The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Hiroshi Date - One of the best experts on this subject based on the ideXlab platform.
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basiliximab for posterior reversible encephalopathy syndrome after lung transplantation
European Journal of Cardio-Thoracic Surgery, 2017Co-Authors: H Yamagishi, Toyofumi F Chenyoshikawa, Hiroshi DateAbstract:: Posterior reversible encephalopathy syndrome is a Neurological Complication associated with calcineurin inhibitors. There is no consensus regarding the continuation of calcineurin inhibitors in the event of posterior reversible encephalopathy syndrome. We report 3 cases of posterior reversible encephalopathy syndrome among 155 lung transplant recipients (1.9%). The calcineurin inhibitor trough level exceeded the therapeutic range in only 1 case. Our findings demonstrate that temporary cessation of calcineurin inhibitors and administration of basiliximab may be effective strategies for managing posterior reversible encephalopathy syndrome.
Paula Barreras - One of the best experts on this subject based on the ideXlab platform.
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tnf alpha inhibitor associated myelopathies a Neurological Complication in patients with rheumatologic disorders
Journal of the Neurological Sciences, 2017Co-Authors: Paula Barreras, Maureen A Mealy, Carlos A PardoAbstract:Abstract Objectives Tumor necrosis factor-alpha inhibitors (TNFα-I) are biological agents used in the treatment of rheumatologic disorders. TNFα-I have been associated with demyelinating disorders mimicking multiple sclerosis. The goal of this report is to illustrate cases of myelopathy which developed during the use of TNFα-I. Methods We describe the clinical, neuroimaging and laboratory features of 4 cases of myelopathy associated with TNFα-I. Results The mean period of TNFα-I exposure was 27 [12–36] months. Three of the four patients exhibited active inflammatory myelopathy as the spinal cord MRI lesions enhanced with gadolinium and CSF pleocytosis or oligoclonal bands were present. All patients had normal brain MRIs at the time of presentation. Conclusions TNFα-I may play a role in the development of myelopathies in absence of brain involvement or other features of demyelinating disease. TNFα-I associated myelopathy should be considered in patients with history of treatment with TNFα-I who exhibit symptoms of myelopathy.
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tnf alpha inhibitor associated myelopathies a Neurological Complication in patients with rheumatologic disorders p4 068
Neurology, 2015Co-Authors: Paula Barreras, Maureen A Mealy, Carlos PardovillamizarAbstract:BACKGROUND: Tumor necrosis factor-alpha inhibitors (TNFα-I) are widely used medications for the treatment of rheumatologic disorders; however, they are also recognized as triggering factors for demyelinating disorders that mimic multiple sclerosis. Cases of “idiopathic transverse myelitis” have rarely been reported in association with TNFα-I. OBJECTIVE: To report 4 new cases of myelopathy associated with TNFα-I and to raise awareness about the risk of TNFα-I associated myelopathies in patients with rheumatologic disorders. METHODS: We analyzed the clinical, neuroimaging and laboratory information of 4 patients with new onset myelopathy attributed to TNFα-I evaluated at the Johns Hopkins Transverse Myelitis Center between 2010 -2014. RESULTS: Three women and one man with rheumatologic diseases including rheumatoid arthritis, Crohn’s disease and lupus were diagnosed with new onset myelopathies at a mean age of 50 years [range 42-54]. The mean period of TNFα-I exposure before onset was 27 months [range 12-36]. Markers of inflammation were present in 3 patients (75[percnt]). CSF pleocytosis was present in 2 (50[percnt]) and positive oligoclonal bands in 3 (75[percnt]) patients. MRI lesions were focal non-extensive in 2 (50[percnt]), multifocal non-extensive in 1 (25[percnt]) and longitudinally extensive in 1 (25[percnt]) cases. Lesion enhancement was seen in 2 (50[percnt]) patients. All patients had normal brain MRIs and did not fulfill the criteria for diagnosis of multiple sclerosis. CONCLUSIONS: TNFα-I may trigger myelopathies without the multifocal brain involvement that characterizes multiple sclerosis. The mechanisms associated with TNFα-I associated myelopathy are unknown but disturbances of cytokine signaling with increase in pro-inflammatory activity, increased T cell autoreactivity and added risk to genetic susceptibility may play immunopathogenic roles. Our clinical observations emphasize the importance of considering TNFα-I induced myelopathy in patients exposed to such medications in the differential diagnosis for transverse myelitis. Study Supported By: The Bart McLean Fund for Neuroimmunology Research & Johns Hopkins Project Restore Disclosure: Dr. Barreras has nothing to disclose. Dr. Mealy has nothing to disclose. Dr. Pardo-Villamizar has nothing to disclose.
