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A 66-year-old male presented with ST-segment-elevation myocardial infarction. Percutaneous coronary intervention (PCI) of the culprit right coronary artery lesion was performed, during which a small wire-related perforation was noted. The perforation was no longer visible post procedure and we opted for conservative management. One month later, coronary angiography before intervention of the left anterior descending and circumflex lesions revealed a focal dilation at the site of the earlier wire perforation. Further imaging with intravascular ultrasound and optical coherence tomography visualized the defect and guided treatment options.
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Enfermedad de la Arteria Coronaria , Rotura Cardíaca , Infarto del Miocardio , Intervención Coronaria Percutánea , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Masculino , Infarto del Miocardio/terapia , Rotura EspontáneaRESUMEN
OBJECTIVE: The objective of the study was to assess the tolerability and safety of galcanezumab in patients with chronic cluster headache (CH) with up to 15 months of treatment. BACKGROUND: Chronic CH is a highly debilitating disease with a substantial and unmet medical need. METHODS: Patients were randomized to receive placebo or galcanezumab (300 mg) monthly for 12 weeks, followed by an optional 52-week open-label extension and 16-week posttreatment follow-up (washout). This is a secondary analysis and long-term follow-up of a previously conducted clinical trial. The safety analysis included patients who received galcanezumab at any time during the study. Outcomes included adverse events (AEs), discontinuations, laboratory values, vital signs, electrocardiograms (ECGs), and suicidality ratings. RESULTS: A total of 233 patients received at least one galcanezumab dose. The mean exposure was 341 days. Galcanezumab-treated patients were mostly male (n = 169/233; 72.5%) with a mean age of 44.9 (±10.9) years. Treatment-emergent adverse events (TEAEs) were reported by 185 patients (n = 185/233; 79.4%), 23 patients (n = 23/233; 9.9%) reported serious adverse events (SAEs), and 18 patients (n = 18/233; 7.7%) discontinued due to AEs. The SAE CH was reported by three patients. The most common TEAEs (>10%) were nasopharyngitis (n = 41/233; 17.6%) and injection site pain (n = 33/233; 14.2%). 27.5% of patients (n = 64/233) had TEAEs related to injection sites. Likely hypersensitivity events, including injection site rash, injection site urticaria, and injection site hypersensitivity were reported (n = 14/233; 6.0%). There were past histories of suicidal ideation (n = 55/237; 23.2%) and suicidal behavior (n = 9/236; 3.8%). During the study, 15 patients (n = 15/230; 6.5%), seven with previous history, reported suicidal ideation. One patient had a nonfatal suicide attempt during the open-label extension and an aborted attempt during the washout. There were no new safety findings compared with the placebo-controlled treatment period in laboratory values, vital signs, or ECGs. CONCLUSIONS: Galcanezumab 300 mg monthly had a favorable tolerability and safety profile in patients with chronic CH with up to 15 months of treatment.
