#Medication Regimens

[seraphichomehealthcare]

Medication management is crucial to senior health, ensuring that older adults take the right medications at the right times. For seniors with multiple health conditions, staying on top of medications can be overwhelming, leading to missed doses or incorrect usage. This can result in unnecessary complications or even hospitalizations. Home health care in Plano, Texas offers professional services that help seniors manage their medications.

[accesshealthphysician]

Managing chronic health conditions is essential for maintaining a high quality of life. Physicians in Jensen Beach, Florida, play a critical role in this process. They offer personalized care plans tailored to each patient’s unique needs, ensuring that chronic issues such as diabetes, hypertension, and heart disease are closely monitored.

[hrmnyhaven]

In Indianapolis, Indiana, where the rhythm of life beats a steady tempo, finding moments of tranquility and balance can sometimes feel like a distant dream. Yet, amidst the hustle and bustle, there exists a haven of serenity and support - Harmony Haven.

[boulevardpharmaceuticalcompoun]

Regarding veterinary compounding in Boston, Massachusetts, finding the correct dosage forms for our furry friends is crucial. Boulevard Pharmaceutical Compounding Center understands the importance of tailored solutions for animals' medication needs. We offer a diverse range of non-sterile compounding options designed specifically for pets. From flavored suspensions that make medication time a treat to chewable formulations that are easy to administer, our pharmacy ensures that giving medications to pets is stress-free for both owners and their beloved companions.

[autisticaradiamegido]

day 192

a break from artfight for some good news! i have finally scheduled a surgical consult to have my enemy (read: uterus) removed. this is a bit of a scarier prospect than my breast reduction was, but i think it will be an equally impactful quality of life improvement when all is said and done!!

anyway those of yall who have been here since the beginning may remember me posting through that whole process so i figure why stop now.

[aldieb]

my entire work day involves attempting to focus on papers while this thing sits 6 inches away staring and vibrating at a consistent volume and frequency

[tomato-greens]

literally every day I take my asthma medication and my body is like :) :) :). it takes a couple days of forgetting to take all daily and emergency medications before the lead blanket really settles over my body, but - especially with Spiriva - as soon as I inhale the medication, my lungs are like, OH TIME AT LAST TO RELAX! and then in about 5-30 minutes I suddenly notice I can breathe without the painful catch that returns every night

[burninlovebutler]

1,000 Follower Party 🥹

when i came back to tumblr, i never expected to have the experience i’ve had or make the connections & friend’s i’ve made - friends that i consider some of my best friends now.

i also didn’t expect the love i’ve received for my writing, it has been truly overwhelming (in a good way obv) - my numbers aren’t the highest but i am so grateful for my time here & the people i’ve met - thank you for all the laughs, cries, screams lol they make me so happy. you all have shown me a kindness that is such a bold reflection of elvis 🥺 it’s so beautiful & it just makes me wanna pay it forward

and thank you for accepting me & letting me take up some space here 💗

**since i do get quite overwhelmed easily with asks (bc my adhd) i can’t guarantee that i’ll be able to do all of them or that they’ll be done quickly but i will try my best to do most!**

(this is long bc i’ve never done a follower celebration before so i’m making up for lost time lol prob nobody cares & this is prob lame but 😭 idk)

anyway send me an ask w one of these if u want ☺️💘

🍉 - About me / Commentary / Opinion

-tell me about yourself / introduce yourself to me if you haven’t already or ask me anything about myself that you’re curious about or just rant about anything!

-idk people come to me for advice often about random stuff ? could be anything you want or writing related! or ask my opinion on anything fandom related or not

👻 - Title Game

-send in a made up fic title and I'lI tell you what I'd write for it 💓

🤗 - Thoughts on you!

- self explanatory - if you wanna hear my thoughts about you💕

📝 - Quotes (specify which you’d prefer)

- random quotes from WIPs

- or fav quote from existing works

💿 - Playlists

2 options for this one:

Send me A or B & i’ll make/write a short 3-6 song playlist for you 💗

A - send me either austin or elvis + a fav trope / vibe / mini fic idea OR any of my fics regarding a certain scene or dynamic

B - send me either austin or elvis + your personal typa vibe/aesthetic/etc

(perhaps also include like what kinda music u listen to / any specific artist you like so i can include some if they overlap w my library ?)

ALSO - specify if you have spotify or not!

