Clinical medicine (London, England)
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Minimal residual disease (MRD) testing is a promising approach to tailor the treatment of multiple myeloma (MM). However, several major concerns remain to be addressed before moving it into daily practice, most of which stem from the dynamic nature of the MRD status. Thus, it is crucial to understand the MRD dynamics and propose its clinical implications. ⋯ Longitudinal assessment of MRD during the treatment course and follow-up is required for monitoring disease progression or relapse, to guide treatment decisions. Accordingly, a prospective study is currently ongoing to investigate the feasibility and benefit of the MRD-tailored therapy according to the longitudinal changes of the MRD status.
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Case Reports
Individualized therapeutic approach to the patient with atypical haemolytic-uremic syndrome.
Atypical haemolytic-uraemic syndrome (aHUS) is a rare disease associated with uncontrolled activation of the alternative complement pathway, leading to thrombotic microangiopathy (TMA). Early diagnosis and treatment with eculizumab, a monoclonal antibody targeting the complement component C5, are crucial to improve outcomes and prevent renal failure and mortality. Current recommendations include lifelong eculizumab therapy, yet this practice presents challenges including high treatment costs and increased infection risks from prolonged complement inhibition. ⋯ Such approaches could mitigate the risks and costs associated with lifelong therapy while maintaining disease control, especially considering the variability in relapse risk among different genetic mutations. This personalised treatment model might significantly impact the management of aHUS, aligning clinical care with individual patient needs and economic considerations. Further research should relate drug pharmacokinetics/pharmacodynamics to clinical/genetic setting to identify milestones of individual patient treatment approach.
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Staphylococcus aureus bacteraemia (SAB) is a multi-system disease associated with a 20-25% mortality in the UK setting. Many patients with SAB are admitted acutely unwell and are treated by the general physician. This review summarises the key management steps that a general physician needs to be aware of when treating patients with SAB. Successful management relies on appropriate empirical and definitive antimicrobial therapy, effective source control, accurate risk stratification and timely identification of metastatic foci of infection, as well as exclusion of infective endocarditis, which can be present in up to 10% of patients with SAB.
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Comparative Study
Differential effects of oral versus intravenous hydrocortisone and dexamethasone on capillary blood glucose levels in adult inpatients - a single centre study.
Corticosteroids raise blood glucose concentrations; however, it remains unknown which form of administration, oral or intravenous, is associated with the greatest degree of blood glucose rise in hospitalised patients. Furthermore, it is not known whether the pattern of the associated hyperglycaemia throughout the day differs depending on the route of administration. ⋯ This study found that oral and intravenous administration of hydrocortisone and dexamethasone do not have a significantly differing impact on blood glucose levels. Capillary glucose monitoring is strongly recommended in all individuals who are on either oral or intravenous corticosteroids.
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This case illustrates a rare cause of facial pain due to glossopharyngeal neuralgia in a 66-year-old male patient. Imaging confirmed an aneurysm of the cervical internal carotid artery as the cause; the aneurysm itself, likely secondary to an elongated styloid process (Eagle's syndrome). The imaging findings and management options are discussed below.