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Background - Migraine is one of the common causes of recurrent headaches. Botulinum toxin type A (Botox®) is a neurotoxin produced by Clostridium botulinum that paralyzes nerves. The purpose of this study was to evaluate the efficacy of pericranial Botox® administration in migraine headache in patients attending a tertiary eye care centre. Method - A prospective, non-randomized study consisting of 54 patients was performed. Subjects were candidates who either sought Botox® treatment for hyperfunctional facial lines with concomitant headache or candidates for Botox® treatment specifically for headaches. Headaches were classified based on International Headache Society criteria. Botox® was injected into the glabellar, temporal, frontal, and/or suboccipital regions of the head and neck. Patients were treated every three months, with a maximum of three sessions. Botox dosage ranged from 75 - 155 Units per patient. Main outcome measures were relief from migraine headache symptoms, reduction of headache severity and duration of symptom free period. Age ranged from 18 to 65 (mean 34.6±6.5) years. Among 54 subjects treatedResults - prophylactically, complete response (symptom elimination) was noted in 31 (57.40%) with a mean {Standard deviation – (SD)} response duration of 4.3 (2.4) months; 16 (29.62%) reported partial response (?50% reduction in headache frequency or severity) with a mean (SD) response duration of 2.5 (1.7) months. 7 (12.96%) reported no response. No systemic adverse effects were reported. Botox® is found to be a safe and effective therapy for prophylacticConclusion - treatment of migraine.
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Rheumatic diseases, a typical kind of autoimmune disease, are often treated with glucocorticoids, immunosuppressants, biological agents, and small-molecule targeted drugs, which often leads to immune dysfunction in patients and increases the risk of activation of latent tuberculosis infection. To regulate the screening, diagnosis, and prophylactic treatment of latent tuberculosis infection in patients with rheumatic diseases, reduce the risk of developing active tuberculosis and improve the prognosis, Peking University Shenzhen Hospital, Shenzhen Third People′s Hospital and Peking Union Medical College Hospital jointly organized domestic experts in the field of rheumatology and tuberculosis to establish the expert consensus on the diagnosis and treatment of latent tuberculosis infection in patients with rheumatic diseases. This consensus focuses on epidemiology, the importance of screening, screening methods, and prophylactic anti-tuberculosis treatment strategies for latent tuberculosis infection combined with rheumatic diseases.
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ABSTRACT Objective The main goal of this study was to correlate migraine improvement, after prophylactic therapy, with cortical thickness changes. Methods Cortical thickness maps were obtained with magnetic resonance imaging (MRI) from 19 patients with migraine before (first scan) and after (second scan) prophylactic treatment, and these were compared with controls using the FreeSurfer MRI tool. Cortical changes were correlated with the headache index (HI). Results Anincrease incortical thickness was found in the right cuneus and precuneus, somatosensory and superior parietal cortices in both patient scans, compared with the controls. No changes were observed in the left hemisphere. Following correction for multiple comparisons, no areas changed from the first to the second scan. Regression analysis showed a significant negative correlation between the HI improvement and cortical thickness changes in the left posterior cingulate, a region involved with nociception and, possibly, the development of chronic pain. Conclusion There were changes in cortical thickness in patients with migraine relative to controls in areas involved with vision and pain processing. Left posterior cingulate cortical changes correlated with headache frequency and intensity.
RESUMO Objetivos Correlacionar a melhora de pacientes enxaquecosos após tratamento preventivo com alterações na espessura do córtex cerebral. Métodos Espessura cortical foi determinada a partir de imagens de ressonância magnética (RM)em 19 pacientes com enxaqueca, antes (1ᵃ RM) e após (2ᵃ RM) o tratamento profilático, e comparada com controles, usando o programa FreeSurfer. Mudanças corticais foram correlacionadas com o índice de cefaleia (HI). Resultados O hemisfério direito apresentou aumento da espessura no córtex do cúneus e pré-cúneus, parietal superior e somatossensitivo na primeira RM e na segunda RM, em comparação aos controles. Após correção para comparações múltiplas, nenhuma região cortical se mostrou estatisticamente diferente entre a primeira e a segunda RM. A regressão mostrou correlação (negativa) significativa entre melhora do HI e mudanças na espessura cortical do cíngulo posterior esquerdo. Conclusão Existem alterações de espessura cortical em pacientes com enxaqueca em relação a controles em áreas envolvidas com processamento visual e com a dor. As alterações corticais no cíngulo posterior esquerdo variaram de acordo com a frequência e intensidade das crises.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Gyrus Cinguli/pathology , Migraine Disorders/pathology , Migraine Disorders/prevention & control , Organ Size , Reference Values , Severity of Illness Index , Magnetic Resonance Imaging/methods , Case-Control Studies , Monte Carlo Method , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Post-Exposure Prophylaxis/methods , Gyrus Cinguli/diagnostic imaging , Migraine Disorders/diagnostic imagingABSTRACT
Febrile seizures is one of the most common neurological diseases in childhood and the most common reason of convulsions. Although most of the convulsions have a good prognosis, prolonged febrile seizures can lead to hypoxic ischemic brain injury and influence the long-term intellectual development if the convulsions are repeated. It will lead to cognitive abilities, learning and memory decline, and even become the pathophysiological etiology of intractable epilepsy. Therefore,it has been became a great concern due to its serious impact on the quality of the child′s life. How to safely and effectively prevent the onset of febrile seizures has been an important task in pediatric clinical work. At present,there are some variously pre-ventive treatment guidelines or specifications,but it still left a debate about its effect. This article reviewed the progress of the studies on the preventive treatment of febrile seizures,so as to improve the understanding and the level of clinical preventive treatment of febrile seizures of the pediatricians.