🦋 - Moodboards

similar to ^ playlists

send me A or B [+ the respective details] & i’ll make a 3-6 pic mini moodboard for you 💓

👀 - My fics

-ask me about any of my fics! send me one of my fics & talk/ask me anything about them like how i got the idea / ideas for certain plots or scenes or my writing process or my fav lines/plots/scenes or anything really idk

- or hints out of context 🤭 i love doing those

👽 - Head Cannons

-ask me about a specific fic of mine OR elvis/austin under a certain setting / trope / plot / pairing & i’ll share/make some head cannons for it

🌸 - Recommendations

-recommend some things for me! movies, shows, music, makeup!!/skincare!, tarot decks, books, anything & i’ll answer w some of my own 💓

since my writing process is rather lengthy & intricate i don’t like to write blurbs or take requests etc. so unfortunately i can’t be like y’all that can write/post a million lil stories effortlessly ☹️ i so wish i could, i’m just not built like that 😭

HOWEVER it seems just wrong for me to not include some sort of fic component in my celebration since i am mainly a fic blog SO

i decided i wanted to do a lil contest ??? idk lol

🦋winner will receive a imagine/one shot with the plot request of their choosing🦋

TO ENTER:

- make sure you are following me lol

- like & reblog this post

- comment 🍉🥀 on this post

- comment something that made you happy today 💓

- bonus entry: reblog this w proof that you took a drink of water when you read this 💗 (empty water bottle/cup or something!)

that’s it!

💗whenever the winner is chosen i will convene with them directly on what sort of fic they want & i will write one for them (tho it may take some time lol) 💗

✨contest will be open for the next 2 weeks & the winner will be chosen at random around then! [04.07.23]✨

tagging some of my fav people i’ve met through this blog/fandom 🥰

@cryingabtab @lllsaslll @presleysdarling @loving-elvis @samfangirls @bisexualwvtson @troubleinapinksuit @karamelcoveredolicity @lindszeppelin @succsessions @steph-speaks @luluthesandgoose @ab4eva @softsatnin @elvisfatass @homerow99 @michellelv @flwrs4aust @powerofelvis @elvisabutler @sournatromanoff @jelliedonut @sagesolsticewrites @fangirlwithasweettooth @thatbanditqueen @purejasmine @slowsweetlove @areacodefan @generoustreemystic @golden-kiwis

and so many more 😭 anyone whom i’ve inevitably missed due to my overly medicated rotting brain 😭

again i love you all so much 🥺 thank you for letting me be a part of this beautiful little family 🥺💗

-mel xx

[jcsmicasereports]

Primary dural-based parafalcine diffuse large b-cell lymphoma mimicking meningioma by Amr El Mohamad in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Primary dural-based diffuse large B-cell lymphoma is very rare. Only few cases were reported in the literature. Case presentation: Herein, we present a case of an immunocompetent patient with primary dural-based diffuse large B-cell lymphomas mimicking meningioma associated with ghost tumor phenomenon without any evidence of a systemic lymphoma. Conclusion: Primary central nervous system lymphomas are rare. Clinicians should always consider this lesion as a differential diagnosis if radiological findings are not indicative of typical one meningiomas.

Key words: Dural-based tumor, diffuse large B-cell lymphoma, ghost tumor, MATRIX regimen, central nervous system.

Introduction

Primary central nervous system lymphomas (CNSLs) (PCNSLs) are rare and account for 2%–5% of all brain tumor cases, whereas secondary CNSLs are more common [1,2]. One study has shown that the most common intraparenchymal histological type is diffuse large B-cell lymphoma, as among 26 patients with PCNSL, 25 had diffuse large B-cell lymphoma [3]. Although primary dural-based lymphomas are rare, the most common area of involvement is the cerebral hemispheres. Most dural-based lymphomas are secondary and present as extra-nodal systemic diffuse large B-cell lymphomas. Primary dural-based lymphomas are usually histologically marginal-zone lymphomas, representing a group of lymphomas that have been historically classified together because they appear to arise from post-germinal center and marginal-zone B cells and share a similar immunophenotype, and few cases were reported to be diffuse large B lymphomas [4]. Here, we present a case of an immunocompetent patient with primary dural-based diffuse large B-cell lymphomas mimicking meningioma associated with ghost tumor phenomenon without any evidence of systemic disease.

