This document summarizes a randomized, double-blind clinical trial comparing the efficacy and safety of cinnarizine versus topiramate in preventing migraines in children and adolescents. 44 patients between the ages of 4-15 years old who experienced migraines were equally divided into two groups - one receiving cinnarizine and the other receiving topiramate over 12 weeks. Both treatments significantly reduced monthly migraine frequency and intensity compared to baseline. However, cinnarizine showed a greater reduction in mean monthly migraine intensity compared to topiramate at the end of the study period. Both treatments were well tolerated with no serious adverse effects reported. The study found no significant differences between cinnariz
Influence of patient counseling on medication adherence in epileptic patientsSriramNagarajan17
This study examined the effects of patient counseling on medication adherence among 250 epileptic patients in Erode district, India over 6 months. The study found that treatment effectiveness increased to 70-85% in children and 60-75% in males and females after patient counseling. Adherence was lower in females potentially due to adverse drug effects and non-adherence. The study concluded that proper patient counseling and education are important for improving therapy for epileptic patients by enhancing communication between physicians and patients/caregivers.
A thorough research was conducted among the individuals to understand the perspective of individuals towards self-medication. Self medication was even started for chronic diseases. The result was very surprising and new which we got to know.
Consensus Guidelines on Management of Childhood Convulsive Status Epilepticusmandar haval
The document provides consensus guidelines for the evaluation and management of childhood convulsive status epilepticus in India. It was developed through a multi-disciplinary consensus workshop involving experts from across India. The guidelines define status epilepticus and discuss the epidemiology in India. They emphasize the importance of early pre-hospital management to initiate treatment as soon as possible. The initial management should consist of a parenteral benzodiazepine by any feasible route. Subsequent in-hospital management is also outlined. The aim is to provide a standardized, evidence-based protocol tailored for use in India given available resources and common etiologies.
Neukirch & Colagiuri, 2013 (online) - PE sleep, warning, and side effectNadine Neukirch
- The study tested whether warnings about potential side effects from medical treatment can induce those side effects via the placebo effect.
- 91 undergraduate students experiencing sleep difficulties were randomly assigned to receive either a warning about increased or decreased appetite from a new sleep medication or no warning, and then to receive placebo pills or no treatment for one week.
- Those who received placebo treatment reported significantly better sleep, showing a placebo effect, but their sleep as measured by activity monitors was unaffected.
- Those who received warnings were much more likely to report the warned-about side effect than those not warned, showing that warnings can induce side effects via expectancy even when only placebo treatment is received.
This document summarizes research on the use of vagus nerve stimulation (VNS) as an adjunctive treatment for intractable epilepsy in children. It describes a 10-year-old boy's epilepsy case and the question of whether VNS can decrease seizure frequency in such cases. It then details the author's literature search methods and provides a structured summary of 25 relevant studies investigating the effects of VNS on seizure frequency reduction in children with intractable epilepsy. The studies presented are predominantly retrospective case series with small sample sizes, though some prospective case series and one randomized controlled trial are included. Reported seizure frequency reduction rates with VNS ranged widely, from over 90% in some cases to no response in others.
Providing quality pediatric pain management during end of life carecassidydanielle
Author: Danielle Cassidy, PharmD, BCPS
Audience: continuing education for hospice nurses
Background: describes common developmentally appropriate tools for assessing pain in children, general principles of pediatric pharmacology, common pharmacological interventions, side effects commonly associated with opioid medications & side effect management strategies.
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
Influence of patient counseling on medication adherence in epileptic patientsSriramNagarajan17
This study examined the effects of patient counseling on medication adherence among 250 epileptic patients in Erode district, India over 6 months. The study found that treatment effectiveness increased to 70-85% in children and 60-75% in males and females after patient counseling. Adherence was lower in females potentially due to adverse drug effects and non-adherence. The study concluded that proper patient counseling and education are important for improving therapy for epileptic patients by enhancing communication between physicians and patients/caregivers.
A thorough research was conducted among the individuals to understand the perspective of individuals towards self-medication. Self medication was even started for chronic diseases. The result was very surprising and new which we got to know.
Consensus Guidelines on Management of Childhood Convulsive Status Epilepticusmandar haval
The document provides consensus guidelines for the evaluation and management of childhood convulsive status epilepticus in India. It was developed through a multi-disciplinary consensus workshop involving experts from across India. The guidelines define status epilepticus and discuss the epidemiology in India. They emphasize the importance of early pre-hospital management to initiate treatment as soon as possible. The initial management should consist of a parenteral benzodiazepine by any feasible route. Subsequent in-hospital management is also outlined. The aim is to provide a standardized, evidence-based protocol tailored for use in India given available resources and common etiologies.
Neukirch & Colagiuri, 2013 (online) - PE sleep, warning, and side effectNadine Neukirch
- The study tested whether warnings about potential side effects from medical treatment can induce those side effects via the placebo effect.
- 91 undergraduate students experiencing sleep difficulties were randomly assigned to receive either a warning about increased or decreased appetite from a new sleep medication or no warning, and then to receive placebo pills or no treatment for one week.
- Those who received placebo treatment reported significantly better sleep, showing a placebo effect, but their sleep as measured by activity monitors was unaffected.
- Those who received warnings were much more likely to report the warned-about side effect than those not warned, showing that warnings can induce side effects via expectancy even when only placebo treatment is received.
