importance of maternal ischemia modified albumin, non stress test and doppler ultrasonography in foreseeing perinatal asphyxia

Background: The aim of this study is to evaluate the importance of ischemia changed albumin, in foreseeing fetal asphyxia and comparing it between normal and preeclamptic pregnant. Method: We planned our study as a prospective case-controlled study between May 2011 and June 2013. We recruited 104 pregnant women complicated by preeclampsia and 110 healthy pregnant women in the study. Doppler ultrasonography, non-stress test and fetal biometric measurements were performed. Venous blood samples taken to measure ischemia modified albumin (IMA). The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal cord blood gas examination and 1.-5. minutes APGAR scoring. Results: Women with preeclampsia had higher IMA compared to controls. The correlations between umbilical artery doppler systolic/diastolic (S/D) ratio, brain sparing effect, non stress test and IMA analyzed. We have found IMA statistically high when S/D ratio is above 2 standard deviations (preeclampsia; 11.83±1.33 vs 19.62±1.56 p<0.001, control; 10.28±1.57 vs 18.09±2.13 p<0.001) or brain sparing effect started (preeclampsia; 25.59±2.48 vs 9.16±1.99 p<0.001, control; 16.37±1.97 vs 6.72± 1.53 p<0.001) or abnormal NST findings occurred (preeclampsia; 10.69±1.92 vs 20.72±1.15 p<0.001, control; 7,42±1,94 vs 9,72±2,19 p<0.001). Conclusions: Maternal IMA levels are found high in preeclamptic pregnant women and it can be used as a biomarker for determining fetal wellbeing.

Sensorineural Hearing Loss of Suspected Autoimmune Etiology: Two Cases of Cogan’s Syndrome

Cogan’s syndrome is a rare inflammatory disease characterized by non-syphilitic keratitis and vestibulo-auditory symptoms including hearing loss, tinnitus, and vertigo. Although its precise pathogenesis is not known, Cogan’s syndrome is generally considered an autoimmune disease. This hypothesis is supported by the frequently successful remission of hearing loss after steroid administration and the association with other autoimmune disorders such as rheumatoid arthritis. Medical treatment of Cogan’s syndrome depends on disease severity and on how extensive the disease is. The involvement of inner ear pathology requires systemic corticosteroid therapy. In cases of treatment failure or the need for a corticosteroid-sparing effect, other immunosuppressive drugs can be used. We experienced two patients with typical Cogan’s syndrome, presenting bilateral progressive sensorineural hearing loss and dizziness with ocular involvement, which we have successfully treated with systemic steroid administration and immunosuppressive therapy.

Methotrexate Use in Generalized Autoimmune Myasthenia Gravis: A Case series

Methotrexate (MTX) is an inexpensive and well-tolerated immunosuppressive medication that is used anecdotally in autoimmune myasthenia gravis (MG). However, the efficacy in MG is unclear at this time. This retrospective analysis describes six patients with acetylcholine receptor antibody positive MG who were treated with MTX and corticosteroids. The efficacy of MTX was measured by steroid-sparing effect and the Myasthenia Gravis Foundation of America (MGFA) classification. MTX initiation was associated with a reduction in prednisone dosage in all patients. Minimal manifestation status was reached at an average duration of 10 months in 5 patients. No patients were hospitalized for myasthenia gravis exacerbations. There were no major side effects experienced with MTX use. This retrospective analysis suggests that MTX is safe and probably efficacious as a corticosteroid-sparing agent in the management of MG.

Phase 2 Trial of Rituximab in Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis: The BeatMG Study

OBJECTIVE:To determine whether rituximab is safe and potentially beneficial, warranting further investigation in an efficacy trial for acetylcholine receptor antibody-positive generalized MG (AChR-Ab+ gMG).METHODS:The B-Cell Targeted Treatment in MG (BeatMG) study was a randomized, double-blind, placebo-controlled, multicenter phase-2 trial that utilized a futility design. Individuals 21-90 years of age, with AChR-Ab+ gMG (MG Foundation of America Class II-IV) and receiving prednisone ≥15 mg/day were eligible. The primary outcome was a measure of steroid-sparing effect, defined as the proportion achieving ≥75% reduction in mean daily prednisone dose in the 4-weeks prior to week 52 and with clinical improvement or no significant worsening as compared to the 4-week period prior to randomization. The co-primary outcome was safety. Secondary outcomes included MG-specific clinical assessments. Fifty-two individuals were randomized (1:1) to either a two-cycle rituximab/placebo regimen, with follow-up through 52-weeks.RESULTS:Of the 52 participants included, mean (±SD) age at enrollment was 55.1 (±17.1) years; 23 (44.2%) were female, and 31 (59.6%) were MGFA Class II. The mean (±SD) baseline prednisone dose was 22.1 (±9.7) mg/day. The primary steroid-sparing outcome was achieved in 60% of those on rituximab vs. 56% on placebo. The study reached its futility endpoint (p=0.03) suggesting that the pre-defined clinically meaningful improvement of 30% due to rituximab over placebo was unlikely to be achieved in a subsequent, larger trial. No safety issues identified.CONCLUSIONS:While rituximab was safe and well-tolerated, these results suggest that there is a low probability of observing the defined clinically meaningful steroid-sparing effect over a 12-month period in a phase-3 trial of mild-moderately symptomatic AChR-Ab+ gMG.CLASSIFICATION OF EVIDENCE:This study provides Class I evidence that for mild-to-moderate AChR-Ab+ gMG, compared with placebo, rituximab is safe but unlikely to reduce steroid use by an absolute difference of at least 30% at 1 year.TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02110706

