Medicine
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Acute generalized exanthematous pustulosis (AGEP) is a serious adverse skin reaction characterized by the rapid appearance of densely distributed, small, sterile pustules with erythema. However, its pathogenesis is not fully understood. Hydroxychloroquine is widely used for the treatment of autoimmune diseases. Some patients presenting with AGEP have IL36RN and CARD14 gene mutations. Our report describes a patient with rheumatoid arthritis and AGEP associated with hydroxychloroquine and a newly discovered CARD14 gene mutation. ⋯ There has been little basic research on AGEP-related genetics, and the CARD14 mutation may underlie several pustular rashes, including AGEP and generalized pustular psoriasis. Follow-up studies and further accumulation of patient data are required.
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Horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is a second common canal of Benign Paroxysmal Positional Vertigo (BPPV); its actual incidence may have been underestimated because of its complex pathogenesis. Although the canalith repositioning maneuver is the treatment of choice, it has a high recurrence rate, affecting some patients' lives and psychology. We submit a case report describing acupuncture and wheat grain moxibustion treatment for HSC-BPPV. ⋯ This brief clinical report suggests that acupuncture therapy may be a complementary option for treating HSC-BPPV.
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The burden of malignant neoplasms is increasing worldwide. Healthy lifestyles such as maintaining a healthy body weight are important to improve survival rate in cancer patients. This study was aimed to test the hypothesis that weight change affects mortality in patients newly diagnosed with cancer. ⋯ After stratifying according to baseline body mass index (BMI), weight maintenance and gain were negatively associated with all-cause mortality (0.286 [0.138-0.592] for weight maintenance and 0.119 [0.027-0.533] for weight gain) among those with a BMI < 25 kg/m2. Weight maintenance and gain reduced the risk of all-cause mortality in patients newly diagnosed with any cancer. In addition, weight maintenance was significantly related to cancer-related mortality.
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Pharmacy refill records (PRR), are an accessible strategy for estimating adherence in low- and middle-income countries (LMICs). However, the low-cost urine-tenofovir point-of-care test opens up the possibility of an objective metric of adherence that is scalable to LMICs. This study compared adherence to tenofovir-based regimens using urine-tenofovir point-of-care (POC) test with pharmacy refill records in a Nigerian population of HIV-positive persons. ⋯ The logistic regression model showed that an increase in pharmacy-refill record of ≥ 95% was associated with viral suppression (P = .019). From the ROC curve, the sensitivity was same at 95.5% for both methods, but the specificity of the urine-tenofovir point-of-care test was greater (96.6% vs 95.5%) than pharmacy refill record (P = .837). Urine-tenofovir point-of-care test provided equivalent adherence data to pharmacy refill data.
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Septic cavernous sinus thrombosis (SCST) is a rare infectious thrombophlebitic disease. The infection often arises from the tissues surrounding the cavernous sinus as well as the cavernous sinus drainage. Early symptoms of SCST include fever, headache, proptosis, ptosis, bulbar conjunctival edema, and limited eye movement. The complications include venous sinus thrombosis, intracerebral abscess, and subdural empyema. Aneurysmal subarachnoid hemorrhage combined with acute cerebral infarction has not been reported. ⋯ We report a case of SCST mainly presenting as acute cerebral infarction and aneurysmal subarachnoid hemorrhage, with an acute onset and ultimately a poor prognosis. This complication is extremely rare and have not yet reported according existing literatures but can be life-threatening if not recognized and treated promptly. Early antibiotic administration and early sinus drainage may alter the patient's prognosis. By describing this unusual the case we hope to raise awareness of the need of early illness detection and treatment in order to avoid catastrophic consequences. It also exemplifies the mechanism of acute inflammatory disorders and aneurysm development.