The use of the monoclonal antibody Erenumab in patients with chronic migraine in real clinical experience

Patients with chronic migraine are characterized by frequent severe headache attacks, polypharmacy (painkillers), insufficient effect of preventive therapy, and a decrease in the quality of life. The aim of a prospective open-label study was the evaluation of the efficacy and tolerance of Erenumab (Irinex) in the treatment of patients with chronic migraine in real clinical practice.Material and methods. 48 patients with chronic migraine were clinically and neurologically examined (35.5 [19; 56]; diagnosis was established according to the criteria of ICHD classification and diagnosis of migraine. Medical monitoring period was 3 months. Clinical and neurological testing and subcutaneous administration of Erenumab (Irinex) 70 mg were performed once a month during the whole period.Results. Safety, good tolerance and an obvious significant clinical effect were noted when using Erenumab (Irinex) 70 mg. It led to a significant improvement in clinical score and the course of chronic migraine, the effectiveness of rapid relief of symptoms and significant reduction in the need for painkillers in most patients. The best results were found after 3 months of therapy.

Lactose versus Lactose Free Regimen in Children with Acute Diarrhea

BACKGROUND: Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood, and it is one of the most important causes of morbidity and mortality in children. AIM: Assessment of lactose-free formula effect in nutritional treatment in formula-fed children with acute diarrhea. PATIENTS AND METHODS: A cross-section interventional study carried out on 60 formula-fed children, under two years, referring with acute diarrhea, 30 children obtain lactose-free formulation and 30 children with no lactose-containing formula. According to the period of diarrheal stop and weight, changes compering two groups. RESULTS: Thirty-two males and 28 females children (7.25 ± 5.1 months) included. Children with lactose-free formula had a significantly slighter dated to diarrhea relief compared with control group children (p < 0.01). No variance between two groups in weight change (6.9 ± 3.03 vs. 7.05 ± 3.07 kg, p = 0.2). (46.6%) of patients on Lactose free formula were discharged on the third post admission day, lactose-free formula has more effective recovery to those on cow milk formula (4.1 ± 1.2 vs. 6 ± 1.3 days, p < 0.01 significant). CONCLUSION: Quick giving of lactose-free formulation to children on formula feeding show rapid relief of acute diarrhea.

Congenital hypopituitarism with monosomy of chromosome 18

Congenital hypopituitarism is a rare disease. It can be caused by isolated inborn defects of the pituitary, gene mutations (PROP1, PIT1), and chromosomal abnormalities.Deletions of chromosome 18 (De Grouchy syndrome types 1 and 2) are a group of rare genetic diseases with a frequency of 1:50,000. Hypopituitarism in these syndromes is detected in from 13 to 56% of cases and depends on the size and location of the deleted segment.We have described a series of clinical cases of patients with congenital hypopituitarism due to deletions in chromosome 18. All children had a characteristic dysmorphic features and delayed mental and speech development. Within first months of life, patients developed muscular hypotension, dysphagia, and respiratory disorders. The patients had various congenital malformations in combination with hypopituitarism (isolated growth hormone deficiency and multiple pituitaryhormone deficiencies). In the neonatal period, there were the presence of hypoglycemia in combination with cholestasis.Hormone replacement therapy led to rapid relief of symptoms.Сhromosomal microarray analysis in 2 patients allowed us to identify exact location of deleted area and deleted genes and optimize further management for them.

Comparative effectiveness of flea allergic dermatitis treatment regimens in dogs and cats

The article discusses the influence of external factors on the degree of risk of infection with flea allergic dermatitis among pets. Studied modern veterinary drugs that can be used to treat and prevent flea allergic dermatitis caused by flea lesions. Also, effective regimens for the treatment and prevention of flea allergic dermatitis have been drawn up. It was found that the preparation in the form of a collar is less effective than preparations in the form of "Spot-on". A flea collar is also less effective in dogs with thick coats. The drug in the form of "Spot-on" contact action begins to act after 12 hours, in contrast to the collar, which begins to act in full force after two days. The peculiarity of the form of release of the drug "Spot-on" allows it to evenly disperse on the skin of the animal and prevent a flea bite. This leads to rapid relief of itching and excludes new scratching. The tablet form does not fully protect against flea bites, which leads to a new outbreak of dietary supplements in the animal. The use of Spot-on drops in one of the group of subjects and the collar in the other group increased the effect of protection against flea bites and reduced the risk of developing dietary supplements in dogs. For cats, it is recommended to regularly treat fleas with the Spot-on contact action drug, the effectiveness of which has been proven by a decrease in the number of fleas in animals after the first day of treatment, in contrast to the form of release of the drug in the form of a collar. Droplet formulations in cats have also been shown to reduce itching and scratching.

Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial

Background: Total sleep deprivation (TSD) combined with bright light therapy (BLT) has been suggested as a valuable add-on to standard treatment for rapid relief of depression. However, there is a lack of randomized controlled trials in real-life clinical settings. The aim of this pragmatic randomized clinical trial was to investigate the effectiveness, acceptance, and feasibility of TSD combined with BLT as add-on to standard treatment for depression in a real-life clinical setting.Methods: Thirty-three inpatients were randomly assigned to either: a) an intervention group receiving a single-night TSD followed by 6 days BLT (10.000 lux, 30 min/day) as add-on to standard treatment; or b) a control group receiving a short sleep-hygiene consultation in addition to standard treatment. The follow-up period was 1 week.Results: No statistical differences were found in response rates, reduction of depressive and insomnia symptoms, length of stay, readmission rate, and clinical improvement. Both groups reported positive experiences toward the received treatment with low drop-out rates.Conclusions: One-night TSD followed by BLT was not effective as a rapid relief for depression at 1-week follow-up; however, the treatment was feasible and well-tolerated.

Hypertensic crisis — clinical interpretation of the term

The term «hypertensic crisis» is used to describe a condition that develops over time, and the outcomes depend on both, timing and completeness of medical care and the initial clinical status of the patient. The term «uncontrollable arterial hypertension» in ESC and RSC recommendations (2018–2020) cannot replace the concept of “uncomplicated HC” completely . It is advisable to adhere to the recommendations of the Russian Medical Society for Arterial Hypertension (RMSAH) developed in 2019, in which the division into complicated and uncomplicated HC still remains. In clinical practice, three variants of a signifi cant increase in blood pressure in patients with arterial hypertension should be distinguished: an isolated increase in blood pressure, uncomplicated and complicated HC. It is necessary to stratify patients with uncomplicated HC according to the degree of risk of cardiovascular complications development in order to determine the indications for their hospitalization. The rapid relief of a significant increase in blood pressure should lead to a safe level of patient’s pressure, taking into account the risk of hypotension and hypoperfusion of vital organs and systems.

Acute proptosis secondary to bilateral pansinus mucopyocele with orbital compartment syndrome: a rare presentation, its management and outcome

A 37-year-old Indian female presented with forward protrusion of left eye for one week, associated with progressive diminution of vision. The patient had undergone sinus surgery for nasal polyposis a year ago. On examination, there was severe proptosis and limitation of extraocular movements in all gazes. CT-scan revealed a heterogeneous expansile mass, arising from left fronto-ethmoidal sinus, infiltrating left orbit. MRI showed T2-hyperintense, peripherally enhancing areas in bilateral nasal cavity (right >left), bilateral ethmoidal sinuses and frontal, sphenoidal and maxillary sinuses. Otorhinolaryngology consultation was sought and in view of vision threatening proptosis — with likely orbital compartment syndrome — emergent endoscopic guided exploration and orbital decompression was undertaken. Rapid relief of signs and symptoms was achieved, with normal vision, extraocular movements and resolution of proptosis. Cytology and microbiology ruled out infectious or malignant aetiology and helped in resolving a diagnostic dilemma. Histopathology confirmed the diagnosis of mucopyocele and follow-up period was uneventful.

Local treatment of pain in Tietze syndrome: A single-center experience

Background: In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome. Methods: Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination. Results: At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection. Conclusion: Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.

Staged surgical treatment of brachioplexopathy in an adolescent with Klippel-Feil syndrome: a rare clinical case and literature review

Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.