The Safety and Efficacy of Pregabalin Add-on Therapy in Restless Legs Syndrome Patients

Pregabalin is increasingly being used as a first-line treatment for symptomatic control of restless legs syndrome (RLS). This study aimed to evaluate the efficacy and safety of pregabalin as add-on therapy in RLS patients already taking dopamine agonists (DA) but still in need of further management. Patients with idiopathic RLS were enrolled, and all had already been prescribed DA for at least 3 months but still had either persistent symptoms, side effects, or comorbid insomnia. An initial dose of 75 mg pregabalin was begun, adjusted as needed, and maintained at a stable dose for 4 weeks, followed by observation for a total of 8 weeks. RLS symptoms and insomnia scores were evaluated before and after add-on pregabalin treatment. Patients were monitored for side effects that could be attributed to pregabalin. A total of 32 RLS patients were enrolled, and 20 subjects remained until the endpoint. After the pregabalin add-on, the mean IRLS score showed significant improvement compared to the baseline (p < 0.001). The insomnia severity index score also improved (p = 0.036), and no serious adverse effects were observed. Our preliminary data suggests the potential for pregabalin as an add-on therapy to DA with regards to both efficacy and safety in patients who have inadequate RLS improvement.

Approach to Neuropathic Pain

Neuropathic pain is a common chief complaint encountered by neurologists and primary care providers. It is caused by disorders involving the somatosensory nervous system. The clinical evaluation of neuropathic pain is challenging and requires a multifaceted systematic approach with an emphasis on a thorough history and physical examination to identify characteristic signs and symptoms. Ancillary laboratory investigations, targeted imaging, and electrodiagnostic studies further help identify underlying etiologies to guide specific treatments. Management of neuropathic pain encompasses treating the underlying pathology as well as symptomatic control with nonpharmacological, pharmacological, and interventional therapies. Here, we present an approach to help evaluate patients with neuropathic pain.

Osteopontin as a biomarker for COVID-19 severity and multisystem inflammatory syndrome in children: A pilot study

This study sought to evaluate the candidacy of plasma osteopontin (OPN) as a biomarker of COVID-19 severity and multisystem inflammatory condition in children (MIS-C) in children. A retrospective analysis of 26 children (0–21 years of age) admitted to Children’s Healthcare of Atlanta with a diagnosis of COVID-19 between March 17 and May 26, 2020 was undertaken. The patients were classified into three categories based on COVID-19 severity levels: asymptomatic or minimally symptomatic (control population, admitted for other non-COVID-19 conditions), mild/moderate, and severe COVID-19. A fourth category of children met the Centers for Disease Control and Prevention's case definition for MIS-C. Residual blood samples were analyzed for OPN, a marker of inflammation using commercial ELISA kits (R&D), and results were correlated with clinical data. This study demonstrates that OPN levels are significantly elevated in children hospitalized with moderate and severe COVID-19 and MIS-C compared to OPN levels in mild/asymptomatic children. Further, OPN differentiated among clinical levels of severity in COVID-19, while other inflammatory markers including maximum erythrocyte sedimentation rate, C-reactive protein and ferritin, minimum lymphocyte and platelet counts, soluble interleukin-2R, and interleukin-6 did not. We conclude OPN is a potential biomarker of COVID-19 severity and MIS-C in children that may have future clinical utility. The specificity and positive predictive value of this marker for COVID-19 and MIS-C are areas for future larger prospective research studies.

COVID-19 related olfactory dysfunction prevalence and natural history in ambulatory patients

Background: Evidence regarding prevalence of COVID-19 related Olfactory dysfunction (OD) among ambulatory patients is highly variable due to heterogeneity in study population and measurement methods. Relatively few studies have longitudinally investigated OD in ambulatory patients with objective methods. Methods: We performed a longitudinal study to investigate OD among COVID-19 ambulatory patients compared to symptomatic controls who test negative. Out of 81 patients enrolled, 45 COVID-19 positive patients and an age- and sex-matched symptomatic control group completed the BSIT and a questionnaire about smell, taste and nasal symptoms. These were repeated at 1 month for all COVID-19 positive patients, and again at 3 months for those who exhibited persistent OD. Analysis was performed by mixed-effects linear and logistic regression. Results: 46.7% of COVID-19 patients compared to 3.8% of symptomatic controls exhibited OD at 1-week post diagnosis. At 1 month, 16.7%, (6 of 36), of COVID-19 patients had persistent OD. Mean improvement in BSIT score in COVID-19 patients between 1-week BSIT and 1 month follow-up was 2.0. OD did not correlate with nasal congestion. Conclusions: Ambulatory COVID-19 patients exhibited OD significantly more frequently than symptomatic controls. Most patients regained normal olfaction by 1 month. The BSIT is a simple validated and objective test to investigate the prevalence of OD in ambulatory patients. OD did not correlate with nasal congestion which suggests a congestion-independent mechanism of OD.

