Nonsteroidal anti-inflammatory drugs-induced hypersensitivity reactions: Algorithm for the diagnostic and management

The role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in neurosurgical practice is a secondary one, however they are still constantly involved in perioperative management of pain or in nonoperative management of acute radiculopathy. Beside the well-known adverse reactions (ADRs), the neurosurgeon practitioner should also take in account the drug hypersensitivity reactions (DHRs) of NSAIDs and be able to deal with it. The aim of this paper was to review the diagnostic and management steps for NSAIDs-induced Hypersensitivity Reactions. The actual stratification of NSAIDs-induced Hypersensitivity Reactions is based on understanding of the heterogeneity of immunological/non-immunological mechanisms of reactions and complexity of clinical manifestations. Practically, this stratification allows the physician to assess suspicion of DHR, based on anamnesis and clinical analysis, and to consider further practical steps to manage and eventually confirm the diagnosis. Drug allergies are considered only the DHRs for which a definite immunological mechanism (either drug-specific antibody or T cell) is demonstrated. In conclusion, clinical analysis and anamnesis of patient with NSAIDs-induced Hypersensitivity Reactions can be realized by any physician and could be enough to diagnose, but it is not sufficient to confirm the diagnosis. In vitro tests and oral provocation challenges may be necessary to be undertaken by an allergy specialist

Extradural autologous temporal muscle graft mimicking a meningioma: Case report

Meningiomas are the most common dural tumour, but there are also many other dural masses which mimic their appearances, such as neoplastic and non-neoplastic lesions. In this paper we report another mass which may mimic a dural lesion, namely a muscle graft harvested from the temporal site and left in situ, used to achieve haemostasis in a posttraumatic temporal extradural hematoma in a young male patient. Solid knowledge of differentiating neuroimaging characteristics of dural masses, as well as its corroboration with the patient’s medical history are extremely helpful in establishing an accurate diagnostic

Anatomical localization of intracranial grade II meningiomas in North-Eastern Romania: Our 25-years experience

Objective. Our research aims to assess a possible connection between tumour localization and histological subtypes of grade II meningiomas. Material and methods. 143 patients with grade II WHO meningiomas underwent surgical resection in "Prof. Dr. N. Oblu" Emergency Clinical Hospital Ia?i between 1990 and 2015. The collected data included: patient age, gender, tumour localization and histopathological diagnosis (atypical, clear cells and chordoid meningioma). Results. 135 (94.4%) of all 143 patients with grade II meningiomas were atypical meningiomas, 6 (4.2%) were cell clear meningiomas and only 2 (1.4%) were chordoid meningiomas. As concerns their distribution by gender, 79 (55.2%) were female and 64 (44.8%) were male. Grade II meningiomas were most commonly located at convexity 49.7% (n=71), followed by skull base in 30.8% (n=44) of the cases and parasagittal/falcine in 14.7% (n=21) of the patients. Conclusions. The most common localization of grade II meningiomas was convexity, followed by skull base, parasagittal/falcine and intraventricular areas. We have also noticed that convexity meningiomas are more frequent in women, unlike the other anatomical localizations in which the male-female ratio is almost equal. Therefore, further research is necessary to determine the role of embryological, anatomopathological and genetic factors in underlying the connection between meningioma grade and anatomical localization

“The Silk Road” via subarachnoid cisterns: Cerebrospinal fluid dissemination of meningiomas

Meningiomas are generally slow-growing extra-axial benign tumours and in rare cases they can metastasize both neural and extra-neural. Intracranial meningiomas with leptomeningeal dissemination are extremely rare and the exact pathogenesis still remains unknown. The aim of this review is to analyse the pathways of intracranial and spinal metastatic spread of intracranial meningiomas and to discuss their particular clinical and pathological features. We highlight the fact that there is a possibility of leptomeningeal dissemination, even if cerebrospinal fluid cytology is negative, in patients with a medical history of a resected meningioma. We identified three possible ways of dissemination: haematogenous, through the CSF, or during surgery. From a histopathological point of view, the more malignant the meningioma, the more likely its leptomeningeal dissemination

