Botulism,where are we now?

Introduction.?Botulism is a neuroparalytic illness caused by botulinum toxin, a product of the Clostridium botulinum bacteria and characteristically presents as an acute, symmetrical, descending flaccid paralysis. Albeit it is the most poisonous substance known, which even poses a major threat as biological weapons, purified and highly diluted botulinum toxin can be used to treat a wide variety of conditions associated with muscular hyperactivity, glandular hypersecretions and pain. There are six clinical presentations associated with current occurring botulism, each results from absorption of botulinum toxin into the bloodstream. Aim.?The aim of this review is to summarize the current knowledge on the microbiology, epidemiology, vaccine research and clinical management of human botulism. Conclusions.?Early diagnosis and management rely on history and physical examination. Delay in treatment may allow progression of paralysis, protracted hospitalization and deaths of long-term mechanical ventilation and intensive care unit care. The clinicians must take this disease into consideration of a possible outbreak. Awaiting laboratory confirmation is an egregious error, while awareness of the clinical sign and symptoms of botulism is critical for early diagnosis. Rapid management and followed public health surveillance may greatly alleviate disease severity and decrease mortality rates.     

Genetics and cardiomyopathy: where are we now?

Many cases of cardiomyopathy have a genetic component: 90% of cases of hypertrophic cardiomyopathy are familial, and genetic factors may be responsible for 30% to 50% of cases of dilated cardiomyopathy. Clinical genetic testing for hypertrophic cardiomyopathy is becoming available, with significant implications for the clinician. This article gives an overview of how these genetic discoveries were made and how these new insights from genetics will affect clinical practice.     

Therapy outcome measures: where are we now?

Outcomes information contributes to the provision of quality services: sharing that information requires speech-language pathologists (SLPs) to use terminology readily understood by professions ranging from health and education to social and voluntary services. The Therapy Outcome Measure (TOM) provides a way of presenting outcome data in a digestible form, comprising part of a range of multiple measures used to collect information on the structures, processes, and outcomes of care. TOM was developed to provide a practical method of measuring outcomes in routine clinical practice. Furthermore, it has been used in a number of research studies as an outcome indicator. As an example of its utility in research, the article cites a benchmarking study, together with examples of internal and external benchmarking of outcomes intended to illustrate how the benchmarking of TOM data can inform practice. The TOM can therefore inform SLPs on their own outcomes, the outcomes for specific client groups, and, by benchmarking TOM data, can contribute to the delivery of better, more efficient services.     

Treatment of congenital cytomegalovirus: where are we now?

Congenital cytomegalovirus (CMV) is the most common congenital infection in the USA, affecting approximately 1% of all live births. While the majority of infants will remain asymptomatic, approximately 10% will be symptomatic at birth and another 10-15% will go on to develop problems during the first 6 years of life. Congenital CMV is now the most common cause of nonhereditary sensorineural hearing loss in children. Accordingly, researchers and clinicians have long been interested in identifying strategies to prevent or treat symptomatic congenital CMV infection. This article reviews congenital CMV with a focus on treatment strategies.     

Electronic fetal heart rate monitoring: where are we now?

Electronic fetal heart rate monitoring (EFM) continues to be the primary method utilized for fetal assessment in the United States. Standardization of nomenclature associated with this perinatal technology has evolved over the past 40 years such that the current nomenclature recommended by the National Institute of Child Health and Human Development (NICHD) has been adopted by professional perinatal organizations as the agreed-upon method for professional communication and documentation. Current research continues to focus on the optimal management of intrapartum fetal heart rate tracings. The clinical controversies and challenges related to electronic fetal heart rate monitoring continue to evolve.     

Pulmonary hypertension and the serotonin hypothesis: where are we now?

