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https://www.readbyqxmd.com/read/29791948/multiple-sclerosis
#1
Bassem I Yamout, Raed Alroughani
Multiple sclerosis (MS) is a chronic central nervous system inflammatory disease of autoimmune etiology, mediated by activated T cells with evolving evidence of a significant contribution from B cells and cells of the innate immune system. The disease is thought to be due to a complex interaction between different genetic and environmental factors. The prevalence of MS is rising all over the world, due on one hand to earlier diagnosis and prolonged survival, and on the other to a true increase in incidence of the disease...
April 2018: Seminars in Neurology
https://www.readbyqxmd.com/read/29791439/multi-biomarker-disease-activity-score-as-a-predictor-of-disease-relapse-in-patients-with-rheumatoid-arthritis-stopping-tnf-inhibitor-treatment
#2
Marjan Ghiti Moghadam, Femke B G Lamers-Karnebeek, Harald E Vonkeman, Peter M Ten Klooster, Janneke Tekstra, Annemarie M Schilder, Henk Visser, Eric H Sasso, David Chernoff, Willem F Lems, Dirk-Jan van Schaardenburg, Robert Landewe, Hein J Bernelot Moens, Timothy R D J Radstake, Piet L C M van Riel, Mart A F J van de Laar, Tim L Jansen
OBJECTIVE: Successfully stopping or reducing treatment for patients with rheumatoid arthritis (RA) in low disease activity (LDA) may improve cost-effectiveness of care. We evaluated the multi-biomarker disease activity (MBDA) score as a predictor of disease relapse after discontinuation of TNF inhibitor (TNFi) treatment. METHODS: 439 RA patients who were randomized to stop TNFi treatment in the POET study were analyzed post-hoc. Three indicators of disease relapse were assessed over 12 months: 1) restarting TNFi treatment, 2) escalation of any DMARD therapy and 3) physician-reported flare...
2018: PloS One
https://www.readbyqxmd.com/read/29790981/economic-impact-of-aging-on-the-initial-spine-care-of-patients-with-acute-spine-trauma-from-bedside-to-teller
#3
Julio C Furlan, Michael G Fehlings, B Catharine Craven
BACKGROUND: Aging of the population has prompted an escalation of service utilization and costs in many jurisdictions including North America. However, relatively little is known on the economic impact of old age on the management of acute spine trauma (AST). OBJECTIVE: To examine the potential effects of age on the service utilization and costs of the management of patients with acute spine trauma. METHODS: This retrospective cohort study included consecutive patients with AST admitted to an acute spine care unit of a Canadian quaternary university hospital between February, 2002 and September, 2007...
May 22, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29790628/metabolic-syndrome-and-its-components-are-associated-with-increased-chronic-kidney-disease-risk-evidence-from-a-meta-analysis-on-11-109-003-participants-from-66-studies
#4
Shahab Alizadeh, Mahsa Ahmadi, Behnam Ghorbani Nejad, Abolghassem Djazayeri, Sakineh Shab-Bidar
BACKGROUND & AIMS: Observational studies examining the relationship between metabolic syndrome and the risk of chronic kidney disease (CKD) have reported inconclusive results. This meta-analysis was performed to resolve these controversies. METHODS: The MEDLINE, EMBASE, and PubMed databases were systematically searched from their inception until March 2016 to identify all relevant studies. Risk estimates and their corresponding 95% confidence intervals (CIs) for the associations of MetS and its components with CKD risk were extracted and pooled using a random-effects model...
May 23, 2018: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/29790618/intratendinous-injection-of-autologous-adipose-tissue-derived-mesenchymal-stem-cells-for-the-treatment-of-rotator-cuff-disease-a-first-in-human-trial
#5
Chris H Jo, Jee Won Chai, Eui Cheol Jeong, Sohee Oh, Paul S Kim, Jeong Yong Yoon, Kang Sup Yoon
Despite relatively good results of current symptomatic treatments for rotator cuff disease, there has been an unmet need for fundamental treatments to halt or reverse the progress of disease. The purpose of this study was to assess the safety and efficacy of intratendinous injection of autologous adipose-tissue derived MSCs (AD MSCs) in patients with rotator cuff disease. The first part of the study consists of 3 dose-escalation cohorts; the low- (1.0x107 cells), mid- (5.0x107 ), and high-dose (1.0x108 ) groups with 3 patients each for the evaluation of the safety and tolerability...