This document summarizes research on the use of vagus nerve stimulation (VNS) as an adjunctive treatment for intractable epilepsy in children. It describes a 10-year-old boy's epilepsy case and the question of whether VNS can decrease seizure frequency in such cases. It then details the author's literature search methods and provides a structured summary of 25 relevant studies investigating the effects of VNS on seizure frequency reduction in children with intractable epilepsy. The studies presented are predominantly retrospective case series with small sample sizes, though some prospective case series and one randomized controlled trial are included. Reported seizure frequency reduction rates with VNS ranged widely, from over 90% in some cases to no response in others.
Providing quality pediatric pain management during end of life carecassidydanielle
Author: Danielle Cassidy, PharmD, BCPS
Audience: continuing education for hospice nurses
Background: describes common developmentally appropriate tools for assessing pain in children, general principles of pediatric pharmacology, common pharmacological interventions, side effects commonly associated with opioid medications & side effect management strategies.
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
This document discusses the nurse's responsibilities regarding safe medication administration. Nurses must know the name, use, effects, interactions and monitoring needs of any drugs they administer. They are responsible for ensuring the right patient receives the right drug by the right route at the right time with right documentation. Errors must be reported to improve safety. The nursing process of assessment, diagnosis, planning, implementation and evaluation should be applied to medication administration.
This study compared the clinical manifestations of 71 patients with ocular myasthenia gravis (MG) to those with generalized MG. Patients with generalized MG had a higher rate of other autoimmune diseases and required long-term steroid treatment more often than those with ocular MG alone. Both groups experienced similar ophthalmic symptoms. The study recommends regular eye exams for all MG patients due to risks from autoimmune diseases and long-term steroid use.
This randomized controlled trial investigated whether acupuncture or sham acupuncture was more effective than no acupuncture in reducing migraine headaches in 302 patients. The trial found that both acupuncture and sham acupuncture led to greater reductions in moderate or severe headache days compared to the waiting list control group. However, acupuncture was not found to be more effective than sham acupuncture for reducing headache days. The proportion of "responders", defined as at least a 50% reduction in headache days, was similar between the acupuncture (51%) and sham acupuncture (53%) groups, and higher than the waiting list group (15%). The trial concluded that acupuncture was no more effective than sham acupuncture for reducing migraine headaches, although both were more
Patients often do not fully adhere to medical advice for several reasons: they may forget to follow regimens, feel side effects outweigh benefits, or be unable to afford treatments. Non-adherence is difficult to measure accurately and is common, with some studies finding only about 60% of patients still adhering to long-term regimens after a few years. Multiple factors influence adherence, including characteristics of the treatment regimen, the patient's cognitive and emotional state, psychosocial support, medical knowledge and beliefs. Improving communication between doctors and patients can help increase adherence.
This document outlines key points about seizure types, epilepsy, anti-epileptic drug (AED) selection and treatment principles. It discusses what constitutes an epileptic versus non-epileptic seizure, as well as provoked versus unprovoked seizures. Guidelines for AED selection include considering the patient's age, sex, weight, comorbidities, seizure type, and epilepsy syndrome. Principles of monotherapy, polytherapy and converting between the two are presented. Specific AEDs are recommended for different seizure types. Levetiracetam is the most commonly prescribed initial AED according to recent studies.
Poster for the 2018 Society for Teachers of Family Medicine Annual Meeting: A...Christina Czuhajewski
Presented at the 2018 STFM Annual Meeting, entiteld: Adolescent Views on Prescription and Nonprescription Opioid Use: Findings from the MyVoice Longitudinal Mixed Methods Study
Choosing the right antiseizure medication for epilepsy Ersifa Fatimah
The document discusses choosing the right antiseizure medication for epilepsy. It covers several key points:
1) Antiseizure medications (ASMs) are the first-line treatment for epilepsy, and many patients can achieve seizure freedom with the appropriate drug. However, the number of ASM options has increased and not all work for every seizure type or patient.
2) Choosing the right ASM involves considering factors like seizure type, patient characteristics, tolerability, and potential for drug interactions to select the most suitable option. The goal is to tailor treatment to the individual.
3) Successful treatment requires not only selecting the right ASM but also properly managing dosage, monitoring for side effects and
This study evaluated levels of depression, anxiety, and stress among 246 undergraduate physiotherapy students in India using the Depression Anxiety Stress Scale. The results found that most students fell into the normal range for all three factors. However, some students showed mild, moderate, or severe levels of anxiety and stress. Students in their third year, final year, and internship tended to have higher levels, possibly due to academic pressures. The study concluded students experience normal psychological stress overall, but the university should provide counseling support to help students manage pressures and reduce abnormal stress, anxiety, or depression.
The document discusses the use of evidence-based medicine to evaluate complementary and alternative medicine. It begins with background on the importance of staying current with medical literature and using well-formulated clinical questions. It then discusses how to develop background and foreground clinical questions using the PICO framework to identify patients, interventions, comparisons, and outcomes. Several examples of applying PICO to clinical scenarios are provided. The document also reviews types of medical literature and types of clinical studies used in evidence-based evaluations.
Dr. Remya Krishnan shares her journey in Ayurvedic medicine, beginning with frustration after not being accepted to an MBBS program. During her BAMS, she found the curriculum mechanical and not focused on clinical results. A turning point was marrying a husband passionate about Ayurveda, who treated her ailments without modern drugs. This inspired her to apply Ayurvedic principles to her own family's health with good results. She emphasizes the need to practice Ayurveda based on its scientific principles and intended effects, not just as a philosophy. The biggest challenges are confirmation bias and not exploring each case individually based on clinical situation.
The document discusses health literacy and effective patient-physician communication strategies, noting that limited health literacy adversely impacts patient health outcomes and that using clear communication techniques such as plain language, teach back methods, and soliciting questions can help address this issue and improve patient understanding. It also provides statistics showing nearly half of U.S. adults have below basic or basic health literacy skills.
