Early treatment of acute migraine: New evidence of benefits

Cephalalgia ◽  
2009 ◽  
Vol 29 (3_suppl) ◽  
pp. 15-21
Author(s):  
D Valade
Keyword(s):  
Perceived Barriers ◽  
Management Approach ◽  
Migraine Treatment ◽  
Positive Outcomes ◽  
Barriers To Adoption ◽  
Current Management ◽  
Migraine Headaches ◽  
Therapeutic Outcomes ◽  
Lower Pain ◽  
New Evidence

The current management approach to migraine headaches advocates use of triptan medications early in the course of an attack while pain is still mild, rather than waiting to treat the pain when it has progressed to moderate-severe. Recently, strong new evidence for the benefits of early intervention has become available. The AEGIS, AIMS and AwM studies of almotriptan in patients with migraine indicate that earlier treatment initiation and lower pain intensity at the time of treatment are important predictors of enhanced therapeutic outcomes. The opportunity to treat early exists for about 50% of all migraine attacks, which offers considerable scope for improving migraine management. Importantly, treating pain early and before it has progressed beyond ‘mild’ meets many of the expectations patients have of their migraine treatment. It is believed that consistent, positive outcomes may assist in overcoming the various physician-and patient-perceived barriers to adoption of this beneficial treatment strategy.

scholarly journals Immune-Related Pancytopenia Induced by Anti-PD-1 Therapy – Interrupt or Continue Treatment – The Role of Immunohistochemical Examination

2019 ◽  
Vol 12 (3) ◽  
pp. 820-828 ◽  
Author(s):  
Bożena Cybulska-Stopa ◽  
Andrzej Gruchała ◽  
Maciej Niemiec
Keyword(s):  
Bone Marrow ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Death Receptor ◽  
Positive Outcomes ◽  
Hematological Disorders ◽  
Therapeutic Outcomes ◽  
Appropriate Treatment ◽  
Programmed Death

Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T-lymphocyte antigen 4 (anti-CTLA-4) and anti-programmed death receptor-1/ligand-1 (anti-PD-1/anti-PD-L1) caused a breakthrough in oncology and significantly improved therapeutic outcomes in cancer patients. ICIs generate a specific reaction in T cells, directed against antigens on cancer cells, leading to their damage and death. Through similar or the same antigens, activated lymphocytes may also have a cytotoxic effect on healthy cells, causing development of specific adverse effects – so-called immune-related adverse events (irAEs). We present the case report of a 56 year old patient with disseminated melanoma. During treatment with immunotherapy (anti PD-1), neutropenic fever and pancytopenia occurred. Trepanobiopsy of the bone marrow was performed to determine the cause of pancytopenia. Histopathological assessment of bone marrow combined with immunophenotype investigations may explain the cause of hematological disorders occurring in the course of treatment with ICIs, and support the choice of an appropriate treatment, directly translated into positive outcomes.

scholarly journals Comparison of efficacy and safety of three drugs levetiracetam, sodium valproate, and nortriptyline in the prevention of migraine headache

2020 ◽  
pp. 336-343
Keyword(s):  
Sodium Valproate ◽  
Severe Headache ◽  
Migraine Treatment ◽  
Chi Square ◽  
Migraine Headaches ◽  
Neurology Clinic ◽  
Quasi Experimental ◽  
The Mean ◽  
Acute Attacks ◽  
Mild Headache

Background and Aim: Headache is the most common cause of referral to a physician. Two approaches of the migraine treatment include: treat the acute attacks and prevent future attacks. In this regard, the aim of this study was to investigate the effect of three drugs lutiracetam, sodium valproate and nortriptyline in the control of migraine headaches in patients with migraine in Birjand Neurology Clinic. Materials and Methods: This study is a quasi-experimental study. According to the physician, 120 migraine patients were divided into one of three groups: Lutiracetam with a daily dose of 250 mg, sodium valproate 500 mg and nortriptyline 25 mg for 4 weeks. Patientschr('39') information was collected through a questionnaire. Then the data were analyzed by SPSS) Version 16) software by using chi-square, paired t-test, and ANOVA. Results: 120 patients were divided into three groups of 40 patients. The mean age of the subjects was 33±11 years, 53.3% of them were female and 46.7% of them were male. In total, 46.7% of patients had severe headache before taking these three drugs. None of them had severe headache after taking the drug and 77.5% of them had mild headache. Lutiracetam group showed the greatest decrease in headache intensity. (P=0.01). Conclusion: Levetiracetam appears to be more effective than the other two drugs, especially sodium valproate, in reducing different degrees of headache.

