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https://www.readbyqxmd.com/read/29792372/sativex%C3%A2-as-add-on-therapy-vs-further-optimized-first-line-antispastics-savant-in-resistant-multiple-sclerosis-spasticity-a-double-blind-placebo-controlled-randomised-clinical-trial
#1
Jolana Markovà, Ute Essner, Bülent Akmaz, Marcella Marinelli, Christiane Trompke, Arnd Lentschat, Carlos Vila Silván
Purpose/aim: To evaluate the efficacy of tetrahydrocannabinol [THC]:cannabidiol [CBD] oromucosal spray (Sativex®) as add-on therapy to optimized standard antispasticity treatment in patients with moderate to severe multiple sclerosis (MS) spasticity. METHODS: Sativex as Add-on therapy Vs. further optimized first-line ANTispastics (SAVANT) was a two-phase trial. In Phase A, eligible patients received add-on THC:CBD spray for 4 weeks to identify initial responders (≥ 20% improvement from baseline in spasticity 0-10 numerical rating scale [NRS] score)...
May 24, 2018: International Journal of Neuroscience
https://www.readbyqxmd.com/read/29791989/an-unexpected-adverse-event-during-colonoscopy-screening-bochdalek-hernia
#2
Joon Seop Lee, Eun Soo Kim, Min Kyu Jung, Sung Kook Kim, Sun Jin, Deok Heon Lee, Jun Won Seo
Bochdalek hernia (BH) is defined as herniated abdominal contents appearing throughout the posterolateral segment of the diaphragm. It is usually observed during the prenatal or newborn period. Here, we report a case of an adult patient with herniated omentum and colon due to BH that was discovered during a colonoscopy. A 41-year-old woman was referred to our hospital with severe left chest and abdominal pain that began during a colonoscopy. Her chest radiography showed colonic shadow filling in the lower half of the left thoracic cavity...
May 25, 2018: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/29791941/understanding-refugees-health
#3
Martin Müller, Dana Khamis, David Srivastava, Aristomenis K Exadaktylos, Carmen Andrea Pfortmueller
According to the United Nations Refugee Agency (UNHCR), 65.6 million people have been forcibly displaced worldwide. Several factors have a major influence on asylum seekers' health; so, their health profile is markedly different from that of the population in the country of asylum. The aim of this study is to review the major issues physicians need to be aware of when treating asylum seekers, with a special focus on the neurological problems of asylum seekers and refugees. The major impact factors on refugees' health are linked to experiences and exposure (1) in the country of origin, (2) in refugee camps and en route to Europe, and (3) in the process of immigration into the host country and living in European asylum centers...
April 2018: Seminars in Neurology
https://www.readbyqxmd.com/read/29791829/burosumab-therapy-in-children-with-x-linked-hypophosphatemia
#4
Thomas O Carpenter, Michael P Whyte, Erik A Imel, Annemieke M Boot, Wolfgang Högler, Agnès Linglart, Raja Padidela, William Van't Hoff, Meng Mao, Chao-Yin Chen, Alison Skrinar, Emil Kakkis, Javier San Martin, Anthony A Portale
BACKGROUND: X-linked hypophosphatemia is characterized by increased secretion of fibroblast growth factor 23 (FGF-23), which leads to hypophosphatemia and consequently rickets, osteomalacia, and skeletal deformities. We investigated burosumab, a monoclonal antibody that targets FGF-23, in patients with X-linked hypophosphatemia. METHODS: In an open-label, phase 2 trial, we randomly assigned 52 children with X-linked hypophosphatemia, in a 1:1 ratio, to receive subcutaneous burosumab either every 2 weeks or every 4 weeks; the dose was adjusted to achieve a serum phosphorus level at the low end of the normal range...
May 24, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29791570/osteoradionecrosis-of-the-jaws-case-series-treated-with-adjuvant-low-level-laser-therapy-and-antimicrobial-photodynamic-therapy
#5
Guilherme Henrique Ribeiro, Mariana Comparotto Minamisako, Inês Beatriz da Silva Rath, Aira Maria Bonfim Santos, Alyne Simões, Keila Cristina Rausch Pereira, Liliane Janete Grando
BACKGROUND: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa...
