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HIV related Myelopathy

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61. Prospective Comparative Study to Compare Safety and Effectiveness of Two Vertebral Compression Fracture Reduction Techniques

, Comparative Clinical Study to Compare the Safety and Effectiveness of Two Vertebral Compression Fracture (VCF) Reduction Techniques: the SpineJack® and the KyphX Xpander® Inflatable Bone Tamp Study Start Date : April 2015 Actual Primary Completion Date : February 20, 2018 Actual Study Completion Date : February 20, 2018 Resource links provided by the National Library of Medicine related topics: Arms and Interventions Go to Arm Intervention/treatment Experimental: SpineJack® system VCF treatment system (...) and effectiveness): Reduction in VCF fracture-related pain at 12 months from baseline as measured by a 100 mm VAS scale (reduction of pain at 12 months by > 20 mm) AND, Maintenance or improvement in function at 12 months from baseline as measured by the 100 point Oswestry Disability Index (ODI) AND, Absence of device-related serious adverse events, defined as device-related adverse events (device migration, recollapse, protrusion) or symptomatic cement extravasation requiring surgical re-intervention

2015 Clinical Trials

62. Selumetinib in Treating Patients With Neurofibromatosis Type 1 and Plexiform Neurofibromas That Cannot Be Removed by Surgery

Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment Official Title: Phase II Trial of the MEK1/2 Inhibitor Selumetinib (AZD6244 Hydrogen Sulfate) in Adults With Neurofibromatosis Type 1 (NF1) and Inoperable Plexiform Neurofibromas Actual Study Start Date : January 11, 2016 Estimated Primary Completion Date : June 30, 2019 Resource links provided by the National Library of Medicine related topics: related topics: resources: Arms and Interventions Go to Arm (...) of or close proximity to vital structures, invasiveness, or high vascularity of the PN; the PN either causes morbidity or it is growing and has the potential to cause morbidity such as (but not limited to): head and neck lesions that could compromise the airway or great vessels, paraspinal lesions that can cause myelopathy, brachial or lumbar plexus lesions that could cause nerve compression and loss of function, lesions that could result in major deformity (e.g., orbital lesions) or are significantly

2015 Clinical Trials

63. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

of serious adverse events for other genera. ES-4 Key Question 6. How does harm associated with Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and Bacillus relate to use of concomitant antibiotics, confounding diet therapies, corticosteroid use, immune suppressants, or other potential confounders? We did not identify studies that addressed possible interactions or confounders of probiotics interventions. Although the risk of adverse events in general might be higher (...) that have been employed for their probiotic properties are most commonly species of Lactobacillus and Bifidobacterium; other bacterial genera, such as Streptococcus, Enterococcus, and Bacillus, and species of the yeast genus Saccharomyces have also been studied. Probiotic properties of genera, species, and strains may vary according to the indication. Related to probiotic organisms, prebiotics are food products defined as nondigestible food ingredients that benefit the host by selectively stimulating

2011 EvidenceUpdates

64. Neurosyphilis (Overview)

process known. Invasion of the CNS occurs early in the course of untreated syphilis. Of late, there has been a drastic increase, worldwide, in the incidence of syphilis, especially in urban areas. [ ] This fact leads clinicians to heighten their degree of suspicion, being profoundly alert to the possibility of this infection within the HIV populations. [ ] Neurosyphilis, quite directly, is defined as a CSF WBC count of 20 cells/µL or greater or a reactive CSF Venereal Disease Research Laboratory (VDRL (...) in whites than in blacks and is twice as common in males as in females. It is contracted most often during earlier years of sexual activity. Sometimes, not until decades later is the disease expressed clinically, as any of the myriad signs and symptoms within the spectrum of progressive chronic infection. In parts of Africa, the incidence may be in excess of 2300 cases per 100,000 population. In Nigeria, patients with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to therapy more