May 23, 2018: Stem Cells
https://www.readbyqxmd.com/read/29790369/an-innovative-perioperative-pain-program-for-chronic-opioid-users-an-academic-medical-center-s-response-to-the-opioid-crisis
#6
Marie N Hanna, Traci J Speed, Ronen Shechter, Michael C Grant, Rosanne Sheinberg, Elizabeth Goldberg, Claudia M Campbell, Nicholas Theodore, Colleen G Koch, Kayode Williams
Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis with alarming rates of addiction and opioid-related deaths. In the surgical setting, opioid prescriptions have been implicated as a contributing factor to the opioid epidemic. The authors developed an innovative model to address aspects of pain management and opioid utilization during preoperative evaluation, acute surgical hospitalization, and postoperative follow-up for chronic opioid users. This program involves multidisciplinary teams that include acute and chronic pain specialists, psychiatrists, integrative medicine specialists, and physical medicine and rehabilitation services...
May 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29789983/principles-of-fluid-management-and-stewardship-in-septic-shock-it-is-time-to-consider-the-four-d-s-and-the-four-phases-of-fluid-therapy
#7
REVIEW
Manu L N G Malbrain, Niels Van Regenmortel, Bernd Saugel, Brecht De Tavernier, Pieter-Jan Van Gaal, Olivier Joannes-Boyau, Jean-Louis Teboul, Todd W Rice, Monty Mythen, Xavier Monnet
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition...
May 22, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29789411/heliox-adjunct-therapy-for-neonates-with-congenital-diaphragmatic-hernia
#8
Audra C Wise, Mallory A Boutin, Ellen M Knodel, James A Proudfoot, Brian P Lane, Marva L Evans, Denise M Suttner, Amy L Kimball
BACKGROUND: Congenital diaphragmatic hernia remains a complex disease with significant morbidity and mortality. Hypercarbia is a common derangement in this population, which often requires escalating ventilator support. By decreasing airway turbulence and enhancing CO2 removal, inhaled helium-oxygen mixture (heliox) has the potential to improve ventilation and thereby decrease ventilator support and its associated lung injury. METHODS: Retrospective cohort review of all neonates with congenital diaphragmatic hernia treated at Rady Children's Hospital San Diego during 2011-2015...
May 22, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29785480/potential-treatment-options-in-a-post-antibiotic-era
#9
R R Bragg, C M Meyburgh, J-Y Lee, M Coetzee
Following the Golden Age of antibiotic discovery in the previous century, the rate of antibiotic discovery has plummeted during the past 50 years while the incidence of antimicrobial resistance is ever-increasing. Presently, humankind is forced to address a major public health threat in the form of multiple drug resistance and urgent action is required to halt the advent of a post-antibiotic era. This chapter aims to draw the attention to the escalating global crisis of antimicrobial resistance fueled by the irresponsible use of antibiotics in healthcare and animal production sectors...
2018: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29783156/transient-impairment-of-olfactory-threshold-in-acute-multiple-sclerosis-relapse
#10
Gabriel Bsteh, Harald Hegen, Felix Ladstätter, Klaus Berek, Matthias Amprosi, Sebastian Wurth, Michael Auer, Franziska Di Pauli, Florian Deisenhammer, Andreas Lutterotti, Thomas Berger
BACKGROUND: Impairment of olfactory threshold is a feature of early and active relapsing remitting multiple sclerosis (RRMS). It predicts inflammatory disease activity and was reported to be transient. However, the timing of onset and resolve of olfactory threshold impairment remains unclear. OBJECTIVE: To prospectively assess the development of olfactory threshold in acute MS relapse over time in comparison to stable MS patients. METHODS: In a prospective observational design, we measured olfactory threshold by performing the Sniffin' Sticks test (minimum score 0, maximum score 16 reflecting optimal olfactory function) at baseline and after 4, 12 and 24 weeks...