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Anticuerpos Monoclonales Humanizados/farmacología , Cefalalgia Histamínica/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Enfermedad Crónica , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de SaludRESUMEN
BACKGROUND: Many patients who require migraine preventive treatment have not been able to tolerate or have not responded to multiple previous preventive medications. We aimed to assess the safety and efficacy of galcanezumab, an antibody to calcitonin gene-related peptide, in patients with migraine who had not benefited from preventive medications from two to four categories. METHODS: CONQUER was a multicentre, randomised, double-blind, placebo-controlled, phase 3b trial done at 64 sites (hospitals, clinics, or research centres) in 12 countries (Belgium, Canada, Czech Republic, France, Germany, Hungary, Japan, the Netherlands, South Korea, Spain, the UK, and the USA). Patients were 18-75 years of age, with episodic or chronic migraine, with migraine onset before the age of 50 years, who had a documented failure of preventive medications from two to four drug categories in the past 10 years owing to lack of efficacy or tolerability, or both. Patients were randomised 1:1 to receive subcutaneous placebo or galcanezumab 120 mg per month (with a 240 mg loading dose administered as two 120 mg injections) for 3 months. For masking purposes, patients receiving placebo also received two injections during the first dosing visit. Randomisation was done by a computer-generated random sequence by means of an interactive web-response system stratified by country and migraine frequency (low frequency episodic migraine, four to fewer than eight migraine headache days per month; high frequency episodic migraine, eight to 14 migraine headache days per month and fewer than 15 headache days per month; chronic migraine, at least eight migraine headache days per month and at least 15 headache days per month). The primary endpoint was the overall mean change from baseline in number of monthly migraine headache days during the 3-month treatment period in all patients who were randomly assigned and received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT03559257, and is now completed. FINDINGS: Between Sept 10, 2018, and March 21, 2019, 462 participants with episodic (269 [58%]) or chronic (193 [42%]) migraine were randomly assigned and received at least one injection with placebo (n=230) or galcanezumab (n=232). Galcanezumab-treated patients had significantly greater reduction in migraine headache days versus placebo across months 1-3. The galcanezumab group had on average 4·1 fewer monthly migraine headache days compared with baseline (13·4), while the placebo group had on average 1·0 fewer than at baseline (13·0; between-group difference -3·1 [95% CI -3·9 to -2·3]; p<0·0001; effect size=0·72). Types and number of treatment-emergent adverse events were similar between galcanezumab and placebo. Treatment-emergent adverse events were reported in 122 (53%) of 230 patients in the placebo group and 119 (51%) of 232 patients in the galcanezumab group. There were four serious adverse events during the study, two (1%) reported in the placebo group and two (1%) reported in the galcanezumab group. INTERPRETATION: Galcanezumab was superior to placebo in the preventive treatment of migraine and was safe and well tolerated in patients for whom multiple previous standard-of-care preventive treatments had failed. Galcanezumab might represent an important treatment option for patients who have not benefited from or tolerated previous standard-of-care treatments. FUNDING: Eli Lilly.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/tratamiento farmacológico , Insuficiencia del Tratamiento , Adolescente , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The International Classification of Headache Disorders lists different subtypes of medication overuse headache (MOH), according to the medication overused. The aim of this study is to evaluate whether the different subtypes correspond to clinically distinguishable phenotypes in a large population. METHOD: This descriptive cross-sectional observational study included 660 patients with MOH referred to headache centers in Europe and Latin America as a part of the COMOESTAS project. Information about clinical features was collected with structured patient interviews and with self-administered questionnaires for measuring disability, anxiety, and depression. RESULTS: Female/male ratio, body mass index, marital status, and level of education were similar among in subjects enrolled in the 5 centers. The mean age was higher among subjects overusing triptans (T-MOH) with respect to subjects overusing simple analgesic (A-MOH). Duration of headache before chronification was longer in T-MOH (19.2 ± 11.9 years) and in subjects overusing ergotamines (E-MOH, 17.8 ± 11.7 years) with respect to the A-MOH group (13.1 ± 10.9; P < .001 and P = .017, respectively) and in T-MOH with respect multiple drug classes (M-MOH, 14.9 ± 11.7; P = .030). Migraine Disability Assessment (MIDAS) score was significantly lower in E-MOH group (33.6 ± 41.6), while T-MOH group (56.8 ± 40.6) had a significant lower MIDAS score with respect to M-MOH (67.2 ± 62.5; P = .016 and P = .037, respectively). Prevalence of depression and anxiety was lower in patients overusing T with respect to other groups of patients (χ2 = 10.953, P = .027 and χ2 = 25.725, P < .001, respectively). CONCLUSION: In this study on a large and very well characterized population of MOH, we describe the distinctive clinical characteristics of MOH subtypes. These findings contribute to more clearly define the clinical picture of a poorly delineated headache disorder. They also provide some insights in the possible trajectories leading to this highly disabling chronic headache, that is classified as a secondary form, but whose occurrence is entirely dependent on an underlying primary headache.