2018: Journal of Applied Oral Science: Revista FOB
https://www.readbyqxmd.com/read/29791302/preferences-of-adults-with-spinal-cord-injury-for-widely-used-health-related-quality-of-life-and-subjective-well-being-measures
#6
Alina Ionela Palimaru, William E Cunningham, Marcus Dillistone, Arturo Vargas-Bustamante, Honghu Liu, Ron D Hays
OBJECTIVE: To describe preferences for survey instruments on health-related quality of life (HRQOL) and subjective well-being (SWB) among adults with spinal cord injury (SCI), and compare perspectives on the instruments between the United States and the United Kingdom. DESIGN: We conducted 20 in-depth interviews. SETTING: Participants were interviewed in their homes, some in person and some via Skype. PARTICIPANTS: A convenience sample of 20 adults with SCI (10 in the US and 10 in the UK) were recruited via print and on-line advertisements...
May 23, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29791238/low-dose-ketamine-infusion-for-adjunct-management-during-vaso-occlusive-episodes-in-adults-with-sickle-cell-disease-a-case-series
#7
Nicole Palm, Catherine Floroff, Tanna B Hassig, Alice Boylan, Julie Kanter
The optimal management of recurrent painful episodes in individuals living with sickle cell disease (SCD) remains unclear. Currently, the primary treatment for these episodes remains supportive, using fluids and intravenous opioid and anti-inflammatory medications. Few reports have described the use of adjunct subanesthetic doses of ketamine to opioids for treatment of refractory pain in SCD. This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs)...
May 23, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29790726/minimally-invasive-approaches-to-craniosynostosis
#8
Arjun V Pendharkar, Maryam N Shahin, Claudio Cavallo, Xiaochun Zhao, Allen L Ho, Eric S Sussman, Gerald A Grant
Craniosynostosis (CS) is defined as the premature fusion of one or more calvarial sutures. This carries several consequences, including abnormal/asymmetric cranial vault development, increased intracranial pressure, compromised neurocognitive development, and craniofacial deformity. Definitive management is surgical with the goal of protecting cerebral development by re-establishing normal cranial vault expansion and correcting cosmetic deformity. In today's practice, CS surgery has advanced radically from simple craniectomies to major cranial vault reconstructive (CVR) procedures...
May 22, 2018: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29790572/-selective-dorsal-rhizotomy-a-review-of-the-literature-on-this-technique-for-the-treatment-of-spasticity-in-infantile-cerebral-palsy
#9
REVIEW
M Garriz-Luis, R Sanchez-Carpintero, M Alegre, S Tejada
INTRODUCTION: Infantile cerebral palsy is a well-known condition, the prevalence of which has varied only slightly over the years. The most common subtype is spastic diplegia, and spasticity is the most disabling symptom. Its treatment involves a multidisciplinary intervention that includes rehabilitation, the use of drugs, and orthopaedic and nervous system surgery, where selective dorsal rhizotomy is a prominent procedure. AIM: To present a thorough review of the use, indication and long-term consequences of selective dorsal rhizotomy...
June 1, 2018: Revista de Neurologia
https://www.readbyqxmd.com/read/29790404/clinical-and-neurophysiological-changes-after-targeted-intrathecal-injections-of-bone-marrow-stem-cells-in-a-c3-tetraplegic-subject
#10
Andrea Jimena Santamaria, Francisco D Benavides, Darcy L DiFede, Aisha Khan, Marietsy V Pujol, W Dalton Dietrich, Antonio Marttos, Barth A Green, Joshua M Hare, James Guest
High-level quadriplegia is a devastating condition with limited treatment options. Bone marrow derived stem cells (BMSCs) are reported to have immunomodulatory and neurotrophic effects in spinal cord injury (SCI). We report a subject with complete C2 SCI who received 3 anatomically targeted intrathecal infusions of BMSCs under a single-patient expanded access IND. She underwent intensive physical therapy and was followed for over 2 years. At end-point, her AIS grade improved from A to B and she recovered focal pressure touch sensation over several body areas...