May 18, 2018: Multiple Sclerosis and related Disorders
https://www.readbyqxmd.com/read/29782960/the-acute-and-residual-effects-of-escalating-analgesic-range-doses-of-ketamine-on-driving-performance-a-simulator-study
#11
Amie C Hayley, Maja Green, Luke A Downey, Con K K Stough, Michael Keane, Brook Shiferaw, Panagiota Kostakis, Yahya Shehabi
Ketamine hydrochloride elicits potent psychotomimetic and neurobehavioural effects which make it incompatible with driving; however, the direct effect on driving performance is yet to be assessed. Using an open label, within-subjects protocol, 15 males and 5 females (mean age = 30.8 years) were administered three fixed, stepwise increasing sub-anaesthetic doses of intravenous (IV) ketamine solution [(i) 8 mg/h IV infusion plus 30 mg bolus, (ii) 12 mg/h IV infusion and (iii) 20 mg/h infusion]. Whole blood ketamine and norketamine concentrations were determined at each treatment step and at 2 h post-infusion...
May 18, 2018: Progress in Neuro-psychopharmacology & Biological Psychiatry
https://www.readbyqxmd.com/read/29780690/an-update-on-the-treatment-of-pediatric-autoimmune-encephalitis
#12
Cory Stingl, Kathleen Cardinale, Heather Van Mater
Purpose of review: Autoimmune encephalitis (AE) is an increasingly recognized etiology for neuropsychiatric deficits that are highly responsive to immunotherapy. As a result, rheumatologists are often called upon to help with the diagnosis and treatment of these conditions. The purpose of this review is to provide an update on the pharmacologic treatment of AE. Recent findings: To date, there are no prospective randomized placebo-controlled trials to guide treatment recommendations for AE...
March 2018: Current Treatment Options in Rheumatology
https://www.readbyqxmd.com/read/29780364/antibacterial-efficacy-of-polysaccharide-capped-silver-nanoparticles-is-not-compromised-by-acrab-tolc-efflux-pump
#13
Mitali Mishra, Satish Kumar, Rakesh K Majhi, Luna Goswami, Chandan Goswami, Harapriya Mohapatra
Antibacterial therapy is of paramount importance in treatment of several acute and chronic infectious diseases caused by pathogens. Over the years extensive use and misuse of antimicrobial agents has led to emergence of multidrug resistant (MDR) and extensive drug resistant (XDR) pathogens. This drastic escalation in resistant phenotype has limited the efficacy of available therapeutic options. Thus, the need of the hour is to look for alternative therapeutic approaches to mitigate healthcare concerns caused due to MDR bacterial infections...
2018: Frontiers in Microbiology
https://www.readbyqxmd.com/read/29779849/how-much-progress-has-there-been-in-the-second-line-treatment-of-multiple-sclerosis-a-2017-update
#14
REVIEW
A Maarouf, C Boutière, A Rico, B Audoin, J Pelletier
In 1993, the US Food and Drug Administration (FDA) approved the first drug specifically for treating multiple sclerosis (MS). More than two decades later, a dozen such treatments are now available. Of these, four are considered second-line treatments for use in escalation strategies and two new drugs are currently undergoing accreditation procedures. Soon, they will provide clinicians with a range of six effective disease-modifying treatments (DMTs) to thwart the inflammatory processes in MS patients with active disease...
May 17, 2018: Revue Neurologique
https://www.readbyqxmd.com/read/29779416/long-term-triple-therapy-de-escalation-to-indacaterol-glycopyrronium-in-copd-patients-sunset-a-randomized-double-blind-triple-dummy-clinical-trial
#15
Kenneth R Chapman, John R Hurst, Stefan-Marian Frent, Michael Larbig, Robert Fogel, Tadhg Guerin, Donald Banerji, Francesco Patalano, Pankaj Goyal, Pascal Pfister, Konstantinos Kostikas, Jadwiga A Wedzicha
RATIONALE: There are no studies on ICS withdrawal in patients on long-term triple therapy in the absence of frequent exacerbations. OBJECTIVE: To evaluate the efficacy and safety of the direct de-escalation from long-term triple therapy to indacaterol/glycopyrronium in non-frequently exacerbating COPD patients. METHODS: This 26-week, randomized, double-blind, triple-dummy study assessed the direct change from long-term triple therapy to indacaterol/glycopyrronium (110/50μg once daily) or continuation of triple therapy (tiotropium 18μg once daily plus combination of salmeterol/fluticasone propionate [50/500μg] twice daily) in non-frequently exacerbating patients with moderate-to-severe COPD...
