Lung Transplantation as a way to Escape Pneumonia in Patients with COVID-19: Lessons from ARDS and Influenza.

In this era, the novel Coronavirus, referred to as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a life-threatening virus with a high mortality rate (4.2%) and with no absolute treatment as of yet, may ultimately result in acute respiratory distress syndrome (ARDS). ARDS is one of the fatal complications, highlighted by pulmonary infiltration and severe hypoxemia. This condition can be developed from primary lung inflammation caused by various viruses, particularly influenza viruses, some of the most common human pathogens. Due to this issue, many studies explored several approaches for ARDS treatment. Lung transplantation has been claimed as an efficient cure for severe ARDS and Influenza, which can also be offered for treating critical lung complications of SARS-CoV-2. Thereupon, to the best of our knowledge for the first time, we aimed to review all available data about capability of lung transplantation for the treatment of critically ill patients with ARDS, Influenza, and SARS-CoV-2.

The journeys of patients with trigeminal neuralgia on a background of multiple sclerosis.

Aim: Multiple sclerosis (MS) is well recognized as a secondary cause for trigeminal neuralgia (TN). In this case series, we detail the management of all the patients with TN and MS (pwTNMS) presenting to a specialist unit. Materials & methods: A prospective patient database was used to extract key clinical data on pharmacological, psychometric and surgical management of 20 pwTNMS. Results: 65% of pwTNMS underwent surgical interventions for management of their pain.12/20 achieved remission periods, through surgery and/or medication. Significant improvement was noted on the global impression of change illustrated by a p < 0.001. Conclusion: pwTNMS require a multifaceted approach combining polypharmacy, surgical interventions and psychological support. Developing self-management skills is crucial if patients are to live well with pain.

Lay abstract Aim: Multiple sclerosis (MS) is understood to be the leading secondary cause for the development of trigeminal neuralgia (TN). Very little is known about how this group of patients are managed, in terms of the medication and surgical treatments used. In this study we follow the journey of all the patients with TN and MS (pwTNMS) presenting to the same multidisciplinary (several specialists) unit, detailing their management and impact on the quality of life. Materials & methods: Data were collected on 20 pwTNMS on what types of medication and surgical treatments were undertaken to try and manage their pain. Results: A total of 65% of pwTNMS underwent one or more surgical treatments for management of their pain. Twelve patients achieved periods of being pain free, through surgery and/or medication. There was significant improvement noted on the global impression of change in pain. Pain catastrophizing scores remained high, suggesting many patients remained fearful and worried regarding their pain. Conclusion: TN in patients with MS can be very challenging to manage, often necessitating a more complex approach to treatment involving a combination of medication, surgery and psychological support, to achieve better management of their pain. Multiple medications are often used in an attempt to reduce adverse drug side effects. Patients, are likely to undergo frequent surgical procedures. A multidisciplinary approach encouraging self-management is crucial if patients are to live well with their pain and improve prognosis.

Trigeminal neuralgia: Comparison of characteristics and impact in patients with or without multiple sclerosis.

OBJECTIVES: The commonest secondary cause for trigeminal neuralgia (TN) is multiple sclerosis (MS) and little is known about this group of patients in terms of their presentation and treatments. We compared patients with TN and MS (pwTNMS) with a cohort of patients with primary TN, who had been referred to the same specialist unit, both in terms of characteristics and impact on quality of life at the time of their first assessment. METHODS: Using a prospective patient database we extracted key clinical data and results from psychometrically tested questionnaires of 26 pwTNMS and compared them to an age and gender-matched set of 68 patients with primary TN. RESULTS: Our findings suggest that pwTNMS exhibit a more severe clinical phenotype than primary TN. Prior to referral, pwTNMS are more likely to have used more healthcare services and undergone more neurosurgical interventions. Strikingly, pwTNMS exhibit reduced lengths and duration of remission periods and fewer identifiable triggers. Furthermore, pwTNMS report significant impact on quality of life comparable to those in primary TN, scoring highly in measures of anxiety, depression, and catastrophizing, but also report greater sleep disturbance, and overall interference in activities of daily living. CONCLUSIONS: pwTNMS have a more intractable TN, one which may necessitate a more complex approach to treatment, earlier referral to secondary care and an extensive assessment of mental health. Quality of life in pwTNMS is severely affected by both their MS and their TN, suggesting management should occur in specialist centres with access to a multidisciplinary team.