Spinal tuberculosis - Current management approach

2019 ◽  
Vol 18 (2) ◽  
pp. 35 ◽  
Author(s):  
JohnE Onuminya ◽  
Eghosa Morgan ◽  
MutaleebAyodele Shobode
Keyword(s):  
Spinal Tuberculosis ◽  
Management Approach ◽  
Current Management

Barriers to the acceptance and use of autologous platelet gel

Perfusion ◽  
2008 ◽  
Vol 23 (5) ◽  
pp. 283-289 ◽  
Author(s):  
J Whitlow ◽  
AG Shackelford ◽  
AN Sievert ◽  
JJ Sistino
Keyword(s):  
Statistical Analysis ◽  
Tissue Regeneration ◽  
Online Survey ◽  
Perceived Barriers ◽  
Barriers To Adoption ◽  
Platelet Gel ◽  
Factors Influencing ◽  
Significant Difference ◽  
Literature Reviews ◽  
Autologous Platelet

The process of producing and applying platelet concentrate (gel) to wounds has been shown by several researchers to accelerate healing and promote tissue regeneration in a broad spectrum of healthcare practices. Despite the evidence, widespread adoption of this technology has not occurred. The purpose of this research is to identify those factors acting as barriers to the adoption of platelet gel use. Subscribers to Perflist and Perfmail, online perfusion community listservs, were invited to participate in an online survey designed to identify factors influencing platelet gel adoption. Respondents provided their opinions on cost, clinical application, effectiveness, and perceived barriers to adoption and use of platelet gel. Statistical analysis of the non-user responses identifies lack of reimbursement and physician acceptance as significant barriers to the adoption of platelet gel. Questionable efficacy, cost, additional training, and the lack of personnel do not appear to be significant barriers to the use of platelet gel. There does not appear to be a significant difference among the user and non-user employment distributions. This study suggests that education of physicians via literature reviews or in-service plays a significant role in gaining adoption of platelet gel.

scholarly journals Moose Management Strategies under Changing Legal and Institutional Frameworks

2020 ◽  
Vol 12 (20) ◽  
pp. 8482 ◽  
Author(s):  
Linas Balčiauskas ◽  
Yukichika Kawata ◽  
Laima Balčiauskienė
Keyword(s):  
Management Strategies ◽  
Management Approach ◽  
Moderate Increase ◽  
Current Management ◽  
Continuous Growth ◽  
East Europe ◽  
Population Decrease ◽  
Hunting Bag ◽  
Moose Population

Moose (Alces alces) management strategies in Lithuania, East Europe, were analyzed. The study was intended to show the (un)sustainability of the current management approach in relation to changes in hunting rules, hunting organization and development of the responsible administrative bodies. Moose population and bag dynamics were analyzed using I index in connected scatterplots and compound annual growth rates (CAGR). In 1962–2020, the CAGR of the moose population was 3.84%, resulting in a population size increase of nearly 10 times. The seesaw principle in moose management was confirmed, showing three periods of population decrease (1973–1977, 1989–1995, 2000–2005), and two periods of hunting bag decrease (1976–1978 and 1990–1993). All decline phases were related to legal and administrative issues in the country. Since 2006, population growth has not been controlled. Lithuania has no long-term strategy of the moose population management at any administrative level. The current management approach is not sustainable, as it has not ensured long-term stability of the moose population. The current continuous growth of population, followed by only a moderate increase in the hunting bag, is related to the possibility for owners to adopt long-term planning of the hunting plot units.

Hypersensitivity to Mechanical and Intra-articular Electrical Stimuli in Persons with Painful Temporomandibular Joints

2007 ◽  
Vol 86 (12) ◽  
pp. 1187-1192 ◽  
Author(s):  
E.E. Ayesh ◽  
T.S. Jensen ◽  
P. Svensson
Keyword(s):  
Pressure Pain Threshold ◽  
Lateral Side ◽  
Nociceptive Pathways ◽  
Temporomandibular Joints ◽  
Clinical Pain ◽  
Lower Pain ◽  
Pain Detection ◽  
Quantitative Sensory Tests ◽  
Electrical Stimuli ◽  
New Evidence

