Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Κυριακή 26 Αυγούστου 2018

Is Medication Overuse Drug Specific or Not? Data from a Review of Published Literature and from an Original Study on Italian MOH Patients

Abstract

Purpose of Review

The aim is twofold. First, to give an insight on the role exerted by different classes of drugs in favouring migraine chronification. Second, to explore the relationship between type and amount of overused medications and history of previous withdrawal treatment and of frequent relapses.

Recent Findings

All drug classes were found to favour migraine chronification. No data are available for the association with relapses into CM-MOH. Our clinical study shows that patients who underwent previous withdrawal treatments were more likely to be overusers of multiple drug classes and overuse higher amounts of symptomatic medications, particularly, indomethacin, eletriptan and tramadol. Frequent relapsers were more likely to be overusers of opioids or ergotamine and caffeine derivates or of multiple classes, particularly acetylsalicylic acid and ergotamine/caffeine derivates.

Summary

The joint results our review and clinical study do not seem to support the idea that MOH is drug-specific: rather, it points out that all drug classes may induce migraine chronification. Those drugs which are at higher risk of overuse are among those preferred by the "worst" patients, i.e. those who needed one or more withdrawal treatments for MOH. Our results reinforce the clinical impression that patients with CM and MOH, and particularly the most difficult to treat for their poor response to withdrawal treatments, are characterised by a particular drive towards the consumption of "whatever is likely to be perceived to provide some relief", despite these drugs that are perceived as "more powerful", are often indicated as second- or third-line medications.



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The Evolving Landscape of Acute Pain Management in the Era of the Opioid Crisis

Abstract

Purpose of Review

The purpose of the study is to evaluate and analyze the role of both opioid and non-opioid analgesics in the emergency department (ED).

Recent Findings

Studies have shown that the implementation of opioid-prescribing policies in the ED has the potential to reduce the opioid addiction burden. Clinical studies point to inconsistencies in providers' approach to pain treatment. In this review, we discuss specific aspects of opioid utilization and explore alternative non-opioid approaches to pain management.

Summary

Pain is the most common reason patients present to the ED. As such, emergency medicine (EM) providers must be well versed in treating pain. EM providers must be comfortable using a wide variety of analgesic medications. Opioid analgesics, while effective for some indications, are associated with significant adverse effects and abuse potential. EM providers should utilize opioid analgesics in a safe and rational manner in an effort to combat the opioid epidemic and to avoid therapeutic misadventures. EM providers should be aware of all of their therapeutic options, e.g., opioid and non-opioid, in order to provide effective analgesia for their patients, while avoiding adverse effects and minimizing the potential for misuse.



https://ift.tt/2PEeQLH

Naloxone Academic Detailing: Role of Community Outreach Teaching

Abstract

Purpose of Review

Testing the efficacy of academic detailing in improving the practice of prescribing naloxone for patients on high-dose opioids.

Recent Findings

Academic detailing has been identified as an effective method for improving health care practices through focused community education.

Summary

We found that academic detailing is an effective method in improving health care providers' knowledge about the importance of prescribing naloxone for patients on high-dose opioids. We also found that prescribers prescribed more naloxone after our education program. This study reflects the importance of education and academic detailing in resolving health problems. Academic detailing can provide effective preventive tools that can reduce the incidence of health problems we encounter.



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Thoracic endovascular aortic repair with perioperative antibiotic therapy for infected ductus arteriosus aneurysm in an adult

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Abstract
Ductus arteriosus aneurysm (DAA) is rare in adults, but often involves life-threatening complications. Open repair is common, but is invasive and relatively dangerous. With the continued development of endovascular devices, we can now choose endovascular repair for DAA. However, endovascular repair for infected lesion is controversial. We report a successful case of thoracic endovascular aortic repair with perioperative antibiotic therapy for infected DAA in a 59-year-old man.

https://ift.tt/2MCgHD3

Retrograde embolization of anterior tibial artery for an iatrogenic arterio-venous fistula causing left lower extremity claudication