Safety Considerations in the use of Psychotropic Medication in Children and T...Stephen Grcevich, MD
The document summarizes safety considerations for commonly used psychotropic medications in children and teens. It reviews the adverse effect profiles and risks of second-generation antipsychotics, antidepressants, stimulants, and mood stabilizers. It also discusses monitoring standards for potential adverse events during pharmacologic treatment of youth. Specific topics covered include the metabolic effects and monitoring of antipsychotics, risks of tardive dyskinesia, suicidal ideation risks of antidepressants varying by condition, side effects of stimulants including cardiovascular risks and effects on growth, and side effects of mood stabilizers.
- Drug therapy in pediatric patients presents unique challenges due to physiological differences compared to adults that influence pharmacokinetics. Organs such as the liver and kidneys are immature at birth and do not reach adult functionality until approximately 1 year of age. This results in altered absorption, distribution, metabolism, and excretion of drugs in neonates and infants.
- Due to organ immaturity, neonates and infants experience more intense and prolonged responses to drugs. They are at higher risk for adverse effects from drugs cleared primarily by the liver or kidneys. Careful monitoring is needed when dosing pediatric patients.
- Initial pediatric doses are approximations, often based on body surface area calculations. Frequent assessment and potential dose adjustments are
A systematic review of 9 studies comparing PEG and NG tube feeding in adults with swallowing disturbances found:
1) PEG was associated with a lower risk of treatment failure, especially in patients with neurological diseases.
2) There was no significant difference in complication rates between PEG and NG tubes.
3) PEG may be associated with a decreased risk of pneumonia compared to NG tubes and longer survival time.
Retail investors often make mistakes when investing in stocks such as not researching company fundamentals, buying cheap stocks without considering value, having a short-term outlook, and not reviewing their portfolio regularly. They also tend to hold on to losing stocks for too long rather than cutting their losses, enter markets at peaks and exit at lows, and follow unsolicited tips which can lead them to invest in unsuitable companies. Investors should take a long-term approach, buy undervalued stocks of companies with strong fundamentals, set stop-losses, and not blindly follow tips or allow brokers to trade without oversight.
This document provides an overview of how to grow a business using LinkedIn. It discusses optimizing profiles, connecting with others, and engaging with your network on LinkedIn. The key recommendations include completing your profile with a photo, optimized headline and summary, connecting widely within your industry, engaging with your network by posting valuable content and comments, and consistently using LinkedIn to build your professional presence and network.
This study reports on the vascular plant flora inventory of the Nowata County portion of the Oologah Wildlife Management Area in northeastern Oklahoma. A total of 470 species across 305 genera and 95 families were collected. The most species-rich families were Poaceae, Asteraceae, and Fabaceae. 364 species documented in this study had not previously been reported in Nowata County. The inventory provides valuable information on the plant diversity in the area for research, conservation, and management purposes.
The Definative Guide to Avoid Suspension or Termination of Your Amazon Seller...Joseph Hansen
As a former long-time member of Seller Performance, Amazon’s team responsible for monitoring and regulating the Amazon third-party marketplaces, I have seen far too many sellers run their businesses without a proper understanding of rules and procedures needed to stay the path towards a highly-disciplined, clean operation.
This document discusses the nurse's responsibilities regarding safe medication administration. Nurses must know the name, use, effects, interactions and monitoring needs of any drugs they administer. They are responsible for ensuring the right patient receives the right drug by the right route at the right time with right documentation. Errors must be reported to improve safety. The nursing process of assessment, diagnosis, planning, implementation and evaluation should be applied to medication administration.
This study compared the clinical manifestations of 71 patients with ocular myasthenia gravis (MG) to those with generalized MG. Patients with generalized MG had a higher rate of other autoimmune diseases and required long-term steroid treatment more often than those with ocular MG alone. Both groups experienced similar ophthalmic symptoms. The study recommends regular eye exams for all MG patients due to risks from autoimmune diseases and long-term steroid use.
This randomized controlled trial investigated whether acupuncture or sham acupuncture was more effective than no acupuncture in reducing migraine headaches in 302 patients. The trial found that both acupuncture and sham acupuncture led to greater reductions in moderate or severe headache days compared to the waiting list control group. However, acupuncture was not found to be more effective than sham acupuncture for reducing headache days. The proportion of "responders", defined as at least a 50% reduction in headache days, was similar between the acupuncture (51%) and sham acupuncture (53%) groups, and higher than the waiting list group (15%). The trial concluded that acupuncture was no more effective than sham acupuncture for reducing migraine headaches, although both were more
Patients often do not fully adhere to medical advice for several reasons: they may forget to follow regimens, feel side effects outweigh benefits, or be unable to afford treatments. Non-adherence is difficult to measure accurately and is common, with some studies finding only about 60% of patients still adhering to long-term regimens after a few years. Multiple factors influence adherence, including characteristics of the treatment regimen, the patient's cognitive and emotional state, psychosocial support, medical knowledge and beliefs. Improving communication between doctors and patients can help increase adherence.
This document outlines key points about seizure types, epilepsy, anti-epileptic drug (AED) selection and treatment principles. It discusses what constitutes an epileptic versus non-epileptic seizure, as well as provoked versus unprovoked seizures. Guidelines for AED selection include considering the patient's age, sex, weight, comorbidities, seizure type, and epilepsy syndrome. Principles of monotherapy, polytherapy and converting between the two are presented. Specific AEDs are recommended for different seizure types. Levetiracetam is the most commonly prescribed initial AED according to recent studies.