May 20, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29779292/paediatric-constipation-an-approach-and-evidence-based-treatment-regimen
#16
Harveen Singh, Frances Connor
BACKGROUND: Constipation affects 5-30% of children and is responsible for 3% of primary care visits. General practitioners (GPs) are frequently the first medical encounter for concerned parents regarding their child's bowel habit. OBJECTIVE: The aim of this article is to review the assessment and management of children with constipation to empower GPs to initiate treatment and know when to refer to a paediatrician. DISCUSSION: In the absence of organic aetiology, childhood constipation is almost always functional and often due to painful bowel movements that prompt the child to withhold stool...
May 2018: Australian journal of general practice
https://www.readbyqxmd.com/read/29776892/technique-for-the-administration-of-high-dose-rate-brachytherapy-to-the-bile-duct-using-a-nasobiliary-catheter
#17
Christopher L Deufel, Keith M Furutani, Robert A Dahl, Michael P Grams, Luke B McLemore, Christopher L Hallemeier, Michelle Neben-Wittich, James A Martenson, Michael G Haddock
PURPOSE: Cholangiocarcinoma patients who are potential candidates for liver transplantation may be treated with high-dose-rate (HDR) brachytherapy using a minimally invasive nasobiliary catheter in an effort to escalate the radiotherapy dose to the tumor and maximize local control rates. This work describes the equipment, procedures, and quality assurance (QA) that enables successful administration. METHODS AND MATERIALS: This work describes the nasobiliary catheter placement, simulation, treatment planning, treatment delivery, and QA...
May 16, 2018: Brachytherapy
https://www.readbyqxmd.com/read/29776383/escalate-adaptive-treatment-approach-for-adolescents-and-adults-with-adhd-study-protocol-for-a-randomized-controlled-trial
#18
Toivo Zinnow, Tobias Banaschewski, Andreas J Fallgatter, Carolin Jenkner, Florence Philipp-Wiegmann, Alexandra Philipsen, Wolfgang Retz, Esther Sobanski, Johannes Thome, Michael Rösler
BACKGROUND: Over the last decade, a wide range of attention-deficit/hyperactivity disorder (ADHD) treatment approaches for adults, including both pharmacological interventions and psychosocial treatments, have been proposed and observed to be efficient. In practice, individual treatment concepts are based on results of clinical studies as well as international guidelines (NICE Guidelines) that recommend a step-by-step treatment approach. Since the evidence supporting this approach is limited, the aim of the present study is to determine an optimal intervention regarding severity levels of ADHD symptomatology conducting a randomized controlled trial...
May 18, 2018: Trials
https://www.readbyqxmd.com/read/29775206/prospective-determination-of-aspirin-sensitivity-in-patients-resistant-to-low-dose-aspirin-a-proof-of-concept-study
#19
Erica S Westphal, Michelle Rainka, Michelle Amsler, Traci Aladeen, Caitlin Wisniewski, Vernice Bates, Fran M Gengo
This study tested the capability of an assay to predict aspirin response and reduce ischemic events, and healthcare costs, and delays to optimal treatment. Patients who needed aspirin in the course of normal medical care were included. Patients were excluded if they had disorders affecting platelet function, alcohol use within 24 hours of a test, or NSAID use. Dose escalation of chewable aspirin from 81 mg, to 162 mg, to 325 mg daily occurred based on the results of whole blood impedance aggregation testing to the agonists, collagen (1ug/mL, 5 ug/mL) and arachidonate (0...
May 18, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29773661/phase-i-study-of-oncolytic-vaccinia-virus-gl-onc1-in-patients-with-peritoneal-carcinomatosis
#20
Ulrich M Lauer, Martina Schell, Julia Beil, Susanne Berchtold, Ursula Koppenhöfer, Jörg Glatzle, Alfred Königsrainer, Robert Möhle, Dominik Nann, Falko Fend, Christina Pfannenberg, Michael Bitzer, Nisar P Malek
OBJECTIVE: Peritoneal carcinomatosis (PC) is common in advanced tumor stages or disease recurrence arising from gastrointestinal cancers, gynecologic malignancies, or primary peritoneal carcinoma. Since current therapies are mostly ineffective, new thera-peutic approaches are needed. Here, we report on a phase I study designed to assess safety, MTD, and anti-tumor activity of intra-peri-toneal (i.p.) administration of oncolytic vaccinia virus GL-ONC1 in advanced stage PC patients. DESIGN: GL-ONC1 was administered i...
May 17, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
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