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Cefaleas Secundarias/psicología , Adulto , Anciano , Ansiedad/etiología , Ansiedad/psicología , Índice de Masa Corporal , Estudios de Cohortes , Estudios Transversales , Depresión/etiología , Depresión/psicología , Evaluación de la Discapacidad , Escolaridad , Europa (Continente)/epidemiología , Femenino , Cefaleas Secundarias/complicaciones , Cefaleas Secundarias/epidemiología , Humanos , América Latina/epidemiología , Masculino , Estado Civil , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Encuestas y Cuestionarios , Triptaminas/efectos adversos , Triptaminas/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: Maintenance of effect following treatment with galcanezumab compared to placebo in adult patients with episodic or chronic migraine was evaluated. METHODS: In 2 similarly designed studies of patients with episodic migraine (6 months) and 1 study of patients with chronic migraine (3 months), patients randomized in a 1:1:2 ratio received a subcutaneous injection of galcanezumab 120 mg/month (after an initial loading dose of 240 mg) or 240 mg/month or placebo. Maintenance of effect during the double-blind phase was evaluated based on a comparison of the percentages of galcanezumab- and placebo-treated patients with maintenance of 30, 50, 75, and 100% response (defined as ≥30, ≥50, ≥75, and 100% reduction from baseline in monthly migraine headache days [MHD]) at an individual patient level. Logistic regression analyses were used for between treatment comparisons. RESULTS: A total of 1773 adult patients with episodic migraine (n = 444 for galcanezumab 120 mg; n = 435 for galcanezumab 240 mg; n = 894 for placebo for 2 studies pooled) and 1113 patients with chronic migraine (n = 278 for galcanezumab 120 mg; n = 277 for galcanezumab 240 mg; n = 558 for placebo) were evaluated. In patients with episodic migraine, ≥50% response was maintained in 41.5 and 41.1% of galcanezumab-treated patients (120 mg and 240 mg, respectively) for ≥3 consecutive months (until patient's endpoint) and 19.0 and 20.5%, respectively, for 6 consecutive months and was significantly greater than the 21.4 and 8.0% of placebo-treated patients at ≥3 and 6 months consecutively (P < 0.001). Approximately 6% of galcanezumab-treated patients maintained ≥75% response all 6 months versus 2% of placebo-treated patients. Few galcanezumab-treated patients maintained 100% response. In patients with chronic migraine, 29% of galcanezumab-treated patients maintained ≥30% response all 3 months compared to 16% of placebo patients while ≥50% response was maintained in 16.8 and 14.6% of galcanezumab-treated patients (120 mg and 240 mg) and was greater than placebo (6.3%; p < 0.001). Few patients maintained ≥75% response. CONCLUSIONS: Treatment with galcanezumab 120 mg or 240 mg demonstrated statistically significant and clinically meaningful persistence of effect in patients with episodic migraine (≥3 and 6 consecutive months) and in patients with chronic migraine (for 3 months). STUDY IDENTIFICATION AND TRIAL REGISTRATION: Study Identification: EVOLVE-1 (I5Q-MC-CGAG); EVOLVE-2 (I5Q-MC-CGAH); REGAIN (I5Q-MC-CGAI) TRIAL REGISTRATION: ClinicalTrials.gov ; NCT02614183 (EVOLVE-1); NCT02614196 (EVOLVE-2); NCT02614261 (REGAIN).
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Anticuerpos Monoclonales/uso terapéutico , Péptido Relacionado con Gen de Calcitonina/antagonistas & inhibidores , Trastornos Migrañosos/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Análisis de RegresiónRESUMEN
PURPOSE OF REVIEW: Neuromodulation is an alternative in the management of medically intractable cluster headache patients. Most of the techniques are invasive, but in the last 2 years, some studies using a noninvasive device have been presented. The objective of this article is to review the data using this approach. RECENT FINDINGS: Techniques as occipital nerve stimulation or sphenopalatine ganglion stimulation are recommended as first-line therapy in refractory cluster patients, but they are invasive and maybe associated with complications. Noninvasive vagal nerve stimulation with an external device has been tried in cluster patients. Results from clinical practice and a single randomized clinical trial have been presented showing a reduction of the number of cluster attacks/week in the patients treated with the device. The rate of adverse events was low and most of them were mild. SUMMARY: In the last decade, invasive neuromodulation treatments have demonstrated good efficacy in cluster refractory patients. Noninvasive approaches such as the noninvasive vagal nerve stimulation have shown efficacy in one trial and could be an easier alternative in the management of this debilitating headache. We need to replicate these results with further controlled studies and conduct basic research in order to clarify the mechanism of action.