Poster for the 2018 Society for Teachers of Family Medicine Annual Meeting: A...Christina Czuhajewski
Presented at the 2018 STFM Annual Meeting, entiteld: Adolescent Views on Prescription and Nonprescription Opioid Use: Findings from the MyVoice Longitudinal Mixed Methods Study
Choosing the right antiseizure medication for epilepsy Ersifa Fatimah
The document discusses choosing the right antiseizure medication for epilepsy. It covers several key points:
1) Antiseizure medications (ASMs) are the first-line treatment for epilepsy, and many patients can achieve seizure freedom with the appropriate drug. However, the number of ASM options has increased and not all work for every seizure type or patient.
2) Choosing the right ASM involves considering factors like seizure type, patient characteristics, tolerability, and potential for drug interactions to select the most suitable option. The goal is to tailor treatment to the individual.
3) Successful treatment requires not only selecting the right ASM but also properly managing dosage, monitoring for side effects and
This study evaluated levels of depression, anxiety, and stress among 246 undergraduate physiotherapy students in India using the Depression Anxiety Stress Scale. The results found that most students fell into the normal range for all three factors. However, some students showed mild, moderate, or severe levels of anxiety and stress. Students in their third year, final year, and internship tended to have higher levels, possibly due to academic pressures. The study concluded students experience normal psychological stress overall, but the university should provide counseling support to help students manage pressures and reduce abnormal stress, anxiety, or depression.
The document discusses the use of evidence-based medicine to evaluate complementary and alternative medicine. It begins with background on the importance of staying current with medical literature and using well-formulated clinical questions. It then discusses how to develop background and foreground clinical questions using the PICO framework to identify patients, interventions, comparisons, and outcomes. Several examples of applying PICO to clinical scenarios are provided. The document also reviews types of medical literature and types of clinical studies used in evidence-based evaluations.
Dr. Remya Krishnan shares her journey in Ayurvedic medicine, beginning with frustration after not being accepted to an MBBS program. During her BAMS, she found the curriculum mechanical and not focused on clinical results. A turning point was marrying a husband passionate about Ayurveda, who treated her ailments without modern drugs. This inspired her to apply Ayurvedic principles to her own family's health with good results. She emphasizes the need to practice Ayurveda based on its scientific principles and intended effects, not just as a philosophy. The biggest challenges are confirmation bias and not exploring each case individually based on clinical situation.
The document discusses health literacy and effective patient-physician communication strategies, noting that limited health literacy adversely impacts patient health outcomes and that using clear communication techniques such as plain language, teach back methods, and soliciting questions can help address this issue and improve patient understanding. It also provides statistics showing nearly half of U.S. adults have below basic or basic health literacy skills.
Safety Considerations in the use of Psychotropic Medication in Children and T...Stephen Grcevich, MD
The document summarizes safety considerations for commonly used psychotropic medications in children and teens. It reviews the adverse effect profiles and risks of second-generation antipsychotics, antidepressants, stimulants, and mood stabilizers. It also discusses monitoring standards for potential adverse events during pharmacologic treatment of youth. Specific topics covered include the metabolic effects and monitoring of antipsychotics, risks of tardive dyskinesia, suicidal ideation risks of antidepressants varying by condition, side effects of stimulants including cardiovascular risks and effects on growth, and side effects of mood stabilizers.
- Drug therapy in pediatric patients presents unique challenges due to physiological differences compared to adults that influence pharmacokinetics. Organs such as the liver and kidneys are immature at birth and do not reach adult functionality until approximately 1 year of age. This results in altered absorption, distribution, metabolism, and excretion of drugs in neonates and infants.
- Due to organ immaturity, neonates and infants experience more intense and prolonged responses to drugs. They are at higher risk for adverse effects from drugs cleared primarily by the liver or kidneys. Careful monitoring is needed when dosing pediatric patients.
- Initial pediatric doses are approximations, often based on body surface area calculations. Frequent assessment and potential dose adjustments are
A systematic review of 9 studies comparing PEG and NG tube feeding in adults with swallowing disturbances found:
1) PEG was associated with a lower risk of treatment failure, especially in patients with neurological diseases.
2) There was no significant difference in complication rates between PEG and NG tubes.
3) PEG may be associated with a decreased risk of pneumonia compared to NG tubes and longer survival time.
Retail investors often make mistakes when investing in stocks such as not researching company fundamentals, buying cheap stocks without considering value, having a short-term outlook, and not reviewing their portfolio regularly. They also tend to hold on to losing stocks for too long rather than cutting their losses, enter markets at peaks and exit at lows, and follow unsolicited tips which can lead them to invest in unsuitable companies. Investors should take a long-term approach, buy undervalued stocks of companies with strong fundamentals, set stop-losses, and not blindly follow tips or allow brokers to trade without oversight.
This document provides an overview of how to grow a business using LinkedIn. It discusses optimizing profiles, connecting with others, and engaging with your network on LinkedIn. The key recommendations include completing your profile with a photo, optimized headline and summary, connecting widely within your industry, engaging with your network by posting valuable content and comments, and consistently using LinkedIn to build your professional presence and network.
This study reports on the vascular plant flora inventory of the Nowata County portion of the Oologah Wildlife Management Area in northeastern Oklahoma. A total of 470 species across 305 genera and 95 families were collected. The most species-rich families were Poaceae, Asteraceae, and Fabaceae. 364 species documented in this study had not previously been reported in Nowata County. The inventory provides valuable information on the plant diversity in the area for research, conservation, and management purposes.
The Definative Guide to Avoid Suspension or Termination of Your Amazon Seller...Joseph Hansen
As a former long-time member of Seller Performance, Amazon’s team responsible for monitoring and regulating the Amazon third-party marketplaces, I have seen far too many sellers run their businesses without a proper understanding of rules and procedures needed to stay the path towards a highly-disciplined, clean operation.
