ABSTRACT
ABSTRACT HTLV-I is the first retrovirus directly associated with human malignancy. HTLV-I is endemic in the Caribbean, Japan, parts of Africa, the Middle East and South America. This enveloped double-stranded RNA virus is transmitted by routes similar to HIV, including untested blood/blood product transfusions, sexual contact, intravenous drug abuse, and from mother to child in a vertical transmission. HTLV infection rarely occurs outside of the above sites and very few studies are available globally. Although the retrovirus identified as being associated with chicken sarcoma was described by Rous (1908), the first human retrovirus was not isolated until 1978 from cutaneous T-cell lymphoma in black Americans. Endemicity of the disease in the Caribbean was discovered in 1982 after adult T-cell leukemia (ATL) was found in some London patients, all of Caribbean origin. To date, there is still a lack of studies on the role of viruses in diseases such as inflammatory disorders, arthritis, Sjogren's syndrome, and infectious dermatitis. In Saint Vincent, there were no documented studies that reflected the prevalence and expression of the virus although we did report some cases of HIV-positive HTLV-I ATL. This article discusses the diagnosis and management of a 55-year-old female with an atypical presentation of adult T-cell lymphoma, and we conducted a literature review to determine the prevalence and common presentations of ATL.
ABSTRACT
Botulinum toxin-A (BoNT-A) is an effective treatment for cervical dystonia (CD) and spastic paresis (SP), but it requires in-depth knowledge of anatomy and injection techniques. The Ixcellence Network® is an educational programme to provide neurology, neuropaediatrics, and physical medicine and rehabilitation (PMR) specialists with access to best clinical practices and innovations regarding SP and CD management with BoNT-A. To assess the benefits of such educational programmes and identify unmet needs, a multidisciplinary scientific committee designed INPUT (INjection Practice, Usage & Training), an international multicentric survey describing training and practices among this trained and experienced population. A self-completed questionnaire was sent online to 553 trainees and 14 trainers from the Ixcellence Network®. Among the 131 respondents, 92% specialized in PMR (48%) or neurology (44%), with a mean experience of 15.5 years in their clinical fields and 10.9 years of BoNT-A injection. Most of them (98%) reported having received training before performing their first BoNT-A injection and attending specific courses on how to perform it without any instrumental guidance (76%), and with ultrasound (73%), electrical stimulation (44%) or electromyography (41%). In terms of practices, 92% of respondents reported using at least one guidance technique while injecting, with ultrasound being the most used technique (48%). Attending specific courses was significantly associated with greater self-confidence and use, e.g. for injection with ultrasound, mean self-confidence, on a scale from 1 (not confident) to 10 (fully confident), was 7.9 for trained respondents (vs 4.0 for untrained respondents, p < 0.001) of whom 70% stated that they used this technique regularly or systematically (vs. 11% of untrained healthcare professionals (HCPs), p < 0.0001). Moreover, 84% of respondents reported having trained colleagues, residents or fellows through theoretical (70%) or practical teaching in individuals (80%) or in small groups (65%). Overall, 86% of respondents reported a notable increase over the past 5 years of the number of patients treated with BoNT-A. INPUT is the first international survey describing training and practices in SP and CD management of physicians who attended a dedicated educational programme. The results highlighted the importance of training for self-confidence, and the use of specific techniques and new approaches.