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Encéfalo/fisiología , Cefalalgia Histamínica/terapia , Terapia por Estimulación Eléctrica/métodos , Nervio Vago/fisiología , HumanosRESUMEN
The perylene derivatives 3-isocyanoperylene (Per-N≡C) (4a) and N-(2,5-di-tert-butylphenyl)-9-isocyano-perylene-3,4-dicarboximide (PMI-N≡C) (4b) were prepared and used to synthesize gold complexes [AuX(CNR)] (X = C6F5 (5a,b), C6F4-O(n)Bu-p (6b)). The reaction of 5b and 6b with HNEt2 led to the carbene complexes [AuX{C(NEt2)(NHR)}] (7b, 8b), respectively. The molecular structure of complexes 7b and 8b have been determined by X-ray diffraction analysis showing intermolecular π-stacking of the perylene groups and C6F5 rings and no Au···Au interactions. The derivative compounds [M(CO)5(CNR)] (M = Cr (9a,b), Mo (10a,b) or W (11a,b)) and trans-[Pd(CNR)2(C6F3Cl2)2] (12a,b) were also prepared. All complexes exhibit fluorescence associated with the perylene fragment with emission quantum yields, in solution at room temperature, in the range 0.05-0.93 and emission lifetimes ~ 4 ns. DFT calculations were performed of the absorption spectra of the ligands Per-N≡C and PMI-N≡C and representative complexes [Au(C6F5)(CNR)], [Cr(CO)5(CNR)], showing a perylene-dominated intraligand π-π* emissive state, from the HOMO and LUMO orbitals of the perylene chromophore, but with significantly different absorption maxima by the influence of the metal fragment, particularly significant in the Per-N≡C derivatives.
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Cluster headache is a severe, debilitating disorder with pain that ranks among the most severe known to humans. Patients with cluster headaches have few therapeutic options and further, 10-20% develop drug-resistant attacks. The often brief duration of cluster attacks makes abortive therapy a challenge, and preventive medications are almost always provided to patients, but the side effects of these preventive medications can be significant. The sphenopalatine ganglion (SPG) is believed to play a role in headache pain and cranial autonomic symptoms associated with cluster headache, which is a result of activation of the trigeminal-autonomic reflex. For over 100 years, the SPG has been a clinical target to treat primary headache disorders using pharmacologic and nonpharmacologic methods. Radiofrequency lesioning and nerve-resection therapies, while initially beneficial, are irreversible procedures, and the use of neurostimulation provides one method of interfacing with the neural pathways without causing permanent damage to neural tissue. SPG neurostimulation is both reversible and adjustable, and has recently been tested in both proof-of-concept work and in a randomized, sham-controlled trial for the treatment of cluster headache. A randomized, sham-controlled study of 32 patients was performed to evaluate further the use of SPG stimulation for the acute treatment of chronic cluster headache. Of the 32 patients, 28 completed the randomized experimental period. Overall, 68% of patients experienced an acute response, a frequency response, or both. In this study the majority of adverse events were related to the implantation procedure, which typically resolved or remained mild in nature at 3 months following the implant procedure. This and other studies highlight the promise of using SPG stimulation to treat the pain-associated cluster headache. SPG stimulation could be a safe and effective option for chronic cluster headache.