This document summarizes guidelines from the Japanese Society of Pediatric Cardiology and Cardiac Surgery for the medical treatment of acute Kawasaki disease. It discusses the purpose of treatment guidelines, evidence classification systems, and background on revising previous guidelines. The primary treatment for acute Kawasaki disease is intravenous immunoglobulin (IVIG) to reduce risks of coronary artery abnormalities. For patients resistant to first-line IVIG treatment, second-line options include additional IVIG, steroids, infliximab, cyclosporin A, and methotrexate, though evidence is limited. Risk stratification models may help determine initial combination treatment for high-risk patients.
Gajanan Bhavare is a Finacle application support professional with over 8 years of experience in core banking software implementation and support. He has extensive experience providing level 1 and 2 support for Finacle version 10.2. He is currently working in Mumbai and is seeking a new opportunity with a salary of Rs. 60,000 take home. His experience includes implementation support, testing, and resolving various banking issues for several banks on the Finacle platform.
This document discusses emergency management of hypertension in children. It begins with definitions of normal blood pressure, prehypertension, and stages of hypertension in children. It then discusses the etiology, pathogenesis and management of hypertensive crisis in children. The main points are:
1. Hypertensive crisis is more common in children with secondary hypertension, usually of renal origin, though it can rarely occur in primary hypertension.
2. Factors involved in the pathogenesis of hypertensive crisis include elevated blood pressure, fluid overload, sympathetic overactivity, activation of the renin-angiotensin-aldosterone system, oxidative stress, endothelial dysfunction, and inflammation.
3. Management of hypertensive crisis in
Introduction true vertigo is a type of vertigo identifieniraj57
This study compared the effectiveness of hyoscine and diazepam in treating true vertigo in 69 patients in an emergency department. Patients were randomly assigned to receive either 5 mg of hyoscine or 10 mg of diazepam. Vertigo severity was assessed before and 1 and 2 hours after drug administration in different positions. Diazepam was significantly more effective at relieving vertigo in all positions compared to hyoscine based on treatment success rates. Complete relief of vertigo occurred in 40-63% of patients given diazepam but only 2.6-12.5% of those given hyoscine. The study suggests that diazepam is a better option than hyoscine for
The role of melatonin in pediatric headachescscoville
The document summarizes a study on the use of melatonin to treat chronic headaches in pediatric patients. The study involved 21 patients ages 6-16 who took 3mg of melatonin daily for 3 months. It found that headaches were reduced in frequency and duration, with 14 patients reporting over a 50% reduction in attacks. While a small uncontrolled study, it provides preliminary evidence that melatonin may help reduce chronic headaches in children. Larger randomized controlled trials are still needed.
Pyridoxine supplementation led to a significant decrease in migraine attack severity, duration, and headache diary results compared to placebo, but did not significantly impact attack frequency. A double-blind randomized clinical trial of 66 migraine patients with aura found that those receiving 80 mg of pyridoxine per day experienced greater reductions in severity (-2.20 vs -1), duration (-8.30 hours vs -1.70 hours), and headache diary results (-89.70 vs -6.10) compared to the placebo group after 12 weeks. However, pyridoxine did not significantly decrease attack frequency more than placebo.
This study compared the effects of acetaminophen and ibuprofen on fever control and seizure prevention in 72 children with febrile seizures. Children received either acetaminophen or ibuprofen to control fever episodes over 6 months. Ibuprofen was found to be more effective at reducing fever at 6, 12, and 24 hours compared to acetaminophen. However, the medication type did not affect risk of seizure recurrence. Both medications effectively controlled fever without significant adverse effects.
Topiramate 100 mg/day was shown to be effective for migraine prophylaxis in pediatrics based on a randomized, double-blind study. It resulted in a 72.2% reduction in monthly migraine attacks compared to 44.4% for placebo. Side effects were more common with topiramate but were not outside expectations. The study demonstrated topiramate's safety and efficacy in pediatrics for migraine prevention at a 100 mg daily dose.
Transition from methylphenidate or amphetamine to atomoxetine in children and...hospital higueras
This study investigated transitioning children and adolescents with ADHD from methylphenidate or amphetamine to atomoxetine. 62 patients participated, with most having ADHD-combined type and previously receiving methylphenidate. Patients transitioned from their stimulant to atomoxetine over 2 weeks. ADHD symptoms improved significantly from baseline to study end based on parent ratings. Most parents and over half of patients preferred atomoxetine treatment to their previous stimulant. The transition was generally well-tolerated, though some increases in blood pressure and heart rate were observed. This pilot study suggests children and adolescents can be successfully switched from stimulants to atomoxetine with resulting ADHD symptom improvement.
Ольга Бермант-Полякова. Новейшие исследования в современной зарубежной психол...Olga Bermant-Polyakova
This document summarizes key aspects of evidence-based practice in psychology (EBPP) as defined by the American Psychological Association (APA). It discusses that EBPP involves integrating the best available research evidence with clinical expertise and patient characteristics, values, and context. It provides definitions for best research evidence, clinical expertise, and consideration of patient factors. It notes that the goal of EBPP is to promote effective psychological practice and enhance public health.
This study evaluated the drug utilization and rationality of antiepileptic drugs used to treat epilepsy patients at a tertiary care hospital in Dehradun, India. The study found that most epilepsy patients had generalized tonic-clonic seizures. Polytherapy was used more than monotherapy, with 2-drug combinations being most common. First generation antiepileptic drugs like phenytoin were prescribed more than second generation drugs. Phenytoin was the most commonly prescribed antiepileptic drug. The majority of patients receiving polytherapy had a rational drug regimen.