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Abstract
Lower extremity angiogram is generally a safe and effective procedure with a low rate of vascular complications. We report here a unique case of a 33-year-old female with anterior tibial artery (ATA) to anterior tibial vein fistula formation after lower extremity endovascular intervention. This was initially treated with open repair of the fistula and ligation of ATA. However, patient continued to complain of claudication like symptoms. Patient subsequently had an endovascular embolization of ATA in a retrograde fashion. Recovery was unremarkable; patient was discharged home same day. Three months postoperatively patient denies leg pain, a follow-up arterial duplex failed to show presence of arterio-venous fistula. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after lower extremity endovascular intervention.

https://ift.tt/2P8Fk6R

Urgent Repositioning After Venous Air Embolism During Intracranial Surgery in the Seated Position: A Case Series

Background: Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. Methods: Patients undergoing a neurosurgical procedure in the seated position at a single institution between January 2000 and October 2013 were identified. Corresponding medical records, neurosurgical operative reports, and computerized anesthetic records were searched for intraoperative VAE diagnosis. Extreme VAE was defined as a case in which urgent seated to level position change was performed for patient safety. Detailed examples of extreme VAE cases are described, including their intraoperative course, VAE management, and postoperative outcomes. Results: There were 8 extreme VAE (0.47% incidence), 6 during suboccipital craniotomy (1.5%) and 2 during deep brain stimulator implantation (0.6%). VAE-associated end-expired CO2 and mean arterial pressure reductions rapidly normalized following position change. No new neurological deficits or cardiac events associated with extreme VAE were observed. In 5 of 8, surgery was completed. Central venous catheter placement and aspiration during VAE played no demonstrable role in patient outcome. Conclusions: Extreme VAE during seated intracranial neurosurgical procedures is infrequent. Extreme VAE-associated CO2 exchange and hemodynamic consequences from VAE were transient, recovering quickly back to baseline without significant neurological or cardiopulmonary morbidity. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Arnoley S. Abcejo, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 200 1st St SW, Rochester, MN 55905 (e-mail: Abcejo.Arnoley@mayo.edu). Received April 11, 2018 Accepted July 19, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Effects of nasal dilator strips on subjective measures of sleep in subjects with chronic nocturnal nasal congestion: a randomized, placebo-controlled trial

This exploratory study investigated effects of a new asymmetric butterfly-shaped prototype nasal dilator strip and the currently marketed clear Breathe Right Nasal Strip (BRNS) on subjective measures of nasal ...

https://ift.tt/2Lu783t

Overexpressed fibulin‐3 contributes to the pathogenesis of psoriasis by promoting angiogenesis

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2wnqhyw

Topical silymarin versus hydroquinone in the treatment of melasma: A comparative study

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2MQlIqI

Nitrogen plasma skin regeneration for the treatment of mild‐to‐moderate periorbital wrinkles: A prospective, randomized, controlled evaluator‐blinded trial

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2LscHPO

Split‐face comparison study of transcutaneous pneumatic injection therapy with isotonic and hypertonic glucose solutions

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2MUD8m3

Formulation and characterization of a Helianthus annuus ‐ alkyl polyglucoside emulsion cream for topical applications

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2LvPFYq

Reduction of abdominal skin laxity in women postvaginal delivery using the synergistic emission of radiofrequency and targeted pressure energies

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2MU7tBb

Ultrasound evaluation of arterial anastomosis of the forehead

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2LtRJjF

Comparative study of fractional Erbium: YAG laser vs combined therapy with topical steroid as an adjuvant treatment in melasma

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2MRratf

Chordoma: a case series and review of the literature

Chordoma is a rare malignant tumor of the skull base and axial skeleton, with an incidence of less than 0.1/100,000 per year. Patients with advanced chordoma have a poor prognosis due to locoregional recurrenc...

https://ift.tt/2MvSC0m

Checkpoint inhibition in the treatment of multiple myeloma: A way to boost innate-like T cell anti-tumor function?