Case Presentation

A 58-year-old male individual previously healthy and immunocompetent presented with headache, recurrent vomiting, and memory problems lasting for 3 days. No loss of consciousness, seizure, subjective weakness, or fever was observed. On physical examination, the patient’s Glasgow coma scale score was 15; his pupils were 3 mm in diameter, equal, and reactive; and the patient had nominal aphasia without motor and sensory deficit. He had normal cerebellar functions, and cranial nerve exams revealed no deficit. Head computed tomography (CT) (Fig. 1) showed a 2.2 × 3.8 cm (transverse × anteroposterior) iso-dense lesion with internal hypodensity in the left parasagittal frontal region extending to the right frontal region. Extensive perilesional edema was observed with effacement of the sulci and mass effect on bilateral frontal horns, associated with 3-mm midline shift. Head magnetic resonance imaging (MRI) showed an isointense parasagittal lesion on T1 and heterogeneous intense on T2, with redemonstration of perifocal edema (Fig. 2). Head T1-weighted imaging with contrast enhancement (Fig. 3) showed a large, left frontal, parafalcine, irregular-shaped mass located below the superior sagittal sinus level. It measured 4 × 3 × 3.3 cm in anteroposterior, mediolateral, and craniocaudal, respectively. It showed diffusion restriction (Fig. 4). There was central hyperintensity on T2-weighted imaging, without post-contrast enhancement area representing cyst formation. It exerts a mass effect characterized by effacement of the adjacent sulci, compression of the left lateral ventricle, and a 3-mm shift of the midline structures to the right side, and the impression of our neuroradiologist was atypical meningioma. Regarding extensive edema, dexamethasone was started at a dose of 4 mg, thrice a day, and the patient was planned for craniotomy and resection of the tumor. Initially, the patient was reluctant to undergo surgery; however, subsequently, the patient agreed to undergo surgery after approximately 10 days. During surgery, parasagittal craniotomy was performed; however, to our surprise, no definite mass lesion was found at the proposed site, in contrast to the findings described on imaging. The falx was thinned out and partly deficient. A biopsy sample was obtained from this abnormally appearing falx. Moreover, we obtained biopsy samples under neuronavigation guidance from abnormally appearing tissue, which was completely intra-axial, deep down in the lesion visualized on navigation. On postoperative day 1, MRI head with contrast enhancement (Fig. 5) showed that the previously seen lesion had a significant regression in size. Its right frontal extension and adjacent enhanced meningeal tail showed size reduction. Moreover, some regression in the perilesional vasogenic edema was observed. A significant regression in the previously described enhancement was noted at the left-side lentiform nucleus and external capsule. The MR spectroscopy study showed an increased choline/N-acetyl aspartate ratio and elevated lactate level within the lesion.

The histopathology results of the first brain biopsy samples (Figs.6–7) obtained from the falx cerebri showed meningothelial hyperplasia with calcification and focal perivascular lymphocytic infiltrate composed of small and large, atypical lymphocytes. Immunohistochemical staining was performed; however, the area of interest disappeared. The pathology team recommended another fresh biopsy to have the final diagnosis and flowmetry studies. So, the patient underwent redo craniotomy using the same incision, and multiple biopsy samples were taken. The second fresh brain biopsy (Figs. 8–9) showed multiple brain fragments with predominant perivascular atypical lymphoid infiltrates. Most cells were medium to large with moderate cytoplasm, atypical irregular nuclei having vesicular chromatin, variably prominent nucleoli, and several mitoses, including atypical one. Necrotic areas were also seen. Immunohistochemistry of the second biopsy (Fig.10 A-D) showed that atypical perivascular cells were positive for CD45, CD20, CD79a, BCl2, BCl6, MUM1, OCT2, and C-MYC, and negative for CD10, CD21, TDT, ALK1, EBV-LMP1, CD3, and CD5; however, few reactive/residual lymphocytes were positive for these enzymes. Moreover, 80% of lymphoid cellular nuclei were positive for Ki67. These findings were consistent with diffuse large B-cell lymphoma, not otherwise specified.

