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Neurological updates: neurological complications of CAR-T therapy.

Chimeric antigen receptor (CAR)-expressing T cells now offer an effective treatment option for people with previously refractory B cell malignancies and are under development for a wide range of other tumours. However, neurological toxicity is a common complication of CAR-T cell therapy, seen in over 50% of recipients in some cohorts. Since 2018, the term immune effector cell-associated neurotoxicity syndrome (ICANS) has been used to describe and grade neurotoxicity seen after CAR-T cells and other similar therapies. ICANS following CAR-T therapy is usually self-limiting but can necessitate ad

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… Stupor or coma Seizure N/a N/a Any clinical seizure, focal or generalised, that resolves rapidly. … Stupor or coma Seizure | N/a | N/a | Any clinical seizure, focal or generalised, that resolves rapidly. …

Oncological emergencies associated with gastrointestinal tumors.

Oncological emergencies are defined as acute life-threatening conditions in cancer patients either as a result of the malignancy or as a result of its treatment. In this review, we focus on oncological emergencies associated with gastrointestinal tumors. They can be categorized by their system of origin as hematologic, neurologic or metabolic. Furthermore, we discuss mechanical emergencies such as intestinal obstruction and vena cava superior syndrome as well as acute gastrointestinal bleeding and pulmonary embolism. The patients' performance status as well as prognosis are essential during de

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… Then neurologic changes occur such as fatigue, muscle weakness, stupor and coma. Hypercalcemia may also cause cardiac abnormalities such as arrhythmias, heart block and even cardiac arrest [ 29 ]. GI symptoms include anorexia, nausea, vomiting, ileus, constipation, and, in rare cases, pancreatitis. …

Clinical practice guidelines on addressing cognitive impairment in treatable dementias.

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… | Subacute course Lethargy Fever (may not be present sometimes) Neck stiffness Immunocompromised host (esp in HIV, cryptococcal meningitis) HIV-associated dementia/AID-dementia complex (later stages of HIV infection) Toxoplasmosis | Immunocompromised host Focal neurological signs Cerebral Malaria | Stupor … Hyperkalaemia Parathyroid disorders • Hypoparathyroidism • Hyperparathyroidism | • Paraesthesia • Muscle cramps • Mood disturbances • Dry skin • Tiredness • Muscle weakness • Abdominal pain • Mood symptoms- esp. depression Diabetes Mellitus • Hyperglycaemia • Hypoglycaemia | • • Hyperosmolar state with stupor …

Clinical and epidemiologic characteristics of hospitalized oncological patients with hypercalcemia: a longitudinal, multicenter study.

BackgroundThere are few studies that have analyzed the characteristics of hypercalcemia in hospitalized oncological patients. Our objectives were to describe the clinical characteristics of hospitalized patients with paraneoplastic hypercalcemia and to identify prognostic variables for mortality.MethodsThis was an observational, longitudinal, retrospective, and bicentric study. It included adult patients admitted to two hospitals in Málaga, Spain (2014-2018). The minimum follow-up period was 2 years or until death.ResultsA total of 154 patients were included; the majority (71.4%) were admitted

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… leading to the classification of patients into the following groups: asymptomatic, mild (marked by symptoms such as constipation, asthenia, or depressive mood), moderate (presenting symptoms like muscular weakness, lethargy, or neuropsychiatric alterations), and severe (exhibiting symptoms including stupor …

Совместный транспортер натрий-глюкозы 1/2 ингибирование и риск нейродегенеративных расстройств: Менделианское исследование случайности.

ВВЕДЕНИЕ: Настоящее исследование направлено на оценку воздействия котранспортера с глюкозой натрия. 1 ингибиторы (SGLT1i) и котранспортер с глюкозой натрия 2 ингибиторы (SGLT2i) по нейродегенеративным расстройствам и изучение роли уровней гемоглобина A1c (HbA1c). МЕТОДЫ: При использовании лекарственных средств в целях менделианской случайности мы использовали единичные нуклеотидные полиморфизмы (СНП) проксимальные для генов SLC5A1 и SLC5A2 для анализа влияния SGLT1i и SGLT2i на болезнь Альцгеймера (AD), болезнь Паркинсона (PD), множественный склероз (MS), лобнотемпоральное деменция (FTD), деме

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… Hypoglycemia can lead to a wide array of nonspecific neurological manifestations including confusion, seizures, focal neurological deficits, stupor, and sometimes coma. Seizures and other neurological deficits may also present during hypoglycemia (Barbara et al., 2017 ). …

Прогрессивная многофокальная лейкоэнцефалопатия в химическом антигенном рецепторе T-Cell терапии: тематическое исследование.