In the 1960s, serotonin (5HT) was associated with pulmonary arterial hypertension (PAH) caused by certain diet pills, but has recently been the subject of renewed interest in the field of PAH. Serotonin can be synthesised in the pulmonary endothelium with the rate-limiting step being the activity of tryptophan hydroxylase1 (Tph1). The serotonin is released and can then: (i) pass into the underlying pulmonary smooth muscle cells through the serotonin transporter (SERT) to initiate proliferation and/or (ii) activate serotonin receptors on pulmonary smooth muscle cells to evoke proliferation and/or contraction. Serotonin may also mediate pulmonary fibroblast proliferation via the SERT and/or serotonin receptors. Here we will unravel, discuss and update the 'serotonin hypothesis' of PAH in light of recent advances in the field. In conclusion, the activity of serotonin receptors, the SERT and Tph1 can all be elevated in clinical and experimental PAH and each offers a potentially unique therapeutic target.     

Ericksonian approaches to hypnosis and therapy: where are we now?

Ericksonian approaches to psychotherapy and hypnosis have had a significant impact on many clinical practitioners over the last two decades. This article reviews the current empirical research with regard to the efficacy of these treatment approaches as well as for the key Ericksonian assumptions of: (a) belief in an altered state of consciousness and the existence of specific markers indicating an altered state; (b) the superiority of indirect suggestion over direct suggestion; and (c) client hypnotizability is a function of the hypnotist's skill. The current literature provides empirical support neither for efficacy nor for these key assumptions. The article concludes with a discussion of the need for empirically based research to test the efficacy of Ericksonian therapy and its core components, lest this approach become isolated from the scientific hypnosis and therapy communities.     

Treating hematological malignancies with cell therapy: where are we now?

Introduction: Adoptive cell therapy (ACT) is becoming an increasingly successful and widespread form of treatment for different types of cancer. Compared to chemotherapy or monoclonal antibodies, ACT is an active biological strategy, with infused immune cells featuring dynamic migration, expansion and long-term persistence properties. ACT in hematological malignancies offered the initial proof of principle of the feasibility for this innovative ‘live-drug’.

Areas covered: In this review, the authors summarize the clinical results achieved with two specific strategies in hematological malignancies: chimeric antigen receptor (CAR) and T cell receptor (transgenic TCR) redirected T cells. Moreover, they discuss the recent pre-clinical studies aimed at increasing the feasibility, safety and efficacy of ACT.

Expert opinion: ACT can promote cancer regression in patients with leukemia, lymphoma and multiple myeloma. Nevertheless, more precise targeting of tumor cells and containment of side effects are needed. Overcoming tumor-associated immunosuppressive mechanisms and preventing tumor escape are also emerging as critical barriers. Finally, simplification in the manufacturing procedures should promote wider application of these technologies outside academic centers. Although the enthusiasm for ACT-based therapies is high, comprehensive and systematic clinical studies are required to advance the field.     

Endoscopic ultrasound, where are we now in 2012?

Topics related with endoscopic ultrasound (EUS) made up considerable portion among many invited lectures presented in International Digestive Endoscopy Network 2012 meeting. While the scientific programs were divided into the fields of upper gastrointestinal (UGI), lower gastrointestinal, and pancreato-biliary (PB) categories, UGI and PB parts mainly dealt with EUS related issues. EUS diagnosis in subepithelial lesions, estimation of the invasion depth of early gastrointestinal cancers with EUS, and usefulness of EUS in esophageal varices were discussed in UGI sessions. In the PB part, pancreatic cystic lesions, EUS-guided biliopancreatic drainage, EUS-guided tissue acquisition, and improvement of diagnostic yield in indeterminate biliary lesions by using intraductal ultrasound were discussed. Advanced techniques such as contrast-enhanced EUS, EUS elastography and forward-viewing echoendoscopy were also discussed. In this paper, I focused mainly on topics of UGI and briefly mentioned about advanced EUS techniques since more EUS related papers by other invited speakers were presented afterwards.     

Constipation and palliative care - where are we now?

Constipation is an unpleasant and distressing symptom that many palliative care patients may experience, often having a profound effect on their quality of life. The many management options available reflect the multifactorial nature of constipation. The article explores the complexity of constipation in palliative care and highlights the challenge of managing opioid-induced constipation. Advances in the pharmacological and non-pharmacological management of constipation are reviewed and discussed in the light of relevant research. Further discussion includes definitions, incidence and causes of constipation in palliative care.