Rejected

Nontraumatic convexity subarachnoid hemorrhage (cSAH) is a nonaneurysmal variant that is associated with diverse etiologies.

Immunocompromised patients infected with influenza exhibit prolonged viral shedding and higher risk of resistance. Optimized treatment strategies are needed to reduce the risk of antiviral resistance. This phase IIIb, randomized, double-blind study (NCT00545532) evaluated conventional-dose or double-dose oseltamivir for the treatment of influenza in immunocompromised patients.

To determine which non-narcotic analgesic, acetaminophen (Ofirmev®) or ketorolac (Toradol®), provides better post-operative pain control when combined with an opioid patient-controlled analgesia (PCA) pump. Secondary objectives include comparisons of the rates of ileus, post-operative bleeding, transfusions, and length-of-hospitalization (LOH).

A new generation of cardiac implantable devices, known as Closed Loop Stimulation pacemakers, are now utilized to reduce episodes of bradycardia, syncope, and tachycardia in pregnant women. The device functions differently than conventional pacemakers by responding to changes in the patient`s cardiac output and heart rate based on physiologic demands and acute mental stress. Increased metabolic demands, including physiologic stress often accompany pregnancy, labor, and delivery. The Certified Registered Nurse Anesthetist providing analgesia and anesthesia for the laboring patient with CLS pacemaker may encounter rapid changes in heart rates, initiation of pacing modes, and hypotension resulting from reduced cardiac outputs. The ability to differentiate and diagnose the causes of hemodynamic changes and provide appropriate interventions is essential to optimize maternal and fetal outcomes. This case report details the anesthetic management of a laboring twenty-five-year-old primigravida with an implantable CLS pacemaker secondary to a history of third degree heart block, cardiac ablation after supraventricular tachycardia, and seizures. The parturient experienced intermittent pacing after neuraxial analgesia. Anticipation of the CLS pacemaker's response to the parturient's physiological and emotional response during the labor process will be discussed including recommendations to optimize maternal and fetal outcomes.

Endorphins are endogenous morphine, neuropeptides, produced in the pituitary gland in response to stress and pain. There are three types of endorphins beta-endorphins, enkephalins, and dynorphins binds to mu, kappa, and delta receptors situated on nervous system and immune cells. Cancer is a major threat to mankind killing millions of people around the world annually. There has been recent advancements in the field of surgery, chemotherapy, and radiotherapy, still the prognosis of cancer patients not improved much with increasing morbidity. We can't kill cancer cells without killing normal cells. Cancer cells and normal cells work alike. The aim of the review was to determine the anticancer activities of beta-endorphins.

A great deal of literature has drawn attention to the "complex Chiari," wherein the presence of instability or ventral brainstem compression prompts consideration for addressing both concerns at the time of surgery. This report addresses the clinical and radiological features and surgical outcomes in a consecutive series of subjects with hereditary connective tissue disorders (HCTD) and Chiari malformation. In 2011 and 2012, 22 consecutive patients with cervical medullary syndrome and geneticist-confirmed hereditary connective tissue disorder (HCTD), with Chiari malformation (type 1 or 0) and kyphotic clivo-axial angle (CXA) enrolled in the IRB-approved study (IRB# 10-036-06: GBMC). Two subjects were excluded on the basis of previous cranio-spinal fusion or unrelated medical issues. Symptoms, patient satisfaction, and work status were assessed by a third-party questionnaire, pain by visual analog scale (0-10/10), neurologic exams by neurosurgeon, function by Karnofsky performance scale (KPS). Pre- and post-operative radiological measurements of clivo-axial angle (CXA), the Grabb-Mapstone-Oakes measurement, and Harris measurements were made independently by neuroradiologist, with pre- and post-operative imaging (MRI and CT), 10/20 with weight-bearing, flexion, and extension MRI. All subjects underwent open reduction, stabilization occiput to C2, and fusion with rib autograft. There was 100% follow-up (20/20) at 2 and 5 years. Patients were satisfied with the surgery and would do it again given the same circumstances (100%). Statistically significant improvement was seen with headache (8.2/10 pre-op to 4.5/10 post-op, p < 0.001, vertigo (92%), imbalance (82%), dysarthria (80%), dizziness (70%), memory problems (69%), walking problems (69%), function (KPS) (p < 0.001). Neurological deficits improved in all subjects. The CXA average improved from 127° to 148° (p < 0.001). The Grabb-Oakes and Harris measurements returned to normal. Fusion occurred in 100%. There were no significant differences between the 2- and 5-year period. Two patients returned to surgery for a superficial wound infections, and two required transfusion. All patients who had rib harvests had pain related that procedure (3/10), which abated by 5 years. The results support the literature, that open reduction of the kyphotic CXA to lessen ventral brainstem deformity, and fusion/stabilization to restore stability in patients with HCTD is feasible, associated with a low surgical morbidity, and results in enduring improvement in pain and function. Rib harvest resulted in pain for several years in almost all subjects.

To analyze the clinical characteristics of a long-term follow-up of patients with chronic and high frequency episodic migraine in treatment with OnabotulinumtoxinA.

Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus thrombosis (CVST). As few CVST patients with SLE have been reported, little is known regarding its frequency as an underlying etiology, clinical characteristics, or long-term outcome. We evaluated a large cohort of CVST patients with SLE in a multicenter study of cerebral venous thrombosis, the VENOST study, and their clinical characteristics.

The symptoms of chronic urticaria, be it chronic spontaneous urticaria (CSU) or chronic inducible urticaria (CindU), are mediated primarily by the actions of histamine on H -receptors located on endothelial cells (the wheal) and on sensory nerves (neurogenic flare and pruritus). Thus, 2 generation H -antihistamines (sgAHs) are the primary treatment of these conditions. However, many patients are poorly responsive to licensed doses of antihistamines. In these patients, the current EAACI/GA LEN/EDF/WAO guideline for urticaria suggests updosing of sgAHs up to 4-fold. However, such updosing is off label and the responsibility resides with the prescribing physician. Therefore, the safety of the drug when used above its licensed dose is of paramount importance. An important aspect of safety is potential cardiotoxicity. This problem was initially identified some 20 years ago with cardiotoxic deaths occurring with astemizole and terfenadine, two early sgAHs. In this review we discuss the mechanisms and assessments of potential cardiotoxity of H1-antihistamines when updosed to four-times their licensed dose. In particular, we have focused on the potential of H1-antihistamines to block hERG (human Ether-a-go-go-Related Gene) voltage-gated K+ channels, also known as Kv11.1 channels according to the IUPHAR classification. Blockade of these channels causes QT prolongation leading to torsade de pointes that may possibly degenerate into ventricular fibrillation and sudden death. We considered in detail bilastine, cetirizine, levocetirizine, ebastine, fexofenadine, loratadine, desloratadine, mizolastine and rupatadine and conclude that all these drugs have an excellent safety profile with no evidence of cardiotoxicity even when updosed up to four times their standard licensed dose, provided that the prescribers carefully consider and rule out potential risk factors for cardiotoxicity, such as the presence of inherited long QT syndrome, older age, cardiovascular disorders, hypokalemia and hypomagnesemia, or the use of drugs that either have direct QT prolonging effects or inhibit sgAH metabolism.

Canine acute eosinophilic dermatitis with oedema (CAEDE) and sterile neutrophilic dermatosis have overlapping clinical and histopathological features.