Whole-body positron emission tomography (PET) showed intense fluorodeoxyglucose (FDG) uptake higher than that in the healthy brain cortex, without evidence of coexisting systemic disease. In addition to PET scan, contrast-enhanced chest, abdomen, pelvis CT did not show any other lesions in the body; furthermore, workup for viral markers and autoimmune conditions were all unremarkable, thus confirming the diagnosis of “primary dural-based diffuse large B-cell lymphoma,” distinguishing it from secondary CNSL. The patient was transferred to the Oncology Department and started on three cycles of the methotrexate, cytarabine, thiotepa, and rituximab (MATRIX) protocol, which is the current standard treatment regimen for PCNSLs [5]. Three months after the diagnosis and after receiving two cycles of the MATRIX protocol, brain MRI with contrast enhancement (Fig. 11A, B) showed regression of the lesion, and PET scan showed complete metabolic resolution in terms of decreased FDG activity of the previously seen PCNSL without signs of lymphoma activity elsewhere. Subsequently, the patient received the third cycle of the MATRIX protocol without specific complications. Two weeks later, autologous stem cell transplantation (50 × 106/kg) was performed as part of the consolidation phase of treatment. Six weeks later, conditioning chemotherapy with carmustine–thiotepa was administered, followed by stem cell infusion (CD34 = 12 million/kg). The post-transplant course was complicated with mucositis, folliculitis, diarrhea, febrile neutropenia, and prolonged thrombocytopenia. Two months after transplantation, PET scan was repeated and showed complete metabolic resolution of initially seen PCNSL involvement. Currently, the patient is being followed by the hematology team; the patient is in good health and remission. The last outpatient follow-up was 8 months after the first surgery. The patient was seen by the vascular surgery (for permcath removal) and oncology teams. At this time, the patient was stable with complete remission; then, the patient was lost to follow-up. Another head MRI was performed and showed almost total regression of the lesion.

Discussion

Lymphomas in CNS are classified as primary, arising de novo from brain parenchyma, leptomeninges, eye, and spinal cord and as secondary to systemic lymphoma, which can be dural-based lesions. Secondary CNSLs are more common than PCNSLs. Most PCNSLs are intraparenchymal diffuse large B-cell lymphomas with a predilection to occur in the frontal lobe and then deep nucleic and periventricular locations; the infratentorial cerebellum is the most common location. However, primary dural-based lymphomas are rare, and even when found, they are histologically marginal-zone lymphomas. Few cases of primary dural-based diffuse large B-cell lymphoma have been reported in the literature [4,6]. Furthermore, PCNSLs are more common in immunocompromised patients with a mean age of 34 years, and they occur in immunocompetent individuals at an older age with a mean of 52 years [7]. The patient in this case report was 58 years old and immunocompetent without significant previous medical conditions. The latest review of the literature on primary dural-based lymphoma has been conducted by Quinn et al., who have found only 24 reported cases of primary dural-based diffuse large B-cell lymphoma, which confirms the rarity of the disease and subsequently the limited knowledge regarding this disease entity [8]. CNSLs have rapid response to steroids with shrinkage in size and initial remission [9]. Moreover, the initial response to steroids is associated with a better response to chemoradiotherapy and good prognosis [9]. In the patient in this case report, there was an unintentional delay of surgery for approximately 10 days, and the patient was on steroids (dexamethasone). In this case report, the failure to identify a discrete lesion of the size expected as perceived on initial imaging, despite proper surgical planning using neuronavigation, was probably due to the rapid regression of the tumor in response to steroids. This phenomenon agrees with the scientific literature reporting about the disappearance of lymphomas in response to steroids (ghost tumors) [10,11]. The pathogenesis of primary dural-based lymphoma remains unknown as there is no lymphoid tissue in the dura. It is hypothesized that it is related to chronic infection, autoimmune disease, or chronic inflammatory condition, which recruits polyclonal lymphocytes resulting in monoclonal lymphomas [6]. In contrast, the patient in this case report did not have any chronic conditions. All workups were negative, including the entire viral panel and autoimmune markers. Basic research is needed to determine the etiology of PCNSL, especially dural-based lymphomas. In the patient in this case report, the initial radiological findings were mimicking those of a meningioma: dural-based and uniformly enhanced. There was significant surrounding edema, significant diffusion restriction, and blooming in susceptibility-weighted image, which goes more with higher-grade meningioma or another high-grade lesion. One review has shown that primary dural-based lymphomas can display the “dural tail “sign, further confusing the preoperative diagnosis with meningioma [12], which did happen in the patient in this case report. Therefore, we suggest that in case of a dural-based lesion that has non-typical features of grade 1 meningioma, clinicians should consider lymphoma in the differential diagnosis and avoid steroids unless necessary due to edema and mass effect keeping in mind the ghost tumor phenomena of lymphoma.

