which is close to the reported ~ 40% Mantoux positivity in the general population. Therefore, this method for the screening of LTBI in Indian patients with RA being considered for tumor necrosis factor alpha treatment could be satisfactory for offsetting TB flare. It may apply to other high-burden TB countries around the world.
Highlights
COVID-19 is caused by severe acute respiratory syndrome coronavirus.
Current knowledge about the treatment protocol is still limited.
COVID-19, poses significant challenges to the healthcare system.
Auto-injectors are medical devices designed for the self-administration of injections by patients and for easy administration by healthcare professionals in emergency situations. Although they vary in design and application, auto-injectors are typically built around a spring-loaded syringe. Despite their widespread use in a variety of clinical settings, there have been limited attempts to assess their reliability. This systematic review investigates the reliability of auto-injectors, identifies common causes of failure, and summarizes the overall rate of malfunction.
A systematic review of research published on the PubMed and Cochrane Library databases was performed in July 2022. The relevant studies were assessed for their methodological quality and risk of bias prior to extracting key study outcomes on auto-injector reliability. Finally, a summary rate covering all eligible studies was calculated.
The search identified a total of 110 articles, of which ten were found to be suitable for inclusion. The risk of bias was low, and the methodological quality was high across the ten studies. Out of a total of 2,964 injections administered from an auto-injector, there were 12 device malfunctions, giving a summary rate of 0.40% (±0.23) auto-injector failures. The causes of malfunction varied in nature, with the majority of cases (58.3%) not being specified or not identified.
This review has demonstrated that auto-injectors are reliable devices. Although further research on the nature of malfunctions is needed, the low rate of malfunctions supports training programs for healthcare professionals and patients on the optimum use and maintenance of auto-injectors. It provides a rationale for their continued development.
Aim: India is a high burden tuberculosis country. Past BCG vaccination could cause sensitisation against TB antigens. Patients with systemic inflammatory rheumatic diseases (SIRDs) have inherent anergy. Also, they are often treated with glucocorticoids and other immunomodulatory drugs. These two confounders may affect TST, which is otherwise a robust screening method for studying TB epidemiology. Possibly for these reasons Indian Rheumatology Association did not recommend TST for the screening of TB infection (latent or disease) before initiating TNFi treatment. The present work examined TST results in SIRDs with the objective of whether it could be used for the screening of latent TB infection among SIRD patients in the Indian context. Method: 60 adult rheumatoid arthritis (RA) and 191 axial Spondyloarthritis (axSpA) patients were Mantoux tested using a higher PPD strength of 10 TU to offset inherent disease anergy. The test was read after 48 to 72 hours. It was interpreted according to the nationally recommended cutoffs that takes into account sensitisation to BCG or environmental mycobacteria. Thus, in this study, an induration of >10 mm was considered as 'latent TB infection'. Results: The positivity among RA and axSpA patients was 31.66% and 40.31% respectively, similar to that seen in adult Indians. Conclusion: Based upon these results use of modified TST with 10 TUPPD using >10 mm induration as the cutoff point is recommended for diagnosing TB infection; the test may be appropriate for the screening of latent TB infection in the Indian setting. IRA may consider revising its policy for latent TB screening accordingly.
Pain makes us conscious for the presence of the injurious agent and that is why we seek removal of the injurious agent by appropriate measures. Rheumatoid arthritis (RA) is corelated with aamvata in Ayurved. Rheumatoid arthritis is basically an autoimmune chronic inflammatory disorder that mainly affects the symmetrical metacarpophalangeal joint and more than two to three proximal interphalangeal small joints of the body. This disease is commonly found in females as compared to males. The female male ratio is 3:1. Prevalence of Rheumatoid arthritis increases with age, with 5% of women and 2% of men over 55 years being affected. Rheumatoid arthritis is rare in men under the age of 45, where there is 6:1 female surplus. It’s a very painful disease which usually cause tender, swelling and inflammation in joints. Joint stiffness worse in the morning and remain for more than one hour. Chronic inflammation, granuloma formation and joint destruction is commonly seen. Fatigue, fever, weight loss, irritation and depression are also the most common non-articular symptoms. A satisfactory treatment is available in Ayurvedic medicine for this disorder. Various Ayurvedic drugs have been proved useful for these manifestations. This case report is a classic case of Rheumatoid arthritis, which was treated for six months under the name of aamvata with Ayurvedic drugs. The patient was on modern medicine and we efficaciously exchange him from conventional modern medicine to ayurvedic medicine.
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