Цимерическая антигенная рецепторная (CAR) T-клетотерапия — это новая иммунотерапия, которая продемонстрировала замечательные показатели реакции на рефрактные гематологические заболевания, включая множественные миеломы (ММ). Синдром цитокина (CRS) и нейротоксичность являются хорошо описываемыми побочными эффектами этой терапии. В результате иммунной дисфункции, многообразной терапии, лимфоразрушающей химиотерапии до инъекции клеток, а также продолжительной аплазии клеток B, бенефициары CAR-клеточной терапии также подвергаются повышенному риску инфицирования. Прогрессивная многофукальная лейкоэн

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… There was a plan to either repeat the investigation product infusion or give pembrolizumab 2 weeks afterwards; however, she had a seizure (left head version, gaze deviation, followed by secondary generalization to a tonic-clonic seizure) and became stuporous with right gaze preference. …

Concurrent whole brain radiotherapy and bortezomib for brain metastasis.

BackgroundSurvival of patients with brain metastasis particularly from historically more radio-resistant malignancies remains dismal. A phase I study of concurrent bortezomib and whole brain radiotherapy was conducted to determine the tolerance and safety of this approach in patients with previously untreated brain metastasis.MethodsA phase I dose escalation study evaluated the safety of bortezomib (0.9, 1.1, 1.3, 1.5, and 1.7 mg/m2) given on days 1, 4, 8 and 11 of whole brain radiotherapy. Patients with confirmed brain metastasis were recruited for participation. The primary endpoint was the

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… Grade 3 headache, syncope, neuropathy, hyponatremia, dyspnea, stupor were observed but none were considered DLTs. …

Randomized clinical trial to evaluate safety and efficacy of convalescent plasma use among hospitalized patients with COVID-19 (PERUCONPLASMA): a structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: The general objective of this study is to test the hypothesis that administration of convalescent plasma from donors with previo … ic instability (PA < 60 mmHg refractory to vasopressors) 3. Uncontrolled concomitant infections\ 4. Stupor or coma 5. Platelets < 50,000/μL or disseminated intravascular coagulation 6. Serum creatinine > 3.5 mg/dL or dialysis requirement 7. Total bilirubin > 6 mg/dL or jaundice of unknown etiology 8. Myocardial infarction or acute coronary syndrome 9. Ac …

Сипонимод поддерживает воспоминание в неподдерживающей среде.

Воспаление, характерное для множественных повреждений склероза (MS), приводит к функциональным повреждениям и постепенной потере аксона с течением времени. Хотя, как считается, ремилеляция защищает аксоны, внутренние регенерационные процессы часто являются неполными или полностью неэффективными у многих пациентов с синдромом MS. Хотя точные причины провала воспоминаний остаются неясными, неоднократное обезвоживание в ранее затронутых районах с белыми телами является признанным фактором, способствующим этому. В одном из предыдущих исследований мы продемонстрировали, что модификатор Siпонimod с

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… The following exclusion criteria were applied: severe weight loss (> 10% within 24 h), severe behavioural deficits (decreased locomotion, convulsions, stupor), or infections. No animal met the exclusion criteria during the cuprizone intoxication. …

Emergency Care

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… If airway noises are present or the animal is stuporous, gently and carefully extend the head and neck. If possible, extend the tongue. Wipe mucus, blood, or vomitus from the mouth. In unconscious animals, maintain head and neck stability. 2. Look for signs of breathing. …

Recognition and management of early complications in CAR-T cell therapy and virus-specific T-lymphocyte therapy: a practical clinical reference.

BACKGROUND: Cellular immunotherapies-including chimeric antigen receptor T-cell (CAR-T) therapies and adoptive transfer of virus-specific T lymphocytes (VSTs) - have transformed the treatment of refractory hematological malignancies and post-transplant infectious complications. Eight products are currently authorized by the European Medicines Agency, encompassing seven autologous CAR-T products targeting CD19 or BCMA and tabelecleucel (Ebvallo), the first approved allogeneic off-the-shelf EBV-specific T-cell product for EBV-positive post-transplant lymphoproliferative disease. Despite their cl

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… through stages: Early/mild: Word-finding difficulty (aphasia), dysgraphia (handwriting deterioration), tremor, mild confusion—handwriting changes are an important early hallmark ( 27 , 30 ) Moderate: Expressive and receptive aphasia, agitation, lethargy, impaired short-term memory Severe: Obtundation, stupor … Stupor or coma | Life-threatening prolonged seizure (>5 min); or repetitive clinical or electrical seizures without return to baseline in between | Deep focal motor weakness such as hemiparesis or paraparesis | Diffuse cerebral edema on neuroimaging, decerebrate or decorticate posturing, cranial nerve …

Complete spectrum of adverse events associated with chimeric antigen receptor (CAR)-T cell therapies.