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CONTEXT AND OVERVIEW: Chronic cluster headache (CCH) is a debilitating headache disorder with a significant impairment of the patients' lives. Within the past decade, various invasive neuromodulatory approaches have been proposed for the treatment of CCH refractory to standard preventive drug, but only very few randomized controlled studies exist in the field of neuromodulation for the treatment of drug-refractory headaches. Based on the prominent role of the cranial parasympathetic system in acute cluster headache attacks, high-frequency sphenopalatine ganglion (SPG) stimulation has been shown to abort ongoing attacks in some patients in a first small study. As preventive effects of SPG-stimulation have been suggested and the rate of long-term side effects was moderate, SPG stimulation appears to be a promising new treatment strategy. AIMS AND CONCLUSION: As SPG stimulation is effective in some patients and the first commercially available CE-marked SPG neurostimulator system has been introduced for cluster headache, patient selection and care should be standardized to ensure maximal efficacy and safety. As only limited data have been published on SPG stimulation, standards of care based on expert consensus are proposed to ensure homogeneous patient selection and treatment across international headache centres. Given that SPG stimulation is still a novel approach, all expert-based consensus on patient selection and standards of care should be re-reviewed when more long-term data are available.
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Cefalalgia Histamínica/terapia , Terapia por Estimulación Eléctrica/métodos , Ganglios Parasimpáticos/fisiología , Nivel de Atención , Consenso , Humanos , Selección de PacienteRESUMEN
BACKGROUND: The pain and autonomic symptoms of cluster headache (CH) result from activation of the trigeminal parasympathetic reflex, mediated through the sphenopalatine ganglion (SPG). We investigated the safety and efficacy of on-demand SPG stimulation for chronic CH (CCH). METHODS: A multicenter, multiple CH attack study of an implantable on-demand SPG neurostimulator was conducted in patients suffering from refractory CCH. Each CH attack was randomly treated with full, sub-perception, or sham stimulation. Pain relief at 15 minutes following SPG stimulation and device- or procedure-related serious adverse events (SAEs) were evaluated. FINDINGS: Thirty-two patients were enrolled and 28 completed the randomized experimental period. Pain relief was achieved in 67.1% of full stimulation-treated attacks compared to 7.4% of sham-treated and 7.3% of sub-perception-treated attacks ( P < 0.0001). Nineteen of 28 (68%) patients experienced a clinically significant improvement: seven (25%) achieved pain relief in ≥50% of treated attacks, 10 (36%), a ≥50% reduction in attack frequency, and two (7%), both. Five SAEs occurred and most patients (81%) experienced transient, mild/moderate loss of sensation within distinct maxillary nerve regions; 65% of events resolved within three months. INTERPRETATION: On-demand SPG stimulation using the ATI Neurostimulation System is an effective novel therapy for CCH sufferers, with dual beneficial effects, acute pain relief and observed attack prevention, and has an acceptable safety profile compared to similar surgical procedures.
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Cefalalgia Histamínica/terapia , Terapia por Estimulación Eléctrica/métodos , Electrodos Implantados , Ganglios Parasimpáticos/fisiología , Dimensión del Dolor/métodos , Adolescente , Adulto , Anciano , Cefalalgia Histamínica/fisiopatología , Terapia por Estimulación Eléctrica/instrumentación , Femenino , Humanos , Masculino , Microelectrodos , Persona de Mediana Edad , Fosa Pterigopalatina/fisiología , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Tinnitus affects about 10-15% of the general population and risks for developing tinnitus are rising through increased exposure to leisure noise through listening to personal music players at high volume. The disorder has a considerable heterogeneity and so no single mechanism is likely to explain the presence of tinnitus in all those affected. As such there is no standardized management pathway nor singly effective treatment for the condition. Choice of clinical intervention is a multi-factorial decision based on many factors, including assessment of patient needs and the healthcare context. The present research surveyed clinicians working in six Westernized countries with the aims: a) to establish the range of referral pathways, b) to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c) to seek clinical opinion about levels of satisfaction with current standards of practice. METHODS: A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs) and 365 ear-nose-throat specialists (ENTs) from the US, Germany, UK, France, Italy and Spain. RESULTS: Our international comparison of health systems for tinnitus revealed that although the characteristics of tinnitus appeared broadly similar across countries, the patient's experience of clinical services differed widely. GPs and ENTs were always involved in referral and management to some degree, but multi-disciplinary teams engaged either neurology (Germany, Italy and Spain) or audiology (UK and US) professionals. For acute subjective tinnitus, pharmacological prescriptions were common, while audiological and psychological approaches were more typical for chronic subjective tinnitus; with several specific treatment options being highly country specific. All therapy options were associated with low levels of satisfaction. CONCLUSIONS: Despite a large variety of treatment options, the low success rates of tinnitus therapy lead to frustration of physicians and patients alike. For subjective tinnitus in particular, effective therapeutic options with guidelines about key diagnostic criteria are urgently needed.
