Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

The occurrence of acute promyelocytic leukemia (APL) in HIV-infected patients has been reported in only five cases. Due to a very small number of reported HIV/APL patients who have been treated with different therapies with the variable outcome, the prognosis of APL in the setting of the HIV-infection is unclear. Here, we report a case of an HIV-patient who developed APL and upon treatment entered a complete remission. A 25-years old male patient was diagnosed with HIV-infection in 1996, but remained untreated. In 2004, the patient was diagnosed with primary central nervous system lymphoma. We treated the patient with antiretroviral therapy and whole-brain irradiation, resulting in complete remission of the lymphoma. In 2006, prompted by a sudden neutropenia, we carried out a set of diagnostic procedures, revealing APL. Induction therapy consisted of standard treatment with all-trans-retinoic-acid (ATRA) and idarubicin. Subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission. Due to the poor general condition, consolidation treatment with ATRA was given in March and April 2007. The last follow-up 14 months later, showed sustained molecular APL remission. In conclusion, we demonstrated that a complete molecular APL remission in an HIV-patient was achieved by using reduced-intensity treatment

Reconceptualizing the therapeutic alliance in osteopathic practice: integrating 2 insights from phenomenology, psychology and enactive inference.

This review presents key concepts from neurophysiology, phenomenology, psychology, and narrative medicine which underpin a developing enactive-ecological framework for osteopathic practice. This framework aims to provides a coherent theoretical basis for understanding healthcare processes and outcomes, based on the neuroscience principles of active inference and enactivism. It offers insights into factors that influence patients’ pain perception and behaviour and foster or inhibit the development of effective therapeutic relationships. Although this approach offers promising opportunities to increase the scope of care by harnessing potential in the unique embodied ecological niches created between patients and osteopaths, it raises challenges to traditional treatment agendas. Healthcare which frames the patient-as-a person, and acknowledges the multidimensional nature of the self, requires practitioners to be collaborative and self-aware, and be able to elicit patients’ lived experiences and body stories. Phenomenological and psychological studies into enactivism emphasise the complex, dynamic nature of therapeutic relationships and the need to understand each person’s unique lifeworld context. The new framework represents an important step forward, but further research is now needed to explore ways of integrating active and enactive inference into practice, of developing psychological or mindful self- and body-awareness, and narrative communication skills for shared sense-makin

Paralisia diafragmática unilateral reversível associada a envenenamento loxoscélico sistêmico

Relata-se o caso de um paciente vítima de envenenamento loxoscélico associado a paralisia diafragmática direita reversível. O diagnóstico de envenenamento loxoscélico baseou-se nas informações prestadas pelo paciente de que havia encontrado uma aranha marrom em sua cama no dia seguinte à picada e no quadro clínico típico deste tipo de envenenamento: lesão cutânea necrótica acompanhada de erupção escarlatiniforme e comprometimento sistêmico sob a forma de insuficiência renal aguda, distúrbios da coagulação sangüínea, hemólise intravascular e hemoglobinúria. Estas alterações regrediram completamente com o tratamento conservador. O diagnóstico da paralisia diafragmática baseou-se na elevação da hemicúpula diafragmática direita na radiografia de tórax em inspiração forçada e em sua completa imobilidade no exame radioscópico. A paralisia frênica não existia na radiografia realizada previamente ao acidente e desapareceu completamente trinta dias após o mesmo, o que permitiu associá-la à toxocidade do veneno loxoscélico ou a outras manifestações sistêmicas produzidas por ele