May 23, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29790354/-opioids-and-new-trends-in-pain-therapy
#11
Jan Lejčko
Opioids are well known for their ability to reduce the perception of pain without a loss of consciousness. However, the influence of opioids on organism is very complex. Clinical pharmacology of currently available opioid analgesics is determined by three major factors - their opioid receptor properties, pharmacokinetic properties and genetic polymorphism in the opiate receptor and cytochrome P450 isoform. In acute severe pain are opioids very efficient. Long-term experience with opioid analgesia in patients with cancer pain has shown high favorable risk/benefit ratio...
2018: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/29790293/the-relationship-between-self-reported-restless-sleep-and-objectively-measured-physical-activity-in-adults-with-knee-osteoarthritis
#12
Abigail L Gilbert, Jungwha Lee, Jing Song, Pamela A Semanik, Linda S Ehrlich-Jones, C Kent Kwoh, Dorothy D Dunlop, Rowland W Chang
OBJECTIVE: Despite many health benefits of physical activity, inactivity is endemic among adults with knee osteoarthritis (KOA). Because sleep quality may be a target to improve physical activity behavior, we investigated the cross-sectional relationship between restless sleep and physical activity in participants with or at risk for KOA. METHODS: We analyzed accelerometer-measured physical activity and clinical data from Osteoarthritis Initiative (OAI) participants...
May 22, 2018: Arthritis Care & Research
https://www.readbyqxmd.com/read/29790081/transplant-renal-vein-thrombosis-in-a-recipient-with-aberrant-venous-anatomy
#13
Lyndsey Thiessen, Sarah MacDonell, Chris Wall, Preman Jacob, Ahmed Shoker, Michael A J Moser
Renal vein thrombosis in a transplanted kidney is an uncommon but critical complication that can result in graft loss if management is delayed. A 31-year-old male with known atresia of the inferior vena cava who received a deceased donor renal transplant 7 years previously presented to hospital with severe graft site pain and a week of nausea, vomiting, and chills. Serum creatinine was markedly elevated from baseline. Sonographic examination revealed external iliac vein thrombosis with extension of the thrombus into the transplant renal vein...
May 22, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29790073/effect-of-low-back-pain-risk-stratification-strategy-on-patient-outcomes-and-care-processes-the-match-randomized-trial-in-primary-care
#14
Dan Cherkin, Benjamin Balderson, Rob Wellman, Clarissa Hsu, Karen J Sherman, Sarah C Evers, Rene Hawkes, Andrea Cook, Martin D Levine, Diane Piekara, Pam Rock, Katherine Talbert Estlin, Georgie Brewer, Mark Jensen, Anne-Marie LaPorte, John Yeoman, Gail Sowden, Jonathan C Hill, Nadine E Foster
BACKGROUND: The STarT Back strategy for categorizing and treating patients with low back pain (LBP) improved patients' function while reducing costs in England. OBJECTIVE: This trial evaluated the effect of implementing an adaptation of this approach in a US setting. DESIGN: The Matching Appropriate Treatments to Consumer Healthcare needs (MATCH) trial was a pragmatic cluster randomized trial with a pre-intervention baseline period. Six primary care clinics were pair randomized, three to training in the STarT Back strategy and three to serve as controls...
May 22, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29789351/development-and-validation-of-two-clinical-prediction-models-to-inform-clinical-decision-making-for-lumbar-spinal-fusion-surgery-for-degenerative-disorders-and-rehabilitation-following-surgery-protocol-for-a-prospective-observational-study
#15
Alison B Rushton, Martin L Verra, Andrew Emms, Nicola R Heneghan, Deborah Falla, Michael Reddington, Ashley A Cole, Paul Willems, Lorin Benneker, David Selvey, Michael Hutton, Martijn W Heymans, J Bart Staal
INTRODUCTION: Potential predictors of poor outcome will be measured at baseline: (1) preoperatively to develop a clinical prediction model to predict which patients are likely to have favourable outcome following lumbar spinal fusion surgery (LSFS) and (2) postoperatively to predict which patients are likely to have favourable long-term outcomes (to inform rehabilitation). METHODS AND ANALYSIS: Prospective observational study with a defined episode inception of the point of surgery...