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Se realizó un estudio descriptivo, transversal y prospectivo de 96 pacientes, ingresados en la Unidad de Cuidados Intermedios del Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba, desde enero hasta junio del 2012, con vistas a identificar y estratificar los factores de riesgo del tromboembolismo pulmonar, así como el uso del tratamiento profiláctico durante la estadía hospitalaria de los afectados. Se determinaron los factores de riesgo y se estratificaron en: bajo, moderado, alto y muy alto, teniendo en cuenta si tenían indicación o no de algún tipo de tratamiento profiláctico, lo cual se relacionó con la estadía hospitalaria. Se constató que la mayoría de los afectados tenían asociados más de 2 factores de riesgo, tales como encamamiento prolongado, edad superior a 40 años, sepsis y algún tipo de comorbilidad, que permitieron clasificarlos como de riesgo alto o muy alto de tromboembolismo pulmonar; sin embargo, se indicó tratamiento profiláctico en solo la mitad de ellos.
A descriptive, cross-sectional and prospective study of 96 patients, admitted to the Intermediate Care Unit of "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out from January to June 2012, with the objective of identifying and stratifying the risk factors of pulmonary embolism, as well as the use of the prophylactic treatment during the hospital stay of the affected patients. The risk factors were determined and they were stratified in: low, moderate, high and very high, keeping in mind if they had indication or not of some type of prophylactic treatment, which was related to the hospital stay. It was verified that most of the affected patients had more than 2 risk factors associated, such as prolonged bedridding, age higher than 40 years, sepsis and certain comorbidity type, that allowed to classify them as high or very high risk cases of pulmonary embolism; however, prophylactic treatment was indicated just in half of them.
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Background & objectives: Mother-to-child transmission (MTCT) is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART) or prophylactic treatment (PT) to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. Methods: A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. Results: Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/μl) was high compared to the women on ART (289 cells/ μl). At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. Interpretation & conclusions: Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit mother to child HIV transmission.
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A review of the epidemiology of tuberculosis, its contributing risk factors (excluding HIV) and the role of screening latent tuberculosis infection in Malaysia was done. Despite the global and domestic decrease in prevalence rates of tuberculosis in the past decade, there is an alarming increase in the trend of non communicable diseases in the country. High prevalence rates of major risk factors leading to reactivation of tuberculosis were seen within the population, with diabetes mellitus being in the forefront. The rising numbers in the ageing population of Malaysia poses a further threat of re-emergence of tuberculosis in the years to come. Economically, screening of diabetic patients with comorbidities for latent tuberculosis infection (LTBI) using two major techniques, namely tuberculin sensitivity (TST) and Interferon gamma release assay tests (IGRA) could be a viable option. The role of future research in the detection of LTBI in the Malaysian setting might be necessary to gauge the disease reservoir before implementing prophylactic measures for high risk groups involved.
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Chief Physician WANG Hui-reng is one of the second batch of national prestigious TCM experts. He has been engaged in medical services over 40 years and is adept in preventing and treating the chronic obstructive pulmonary disease (COPD) under the direction of prophylactic treatment, which emphasizes the control of risky factors of COPD, striving for protecting the healthy body, preventing the transmission of the disease and the recurrence after healing.