Unapređenje prakse i upotrebe tehnologija za unapređenje adherence

Medication non-adherence is recognized as a global problem associated with financial burden for patients and healthcare funds. At the European level, different Medication Adherence Technologies (MATech) are in use. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) was launched to: 1) identify current practices for Medication Adherence (MA) support by healthcare professionals; 2) create a structure for the repository of existing MATech that could be used by different stakeholders; and to 3) prepare guidance for sustainable implementation of MATech across European healthcare settings. ENABLE gathered different healthcare professionals and academics from 39 countries, to achieve the set of goals during a four-year period. Several cross-European studies were conducted employing stakeholder consultation (Delphi) and survey methods, including analysis of current practices for assessing and supporting MA in routine care, as well as barriers and facilitators to managing MA, work on medication management during COVID pandemic, reimbursement pathways of adherence interventions and protocols to identify the best practices and technologies. The MATech repository was designed by ENABLE members, and consultation of different stakeholders is currently in progress. The repository structure includes information about the MATech product and provider, goals and content related to managing MA, and information about the scientific evaluation and implementation. A cross-European expert survey identified a limited number of MA enhancing interventions that are currently subject to reimbursement. ENABLE identified the need for collaboration, infrastructure, and reimbursement to enhance the uptake of MATech in daily practice.Neadherenca pacijenata prema terapiji prepoznata je kao globalni problem udružen sa finansijskim opterećenjem pojedinaca i zdravstvenih sistema. Na nivou Evrope koriste se različite tehnologije za unapređenje adherence (Medication Adherence Technologies - MATech). Evropska mreža za razvoj najboljih praksi i tehnologija za unapređenje adherence (ENABLE, COST Action 19132) pokrenuta je sa ciljem da se: 1) identifikuju trenutne prakse unapređenja adherence (medication adhrerence – MA) od strane zdravstvenih profesionalaca; 2) kreira struktura repozitorijuma postojećih MATech koju mogu da koriste različiti stejkholderi; 3) da se pripreme vodiči za održivu implementaciju MATech širom Evrope. ENABLE okuplja zdravstvene profesionalce različitih profesija iz 39 zemalja kako bi se postigli ciljevi tokom četvorogodišnjeg perioda. Nekoliko studija u više zemalja Evrope pokrenuto je kako bi se izvršilo ispitivanje 1) stavova različitih stejkholdera delfi metodom i upitnicima, uključujući analizu trenutnih praksi u vezi analize i podrške MA u rutinskoj praksi, kao i barijere i facilitatore koji utiču na MA, 2) menadžment lekovima tokom COVID pandemije, 3) načine refundacije intervencija u vezi sa MA i 4) protokola koji identifikuju nabolje prakse i tehnologije. Kreirana je struktura MATech repozitorijuma, dok je usaglašavanje sa različitim stejkholderima u toku. Struktura repozitorijuma zasniva se na informacijama o MATech, ciljevima i sadržajima u vezi MA, i informacijama o naučnim procenama i implementaciji MATech. Na području Evrope istraživanje je identifikovalo ograničeni broj intervencija za unapređenje MA koje podležu refundaciji. ENABLE ukazuje na potrebu za kolaboracijom, razvojem infrastrukture i politike refundacije kako bi se unapredila upotreba MATech u rutinskoj praksi.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

Marine-Derived Compounds for the Potential Treatment of Glucocorticoid Resistance in Severe Asthma

One of the challenges to the management of severe asthma is the poor therapeutic response to treatment with glucocorticosteroids. Compounds derived from marine sources have received increasing interest in recent years due to their prominent biologically active properties for biomedical applications, as well as their sustainability and safety for drug development. Based on the pathobiological features associated with glucocorticoid resistance in severe asthma, many studies have already described many glucocorticoid resistance mechanisms as potential therapeutic targets. On the other hand, in the last decade, many studies described the potentially anti-inflammatory effects of marine-derived biologically active compounds. Analyzing the underlying anti-inflammatory mechanisms of action for these marine-derived biologically active compounds, we observed some of the targeted pathogenic molecular mechanisms similar to those described in glucocorticoid (GC) resistant asthma. This article gathers the marine-derived compounds targeting pathogenic molecular mechanism involved in GC resistant asthma and provides a basis for the development of effective marine-derived drugs

Biopolymers for Surgical Applications

Biopolymers have gained significant attention as a class of polymer materials with a wide range of applications, especially in the medical and pharmaceutical field. Due to particular characteristics, such as biocompatibility, biodegradability, non-toxicity, and functionality, they have become promising candidates for various surgical applications, including as bioadhesives, sealants, wound dressings, sutures, drug carriers, coating materials, etc. Recent research shows that further modification of biopolymers by advanced techniques can improve their functionality i.e., antibacterial activity, cell viability, drug-releasing capability, good wet adhesion performance, and good mechanical properties. This mini review aims to provide a brief report on the type of biopolymers and recent developments regarding their use in various surgical applications

New Molecular Targets in the Therapy of Arthrosis Patients

Introduction: Arthrosis represents the progressive degeneration of the joint cartilage, accompanied by the narrowing of the articular space and inflammation, which affects 70% of the population after the age of 60. Research purpose: This paper reviews the opportunity of using proinflammatory cytokine inhibitors as a means of stopping the progress of arthrosis. Material and method: As a result to a research into various clinical trial registers (Arthritis Clinical Trials, Clinical Research and Drug Information) and on specialized e-platforms, 5 randomized, multicentric double-blind clinical studies have been identified, which monitored the efficiency of various biological molecules in the treatment of arthrosis (etanercept, adalimumab, litikizumab, fasinumab and tanezumab). Results: The current pharmacological interventions consist mainly in the prescription of analgesics (acetaminophen, opioid analgesics), non-steroidal and chondroprotective anti-inflammatories. The proinflammatory cytokine inhibitors are already widely used in the inflammatory joint diseases, such as the rheumatoid polyarthritis. Their introduction into the treatment of arthrosis blocks the disease’s etiopathogenic mechanisms. Discussions: Arthrosis physiopathology involves a series of systemic, biological, biochemical factors, molecular and enzymatic processes that generate minimum inflammation. IL-1b and TNF-α are two major cytokines produced by the synovial cells and chondrocytes, which are involved in the destruction of the cartilage matrix by stimulating the production of proteolytic enzymes (MMP and aggrecanase). Conclusions: The utilisation of proinflammatory cytokine inhibitors in arthrosis represents a therapeutic option that requires studies in order to establish whether the introduction of proinflammatory cytokine inhibitors in arthrosis therapy might slow down the disease’s etiopathogenic mechanisms