Chimeric antigen receptor (CAR)-T cell therapies have been approved by FDA to treat relapsed or refractory hematological malignancies. However, the adverse effects of CAR-T cell therapies are complex and can be challenging to diagnose and treat. In this review, we summarize the major adverse events, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and CAR T-cell associated HLH (carHLH), and discuss their pathophysiology, symptoms, grading, and diagnosis systems, as well as management. In a future outlook, we also provide an overview of

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… Stupor or coma Death Seizure N/A N/A Any clinical seizure focal or generalized that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention Life-threatening prolonged seizure (> 5 min); or Repetitive clinical or electrical seizures without return to baseline in between Death … Stupor or coma | Death Seizure | N/A | N/A | Any clinical seizure focal or generalized that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (> 5 min); or Repetitive clinical or electrical seizures without return to baseline in between …

Management and Prevention of Cellular-Therapy-Related Toxicity: Early and Late Complications.

Chimeric Antigen Receptor T (CAR-T) cell therapy has dramatically changed prognosis and treatment of relapsed and refractory hematologic malignancies. Currently the 6 FDA approved products target various surface antigens. While CAR-T therapy achieves good response, life-threatening toxicities have been reported. Mechanistically, can be divided into two categories: (1) toxicities related to T-cell activation and release of high levels of cytokines: or (2) toxicities resulting from interaction between CAR and CAR targeted antigen expressed on non-malignant cells (i.e., on-target, off-tumor effec

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… characteristic progression of symptoms evolving from mild tremor and dysgraphia to expressive aphasia (a highly specific manifestation of ICANS, documented in 88% of patients with ICANS [ 64 ]), apraxia, impaired attention followed by lethargy and depressed consciousness and in severe cases progression to stupor … Consider repeat imaging if persistent ≥ G3 | Tocilizumab as per grade 1 G4: ICE score: 0 And/or Stupor or coma And/or Prolonged seizure ( > 5 min) or repetitive clinical or electrical seizures without return to baseline And/or Diffuse cerebral edema on neuroimaging, clinical signs of elevated intracranial …

Развитие энцефалита рецептора против NMDA у пациента с множественным склерозом.

Энцефалит рецептора против N-метил-D (антиNMDA) является редким подтипом аутоиммунного энцефалита, который часто вызывает симптомы, характерные для ранней стадии заболевания. В данном случае речь идет о пациентке с повторным излучением множественных склерозов (RRMS), у которой появился энцефалит рецептора против NMDA, при этом она прошла курс лечения, позволяющий нейтрализовать болезни. У нее были нейрокогнитивные симптомы и нетипичные магнитные резонансные открытия. Клинические и лабораторные исследования, включая поясничные проколы, подтвердили наличие антител IgG против подблока GluN1 рецеп

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… On day 9 of hospitalisation, the patient’s level of consciousness became stuporous, with a Glasgow Coma Scale score of 6 despite receiving first-line treatment. Generalised hypotonia and roving eye movements were observed. …

The Mechanisms of Altered Blood-Brain Barrier Permeability in CD19 CAR T-Cell Recipients.

Cluster of differentiation 19 (CD19) chimeric antigen receptor (CAR) T cells are a highly effective immunotherapy for relapsed and refractory B-cell malignancies, but their utility can be limited by the development of immune effector cell-associated neurotoxicity syndrome (ICANS). The recent discovery of CD19 expression on the pericytes in the blood-brain barrier (BBB) suggests an important off-target mechanism for ICANS development. In addition, the release of systemic cytokines stimulated by the engagement of CD19 with the CAR T cells can cause endothelial activation and decreased expression

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… Neurotoxicity Domain | Immune Effector Cell–Associated Neurotoxicity Syndrome Grades 1 | 2 | 3 | 4 ICE * score | 7–9 | 3–6 | 0–2 | 0 CAPD † score | 1–8 | 1–8 | ≥9 | Unable to assess Level of consciousness | Awakens spontaneously | Awakens to voice | Awakens to tactile stimulus | Stupor or coma Motor …

Short- and Long-Term Prognosis in Hemodynamically Stable Pulmonary Embolism With Unresectable or Metastatic Malignancies: The Role of Performance Status.