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A Sociedade Brasileira de Cefaléia (SBCe) designou um Comitê Ad Hoc com o propósito de estabelecer um consenso sobre o tratamento profilático da migrânea e de elaborar recomendações para os profissionais da área médica. O Comitê baseou-se em evidências da literatura médica mundial e na experiência pessoal dos integrantes, respeitando-se a realidade dos medicamentos existentes em nosso meio (AU)
The Brazilian Headache Society assigned an Ad Hoc Committee with the purpose of establishing a consensus about prophylactic treatment for migraine and of elaborating recommendations for professionals. The recommendations of the Committee are based in evidences of the world medical literature and on the personal experience of the members, respecting the reality of the existing medication resources in our country (AU)
Subject(s)
Humans , Male , Female , Migraine Disorders/therapy , Societies, Medical , Brazil , Age Factors , Sex Characteristics , Migraine Disorders/prevention & control , Migraine Disorders/drug therapyABSTRACT
PURPOSE: We tried to evaluate the effect of prophylactic treatment with short-term intermittent diazepam or long-term continuous valproate in prenventing the recurrence febrile seizures and compare the efficacy of both drugs. METHODS: Eighty six children who were admitted to the Kwangju Christian Hospital from March, 1997 to July, 1999 with more than three febrile seizures and more than one risk factor were enrolled in our study and followed up for one year. Among them, sixteen belonged to an oral diazepam group and twelve to a valproate group while fifty eight to a control group. We investigated the recurrence rate of each group for the period of a year. RESULTS: In the diazepam group, diazepam(0.3 mg/kg/dose) was administered orally every eight hours during the first febrile day and the recurrence rate was 6.2%. The recurrence rate of the valproate group(17 mg/kg/day, bid) was 25%. Those treatments significantly reduced the recurrence rates of febrile convulsions compared to the untreated control group(74.1%), but no significant differences were found between the two treatment groups in the respect of recurrence rates of febrile seizures. CONCLUSION: Both intermittent diazepam and continuous valproate treatment were equally effective in preventing the recurrence of febrile seizures.
Subject(s)
Child , Humans , Diazepam , Recurrence , Risk Factors , Seizures, Febrile , Valproic AcidABSTRACT
PURPOSE: We conducted randomized study to determine whether high doses (6mg/kg/ day) of iron would exert a more supplemental effect than low doses (3mg/kg/day), and which regimen of recombinant human erythropoietin (rHuEPO) and iron would be more beneficial in the prophylactic treatment of anemia of prematurity. METHODS: We randomly assigned 38 sick premature infants who were more likely than symptom-free premature infants requiring erythrocyte transfusions for infants with anemia of prematurity to receive rHuEPO, 100unit/kg, tiw, subcutaneously, plus iron, 3mg/kg/day, po, daily from the second day of life (group 1), 100unit/kg and 6mg/kg/ day (group 2), 200unit/kg and 3mg/kg/day (group 3), and 200unit/kg and 6mg/kg/day (group 4), respectively. RESULTS: There were no significant differences of hemoglobin levels and iron balances during treatment among all 4 groups. The rates of increase in reticulocyte counts were greater in group 4 and group 2 compared with group 3 and group 1, respectively, though these rates were statistically not significant. The blood volume differences (volume of phlebotomies-volume of transfusions) during treatment were higher in group 4 compared with group 1 (p<0.05). CONCLUSIONS: High doses of iron may be more effective in rapidly increasing reticulocyte counts, and 200unit/kg, tiw of rHuEPO plus 6mg/kg/day of iron is more beneficial in reducing the need for blood transfusions than any other regimen. Therefore the prophylactic treatment of anemia of prematurity and acute blood loss from frequent blood sampling in risky premature infants with rHuEPO, 200unit/kg, tiw, subcutaneously, plus iron 6mg/kg/day, po, daily from the second day of life is effective in reducing the number of blood transfusions. Additional controlled trials utilizing high doses of iron with rHuEPO and larger numbers of patients are justified.
Subject(s)
Humans , Infant , Infant, Newborn , Anemia , Blood Transfusion , Blood Volume , Erythrocyte Transfusion , Erythropoietin , Infant, Premature , Iron , Reticulocyte CountABSTRACT
Objectives: To test whether early prophylactic antidepressant treatment by paroxetine has any beneficial influence on the rate of post-stroke depression (PSD) and rehabilitation of stroke patients. Methods: A randomized, placebo controlled study involved 64 consecutive patients admitted to hospital for an acute stroke; they were treated with placebo, paroxetine (20mg/d) respectively. Before and at the end of the observation, we assessed the rate of PSD and activities of daily living (ADL), degree of neurological deficit (modified Edinburgh-Scandinavia scale, MESS) of all the subjects.Results:At the end of 12-week treatment, the treatment group had lower rate of PSD (10.7%) than control (41.4%); and they had lower score in ADL (27.6?4.8/32.8?4.1) and lower score in MESS (11.1?4.3/13.6?3.2).Conclusion:Prophylactic antidepressant treatment by paroxetine can decrease the rate of PSD and improve the neurological function of post-stroke patients.