Homeopathic and conventional treatment for acute respiratory and ear complain...home
Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H) and 720
conventional (C) treatment. The majority of patients in both groups reported their outcome after 14 days of treatment
as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing). In the perprotocol
set (H: 576 and C: 540 patients) similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further
subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C:
84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40
(0.89–2.22) in children and 0.92 (0.63–1.34) in adults. Adjustments for demographic differences at baseline did not
significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both
treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon
homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Adverse drug reactions occurred more
frequently in adults of the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p = 0.0032), whereas in
children the occurrence of adverse drug reactions was not significantly different (H: 2.0%; C: 2.4%, p = 0.7838).
Homeopathic and conventional treatment for acute respiratory and ear complain...home
This study compared outcomes of homeopathic and conventional treatment for acute respiratory and ear complaints in a primary care setting. Over 1,500 patients from Europe and the US were given either homeopathic or conventional treatment for issues like cough, sore throat, ear pain, runny nose or sinus pain by their primary care physician. Outcomes like recovery levels and time to improvement were assessed after 7, 14, and 28 days via phone interviews. Results showed that the majority (around 87%) of patients in both the homeopathic and conventional treatment groups reported complete recovery or major improvement after 14 days, with no significant differences between groups. Onset of improvement was faster with homeopathic treatment. Adverse reactions were more common in adults
The document discusses GMHAT (Global Mental Health Assessment Tool), a computer-assisted clinical interview used to detect and manage mental disorders. It describes how GMHAT was used to train medical students at SMS Medical College in Jaipur, India to screen for mental health issues in relatives and friends. Several research studies were conducted using GMHAT to assess students and evaluate the impact of traditional teaching versus integrated teaching. The results found integrated teaching significantly improved student scores and skills in recognizing mental health issues compared to traditional teaching alone. GMHAT is described as an easy to use tool that helps improve diagnosis and treatment of mental health patients.
Salon 2 13 kasim 16.00 17.30 sevda türen-ingtyfngnc
This study examined the educational needs of 114 patients in Turkey receiving warfarin treatment for cardiovascular diseases. Warfarin is widely used but also has risks if not taken correctly. The study found that most patients had not received education about their warfarin dosage, drug and food interactions, side effects, and precautions. It recommends that healthcare providers determine patients' educational needs and provide standardized training to ensure safer and more effective warfarin use.
Prophylactic Aminophylline for Prevention of Apnea at Higher-Risk Preterm Neo...amir mohammad Armanian
1. The study assessed the prophylactic effects of aminophylline on apnea in preterm neonates with a gestational age less than 32 weeks and/or birth weight less than 1200g.
2. 52 neonates were randomly assigned to receive either aminophylline (group A) or no aminophylline (group C) for the first 10 days.
3. Primary outcomes like apnea, bradycardia and cyanosis were significantly lower in the aminophylline group compared to the control group. Secondary outcomes like need for CPAP and length of hospital stay were also lower in the aminophylline group.
Journal Article Analysis: Medication Errors in Overweight and Obese Pediatric...Paul Pasco
A journal article analysis ("journal club") I completed during an internship/Advanced Pharmacy Practice Experience (APPE) in medication safety at a hospital.
1) A Cochrane review found that giving paracetamol and ibuprofen together or alternating between the two drugs was more effective at reducing fever in children than either drug alone.
2) When used together, paracetamol and ibuprofen reduced fevers more than single drugs at 1, 4, and 6 hours after administration. Alternating between the drugs also reduced fevers more than single drugs at 4 and 6 hours.
3) However, the evidence on whether combined or alternating therapy improves children's discomfort is inconclusive due to variations in study methods and small sample sizes in the analyses.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
5624 27384-2-pb
1. 18 Iran J Child Neurol. 2014Atumen Vol 8 No 4
1. Pediatrics Centre of Excellence,
Department of Pediatric Neurology,
Children’s Medical Centre, Tehran
University of Medical Sciences, Tehran,
Iran
2. Growth and Development Research
Center, Tehran University of Medical
Sciences, Tehran, Ira
3. Sports Medicine Research Center,
Neuroscience Institute, Tehran University
of Medical Sciences, Tehran, Iran
4. Department of epidemiology and
biostatistics, School of Public Health,
Tehran University of medical sciences,
Tehran, Iran
5. Iranian Centre of Neurological
Research, Neuroscience Institute, Tehran
University of Medical Sciences, Tehran,
Iran
6. Department of Neurology, Sina
Hospital, Tehran University of Medical
Sciences, Tehran, Iran
CorrespondingAuthor:
Togha M. MD
Department of neurology, Sina Hospital,
Imam Khomeini Street, Tehran, Iran.
P.O. Box: 11367-46911
Tel: +98 21 66348520
Fax:+98 21 66348551
Email: toghae@sina.tums.ac.ir
Introduction
Migraine is a common health problem in children and adolescents (1-3). It can
negatively affect children and adolescents in their daily activities and school
performances as well as causes school absenteeism (3,4). The mean age for the
onset of migraines varies in children with gender, and is reported to be 7.2 years
in boys and 10.9 years in girls 5, 6. The prevalence of migraine headaches among
children and adolescents aged between 5 to 15 years ranged from 2.7–10.6% 3. The
prevalence increases with age and is reported to be up to 28% in adolescents, aged
15 to 19-years 3, 7. Migraine headaches show a male predominance in children,
which shifts to a slight female predominance in adolescence that continues into
adulthood (3, 5).