2014 eMedicine.com

65. Transfusion-Transmitted Diseases (Overview)

is a major concern when it comes to transfusing immunocompromised hosts. For this reason, all immunocompromised patients are given CMV-seronegative or leukocyte-depleted blood products. [ , , , ] Human T-cell lymphotrophic virus Human T-cell lymphotrophic virus–1 (HTLV-1) and HTLV-2 have been shown to be transmitted by blood transfusion. The residual risk of transmission is 1 in 3 million in the United States. Infection with these retroviruses may result in HTLV-related myelopathy/ (HAM/TSP) and adult T (...) transmitted through blood transfusion include the following: Human immunodeficiency virus (HIV) West Nile virus (WNV) Cytomegalovirus (CMV) Human T-cell lymphotrophic viruses (HTLVs) Parvovirus B19 Protozoal organisms that can be passed on through transfusion include species of the genus Plasmodium , which cause malaria. Prions, which cause Creutzfeldt-Jakob disease, are also transmissible through transfusion; they cannot be destroyed using current techniques for inactivating pathogens in the blood supply

2014 eMedicine.com

66. Vitamin B-12 Associated Neurological Diseases (Follow-up)

Geriatr Soc . 2003 Mar. 51(3 Suppl):S2-9. . Beach RS, Mantero-Atienza E, Shor-Posner G. Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS . 1992 Jul. 6(7):701-8. . Berger JR, Quencer R. Reversible myelopathy with pernicious anemia: clinical/MR correlation. Neurology . 1991 Jun. 41(6):947-8. . Booth GL, Wang EE. Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events. The Canadian Task Force (...) . Subacute combined sclerosis of the spinal cord and its relation to anemia and to toxemia. J Nerv Ment Dis . 1899. 26:1. Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol . 2000 Oct. 57(10):1422-7. . Ehrenpreis ED, Carlson SJ, Boorstein HL. Malabsorption and deficiency of vitamin B12 in HIV-infected patients with chronic diarrhea. Dig Dis Sci . 1994 Oct. 39(10):2159-62. . Fenwick S. On atrophy of the stomach. Lancet . 1870. ii:78-80. Fine EJ, Hallett M. Neurophysiological study

2014 eMedicine.com

67. Somatosensory Evoked Potentials: Clinical Applications (Follow-up)

in the course of the disease, when distal conduction and F-wave studies may be normal Chronic acquired demyelinating neuropathies Infectious causes (eg, HIV) Toxic neuropathies Focal neuropathy The test of choice in focal neuropathy is standard NCSs. Entrapment neuropathies, such as carpal tunnel syndrome, may be found incidentally when SEPs are recorded. The use of SEP for detection of saphenous neuropathy, intercostal neuropathy, and trigeminal neuropathy has been reported. However, standard NCSs (...) fusion and found SSEP to be a highly sensitive and specific test. Data also showed that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits. [ ] Conditions for which SEPs might be useful See the list below: Subacute combined degeneration and myelopathy , to evaluate the effect of spinal cord compression Hereditary spastic paraplegia Transverse myelitis - Lower-limb SEPs produce a higher yield

2014 eMedicine.com

68. Retinitis, CMV (Diagnosis)

plasma HIV RNA levels (>100,000 copies/mL) The following are potentially helpful imaging studies: Fundus photography Fluorescein retinal angiography Optical coherence tomography (OCT) Ophthalmic ultrasonography Chest radiography Gastrointestinal endoscopy Treatment Pharmacotherapy is the mainstay of treatment when retinal detachment is absent. During the AIDS epidemic of the 1980s and early 1990s in the United States, intracameral drug-eluting devices were used but have since been discontinued (...) lymphadenopathy, and mild hepatitis. CMV generally dwells as a latent intracellular virus in immunocompetent children and adults. CMV may reactivate if host immunity is compromised. In immunocompromised individuals, primary infection or reactivation of latent virus can lead to opportunistic infection of multiple organ systems, including the skin (eg, rashes, ulcers, pustules), lungs (eg, interstitial pneumonitis), gastrointestinal tract (eg, , ), peripheral nerves (eg, radiculopathy, myelopathy), brain (eg