Novel case of Parkinson’s disease and schizophrenia: challenges in the management

Coexistence of idiopathic Parkinson’s disease (iPD) and schizophrenia can pose great diagnostic and therapeutic challenges because of their pathophysiology. Our case highlights such challenges in management. We present a case of 73-year-old man who had parkinsonism for last several years and was also diagnosed with schizophrenia. Due to lack of collateral information about the onset of symptoms and clinical course, it was difficult to distinguish iPD from neuroleptic-induced parkinsonism. Even though, certain clinical findings may help to differentiate between the two conditions, single positron emission computerized tomography/DatScan was used to confirm the diagnosis of iPD. Treatment of coexisting iPD and schizophrenia can be challenging, and a delicate pharmacologic balance must be maintained to ensure adequate symptomatic control. Current evidence suggests that clozapine is a better choice for managing psychosis in these patients due to its unique receptor profile and better safety data.

Löfgren’s Syndrome

Löfgren’s syndrome presents as acute sarcoid arthritis, with a triad of hilar adenopathy, acute polyarthritis and erythema nodosum. Löfgren’s syndrome is self-limited, erythema nodosum, hilar adenopathy and acute polyarthritis usually resolve within a few weeks to months, however polyarthritis can last for up to 2 years. Treatment involves symptomatic control with NSAIDs/colchicine or oral glucocorticoids until symptoms resolve, if disease is resistant to these therapies, hydroxychloroquine, methotrexate or infliximab can be used. Löfgren’s syndrome is a rare presentation of sarcoidosis occurring in only about 5–10% of sarcoid patients. It is, however, important to recognize as it is the most common form of acute sarcoid arthritis and prompt treatment can prevent unnecessary prolonged discomfort for patients.

End stage kidney disease in the elderly: Hope for the best

With an increased number of aged chronic kidney disease (CKD) patients, along with medical and technological advances, the options to approach end‑stage kidney disease (ESKD) have multiplied. Nephrologists should be aware that taking care of elderly patients is different from taking care of younger ones. The spectrum of choices is as wide as the functional status of these patients. For fit ones, the main goal should be to restore function as much as possible and to rehabilitate. On the other hand, for frail patients, the expectations should be realistic in terms of survival, disease trajectory and symptomatic control, because while kidney replacement therapies can prolong life, they do not cure. The issue is complex due to its multidimensional perspective, so decisions must take into account the patient’s options, respecting his/her autonomy, dignity and quality of life. This text aims to review the particularities of geriatric CKD patients’ assessment towards options to care for ESKD, in a specific population which is growing in our practice.

Post COVID-19 Syndrome: A Literature Review

The COVID-19 pandemic shook the entire world in January 2020 last year and is still posing a major threat to the entire humanity. A lot of studies have been conducted studying the diagnosis and management of the disease caused by this highly contagious virus, but less is known about the Post COVID-19 sequelae. There is very limited evidence about the management of COVID-19 after the first three weeks of illness. About 10% of the patients experience prolonged illness after COVID-19. Treatment is mainly focused on reassurance, self-care, and symptomatic control. There are currently no FDA-approved treatments specifically for this condition. Clinicians and researchers have focused on the acute phase of COVID-19, but continued monitoring after discharge for long-lasting effects is needed.

Chemokine Receptor Inhibitor vMIP-II Promoting Lymphocytes in COVID-19 Patients and Its Related Mechanism In Vitro

Coronavirus disease (COVID-19) accompanies severe immune injury as well as a decrease and overactivation of T lymphocytes. We observed that vMIP-Ⅱ, a broad-spectrum chemokine receptor inhibitor, could improve the lymphocyte decrease of COVID-19. Comparisons of T cell populations in PBMCs showed that the effects of vMIP-II on the subsets of T cells and cytokine secretion stimulated by SARS-CoV-2 S protein were the same as those in the asymptomatic infection group: the proportion of CD8+ TCM cells in the vMIP-II treatment and asymptomatic groups was significantly higher than that in the symptomatic control group. Differential gene expression of effector CD8+ T cells suggested that vMIP-II inhibits multiple chemokine receptors and related signal pathway and strengthens their stem proliferating capacity. Thus, vMIP-II reconstitutes cellular immunity lost due to acute infection of SARS-CoV-2 by modulating effector CD8+ T cells to produce more TCM cells.

Chemokine Receptor Inhibitor vMIP-II Promoting Lymphocytes in COVID-19 Patients and Its Related Mechanism In Vitro

Coronavirus disease (COVID-19) accompanies severe immune injury as well as a decrease and overactivation of T lymphocytes. We observed that vMIP-Ⅱ, a broad-spectrum chemokine receptor inhibitor, could improve the lymphocyte decrease of COVID-19. Comparisons of T cell populations in PBMCs showed that the effects of vMIP-II on the subsets of T cells and cytokine secretion stimulated by SARS-CoV-2 S protein were the same as those in the asymptomatic infection group: the proportion of CD8+TCM cells in the vMIP-II treatment and asymptomatic groups was significantly higher than that in the symptomatic control group. Differential gene expression of effector CD8+ T cells suggested that vMIP-II inhibits multiple chemokine receptors and related signal pathway and strengthens their stem proliferating capacity. Thus, vMIP-II reconstitutes cellular immunity lost due to acute infection of SARS-CoV-2 by modulating effector CD8+ T cells to produce more TCM cells.