Management of migraine headaches in children and adolescents consists of bio-
Mahmoud RezaAshraFI MD 1,2
,
Zeinab Najafi MD 1
,
Masih Shafiei 3
,
Kazem Heidari MD 4
,
MansourehToghaMD 5,6
Cinnarizine versus Topiramate in Prophylaxis of Migraines among Children
and Adolescents: A Randomized, Double-Blind Clinical Trial
How to Cite This Article: Ashrafi MR, Najafi Z, Shafiei M, Heidari K, Togha M. Cinnarizine versus Topiramate in Prophylaxis of Migraines
among Children and Adolescents: A Randomized, Double-Blind Clinical Trial. Iran J Child Neurol. 2014 Autumn;8(4): 18-27.
Received: 6-Apr-2014
Last Revised: 5-May-2014
Accepted: 11-May-2014
original ARTICLE
Abstract
Objective
Migraines, a common health problem in children and adolescents, still do not
have an FDA approved preventive treatment for patients under the age of 18
years. This study compares and contrasts the efficacy and safety of cinnarizine
and topiramate in preventing pediatric migraines.
Materials & Methods
In this randomized, double-blind clinical trial 44 migrainous (from 4–15 years
of age) were equally allocated to receive cinnarizine or topiramate. The primary
efficacy measure was monthly migraine frequency. Secondary efficacy measures
were monthly migraine intensity and ≥ 50% responder rate. Efficacy measures
were recorded at the baseline and at 4, 8, and 12 weeks of treatment.
Results
During the double-blind phase of the study, monthly migraine frequency and
intensity were significantly decreased in both the cinnarizine and topiramate
groups when compared to the baseline. However, at the end of the study, the
cinnarizine group exhibits a significant decrease from the baseline in the mean
monthly migraine intensity when compared to the topiramate group (4.7 vs. 3,
respectively; 95% CI = -0.8 to -3.2).
Conclusion
No significant difference between cinnarizine and topiramate was found for the
prevention of pediatric migraines. Both treatments were well tolerated.
Keywords: Cinnarizine; Migraine; Pediatrics; Topiramate
2. 19Iran J Child Neurol. 2014Autumn Vol 8 No 4
behavioral treatments (including life style changes,
stress management, and bio-feedback strategies), acute
treatments, and preventive treatments 8). Preventive
management is recommended when the frequency
of migraine attacks is three or more per month or the
migraine attacks are significantly disabling (as assessed
by a scoring system such as the Pediatric Migraine
Disability Assessment Scale) (9, 10). No medications
are currently approved by the Food and Drug
Administration (FDA) for the preventive treatment of
migraine headaches in patients under the age of 18 years
(8). The preventive treatment of migraines in children
and adolescents is based on information extracted from
adult trials on migraines.
Topiramate has been approved for use of migraine
prevention in adults in Europe and by the FDA (11). Two
randomized, double-blind, placebo-controlled studies
show the effectiveness of topiramate in significant
reduction of monthly migraine frequency in children and
adolescents(12,13).Inanotherrandomized,double-blind,
placebo-controlled trial, topiramate effectively reduced
the mean of monthly migraine frequency in children and
adolescents; however, it didn’t reach significance and the
results trend was towards significance (14). According a
pooled analysis of three pivotal trials, topiramate might
reduce migraine frequency in adolescents (15). Some
other uncontrolled studies also showed the effectiveness
of topiramate in reducing monthly migraine frequency
in children (16-19). The frequency of side effects varied
considerably among previous studies with the most
frequent side effects reported as weight loss, anorexia,
abdominal pain, sedation, paresthesia, and difficulties in
concentration (12-19).
The limited effectiveness of cinnarizine as a preventive
treatment of migraine headaches in adults is known. Two
open-label trials and a randomized, double-blind clinical
trial has shown the effectiveness of cinnarizine treatment
in reducing the monthly migraine frequency in adults
(20-22). These studies also reported no serious adverse
effects (20-22). To the best of our knowledge, no study
has yet investigated the effectiveness of cinnarizine
treatment as a prophylaxis for migraine headaches
among children and adolescents.
To the best our knowledge, no study has compared the
efficacy and safety of cinnarizine with that of topiramate
for migraine prevention among children and adolescents.
In this regard, we conducted a randomized, double-
blind clinical trial to evaluate the efficacy and safety of
cinnarizine in comparison to topiramate as preventive
treatments for migraine headaches among children and
adolescents.
Materials & Methods
We conducted a randomized, double-blind comparative
trial composed of a prospective baseline lasting for 4
weeks followed by a double-blind phase lasting for 12
weeks.
Patients from 4–17 years of age who were admitted to the
pediatric neurology clinic of Children’s Medical Center
Hospital affiliated with Tehran University of Medical
Sciences with the complaint of headache or diagnoses
for migraines were evaluated. A complete history of the
patients’ migraine characteristics as well as a complete
general medical history was recorded along with a
general and neurological physical examinations were
performed. The information collected from recording
the medical history of patients and their physical
examinations, patients who met the eligibility criteria
(including inclusion and exclusion criteria) entered the
prospective baseline phase of the study.
The inclusion criteria were as follows:
1. Children and adolescents, Aged 4–17 years,
diagnosed with migraines (with or without aura)
according to the International Headache society
criteria (23);
2. Having experienced one or more migraine attacks
per month or severe dysfunction in daily and school
activities; and/ or,
3. Children and adolescents without any known
structural brain lesions or other systemic conditions
causing the headaches.