2014 eMedicine.com

69. Vitamin B-12 Associated Neurological Diseases (Diagnosis)

Geriatr Soc . 2003 Mar. 51(3 Suppl):S2-9. . Beach RS, Mantero-Atienza E, Shor-Posner G. Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS . 1992 Jul. 6(7):701-8. . Berger JR, Quencer R. Reversible myelopathy with pernicious anemia: clinical/MR correlation. Neurology . 1991 Jun. 41(6):947-8. . Booth GL, Wang EE. Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events. The Canadian Task Force (...) . Subacute combined sclerosis of the spinal cord and its relation to anemia and to toxemia. J Nerv Ment Dis . 1899. 26:1. Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol . 2000 Oct. 57(10):1422-7. . Ehrenpreis ED, Carlson SJ, Boorstein HL. Malabsorption and deficiency of vitamin B12 in HIV-infected patients with chronic diarrhea. Dig Dis Sci . 1994 Oct. 39(10):2159-62. . Fenwick S. On atrophy of the stomach. Lancet . 1870. ii:78-80. Fine EJ, Hallett M. Neurophysiological study

2014 eMedicine.com

70. Somatosensory Evoked Potentials: Clinical Applications (Treatment)

in the course of the disease, when distal conduction and F-wave studies may be normal Chronic acquired demyelinating neuropathies Infectious causes (eg, HIV) Toxic neuropathies Focal neuropathy The test of choice in focal neuropathy is standard NCSs. Entrapment neuropathies, such as carpal tunnel syndrome, may be found incidentally when SEPs are recorded. The use of SEP for detection of saphenous neuropathy, intercostal neuropathy, and trigeminal neuropathy has been reported. However, standard NCSs (...) fusion and found SSEP to be a highly sensitive and specific test. Data also showed that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits. [ ] Conditions for which SEPs might be useful See the list below: Subacute combined degeneration and myelopathy , to evaluate the effect of spinal cord compression Hereditary spastic paraplegia Transverse myelitis - Lower-limb SEPs produce a higher yield

2014 eMedicine.com

71. Pathophysiology of Chronic Back Pain (Treatment)

studies have indicated that any correlation between clinical symptoms and radiological signs of degeneration is minimal or nonexistent. [ , , , , , ] Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited in others as the cause of chronic spine-related pain conditions. [ , ] Although disk herniation has been popularized as a cause of spinal and radicular pain, asymptomatic disk herniations on computed tomography (CT) and magnetic resonance imaging (MRI) scans are common (...) first determine that pain symptoms are consistent with common activity-related disorders of the spine resulting from the wear and tear of excessive biomechanical and gravitational loading that some traditionally describe as mechanical. [ , ] Mechanical lumbar syndromes are typically aggravated by static loading of the spine (eg, prolonged sitting or standing), by long lever activities (eg, vacuuming or working with the arms elevated and away from the body), or by levered postures (eg, bending

2014 eMedicine.com

72. Neurosyphilis (Treatment)

process known. Invasion of the CNS occurs early in the course of untreated syphilis. Of late, there has been a drastic increase, worldwide, in the incidence of syphilis, especially in urban areas. [ ] This fact leads clinicians to heighten their degree of suspicion, being profoundly alert to the possibility of this infection within the HIV populations. [ ] Neurosyphilis, quite directly, is defined as a CSF WBC count of 20 cells/µL or greater or a reactive CSF Venereal Disease Research Laboratory (VDRL (...) in whites than in blacks and is twice as common in males as in females. It is contracted most often during earlier years of sexual activity. Sometimes, not until decades later is the disease expressed clinically, as any of the myriad signs and symptoms within the spectrum of progressive chronic infection. In parts of Africa, the incidence may be in excess of 2300 cases per 100,000 population. In Nigeria, patients with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to therapy more