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Koen Venken, Mérédis Favreau, Djoere Gaublomme, Eline Menu, Karin Vanderkerken, Dirk Elewaut

Abstract

Multiple myeloma (MM) is a progressive monoclonal B cell malignancy, for which survival and progression largely relies on the crosstalk of tumor cells with the bone marrow (BM) microenvironment, inducing immune escape, angiogenesis, bone destruction and drug resistance. Despite great therapeutic advances, most of the MM patients still relapse and remain incurable. Over the past years, immunotherapy has emerged as a new field in cancer therapy. Here, the immune cells of the patients themselves are activated to target the tumor cells. In MM, several effector cells of the immune system are present in the BM microenvironment; unfortunately, they are mostly all functionally impaired. In this review, we focus on the role of innate-like T cells in MM, particularly CD1d- and MR1- restricted T cells such as respectively invariant natural killer T (iNKT) cells and mucosal associated invariant T (MAIT) cells. These cells have the capacity upon activation to rapidly release copious amounts of cytokines affecting a wide range of innate and adaptive immune responses, and could therefore play a key protective role in anti-tumor immunity. We describe recent observations with regard to functional exhaustion of iNKT and MAIT cells in MM pathology and discuss the potential application of checkpoint inhibition as an attractive target for prolonged activation of these immunomodulatory T cells in the treatment of MM.



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Recovery of atrophic parotid glands in rats fed a liquid diet by switching to a pellet diet

Publication date: Available online 25 August 2018

Source: Archives of Oral Biology

Author(s): Shigeru Takahashi, Rui Takebuchi, Hiroto Taniwaki, Takanori Domon

ABSTRACT
Objective

In this study, we aimed to clarify how parotid glands, made atrophic by a liquid diet, recover after diet change.

Design

Seven-week-old male Wistar rats were fed a pellet (control group) or a liquid diet (experimental group) for the first 14 days. Thereafter, all animals were fed a pellet diet for up to 14 days (days 0-14). The parotid glands were removed, weighed and examined histologically and ultrastructurally. Immunohistochemistry was performed for BrdU, a marker of proliferating cells, and Casp-3, a marker of apoptotic cells.

Results

Feeding of a liquid diet for 14 days induced atrophy of the parotid glands. Histologically, acinar cells were small on day 0, compared with the control group. After changing the diet from liquid to pellet form, acinar cells increased in size over time, recovering nearly fully by day 7. Many BrdU-positive acinar cells were observed in the glands in the experimental group on days 1 and 3. Although more acinar cells were Casp-3-positive compared with the control group on day 0, there was no difference between the two groups after the diet change. Ultrastructurally, the cellular organelles did not exhibit a substantial alteration, except for an increase in secretory granules following diet change.

Conclusions

Our findings suggest that atrophic parotid glands are able to recover to their normal size by switching the diet from liquid to pellet form and that an increase in both the size and number of acinar cells plays an important role in this recovery process.



https://ift.tt/2NhXG4V

Recovery of atrophic parotid glands in rats fed a liquid diet by switching to a pellet diet

Publication date: Available online 25 August 2018

Source: Archives of Oral Biology

Author(s): Shigeru Takahashi, Rui Takebuchi, Hiroto Taniwaki, Takanori Domon

ABSTRACT
Objective

In this study, we aimed to clarify how parotid glands, made atrophic by a liquid diet, recover after diet change.

Design

Seven-week-old male Wistar rats were fed a pellet (control group) or a liquid diet (experimental group) for the first 14 days. Thereafter, all animals were fed a pellet diet for up to 14 days (days 0-14). The parotid glands were removed, weighed and examined histologically and ultrastructurally. Immunohistochemistry was performed for BrdU, a marker of proliferating cells, and Casp-3, a marker of apoptotic cells.

Results

Feeding of a liquid diet for 14 days induced atrophy of the parotid glands. Histologically, acinar cells were small on day 0, compared with the control group. After changing the diet from liquid to pellet form, acinar cells increased in size over time, recovering nearly fully by day 7. Many BrdU-positive acinar cells were observed in the glands in the experimental group on days 1 and 3. Although more acinar cells were Casp-3-positive compared with the control group on day 0, there was no difference between the two groups after the diet change. Ultrastructurally, the cellular organelles did not exhibit a substantial alteration, except for an increase in secretory granules following diet change.