BackgroundThe simplified Pulmonary Embolism Severity Index (sPESI) has limitations when evaluating acute pulmonary embolism (PE) in patients with concurrent malignancy. Despite its utility in predicting outcomes among cancer patients, the role of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) in acute PE remains underexplored. This study aims to assess the prognostic significance of ECOG PS ≥ 3 on short- and long-term mortality in acute PE with malignancy, correlating it with the sPESI.Methods and resultsWe retrospectively analyzed 44 hemodynamically stable acute PE patien

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… . † Defined as disorientation, lethargy, stupor, or coma. …

A Comprehensive Evaluation of CAR-T Cell Gene Therapy, Tracing its Revolutionary Clinical Breakthroughs and Advancements Towards Next-Generation Engineering.

BACKGROUND: CAR-T cell gene therapy has advanced from an experimental concept to a standard curative treatment for selected hematologic malignancies. Substantial clinical evidence has established CAR-T therapy as a cornerstone for relapsed/refractory B-cell malignancies and multiple myeloma, demonstrating durable, long-term remissions. In 2025, the U.S. Food and Drug Administration (FDA) eliminated the Risk Evaluation and Mitigation Strategy (REMS) requirement, reflecting improved clinical management of Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome

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… Global aphasia, stuporous, or focal seizure Definition: ICE score 0. Coma, continuous seizure, or cerebral oedema (36, 37, 38) Management: Supportive care. Increase monitoring frequency. Management: Corticosteroids (e.g., dexamethasone) Management: Corticosteroids (higher dose/frequency). … Global aphasia, stuporous, or focal seizure | Definition: ICE score 0. Coma, continuous seizure, or cerebral oedema | (36, 37, 38) Management: Supportive care. …

Rehabilitation Needs for Patients Undergoing CAR T-Cell Therapy.

PURPOSE OF REVIEW: Chimeric antigen receptor (CAR) T-cell therapy is a relatively new, innovative treatment strategy to manage refractory hematological cancers, including some types of leukemia, lymphoma, and multiple myeloma. This article outlines the CAR T-cell therapy process, toxicity, and complications, along with an overview of the currently known short- and long-term physical and functional sequelae that will be helpful for general or oncology rehabilitation specialists caring for these patients. RECENT FINDINGS: There is a dearth of literature on the topic of rehabilitation of patient

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… Stupor or coma Seizure | N/A | N/A | Any clinical seizure focal or generalized that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (> 5 min); or repetitive clinical or electrical seizures without return to baseline in between Motor …

Potentially fatal complications of new systemic anticancer therapies: pearls and pitfalls in their initial management.

BackgroundVarious types of immunotherapy (i.e. immune checkpoint inhibitors [ICIs], chimeric antigen receptor [CAR] T-cells and bispecific T-cell engagers [BiTEs]) and antibody drug conjugates (ADCs) have been used increasingly to treat solid cancers, lymphomas and leukaemias. Patients with serious complications of these therapies can be presented to physicians of different specialties. In this narrative review we discuss potentially fatal complications of new systemic anticancer therapies and some practical considerations for their diagnosis and initial treatment.ResultsClinical presentation

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… consciousness | ICE score: 3−6 AND/OR Mild somnolence awaking to voice | ICE score: 0−2 AND/OR Depressed level of consciousness awakening only to tactile stimulus AND/OR clinical seizure focal or generalized that resolve with intervention AND/OR Focal or local oedema on neuroimaging | ICE sore: 0 AND/OR Stupor …

Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions.

The discovery of the Human Immunodeficiency Virus (HIV) was led by the merge of clustered cases of Pneumocystis jirovecii Pneumonia (PCP) in otherwise healthy people in the early 80's.1,2 In the face of sophisticated treatment now available for HIV infection, life expectancy approaches normal limits. It has dramatically changed the natural course of HIV from a nearly fatal infection to a chronic disease.3-5 However, PCP still remains a relatively common presentation of uncontrolled HIV. Despite the knowledge and advances gained in the prevention and management of PCP infection, it continues to

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… Dyspnea, nausea and tachycardia usually occur at levels of 30% or above, while lethargy, stupor and deteriorating consciousness occur as methemoglobin levels approach 55%. Levels of 70% are usually fatal. …