PRIMARY HYPERPARATHYROIDISM: OPTIMIZATION OF ANAESTHESIA

Background and Aims. The majority of cases of primary hyperparathyreosis (PHPT) due to solitary adenoma and require the target surgery. Research of new anesthesia/analgesia methods, which afford to have an opioid-sparing effect, is going. Methods. 127 patients with PHPT were divided into 3 groups: the group STI-BCSPB (n=26) was used combined general anesthesia (GA) with sevoflurane (SEV), the tracheal intubation (TI) with the myorelaxant introduction and bilateral cervical superficial plexus blockade (BCSPB); the group STI (n=82) was used SEV anaesthesia with IT and no BCSPB; the group PLM-BCSPB (n=19) was provided propofol (P) GA with protection air-ways by laryngeal mask (LM) and BCSPB. In both groups (STI-BCSPB and PLM-BCSPB) were used co-analgesics, such as dexamethasone (DXM) 8 mg IV, 2% lidocaine (L) 1,0-1,5 mg/kg IV, metamizole (M) or paracetamol (P) 1 g IV, dexketoprofen (DKTP) 50 mg IV as pre-emptive analgesia 30 min before surgery. Ketamine 25 mg IV was used for induction anaesthesia in these groups. In STI group only opioid with P were used for induction of GA. Duration of surgery (DoS), anaesthesia (DoA), opioid consumption, time from the operation ending until the eyes opening (EyOp), desaturation was measured. All data M±m Results. DoS for STI-BCSPB, STI and PLM-BCSPB was respectively 38.7±2.7, 37.8±1.3 and 35.6±1.7 min (NS), DoA was respectively 63.8±3.1, 59.4±1.4 m and 53,8±2.7 min (p= 0.028 STI vs PLM-BCSPB, p= 0.024 STI-BCSPB vs PLM-BCSPB, the difference is significant (DS). EyOp was 15.4±1.1, 15.6±1.2 and 11.6±0.9 min respectively for STI-BCSPB, STI and PLM-BCSPB (p=0.022 STI vs PLM-BCSPB (DS) and p=0.025 STI-BCSPB vs PLM-BCSPB (DS). Desaturation (SpO2 below 92%) due to residual sedation and the effect of muscles relaxants was observed in 39 (47.6%) and 11 (42,3%) patients in STI and STI-BCSPB during the first 30 min postop compared to 2 cases (10.5%) in PLM-BCSPB (both STI groups were DS vs PLM-BCSPB, chi-square test). The dose of intra-op fentanyl was 334.3±17.1, 256.5±16.9 197.3±15.3 mcg in STI, STI-BCSPB and PLM-BCSPB respectively, (DS for PLM-BCSPB vs other groups, DS between STI groups). Conclusions. Combine methods GA with BCSPB have some benefits over mono GA. Co-analgesics afford to achieve an opioidsparing effect. Under ectomy of single parathyroid adenoma, the use of propofol and BSCPB with the laryngeal mask without muscles relaxants seems more preferable compared to sevoflurane anesthesia with BBSCP and tracheal intubation due to the shorter anesthesia duration, time to eye-opening after surgery, lower desaturation frequency.

Integration with Spilanthes Achmella in fibromyalgia syndrome: open-label study six months after the treatment

Fibromyalgia, also known as fibromyalgia syndrome (FM), is a rheumatic syndrome which is currently considered idiopathic and multifactorial. It causes an increase in muscle tension associated with stiffness, asthenia (loss of strength with fatigue), cognitive impairment, insomnia or sleep disorders and impaired sensitivity to stimuli. We performed a prospective evaluation of 149 patients suffering from fibromyalgia syndrome according to the 2010 ACR Criteria. Patients were clinically assessed at baseline and after 1-3-6 months, using the patient-reported outcomes thermometer - 5-item scale (5TPROs). In addition to their therapy, all patients received a supplementation with Spilanthes Achmella. This food supplement is characterized by synergy of bioactive compounds, such as Acmella oleracea extract, and has neurotrophic, anti-inflammatory and pain-relieving effects. All patients were randomized at baseline to receive Spilanthes Achmella, 2 tablets per day for one month and subsequent tapering to 1 tablet per day for 5 months. At six months, a statistically significant difference in the following parameters was shown: pain P<0.001, fatigue P<0.001, physical function P<0.001, depression: P<0.001, general health P<0.001. Conversely, the post-hoc analysis data did not report any significant difference for the parameters between the third and sixth month. A drug-sparing effect was observed (P<0.001). The posthoc analysis revealed a significant difference between T0 and T3 P=0.00066 and between T0 and T6 P=0.00008. Our data indicate that supplementation with Spilanthes Achmella may lead to a significant improvement in pain, fatigue, physical function, depression and general health in fibromyalgia syndrome.