Byung Joo Park - One of the best experts on this subject based on the ideXlab platform.
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Neurological Complication rates of epidural injections and selective nerve blocks a comparison of steroid use patterns
The Clinical Journal of Pain, 2020Co-Authors: Byungkwan Hwang, Joongyeb Lee, Byung Joo ParkAbstract:Objectives Epidural injections and selective nerve blocks are widely used for pain relief, but steroid usage is controversial due to safety concerns. We carried out this retrospective cohort study to estimate the incidence rates of Neurological Complications associated with epidural and selective nerve blocks, in relation to steroid use patterns. Materials and methods Using a national insurance claims database, we identified patients who received at least one epidural injection or nerve block from 2009 to 2013. We estimated incidence rates and hazard ratios in propensity score-matched cohorts stratified by steroids, using the Charlson comorbidity index, age, sex, anesthetics, and antithrombotics as variables. We included cases attending hospital within 24 hours after injection and treated for Neurological Complications. Results Incidence rates of Neurological Complications per 100,000 person-days for injections with and without steroids were 1.48 (95% confidence interval [CI]: 1.25-1.65) and 0.86 (95% CI: 0.66-1.30), respectively; rates for particulate steroid injections and nonparticulate steroid injections were 1.73 (95% CI: 1.41-1.95) and 0.90 (95% CI: 0.43-1.47), respectively. The adjusted hazard ratio (aHR) of Neurological Complications for injections with versus without steroids was 1.71 (95% CI: 0.96-2.49). The aHR of particulate versus nonparticulate steroid injections was 4.98 (95% CI: 1.01-262.35), at the cervicothoracic level. The aHR of Neurological Complications for nonparticulate steroids compared with nonsteroidal injections was 0.97 (95% CI: 0.46-3.01). Discussion At the cervicothoracic level, the incidence rate of Neurological Complications with particulate steroid injections was higher than that with nonparticulate steroid injections. Injections with nonparticulate steroids and without steroids were equally safe.
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Neurological Complication rates associated with epidural injections p1 215
Neurology, 2017Co-Authors: Byungkwan Hwang, Joongyub Lee, Byung Joo ParkAbstract:Objective: The purpose of this study is to estimate the incidence of Neurological Complications associated with epidural injection (EI) and compared these incidences between steroid and non-steroid injections. Background: The Food and Drug Administration (FDA) issued a letter of warning about corticosteroid usage for EIs, which are commonly performed for neck and back pain. The Korean FDA has regulated steroid usage for EI since April, 2013. However, there was no epidemiologic evidence of this regulation. Design/Methods: We used the Health Insurance Record Review & Assessment Service (HIRA) database from 1 January 2009 to 31 December 2013. We made a retrospective cohort to determine the incidence of new Neurological Complications. We excluded patients who had neuro-rehabilitation under ICD-10 codes of Neurological Complications. We estimated incidence rates and hazard ratios of Neurological Complications in propensity score matched cohort stratified by steroids. We used Charlson comorbidity index, age and gender for propensity score matching cohort. We identified the incidence of Neurological Complications in patients who were admitted to the hospital within 24 hours after an EI at outpatient clinics and received neuro-rehabilitation under ICD-10 codes of Neurological Complications during admission or death at discharge. Results: Adjusted hazard ratio (HR) for EI with steroid is 1.82 (95% CI 1.58–2.01) compared to one for EI without steroid. Adjusted HR for particulate steroid injections is 1.83 (95% CI 1.53–2.38), compared to one for non-particulate steroid injections. The incidences of Neurological Complications are 2.37 (person-days, 95% CI, 1.61–4.34) for steroid injections and 1.31 (person-days, 95% CI 0.88–1.51) for injections without steroid at cervicothoracic regions. At lumbosacral regions, the incidences are 1.28 (person-days 95% CI 1.11–1.53) for steroid injections and 0.70 (person-days 95% CI 0.32–0.91) for injections without steroid. Conclusions: After the change of FDA policy for EI, the steroid-usage pattern has been changed. Particulate steroid usage is the main reason of Neurological Complications. Disclosure: Dr. Hwang has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Park has nothing to disclose.
Byungkwan Hwang - One of the best experts on this subject based on the ideXlab platform.