2014 eMedicine.com

73. Vitamin B-12 Associated Neurological Diseases (Treatment)

of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc . 2003 Mar. 51(3 Suppl):S2-9. . Beach RS, Mantero-Atienza E, Shor-Posner G. Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS . 1992 Jul. 6(7):701-8. . Berger JR, Quencer R. Reversible myelopathy with pernicious anemia: clinical/MR correlation. Neurology . 1991 Jun. 41(6):947-8. . Booth GL, Wang EE. Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention (...) . 1995 Dec 6. 274(21):1698-702. . Dana CL. Subacute combined sclerosis of the spinal cord and its relation to anemia and to toxemia. J Nerv Ment Dis . 1899. 26:1. Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol . 2000 Oct. 57(10):1422-7. . Ehrenpreis ED, Carlson SJ, Boorstein HL. Malabsorption and deficiency of vitamin B12 in HIV-infected patients with chronic diarrhea. Dig Dis Sci . 1994 Oct. 39(10):2159-62. . Fenwick S. On atrophy of the stomach. Lancet . 1870. ii:78-80. Fine EJ

2014 eMedicine.com

74. Polyarteritis Nodosa (Overview)

in obstruction and subsequent tissue ischemia or infarction. [ ] Previous Next: Etiology Hepatitis B and PAN The pathogenesis of polyarteritis nodosa (PAN) is unknown, and no animal model is available for study. (HBV) infection is strongly linked with PAN. Evidence for immune complex–induced disease is confined to HBV-related PAN; the role of immune complexes in non-HBV-related PAN remains unclear. [ ] Impaired function of endothelial cells may be part of idiopathic PAN or a consequence of it; in HBV-PAN (...) in a larger 161 patient cohort with HCV-related vasculitis in France. [ ] Despite the presence of serum cryoglobulins, these patients were diagnosed with HCV-PAN on the basis of typical histopathologic features of PAN and/or the presence of microaneurysms and/or multiple stenoses on abdominal and/or renal angiography. A number of other infectious organisms have been reported in association with PAN or PAN-like diseases, but causal evidence is inconsistent. These organisms include varicella-zoster virus

2014 eMedicine.com

75. Polyarteritis Nodosa (Overview)

in obstruction and subsequent tissue ischemia or infarction. [ ] Previous Next: Etiology Hepatitis B and PAN The pathogenesis of polyarteritis nodosa (PAN) is unknown, and no animal model is available for study. (HBV) infection is strongly linked with PAN. Evidence for immune complex–induced disease is confined to HBV-related PAN; the role of immune complexes in non-HBV-related PAN remains unclear. [ ] Impaired function of endothelial cells may be part of idiopathic PAN or a consequence of it; in HBV-PAN (...) in a larger 161 patient cohort with HCV-related vasculitis in France. [ ] Despite the presence of serum cryoglobulins, these patients were diagnosed with HCV-PAN on the basis of typical histopathologic features of PAN and/or the presence of microaneurysms and/or multiple stenoses on abdominal and/or renal angiography. A number of other infectious organisms have been reported in association with PAN or PAN-like diseases, but causal evidence is inconsistent. These organisms include varicella-zoster virus

2014 eMedicine.com

76. Human T-Cell Lymphotrophic Viruses (Treatment)

. J Clin Oncol . 2009 Jan 20. 27(3):453-9. . . Ramos JC, Lossos IS. Newly emerging therapies targeting viral-related lymphomas. Curr Oncol Rep . 2011 Oct. 13(5):416-26. . Yamauchi J, Coler-Reilly A, Sato T, Araya N, Yagishita N, Ando H, et al. Anti-CCR4 antibody mogamulizumab targets human T-lymphotropic virus type I-infected CD8+ as well as CD4+ T cells to treat associated myelopathy. J Infect Dis . 2014 Aug 7. . Nasr R, Marçais A, Hermine O, Bazarbachi A. Overview of Targeted Therapies for Adult (...) of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system. Acta Neuropathol . 2000 Sep. 100(3):245-52. . Beilke MA, Japa S, Moeller-Hadi C, Martin-Schild S. Tropical spastic paraparesis/human T leukemia virus type 1-associated myelopathy in HIV type 1-coinfected patients. Clin Infect Dis . 2005 Sep 15. 41(6):e57-63. . Berger JR, Svenningsson A, Raffanti S, Resnick L. Tropical spastic paraparesis-like illness occurring

