Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

Introduction Current prophylactic drugs for cluster headache are associated with limited efficacy, serious side effects and poor tolerability. Greater occipital nerve injection (GON-injection) has been proven effective and safe as a single, one-time injection in episodic (ECH), and to a lesser extent, chronic cluster headache (CCH). We aim to analyse the effectiveness and safety of repeated GON-injections in medically intractable chronic cluster headache (MICCH). Methods Clinical data of all cluster headache patients who had received at least one GON-injection between 2014 and 2018 in our tertiary headache centre were retrieved from patients’ medical records. Clinical history was taken as part of routine care shortly before and 6 weeks after GON-injection. Results We identified 47 MICCH patients (79 injections), and compared results with 22 non-MI CCH patients (30 injections) and 50 ECH patients (63 injections). Nineteen MICCH patients received repeated injections (32 in total, range 2–8). Rates of clinical relevant improvement to a first injection were similar in all groups (MICCH: 60%, non-MICCH 73%, ECH 76%; attack freedom: MICCH: 30%, non-MICCH 32%, ECH 43%). Furthermore, no difference in response to the first and second injection was shown between groups (all p > 0.29). Median effect duration in MICCH was 6 weeks (IQR 2.8–12 weeks). Side effects were only mild and local. Conclusion In this retrospective analysis, first and repeated GON-injections were well-tolerated and equally effective in MICCH as in non-MICCH, and ECH.

Peripheral Nerve Pulsed Radiofrequency For Trigeminal Neuralgia Treatment: Is It An Effective Method?

ObjectiveTrigeminal neuralgia is a paroxysmal and shock-like pain in the trigeminal nerve area. Various treatment options have been used for trigeminal neuralgia such as medical treatment, interventional procedures and surgical operations. Pulsed radiofrequency (PRF) is a minimally invasive percutaneous technique which seems to be safer and easier to perform.This retrospective study aims to evaluate the analgesic effect, duration of efficacy and side effects of PRF procedures in the peripheral branches of the trigeminal nerve.Methods and MaterialThe data of the patients with trigeminal neuralgia who were followed up in our hospital's algology clinic from 2016 to 2018 were reviewed retrospectively. Patients aged between 18-70 who didn’t respond to medical treatment or couldn’t use medication due to side effects, were treated with PRF procedure for peripheral branches of trigeminal nerve were selected for this study. Demographic profile, clicinal presentation, pain intensity, duration of efficacy and complications were evaluated from their files.Results21 patients who underwent ultrasonography (USG) guided PRF procedures were included the study.Mean visual analog scale (VAS) value of the patients was found to have decreased from 9.25 ± 0.63 to 1.55 ± 0.88 at the end of the first month (p<0.001). The painless period for the patients lasted up to 12 (9-21) months and no complications occurred.ConclusionPRF procedure seems to be an effective and safe method in patients who respond to block of the peripheral branches of the trigeminal nerve.Key message: The use of pulsed radiofrequency method for the treatment of trigeminal neuralgia seems to be an effective and safe method. In addition, being easily applicable and repeatable is another advantage of the method.

Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review

Introduction: The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics for neuraxial and regional analgesia in order to determine the adjuvant with the best effect among all others. More precisely to consider the time to onset, the strength of the effect, duration of the motor and sensory block and some additional effects such as ‘marker of intravascular injection’, safety and toxicity profile. We aimed to find an ideal adjuvant which has all these properties to a good degree. Methodology: For this narrative review we searched the information in Medline, PubMed, Scopus, and Embase databases. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this review. Results: Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All of them try to find the “ideal” adjuvant, having sufficient necessary effects, but we think that due to the difference in various classes of adjuvants, some may be better than others. However, use of combination of adjuvants is not desirable at all times. Conclusion: A variety of adjuvants to local anesthetics are available now, yet the data about most of them remains inconclusive, so more studies are required to found out the best adjuvants with the most desirable profile and the least adverse effects Key words: Local anesthetic; Adjuvants; Pain management; Regional anesthesia. Citation: Dmytro D, Oleksandr N, Kostiantyn D, Evgenii L, Olesya Z. Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review. Anaesth. pain intensive care 2020;24(6):---; DOI: 10.35975/apic.v24i6.1209 Received: 24 March 2020, Reviewed: 23 April, 25 June 2020, Revised: 18 October 2020, Accepted: 27 October 2020

Impact of Medication on Performance of Household Chores by Children with ADHD

Objective: To investigate associations between ADHD medication and household chore performance by children with ADHD. Methods: A parent questionnaire collected information about the adequacy and quality of their child’s performance of two self-care and six family-care chores. Parent perceptions of ADHD medication effect duration were used to identify children with after-school medication benefits (ASMB). Mann-Whitney U tests compared children with and without ASMB across measures of chore performance. Results: A total of 565 parents of children with ADHD that regularly take medication completed the questionnaire. Children with ASMB were more likely to meet parental expectations for five of eight household chores and were more likely to be able to independently complete both self-care and family-care chores than those without ASMB. No differences were noted regarding their need for reminders or assistance with chores. Conclusion: Improvement in chore performance may be an additional consideration with respect to medication selection for children with ADHD.

Therapeutic Options for Treatment of COVID-19: A Review from Repur-posed Drugs to New Drug Targets

A new virus pandemic, COVID-19, has instigated substantial damage to human wellness in terms of death and ailment, economic compromises along with restriction of daily routine life. There is a profound increase in the number of victims and causalities day by day. Thus far, there is no available treatment and vaccination for COVID-19. Under the rapid pace of clinical research work, scientists have reported different drugs having in vitro efficacy against COVID-19. But the evidences for their in vivo use have not been established yet in terms of clinical effect, duration of stay in intensive care units as well as the refuge of these drugs and their combinations. Anti-retroviral, Remdesivir, as well as different repurposed drugs like chloroquine and hydroxychloroquine have shown promising effects in vitro. Numerous clinical tests are underway in order to explore the benefits of these drugs. This review covers the disease pathogenesis and various potential targets with reference to the virulence of COVID-19.

Don’t @ Me: Experimentally Reducing Partisan Incivility on Twitter

I conduct an experiment which examines the impact of moral suasion on partisans engaged in uncivil arguments. Partisans often respond in vitriolic ways to politicians they disagree with, and this can engender hateful responses from partisans from the other side. This phenomenon was especially common during the contentious 2016 US Presidential Election. Using Twitter accounts that I controlled, I sanctioned people engaged partisan incivility in October 2016. I found that messages containing moral suasion were more effective at reducing incivility than were messages with no moral content in the first week post-treatment. There were no significant treatment effects in the first day post-treatment, emphasizing the need for research designs that measure effect duration. The type of moral suasion employed, however, did not have the expected differential effect on either Republicans or Democrats. These effects were significantly moderated by the anonymity of the subjects.

A way to improve neuro regional analgesia: what adjuvant is the best? A narrative review.

Introduction. The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics in order to determine adjuvant with the best effect among all others. More precisely the time of action onset, depth of the effect, duration of the block and some additional effects such as “marker of intravascular injection”, safety and toxicity profile, along with the adjuvant, which have all these properties in a sufficient degree. Materials and methods. We searched for information in Medline, PubMed, Scopus, Embase. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this article. Results. Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All them try to find to find “ideal” adjuvant, that have all needed effects at sufficient degree, but we think that due to the different groups that adjuvants belong to some adjuvants are better than another. Combination of adjuvants is not positive at all times. Conclusion. A variety of adjuvants to local anesthetics are available now, but yet data about most of them remains controversial, so more studies are required to found out best adjuvants and their adverse effects