Conclusions

Our findings suggest that atrophic parotid glands are able to recover to their normal size by switching the diet from liquid to pellet form and that an increase in both the size and number of acinar cells plays an important role in this recovery process.



https://ift.tt/2NhXG4V

Chronic hepatitis C virus infection on patients with nonoropharyngeal head and neck cancers

Publication date: Available online 25 August 2018

Source: Oral Oncology

Author(s): Georgios Angelidakis, Erich M. Sturgis, Minas P. Economides, Ying Jiang, Harrys A. Torres



https://ift.tt/2BOaeQl

Tocilizumab for the Treatment of Mevalonate Kinase Deficiency

Mevalonate kinase deficiency (MKD) is a severe autoinflammatory disease caused by recessive mutations in MVK resulting in reduced function of the enzyme mevalonate kinase, involved in the cholesterol/isoprenoid pathway. MKD presents with periodic episodes of severe systemic inflammation, poor quality of life, and life-threatening sequelae if inadequately treated. We report the case of a 12-year-old girl with MKD and severe autoinflammation that was resistant to IL-1 and TNF-α blockade. In view of this, she commenced intravenous tocilizumab (8 mg/kg every 2 weeks), a humanised monoclonal antibody targeting the IL-6 receptor (IL-6R) that binds to membrane and soluble IL-6R, inhibiting IL-6-mediated signaling. She reported immediate cessation of fever and marked improvement in her energy levels following the first infusion; after the fifth dose, she was in complete clinical and serological remission, now sustained for 24 months. This is one of the first reported cases of a child with MKD treated successfully with tocilizumab and adds to the very limited experience of this treatment for MKD. IL-6 blockade could therefore be an important addition to the armamentarium for the treatment of this rare monogenic autoinflammatory disease.

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A new cover – reflecting a move forward for our Journal

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1399-1400, September 2018.


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Forthcoming Events

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1614-1614, September 2018.


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Pioneers in dermatology and venereology: an interview with Prof. Malcolm Greaves

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1408-1409, September 2018.


https://ift.tt/2BIRfXj

In the future, ‘new’ categories in the evaluation of pressure ulcers should be considered

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1406-1407, September 2018.


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Announcement

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1615-1615, September 2018.


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Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1393-1398, September 2018.


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Cutaneous infection – would you think of algae?

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 9, Page 1401-1402, September 2018.


https://ift.tt/2BNfzr5

Olfactory implant: Demand for a future treatment option in patients with olfactory dysfunction

The Laryngoscope, EarlyView.


https://ift.tt/2wehOyf

“My Dog Deafened Me!”: Case Report of Capnocytophaga canimorsus Infection and Literature Review

The Laryngoscope, EarlyView.


https://ift.tt/2P77JKK

FoxO1 enhances differentiation and apoptosis in human primary keratinocytes

Experimental Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2P698ku

Terbinafine‐induced generalized pustular psoriasis in a patient carrying CARD14 mutation

The Journal of Dermatology, EarlyView.


https://ift.tt/2ockh7S

Telangiectatic mastocytosis versus telangiectasia macularis eruptiva perstans

The Journal of Dermatology, EarlyView.


https://ift.tt/2BLXhGx

Immunological dysfunction in chronic arsenic exposure: From subclinical condition to skin cancer

The Journal of Dermatology, EarlyView.


https://ift.tt/2o8XdHl

Serum 5‐S‐cysteinyldopa behavior in the early phase of nivolumab treatment of 12 melanoma patients

The Journal of Dermatology, EarlyView.


https://ift.tt/2BNhWtS

Two cases of pemphigus vulgaris in remission showing high titer of anti‐desmoglein 3 antibodies

The Journal of Dermatology, EarlyView.


https://ift.tt/2oa97R5

Japanese case of Bothnian‐type palmoplantar keratoderma with a novel missense mutation of p.Trp35Ser in extracellular loop A of aquaporin‐5

The Journal of Dermatology, EarlyView.


https://ift.tt/2BPaQ8m

Onychomycosis caused by Aspergillus subramanianii

The Journal of Dermatology, EarlyView.


https://ift.tt/2PFi0yM

Case of adult‐onset Still's disease with psoriasiform eruptions

The Journal of Dermatology, EarlyView.


https://ift.tt/2NhItAJ