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Actitud del Personal de Salud , Medicina General , Pautas de la Práctica en Medicina , Especialización , Acúfeno/terapia , Enfermedad Aguda , Adulto , Enfermedad Crónica , Europa (Continente) , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos , Autoinforme , Resultado del Tratamiento , Estados UnidosRESUMEN
Posttraumatic headache (PTH) is one of the most controversial disorders in secondary headaches. It is the most common symptom of postconcussion syndrome. There are many unresolved issues around PTH despite the efforts by the International Headache Society to classify and clarify this entity. This article reviews the classification, pathophysiology, and treatment of PTH, as well as best management of patients with psychiatric comorbidities. Due to the complexity of PTH, the different forms of appearance, its pathophysiology, and the implications of psychological factors, a multidisciplinary team to cover all aspects appears as the best way to approach management and treatment.
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Cefalea Postraumática/fisiopatología , Enfermedad Aguda , Enfermedad Crónica , Cefalea/etiología , Humanos , Dolor/fisiopatología , Cefalea Postraumática/clasificación , Cefalea Postraumática/terapiaRESUMEN
In the US, it is estimated that up to 10% of men and 25% of women, particularly those aged 25-55 years, experience debilitating migraines, such that the condition presents an enormous economic burden for patients, health systems, employers and society. Migraine headache is a particularly prevalent condition associated with major reductions in patients' quality of life. From a payer perspective, the implementation of relevant programmes of migraine prophylaxis is highly desirable. Consistent evidence exists, from several randomized, controlled studies, of the efficacy of amitriptyline, divalproex sodium, propranolol, timolol and topiramate in migraine prophylaxis. Considering resource utilization, various studies suggest that migraine prophylaxis with antiepileptics, antidepressants, beta-blockers or calcium channel antagonists markedly reduces triptan use and visits to physician offices and emergency departments (EDs), without compromising quality of care or treatment outcomes. Over recent years, the effects of topiramate in reducing resource utilization in patients with migraine have been relatively widely studied. In US claims database analyses involving >4000 patients with migraine, topiramate significantly reduced triptan use by up to 20% in the 12-month period after starting treatment. Reductions were also noted in the numbers of ED visits, diagnostic procedures, hospital admissions and migraine-related hospitalization days. These long-term benefits of topiramate manifested without any increase in overall headache-related costs. Furthermore, in detailed modelling analyses based on UK and US data, topiramate-induced savings in acute medical services were estimated to offset about one-quarter of the monthly per patient cost of the topiramate regimen, which was shown to be a dominant cost-effective intervention relative to no preventive therapy: cost-effectiveness ratios were calculated as pound 5728 per quality-adjusted life-year (QALY) [2005 costings] and $US10 888 per QALY (2002 costings), respectively. Overall, there is a need to improve quality of care in migraine, and prophylactic therapy appears to be an effective option, particularly with respect to decreasing resource use and improving productivity. For both health-plan payers and employers, topiramate appears to be a cost-effective intervention for preventing migraine.
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Costo de Enfermedad , Eficiencia , Trastornos Migrañosos/prevención & control , Adulto , Costos y Análisis de Costo , Bases de Datos Factuales , Femenino , Fructosa/análogos & derivados , Fructosa/economía , Fructosa/uso terapéutico , Humanos , Masculino , Trastornos Migrañosos/economía , Trastornos Migrañosos/epidemiología , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Topiramato , Reino Unido/epidemiología , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To estimate the impact of migraine on labor productivity and health resources utilization in an active population attending Primary Care settings in Spain. METHODS: An observational, cross-sectional, and multicenter study was designed. Productivity, loss workdays equivalents and previous 3-months health resources utilization were calculated. RESULTS: Four thousand four hundred twenty six patients were evaluated. The migraine group showed the lowest productivity, highest loss workdays equivalents and health resources utilization compared with non-migraine headaches and subjects without headaches (P < 0.05 in all cases). Within the migraine group, lower productivity values were observed in female patients compared to male (64.04 vs 59.69; P < 0.05), while emergency room visits were more frequent for male patients (0.71 vs 076; P < 0.05). CONCLUSIONS: Subjects with migraine showed higher impact on health resources utilization and productivity when evaluated at Primary care level.
