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ExperimentaL Oral Medicine
Published in Samuel Dreizen, Barnet M. Levy, Handbook of Experimental Stomatology, 2020
Samuel Dreizen, Barnet M. Levy
In reviewing what is and what, hopefully, will be the only such “naturally occurring experiment” in human history, DeCoursey118 detailed the effects of atomic bomb radiation on the mouth structures of Japanese victims of Hiroshima and Nagasaki. Lesions of the oral regions became of utmost clinical importance between the 3rd and 6th week after the explosions. Grayish bullae appeared in the posterior pharynx followed by petechial or ecchymotic mucosal hemorrhages with superimposed ulcerations. Ulcerations similar to those of agranulocytic angina developed over the tonsillar areas and spread from one lymphoid island to another, ultimately involving the tongue. The gingivae were hemorrhagic and ulcerated with tissue destruction sometimes spreading to the buccal mucosa, involving the entire cheek and producing the clinical picture of noma. Almost all patients with such lesions died.
Dermatological emergencies in tropical infections and infestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Anup Kumar Tiwary, Niharika Ranjan Lal, Piyush Kumar
Noma neonatorum is a gangrenous and lethal infectious disease of neonates, caused by Pseudomonas aeruginosa [33]. The most commonly involved sites are mucocutaneous junctions of oral cavity, lips, nose, and perianal area, but scrotum and eyelids may also get affected. Without early diagnosis and proper treatment, it frequently leads to severe mutilating deformities and septicemia followed by death [34]. Onset of the disease has been reported up to 120 days of life, but most of the cases occur in the first 2 weeks of life starting after the third postnatal day [35]. It usually presents with erythematous induration of the oral cavity, lips, and nose [36]. In the presence of prematurity and very poor general health condition of the baby, it can be more fatal involving other distant sites, too. Of note, in the very short period of 2–3 days, mucocutaneous lesions turn into a gangrenous ulcer with blackish necrotic slough [37]. Systemic findings indicating septicemia are also associated, such as fever, hypotension, tachypnea, sclerema, hepatosplenomegaly, and respiratory insufficiency. Unfortunately, lack of early management of such cases ultimately results in severe tissue and bone loss with functional deformities leading to death.
The global landscape on interchangeability of biosimilars
Published in Expert Opinion on Biological Therapy, 2022
Anurag S. Rathore, James G. Stevenson, Hemlata Chhabra, Chinmoyee Maharana
In the United Kingdom, the British Biosimilar Association recommends switching to less expensive biosimilar medicine at the prescriber level in light of the scientific evidence, but not for substitution at the pharmacy level [17]. The German Federal agency (Paul Ehrlich Institute) also promotes switching between biosimilars and reference products with proper clinical monitoring, leaving the decision to the physician [18]. Similar regulations on biosimilar switching are recommended in Norway (The Norwegian Medicines Agency, NoMA), and Finland (The Finnish Medicines Agency) but none allows automatic substitution. However, in 2017 NoMA proposed an amendment in its Pharmacy Act to include automatic substitution [19].
Health utility estimation in children and adolescents: a review of health technology assessments
Published in Current Medical Research and Opinion, 2020
Gaëlle Bégo-Le Bagousse, Xiaoying Jia, Sorrel Wolowacz, Laurent Eckert, Jules Tavi, Richard Hudson
Most HTA agencies provide no specific recommendations for utility measurement in pediatric populations (including the Canadian Agency for Drugs and Technologies in Health [CADTH], Zorginstituut Nederland [ZiN], Norwegian Medicines Agency [Legemiddelverket, NoMA] and the Scottish Medicines Consortium [SMC]). For adults, CADTH recommends an indirect method of utility measurement based on a generic classification system and requiring a conversion scale to derive utilities (e.g. EQ-5D, Health Utilities Index [HUI], or Short Form–6 Dimensions [SF-6D]) and reflecting preferences of the Canadian population11. The SMC has indicated a general preference for the EQ-5D in randomized controlled studies, although notes that the EQ-5D may not be appropriate in all circumstances12. Current National Institute for Health and Clinical Excellence (NICE) guidelines13 state that, when necessary, alternative standardized and validated PBMs of health-related quality of life (HRQoL) designed specifically for use in children should be considered when estimating utilities in pediatric populations. They note that the standard EQ-5D has not been designed for use in children, and although an alternative version for children aged 7–12 years is available (EQ-5D-Y), a validated United Kingdom (UK) valuation set is not yet available. No specific measure is deemed suitable for pediatric populations in the NICE Methods Guide or the Technical Support Documents developed by the NICE Decision Support Unit14. Current Haute Autorité de Santé (HAS) guidelines for France15 recognize that it is not possible for young children to report their own health status and state that data may be obtained from other persons, if justified. Reporting by close relatives is preferred, with reporting by health care professionals as a last resort.
Augmented activity of the forearm extensor muscles induced by vibratory stimulation of the palm of the hand in individuals with subacute post-stroke hemiplegia
Published in Brain Injury, 2022
Nodoka Kimura, Mamiko Sato, Yasutaka Kobayashi, Eiichi Naito
During the vibratory stimulation, the activity of the forearm extensors was significantly greater than that of the flexors, regardless of the eye condition, in all hands. The novel findings of the current study included the augmentation of the muscle activity antagonistic to the vibrated muscles (i.e., AVR) when vibratory stimulation was applied to the palm of the paretic and non-paretic hands in patients with stroke. Previous studies have only shown that vibratory stimulation induced antagonistic muscle activities in healthy adults (15,38). Moreover, Noma et al. (18) demonstrated that the application of vibratory stimulation on the spastic flexors in the upper extremity resulted in reduced activity in the spastic flexors after stroke; however, the motor response of the vibrated antagonist muscles was not reported. Thus, these findings suggest that vibratory stimulation to the palm of the hand helps induce muscle activity in the paretic forearm extensors in patients with stroke. Conversely, the results of the current study were inconsistent with the findings reported by Suresh et al. (39) and McPherson et al. (40). Those authors showed that vibratory stimulation of the spastic biceps brachii resulted in exaggerated involuntary contraction of the muscle (i.e., TVR) after stroke. However, they did not examine the extensor muscles. These discrepancies in results might be attributed to differences in the duration of the vibratory stimulation. In the current study, duration of the vibratory stimulation was 60s, whereas Noma et al. (18) delivered the vibratory stimulation over 5 min. In contrast, McPherson et al. (40) applied only for approximately 5 s in patients with stroke. Therefore, these findings imply that a sufficient vibratory stimulation duration could be an important factor to suppress the activity of vibrated flexor muscles.