The role of surgery in PCNSLs is limited mainly to histological diagnosis through biopsy or tumor debulking in case of increased intracranial pressure or impending brain herniation. Some studies have shown no benefit of complete surgical resection of PCNSLs; however, a recent systematic review of 244 articles has shown evidence in support of cytoreductive surgery [13]. Previously, whole-brain radiotherapy (WBRT) was the recommended treatment; however, this treatment modality resulted in a high rate of relapse and a decrease in performance status and cognitive impairment, and with the improvement in survival with high-dose methotrexate, WBRT is no longer recommended. Currently, newly diagnosed PCNSLs are initially treated with induction chemotherapy until complete radiological response, followed by consolidation therapy, to prolong the overall survival [14]. The International Extra Nodal Lymphoma Study Group-32 trial has shown that a methotrexate-based MATRIX regimen results in a good outcome and control rate in PCNSL [5], and it is the standard induction chemotherapy. Ferreri AJM, in his article “The role of autologous stem cell transplantation in PCNSL” has compared various consolidation phase treatment modalities, including beam radiation, carmustine–thiotepa regimens, and autologous stem cell transplantation, and the results showed that autologous stem cell transplantation resulted in good outcomes [15]. The patient in this case report showed a good response to treatment with almost total resolution of PCNSL with three cycles of MATRIX chemotherapy, followed by conditioning chemotherapy with stem cell infusion.

Conclusion

PCNSL is a rare entity. Clinicians should always consider it in differential diagnosis of meningioma if the radiological findings are not typical for meningioma. When there is a high index of suspicion of lymphoma, repeating neuroimaging, particularly MRI, before surgery, especially if the surgery is delayed while the patient is on steroids, may help develop a better management plan while dealing with this rare lesion. In case of lesion disappearance, falx biopsy can be an option. The aim of surgery in PCNSL is mainly biopsy or debulking to decrease intracranial pressure in case of significant mass effect.

List of abbreviation:

Primary central nervous system lymphomas (PCNSLs)

Central nervous system lymphomas (CNSLs)

Head computed tomography (CT)

magnetic resonance imaging (MRI)

positron emission tomography (PET)

fluorodeoxyglucose (FDG)

whole-brain radiotherapy (WBRT)

[quill-pen]

The worst part is thinking about facing the future alone.

I'm an only child. That means I will be the only one responsible for seeing that my parents are taken care of, alongside dealing with my own accumulating health issues. I will be the only one to plan their funerals when they pass. I will be the only one to bury them. I will be all alone in my grief, with no one in my corner to support me and help me heal. No one to hold me when I break into a million pieces. No one to help me process the fact that my parents are gone. No one to reassure me that I'll eventually be okay. No one to help me figure out how to move on live again. Just me. Only me.

And no one will care. Not really. Because they'll all have their own lives and problems to worry about without having to concern themselves with the pathetic, chronically ill woman grieving all on her own.

[lovewithoutresin]

GUESS WHO HAS PATELLAR TENDONITIS!!!!

[vi-visected]

i just completed about ten hours worth of laundry after letting it get out of hand for over a month because i was off my meds and couldn’t bring myself to do anything. but i fucking did it today, i just folded the last load of clean clothes and now i just have to put them away. it feels so good.

[chadillacboseman]

I AM DELIGHTED TO ANNOUNCE THAT I WILL RETURN TO X READER THIS WEEKEND. IF YOU SENT ME A REQ, I WILL WORK ON IT.

[salora-rainriver]

Being on ADHD meds is hilarious. Everything from street drugs to gingko biloba is a potential risk, and it’s never a weaksauce risk like nausea or a mild headache. No, it’s either “your heart might explode” or “call your doctor if you’re experiencing hallucinations and seizures”.

Also funny is telling your hippie mom about these interactions:

[baconcolacan]

When did Tords obsession with Tom begin? (For regimen)

Hmm, well, his earliest “symptomatic” obsession with Tom started during their teenage years.

Like I mostly implied in the fic, Tord has always been fascinated with Tom, largely because Tom can somehow always see him behind whatever facade he puts up. Something not a lot of people are able to do. He’s been pushing at him for years, but Tom has never fallen for his baiting, aside from instances where he irritated him enough.

It’s all very very fascinating.