May 22, 2018: BMJ Open
https://www.readbyqxmd.com/read/29789137/serratus-intercostal-interfascial-block-as-an-opioid-saving-strategy-in-supra-umbilical-open-surgery
#16
M T Fernández Martín, S López Álvarez, M A Pérez Herrero
INTRODUCTION: The administration of local anaesthetic in the serratus-intercostal space provides adequate analgesia in non-reconstructive breast surgery. The aim of this study was to evaluate whether the blockage of the last intercostal nerves (T7-T11) can lead to opioid savings in supra-umbilical open surgery procedures. MATERIAL AND METHODS: A prospective observational study was conducted on patients undergoing open supra-umbilical surgery under general anaesthesia and with a serratus-intercostal plane block [modified Blocking the bRanches of IntercostaL nerves in the Middle Axillary line (BRILMA)] as an associated analgesic strategy...
May 19, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29789000/spontaneous-splenic-rupture-complicating-primary-varicella-zoster-infection-a-case-report
#17
Aarthy Uthayakumar, David Harrington
BACKGROUND: Primary varicella zoster virus (VZV) infection is a common illness, predominantly affecting children. Its course is typically benign, although severe complications have been described. Splenic rupture is an extremely rare and potentially fatal complication of primary VZV infection, with only a handful of cases reported in the literature. CASE PRESENTATION: A 32-year-old Romanian man with no significant past medical history, presented with a 2 day history of sudden onset, worsening generalised abdominal pain and a 1 day history of vomiting...
May 22, 2018: BMC Research Notes
https://www.readbyqxmd.com/read/29788982/tisu-extracorporeal-shockwave-lithotripsy-as-first-treatment-option-compared-with-direct-progression-to-ureteroscopic-treatment-for-ureteric-stones-study-protocol-for-a-randomised-controlled-trial
#18
Samuel McClinton, Sarah Cameron, Kathryn Starr, Ruth Thomas, Graeme MacLennan, Alison McDonald, Thomas Lam, James N'Dow, Mary Kilonzo, Robert Pickard, Ken Anson, Frank Keeley, Neil Burgess, Charles Terry Clark, Sara MacLennan, John Norrie
BACKGROUND: Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention...
May 22, 2018: Trials
https://www.readbyqxmd.com/read/29788920/a-focus-group-study-to-understand-biases-and-confounders-in-a-cluster-randomized-controlled-trial-on-low-back-pain-in-primary-care-in-norway
#19
Erik L Werner, Ida Løchting, Kjersti Storheim, Margreth Grotle
BACKGROUND: Cluster randomized controlled trials are often used in research in primary care but creates challenges regarding biases and confounders. We recently presented a study on low back pain from primary care in Norway with equal effects in the intervention and the control group. In order to understand the specific mechanisms that may produce biases in a cluster randomized trial we conducted a focus group study among the participating health care providers. The aim of this study was to understand how the participating providers themselves influenced on the study and thereby possibly on the results of the cluster randomized controlled trial...
May 22, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29788907/mycobacterium-avium-complex-vertebral-osteomyelitis-in-the-absence-of-hiv-infection-a-case-report-and-review
#20
Megan E Gray, Peter W Liu, Brian Wispelwey
BACKGROUND: Mycobacterium Avium Complex (MAC) is an established microbiologic cause of pulmonary disease, lymphadenitis, and disseminated disease in cases of advanced immune suppression. However, MAC manifesting as vertebral osteomyelitis is less common, and is particularly rare in the absence of Acquired Immunodeficiency Syndrome (AIDS). Prompt diagnosis of MAC vertebral osteomyelitis is challenging, but necessary to prevent serious morbidity or mortality. CASE PRESENTATION: We report a case of MAC osteomyelitis of the lumbar spine in a 70-year-old woman on extended duration corticosteroid therapy for systemic lupus erythematosus who presented with progressive back pain...
May 22, 2018: BMC Infectious Diseases
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