2014 eMedicine.com

77. Transfusion-Transmitted Diseases (Treatment)

is a major concern when it comes to transfusing immunocompromised hosts. For this reason, all immunocompromised patients are given CMV-seronegative or leukocyte-depleted blood products. [ , , , ] Human T-cell lymphotrophic virus Human T-cell lymphotrophic virus–1 (HTLV-1) and HTLV-2 have been shown to be transmitted by blood transfusion. The residual risk of transmission is 1 in 3 million in the United States. Infection with these retroviruses may result in HTLV-related myelopathy/ (HAM/TSP) and adult T (...) transmitted through blood transfusion include the following: Human immunodeficiency virus (HIV) West Nile virus (WNV) Cytomegalovirus (CMV) Human T-cell lymphotrophic viruses (HTLVs) Parvovirus B19 Protozoal organisms that can be passed on through transfusion include species of the genus Plasmodium , which cause malaria. Prions, which cause Creutzfeldt-Jakob disease, are also transmissible through transfusion; they cannot be destroyed using current techniques for inactivating pathogens in the blood supply

2014 eMedicine.com

78. Retinitis, CMV (Overview)

. Examination of the retina by an experienced ophthalmologist is a prerequisite for diagnosis. Blood tests to identify CMV via antigen detection, culture, or polymerase chain reaction (PCR) have been shown to have poor positive predictive value. A negative plasma or tissue PCR result does not exclude CMV end-organ disease. Available laboratory tests that can support a diagnosis of CMV retinitis include the following: CD4 T-cell count < 50 cells/µL High level of CMV viremia measured via PCR High plasma HIV (...) lymphadenopathy, and mild hepatitis. CMV generally dwells as a latent intracellular virus in immunocompetent children and adults. CMV may reactivate if host immunity is compromised. In immunocompromised individuals, primary infection or reactivation of latent virus can lead to opportunistic infection of multiple organ systems, including the skin (eg, rashes, ulcers, pustules), lungs (eg, interstitial pneumonitis), gastrointestinal tract (eg, , ), peripheral nerves (eg, radiculopathy, myelopathy), brain (eg

2014 eMedicine.com

79. Pathophysiology of Chronic Back Pain (Overview)

studies have indicated that any correlation between clinical symptoms and radiological signs of degeneration is minimal or nonexistent. [ , , , , , ] Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited in others as the cause of chronic spine-related pain conditions. [ , ] Although disk herniation has been popularized as a cause of spinal and radicular pain, asymptomatic disk herniations on computed tomography (CT) and magnetic resonance imaging (MRI) scans are common (...) first determine that pain symptoms are consistent with common activity-related disorders of the spine resulting from the wear and tear of excessive biomechanical and gravitational loading that some traditionally describe as mechanical. [ , ] Mechanical lumbar syndromes are typically aggravated by static loading of the spine (eg, prolonged sitting or standing), by long lever activities (eg, vacuuming or working with the arms elevated and away from the body), or by levered postures (eg, bending

2014 eMedicine.com

80. Primary CNS Lymphoma (Overview)

30 cells/µL. Virtually all PCNSLs in patients with AIDS express an Epstein-Barr virus (EBV)-related genome. PCNSL is less frequently associated with EBV in patients without AIDS. The overwhelmingly common risk factor for PCNSL related to human immunodeficiency virus (HIV) infection is intravenous (IV) drug abuse. Corboy et al reported that 56% of a group of immunocompetent and immunocompromised patients had human herpes virus 8 (HHV-8) in their tumors. This is the same herpes virus (...) infected with HIV, and the incidence is expected to rise as patients with low CD4 + counts survive longer. Similar trends toward rising frequency of diagnosis of PCNSL are reported internationally. Sex predilection Among immunocompetent patients with PCNSL, males outnumber females by approximately 2:1. Almost 95% of HIV-infected patients with PCNSL are males. Age predilection The median age of immunocompetent patients with PCNSL is 55 years. The median age of HIV-infected patients with PCNSL is 35

2014 eMedicine.com

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