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Haematological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The DAT indicates that there are anti-red cell antibodies bound to the surface of circulating red cells. It is used in two situations: If there is evidence of a haemolytic anaemia (when a positive DAT indicates autoimmune haemolytic anaemia [AIHA])If there is suspicion of an antibody-mediated blood transfusion reaction
Image Acquisition Protocols
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
A clinical example that requires SPECT imaging is dopamine imaging, used to aid in the diagnosis of Parkinson’s disease. [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β(4-iodophenyl)nortropane (123I-FP-CIT), is a radiopharmaceutical derived from cocaine and which binds to dopamine transporters (DaT) within the striatum [6]. A SPECT scan allows for visualization of the dopamine transporter function in the caudate and putamen. The main use of DaT scanning is in patients with a movement disorder to help differentiate essential tremors from tremor due to Parkinson’s disease. A patient with an essential tremor will demonstrate high symmetric uptake in both caudate and putamen regions. A patient with Parkinson’s disease will demonstrate reduced putamen activity and asymmetric caudate activity. An illustration of the relevant brain and striatum anatomy is given in Figure 15.21a, normal and abnormal uptake distributions are shown in Figures 15.21b and c.
Specific Infections in Children
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Neal Russell, Sarah May Johnson, Andrew Chapman, Christian Harkensee, Sylvia Garry, Bhanu Williams
Patients should be admitted and isolated under contact precautions (personal protective equipment [PPE]) from triage. Diphtheria antitoxin (DAT) should be given immediately to all probable cases10 (an intradermal diluted test dose should be given first due to 0.6% risk of anaphylaxis). Doses for DAT vary according to extent of disease, and national guidelines should be consulted. Antibiotics should be given immediately (intramuscular [IM]/IV benzylpenicillin, IV erythromycin or oral equivalents for less ill or probable/suspected cases). Judicious use of oxygen therapy is advised, as it can mask signs of worsening respiratory distress.
Neurologists’ preferences for device-aided therapy for advanced Parkinson’s disease in Japan
Published in Current Medical Research and Opinion, 2023
Shinsuke Fujioka, Takayasu Mishima, Toru Yamazaki, Magdalena Bebrysz, Mariko Nomoto, Jumpei Yamaguchi, Kimino Fujimura, Hideyuki Migita, Samuel Aballéa, Yoshio Tsuboi
Data were collected through an online survey, which is a typical approach for DCE studies and was not expected to influence the preference estimation17. To support the same understanding of the tasks by all respondents, all attributes and levels were explained on the screen before the first DCE question to ensure all respondents understand them in the same way. The mechanism of action of each device was described, and the size of the devices was compared to articles of everyday use. The “number of oral pills” was defined as the number of pills per day of all oral PD medication taken concomitantly with DAT three months after its introduction. For each level of the attribute “Surgery requirement”, the type of procedure needed to initiate DAT was described, along with its potential risks, reversibility, and length of hospital stay. Detailed descriptions of each attribute and level are available in Appendix 1.
Safety and efficacy of P2Y12 inhibitor monotherapy in patients undergoing percutaneous coronary interventions
Published in Expert Opinion on Drug Safety, 2021
Mattia Galli, Davide Capodanno, Felicita Andreotti, Filippo Crea, Dominick J Angiolillo
WOEST (What is the Optimal antiplatElet and Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary StenTing) [47] was the first RCT investigating a DAT strategy. In WOEST, 573 patients undergoing PCI and requiring OAC (AF in 69% of patients) were randomized to either DAT or TAT for 12 months. In this trial, VKA was used as OAC and clopidogrel as P2Y12 inhibitor in both arms. In the DAT arm, the use of aspirin was limited to in-hospital stay. DAT showed a significant reduction of the primary endpoint of any bleeding compared to TAT. Despite being powered to assess only bleeding, the trial also showed a reduction of death favoring DAT, with similar incidences of MI and ST between the two treatment arms. After the publication of WOEST, 5 more RCTs have been published on this topic [48]. ISAR-TRIPLE (Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation) [49] was the only trial using aspirin (rather than a P2Y12 inhibitor) in addition to VKA in the DAT arm; it randomized 614 patients to either 6 weeks TAT followed by DAT up to 6 months or to 6 months TAT, with clinical outcomes assessed at 9 months in all patients. The rates of the primary endpoint, including death, MI, ST, stroke or Thrombolysis in Myocardial Infarction (TIMI) major bleeding were similar with DAT vs TAT. Between 6 weeks and 9 months, the rate of any Bleeding Academic Research Consortium (BARC) bleeding was significantly lower with DAT.
Establishing apomorphine treatment in Thailand: understanding the challenges and opportunities of Parkinson’s disease management in developing countries
Published in Expert Review of Neurotherapeutics, 2020
Roongroj Bhidayasiri, Onanong Phokaewvarangkul, Karn Sakdisornchai, Kamolwan Boonpang, K. Ray Chaudhuri, Jan Parsons, Praween Lolekha, Parnsiri Chairangsaris, Prachaya Srivanitchapoom, Sharon Benedierks, Pattamon Panyakaew, Thanatat Boonmongkol, Yuwadee Thongchuam, Nitinan Kantachadvanich, Saisamorn Phumphid, Andrew H. Evans, Akravudh Viriyavejakul, Apichart Pisarnpong, Teus van Laar, Priya Jagota
f the three DAT options available, continuous subcutaneous apomorphine infusion is the least invasive, and is also easily reversible, while the other two options require surgery [18,38]. Apomorphine has been used in clinical practice for many years around the world and has proved to be effective and well tolerated for the management of motor fluctuations and dyskinesias in a range of open-label studies [39–42]. Due to its name, a common misperception is that ‘apomorphine’ has similar effects to ‘morphine’ but both clinicians and patients alike should be made aware that, unlike morphine, apomorphine has no narcotic properties [43,44]. While there is no formal study documenting this misconception in Thailand, it was raised by Thai Experts Panel members as a common issue in their clinical practice experience.