This study tested whether persons with TMJ arthralgia have a modality-specific and site-specific hypersensitivity to somatosensory stimuli assessed by quantitative sensory tests (QST). Forty-three healthy persons and 20 with TMJ arthralgia participated. The QST consisted of: sensory and pain detection thresholds and summation threshold to intra-articular electrical stimulation, tactile and pin-prick sensitivity in the TMJ area, pressure-pain threshold and tolerance on the lateral side of the TMJ and on the finger. Persons with TMJ arthralgia had lower pain detection and summation thresholds (P < 0.001), higher ratings of tactile and pin-prick stimuli (P < 0.05), and markedly lower pressure thresholds on the TMJ and finger (P <0.001) than did healthy individuals. Correlation analysis revealed associations between several QST and clinical pain measures. This study provides new evidence of sensitization of the TMJs as well as central nociceptive pathways. QST may facilitate a mechanism-based classification of temporomandibular disorders.

scholarly journals COVID-19 Therapeutics Outcome: Systematic Review and Data Analysis

2020 ◽  
Author(s):  
Mansour Tobaiqy ◽  
Nawal Helmi ◽  
Mohammed Majrashi ◽  
Shrooq Al-Dahery ◽  
Alaa Mujallad
Keyword(s):  
Systematic Review ◽  
Data Analysis ◽  
Statistical Significance ◽  
Analysis Data ◽  
Clinical Settings ◽  
Positive Outcomes ◽  
Negative Outcomes ◽  
Systemic Corticosteroids ◽  
Therapeutic Outcomes ◽  
Number Of Patients

Abstract Background: Several medications already placed in the world therapeutic guidelines for coronavirus disease 2019 (COVID-19) were given to affected patients and produced positive and negative outcomes.Aims of the study: This review evaluated therapeutic outcomes (recovery and mortality) used for COVID-19 patient management in clinical settings since the emergence of SARS-CoV-2 the causative agent of (COVID-19).Method: The PRISMA-P and PRISMA statements were used to facilitate the development and reporting of this systematic review. Included articles were full-text articles, written in English and published in peer-reviewed journals from March 26, 2020. Recent eligible systematic review articles were also included for interpretation and analysis. Data were reported as percentage changes compared to the total number of patients in each study. For each drug, the proportion of positive outcomes were compared to the proportion of negative outcomes using a z-test (p < 0.05) to determine statistical significance.Results: The total number of eligible studies included in this review was 69, and 48 different therapeutics were reported. The data analysis showed positive outcomes for COVID-19 patient treatments using hydroxychloroquine (66.6%), azithromycin (55.5%), lopinavir/ritonavir (54.9%), systemic corticosteroids (52%), umifenovir (51.2%), interferon (50%), remdesivir (45.9%), Ribavirin (43.5%), moxifloxacin (35.3%) and oseltamivir (33.6%). Negative outcomes were related mainly to systemic corticosteroids (21.3%), followed by remdesivir (16.9%), moxifloxacin (13.4%) and oseltamivir (12.5%). However, when comparing the proportions of positive outcomes to negative outcomes for reported drugs, the only statistically significant outcomes were observed among the hydroxychloroquine (p < 0.05) treatment group.Conclusion: This study systematically reviewed 69 research articles linking therapies to clinical outcomes for COVID-19 patients. This review has provided insight into recovery and mortality outcomes associated with available COVID-19 therapeutic options. Data analysis showed positive outcomes for COVID-19 patient treatments primarily with hydroxychloroquine, azithromycin and lopinavir/ritonavir.

Rimegepant: acute treatment for migraine headaches

2021 ◽  
Author(s):  
Golden L Peters ◽  
Erin K Hennessey
Keyword(s):  
Migraine Headache ◽  
Acute Treatment ◽  
Treatment Options ◽  
Migraine Treatment ◽  
Acute Migraine ◽  
The Past ◽  
Vasoactive Peptides ◽  
Migraine Headaches ◽  
Calcitonin Gene ◽  
Acute Migraine Treatment

Migraine headache treatment is quickly evolving. There have been three new acute migraine treatment options (i.e., lasmiditan, rimegepant, ubrogepant) and four new preventive migraine treatment options (i.e., erenumab, fremanezumab, galcanezumab, eptinezumab) released in the past 3 years. The new migraine treatments are focusing on pathways within the newly, better understood neurovascular hypothesis that further describes the pathophysiology of migraine headaches in more detail than before. The discovery of vasoactive peptides, such as calcitonin gene-related peptide, has led to the development of many of these migraine agents. Rimegepant is one of these newly approved agents for acute migraine treatment in adults with or without aura. Rimegepant has been found to decrease pain and symptoms associated with migraine attacks and is generally well-tolerated.

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