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Eficiencia , Trastornos Migrañosos/epidemiología , Salud Laboral/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Adulto , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Prevalencia , Estudios Retrospectivos , Distribución por Sexo , España/epidemiologíaRESUMEN
Transient paraparesis has been reported with intrathecal chemotherapy agents and the most common cause is an incomplete inflammatory myelopathy. We report a case of a 30-year-old man diagnosed with acute lymphoblastic leukaemia who developed subacute anterior lumbosacral polyradiculopathy following intrathecal methotrexate, an unusual complication of intrathecal chemotherapy in adults. Spinal magnetic resonance discarded myelopathy. Cerebrospinal fluid exam showed elevation of protein, mononuclear pleocytosis and immunoglobulin synthesis. Electrodiagnostic study showed alterations of sensory and motor conductions only in lower limbs, consistent with multilevel radiculopathy. Differential diagnosis included toxic and neoplastic polyradiculopathy, and axonal variant of acute inflammatory demyelinating polyradiculoneuropathy. The authors review possible pathogenic mechanisms and propose several therapeutic and preventive options.
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Plexo Lumbosacro/efectos de los fármacos , Metotrexato/efectos adversos , Paraparesia/inducido químicamente , Polirradiculopatía/inducido químicamente , Raíces Nerviosas Espinales/efectos de los fármacos , Adulto , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Interacciones Farmacológicas/fisiología , Resultado Fatal , Humanos , Hidrocortisona/administración & dosificación , Inyecciones Espinales/efectos adversos , Pierna/inervación , Pierna/fisiopatología , Plexo Lumbosacro/patología , Plexo Lumbosacro/fisiopatología , Masculino , Metotrexato/administración & dosificación , Neuronas Motoras/patología , Músculo Esquelético/inervación , Músculo Esquelético/fisiopatología , Conducción Nerviosa/fisiología , Parálisis/inducido químicamente , Paraparesia/patología , Paraparesia/fisiopatología , Polirradiculopatía/patología , Polirradiculopatía/fisiopatología , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Infecciones del Sistema Respiratorio , Sepsis , Raíces Nerviosas Espinales/patología , Raíces Nerviosas Espinales/fisiopatología , Vejiga Urinaria Neurogénica/inducido químicamenteRESUMEN
This paper analyses the effect of caponisation at 8 weeks on growth and on carcass and meat characteristics of Castellana Negra chickens slaughtered at 29 weeks. Caponisation did not result in weight improvements as compared with uncastrated birds. No changes were observed in the growth rate or in the parameters determining the point of inflection in the growth curve (sexual maturity). Regarding carcass characteristics, castration resulted in a wider breast angle and heavier pectoral muscles in caponised birds than in uncastrated birds, but with no differences in thigh and drumstick weight and length. Capon meat showed a higher fat content than that of cocks, making it juicier and less fibrous. No differences were found in fatty acid content (C 14:0, C 18:0, C 18:1 and C 18:2). Nor were there any differences in colour measurements, pH or water loss from the meat. While cocks' thighs + drumsticks were found to be tougher than their breasts, there were no such differences in capons because after castration, thigh + drumstick meat became more tender.
