Rejected

Few studies have evaluated weight change in patients who initiate medical marijuana treatment to address diagnosed health concerns. The objective of this study was to examine whether patients initiating medical marijuana use for a qualifying health condition experienced changes in health and biopsychosocial functioning over time, including weight gain or loss. Specifically, this observational, longitudinal study evaluated changes in the body mass index (BMI) of adults with co-morbid obesity (body mass index [BMI] ≥ 30 kg/m) and severe obesity (BMI ≥ 40 kg/m) who were starting medical marijuana treatment for any of the 23 qualifying medical conditions at one of three dispensaries in Pennsylvania. Height and weight measurements were collected at baseline (prior to medical marijuana use) and then 90 days (± 14 days) later. Participants included in analyses (n = 52, M = 55.0 ± 13.6 years, 59.6% female) had a mean baseline BMI of 36.2 ± 5.4 kg/m and the majority sought medical marijuana for chronic pain (73.1%). No significant change in BMI was observed from baseline to month three (p > 0.05) in the sample. Additionally, no significant change in BMI was observed in the subset of patients with severe obesity (n = 12, p > 0.05). Our findings are limited by low follow-up rates and convenience sampling methodology but may help to mitigate weight gain concerns in the context of medical marijuana use.

Glucosamine is a widely used supplement to treat joint pain and osteoarthritis despite inconclusive randomized trial results on its effectiveness. In contrast, observational studies associate glucosamine with significant reductions in mortality and cancer incidence. We evaluated the extent of bias, particularly selection bias, to explain these surprising beneficial effects.

The purpose of this study was to evaluate the relationship between the lunar cycle and attacks observed in patients diagnosed with migraine and under follow-up in our pediatric neurology clinic.

We present a case of thyroid storm precipitated by discontinuation of antithyroid drugs. The patient developed a concurrent acute coronary event during the resolution period of the thyroid storm. After 48 hours of prudent management of thyroid storm, the patient's sensorium and haemodynamics were stabilised but he had persistent mild chest discomfort and developed new-onset jaw pain. On admission, ECG showed sinus tachycardia. In consideration of persistent mild chest discomfort and new-onset jaw pain, serial ECGs were performed which revealed biphasic T waves in V2-V3 suggestive of Wellens' syndrome type A. This indicated a critical stenosis of the left anterior descending (LAD) coronary artery and impending myocardial ischaemia. The patient underwent urgent coronary catheterisation, which revealed 80% stenosis of proximal LAD and was subsequently revascularised resolving his symptoms. This case underscores the significance of serial ECG monitoring even after the acute phase of thyroid crisis, which helped in timely identification of Wellens' syndrome.

To estimate the associations of physical activity (PA) levels with migraine subtypes.

The lumbar puncture (LP) is a common procedure in the pediatric emergency department. A retrospective review was conducted of patients who had LPs from 2012 to 2016 at 2 children's hospitals to (1) characterize medication use during the pediatric LP and (2) test the hypothesis that varied medication use influences LP outcome. Outcomes were defined as unsuccessful if the LP was documented as unsuccessful, had a cerebrospinal fluid (CSF) red blood cell (RBC) count >400 cells/µL, or if a second LP was performed within 24 hours. In total, 8463 patients were reviewed and 2806 (33%) were included in the study. We noted significant variation in LP medication use. When adjusted for patient demographics, location, weight, position, and provider experience, our regression model revealed that the use of fentanyl, ketamine, nitrous oxide, and propofol were best associated with LP success. These data suggest the need for a standardized LP medication protocol as provider choice in medication significantly influences LP outcome.

To describe real-world baseline characteristics and patient-reported outcomes (PROs) at 6- and 12-month follow-up visits among patients with psoriasis who initiated and maintained secukinumab, stratified by prior exposure to biologics.

To illustrate the possibility of spontaneous involution of a pineal cyst, justifying an initial observation strategy in patients without evident mass effect.

Migraine is a common, neurovascular headache disorder with a complex molecular interplay. The involvement of ion channels in the pathogenesis of migraine gathered considerable attention with the findings that different ion channels subfamilies are expressed in trigeminovascular system, the physiological substrate of migraine pain, and several ion channel openers investigated in clinical trials with diverse primary endpoints caused headache as a frequent side effect. High-conductance (big) calcium-activated potassium (BK ) channel is expressed in the cranial arteries and the trigeminal pain pathway. Recent clinical research revealed that infusion of BK channel opener MaxiPost caused vasodilation, headache and migraine attack. Thus, BK channel is involved in pathophysiological mechanisms underlying headache and migraine, and targeting BK channel presents a new potential strategy for migraine treatment.