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Neurological Complication rates of epidural injections and selective nerve blocks a comparison of steroid use patterns
The Clinical Journal of Pain, 2020Co-Authors: Byungkwan Hwang, Joongyeb Lee, Byung Joo ParkAbstract:Objectives Epidural injections and selective nerve blocks are widely used for pain relief, but steroid usage is controversial due to safety concerns. We carried out this retrospective cohort study to estimate the incidence rates of Neurological Complications associated with epidural and selective nerve blocks, in relation to steroid use patterns. Materials and methods Using a national insurance claims database, we identified patients who received at least one epidural injection or nerve block from 2009 to 2013. We estimated incidence rates and hazard ratios in propensity score-matched cohorts stratified by steroids, using the Charlson comorbidity index, age, sex, anesthetics, and antithrombotics as variables. We included cases attending hospital within 24 hours after injection and treated for Neurological Complications. Results Incidence rates of Neurological Complications per 100,000 person-days for injections with and without steroids were 1.48 (95% confidence interval [CI]: 1.25-1.65) and 0.86 (95% CI: 0.66-1.30), respectively; rates for particulate steroid injections and nonparticulate steroid injections were 1.73 (95% CI: 1.41-1.95) and 0.90 (95% CI: 0.43-1.47), respectively. The adjusted hazard ratio (aHR) of Neurological Complications for injections with versus without steroids was 1.71 (95% CI: 0.96-2.49). The aHR of particulate versus nonparticulate steroid injections was 4.98 (95% CI: 1.01-262.35), at the cervicothoracic level. The aHR of Neurological Complications for nonparticulate steroids compared with nonsteroidal injections was 0.97 (95% CI: 0.46-3.01). Discussion At the cervicothoracic level, the incidence rate of Neurological Complications with particulate steroid injections was higher than that with nonparticulate steroid injections. Injections with nonparticulate steroids and without steroids were equally safe.
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Neurological Complication rates associated with epidural injections p1 215
Neurology, 2017Co-Authors: Byungkwan Hwang, Joongyub Lee, Byung Joo ParkAbstract:Objective: The purpose of this study is to estimate the incidence of Neurological Complications associated with epidural injection (EI) and compared these incidences between steroid and non-steroid injections. Background: The Food and Drug Administration (FDA) issued a letter of warning about corticosteroid usage for EIs, which are commonly performed for neck and back pain. The Korean FDA has regulated steroid usage for EI since April, 2013. However, there was no epidemiologic evidence of this regulation. Design/Methods: We used the Health Insurance Record Review & Assessment Service (HIRA) database from 1 January 2009 to 31 December 2013. We made a retrospective cohort to determine the incidence of new Neurological Complications. We excluded patients who had neuro-rehabilitation under ICD-10 codes of Neurological Complications. We estimated incidence rates and hazard ratios of Neurological Complications in propensity score matched cohort stratified by steroids. We used Charlson comorbidity index, age and gender for propensity score matching cohort. We identified the incidence of Neurological Complications in patients who were admitted to the hospital within 24 hours after an EI at outpatient clinics and received neuro-rehabilitation under ICD-10 codes of Neurological Complications during admission or death at discharge. Results: Adjusted hazard ratio (HR) for EI with steroid is 1.82 (95% CI 1.58–2.01) compared to one for EI without steroid. Adjusted HR for particulate steroid injections is 1.83 (95% CI 1.53–2.38), compared to one for non-particulate steroid injections. The incidences of Neurological Complications are 2.37 (person-days, 95% CI, 1.61–4.34) for steroid injections and 1.31 (person-days, 95% CI 0.88–1.51) for injections without steroid at cervicothoracic regions. At lumbosacral regions, the incidences are 1.28 (person-days 95% CI 1.11–1.53) for steroid injections and 0.70 (person-days 95% CI 0.32–0.91) for injections without steroid. Conclusions: After the change of FDA policy for EI, the steroid-usage pattern has been changed. Particulate steroid usage is the main reason of Neurological Complications. Disclosure: Dr. Hwang has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Park has nothing to disclose.
Tasaduq Fazili - One of the best experts on this subject based on the ideXlab platform.
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post malaria Neurological syndrome a rare Neurological Complication of malaria
Infection, 2019Co-Authors: Sanjay K Yadava, Ashley Laleker, Tasaduq FaziliAbstract:Post-malaria Neurological syndrome (PMNS) is a rare self-limiting Neurological Complication that can occur after recovery from malaria, usually severe falciparum malaria. It is characterized by a myriad of neuropsychiatric manifestations including mild Neurological deficit to severe encephalopathy. PMNS was first described in 1996 and since then there have been 48 cases reported in the English literature. We report another case of PMNS in a 24-year-old healthy male and present a review of the disease entity. We searched PMNS-related journal articles and case reports in the English literature, using PubMed and Google search engines. A total of forty-nine cases meeting the diagnostic criteria of PMNS were selected in this review. PMNS is a rare Complication of severe malaria that might be underreported. It can develop up to 2 months after clearance of parasitemia. Clinical features can be variable. Most cases are self-limited, but more severe cases may benefit from steroid therapy.