RESUMEN
Migraine is a common disorder associated with considerable individual and economic burden. Triptans are recommended for the treatment of migraine of any severity in patients who have failed to gain adequate relief with nonspecific medication; early transition to triptans avoids prolonged morbidity in patients failing to respond to nonspecific medications. There is evidence that early intervention therapy with oral formulations in migraine, soon after the onset of an attack and when pain is still mild, improves efficacy. Seven different triptans are currently marketed, with differing pharmacologic, efficacy and tolerability profiles. Almotriptan has many positive features, which include rigorously demonstrated efficacy in sumatriptan nonresponders, as early therapy and in menstrual migraine. In addition, almotriptan has a favorable pharmacologic profile with a lack of clinically relevant pharmacokinetic interventions with other drugs, adverse reactions rate similar to placebo, superior cost-effectiveness and excellent performance on composite clinical outcome measures that incorporate features of greatest importance to patients. Although effective in both triptan-naive and -experienced patients, and as both early and standard therapy, almotriptan shows greater efficacy in triptan-naive patients and as early treatment, and is consistently one of the preferred triptans in multiattribute decision-making analyses incorporating attributes of significance for patients and physicians. Therefore, almotriptan has many features that make it an ideal choice for a triptan-naive patient moving from nonspecific medication, a patient switching from another triptan owing to inefficacy or tolerability issues and patients being advised to take a triptan early in the course of a migraine attack.
Asunto(s)
Trastornos Migrañosos/tratamiento farmacológico , Agonistas de Receptores de Serotonina/uso terapéutico , Triptaminas/uso terapéutico , Ensayos Clínicos como Asunto , Humanos , Agonistas de Receptores de Serotonina/economía , Triptaminas/economíaRESUMEN
1. This study shows the results of (a) fitting growth data to a Gompertz-Laird model and (b) fitting egg production per housed bird to a Grossman model, in a population of Castellana Negra hens. 2. The maximum growth point for males and females, respectively, occurred at 10.6 and 9.3 weeks and the estimated weights at maturity were 2852 and 1878 g. Growth curve parameters were lower than those of commercial lines and similar to reports of other unselected breeds. 3. The start of lay was at 23 weeks. Total egg production reached 163 at 52 weeks, with a persistency (length of constant production) of 3.4 weeks and a production maximum of 69%. The maximum rate of change segment of the laying curve started at 24.3 weeks of age, and the production maximum started at 5.8 weeks into lay. The rate of decline was 1.4% weekly. 4. The Castellana Negra breed belongs to the class of slow-growing light lines and egg production was 163 eggs per calendar year.
Asunto(s)
Pollos/crecimiento & desarrollo , Pollos/genética , Oviposición/fisiología , Animales , Femenino , Masculino , Modelos Biológicos , Oviposición/genética , EspañaRESUMEN
BACKGROUND: Migraine is frequently under-treated. The 4-item Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire is a simple, patient-friendly tool to identify patients requiring change in acute migraine treatment. OBJECTIVE: To establish a predictive model for the Migraine-ACT questionnaire in primary care. RESEARCH DESIGN AND METHODS: This open-label, prospective, two-visit study at 1100 primary care sites enrolled patients reporting migraine for > 1 year and > or = 1 migraine attack/month. Predictive validity of the Migraine-ACT questionnaire was evaluated using a logistic regression model adjusted for baseline disability, diagnosis, sex, age, attack frequency, attack duration, baseline treatment change, treatment(s) for the study period and baseline Migraine-ACT score. RESULTS: A total of 3272 patients, 78% female, entered the study and 2877 patients (88%) returned at 3 months. Investigators changed baseline migraine treatment for 72% of returning patients. Percentages of patients who were completely or very satisfied with migraine therapy increased from 15% at baseline to 49% at 3 months. The adjusted logistics regression model yielded sensitivity of 86% and specificity of 85% to detect > or = 1-point change in Migraine-ACT score at 3 months (p < 0.001). The model yielded 77% sensitivity and 95% specificity to detect > or = 1-point improvement in patient satisfaction at 3 months among patients who improved > or = 1 point in the Migraine-ACT score (adjusted odds ratio, 2.63; 95% confidence interval, 1.97-3.51; p < 0.001). CONCLUSIONS: The Migraine-ACT questionnaire is a simple but sensitive and specific tool to predict improvements at 3 months resulting from changes in migraine treatment and can be used to detect patients with suboptimal migraine management and to monitor treatment effectiveness.