The exclusion criteria were as follows:
1. Diagnosis of chronic headache, complications of
migraine or migraine variant;
2. Focal neurologic deficit;
3. Severe adverse effects related to the study treatment
drugs that are listed in the contraindications at the
beginning or during the double-blind phase of the
study;
4. Known concomitant serious disease (hepatic, renal,
Cinnarizine in Preventing Pediatric Migraine
3. 20 Iran J Child Neurol. 2014Autumn Vol 8 No 4
cardiovascular, or thyroid disease); and/ or,
5. Use of prophylactic migraine therapy in at least one
preceding month.
In the 4 weeks prospective baseline, the previous
medications of patients for migraines, either for
preventive or acute treatment, were halted; and the
frequency and intensity of the migraines were recorded.
Each patient was given a diary to record the frequency
and intensity of each migraine. Patients had to fill out the
diary every day, whether they experienced migraine or
not. If they had migraine, they also filled out a checklist
of headache characteristics attached to the diaries.
Patients who completed the prospective baseline phase
of the study entered the 12 weeks double-blind phase
of the study. At the start of the double-blind phase,
patients were randomized into two treatment groups.
One group of participants received cinnarizine as the
preventive treatment for migraines (the cinnarizine
group); and the other group of participants received
topiramate as the preventive treatment for migraines
(the topiramate group). The study had no placebo group.
Since the intractable nature of the migraine headaches of
patients, it was immoral to have a group of participants
receiving no preventive treatment. In order to maintain
double blinding, each patient was given an ID code
and the drugs were given to the patients using their ID
codes. Cinnarizine and topiramate tablet characteristics
including the shape, color, and drug packages were
similar to each other but not the same).
At the start of double-blind phase of the study, a
blood count test and a liver enzyme test (SGOT) were
performed. The tests were re-performed at the end of 12
weeks of the double-blind phase.
In the double-blind phase of the study, there were
two groups of patients: 1. the cinnarizine group; and
2. The topiramate group. The cinnarizine group was
administrated with a dose of 37.5 mg every day for
patientsaged4–11years;and50mgeverydayforpatients
aged 12–17 years, from the beginning of the double blind
phase to the end of the 12 weeks. The topiramate group
was administrated with a dose of 50 mg every day from
the beginning of the double blind phase to the end of
the 12 weeks. Adjustment of the dose of cinnarizine and
topiramate in presence of intolerability or occurrence of
serious side effects related to the treatment drugs could
be considered due to the neurologist of this study’s
permission. In addition, patients were permitted to take
analgesics for abortive treatment of acute migraine
attacks throughout the study.
Patient information about the characteristics of migraine
attacks (including the frequency and intensity of attacks)
during the double-blind phase was recorded using
diaries. Each patient was provided with a diary for 90
days, in which all migraine attack characteristics consist
of the duration in hours and the intensity of attacks were
recorded. Parents were also involved by advising them
to assist their children to correctly fill out the diaries.
Follow up visits were scheduled at 4, 8, and 12 weeks
during the double-blind phase of the study. At each visit,
the diaries were checked and collected. Patients were
evaluated using detailed questionnaires to investigate
the occurrence of the side effects during the last 4
weeks (the gaps between visits) and the relation of the
side effects to the treatment drugs. In this regard, the
frequency and the occurrence of treatment related side
effects were assessed.
Efficacy measures
To measure the efficacy of cinnarizine and topiramate
treatments, the frequency and intensity of migraine
attacks and 50% responder rate to the treatments were
evaluated. All required data for calculating the intended
measures were based on information obtained from the
diaries.
Frequency of migraine attacks was defined as the mean
number of migraine attacks that fulfilled the IHS criteria
for migraine with or without aura 23 per each 4 week
period.
The intensity of attacks was measured using the Visual
Analogue Scale (VAS). This scale consists of a 10 cm
line that is divided into 10 parts, which are numbered
0–10. Zero indicates no pain and 10 indicates the worst
pain imaginable. Migraine intensity was defined as the
mean intensity of migraine attacks per each 4 week
period.
A 50% responder rate was defined as the percentage of
patients who had a migraine frequency that was reduced
greater or equal to 50%.
Cinnarizine in Preventing Pediatric Migraine
4. 21Iran J Child Neurol. 2014Autumn Vol 8 No 4
Cinnarizine in Preventing Pediatric Migraine
Safety measures
At each visit of the double-blind phase, safety of the
treatment drugs was assessed by asking the patients’
history of side effects occurrence during the last 4 weeks
with a detailed questionnaire. The relation of the side
effects to the treatment drugs was also assessed at each
visit by interviewing the patients. Special attention was
paid to the occurrence of sleepiness, decreased appetite,
and weight loss.
Statistical analysis
Evaluating the efficacy and safety of the treatments was
based on information obtained from the diaries, patient
history (which was recorded at start of the double-blind
phase and the visits during the double-blind phase),
general and neurological examinations, and laboratory
tests (including, blood count and liver function tests).
Average descriptive statistics and standard deviations
were provided for the treatment groups separately and
for the total population. The differences between the
treatment groups’ baseline characteristics were assessed
by using two sample (unpaired) t test. The comparison
between the baseline phase values and 4, 8, and 12
weeks of treatment during the double-blind phase values
was performed using sample (paired) t test. In order
to analyze the treatment comparability, a student’s t
test for independent samples and analysis of variance
with repeated measures over time was used. Results
are expressed as a mean and p<0.05 was considered
statistically significant. Data were analyzed using SPSS
software (ver. 18) and confidence interval analysis
software.
This trial was approved by the ethics committee of
Tehran University of Medical Sciences. All patients
were given informed consent about the study prior to
entering the study.
Results
A total of 40 participants (23 male and 17 female)
enrolled in the study, with a mean age of 9.0 (range,
4–15) years. At the baseline, the mean (SD) of monthly
migraine frequency was 7.7±7.2 and the mean (SD) of
monthly migraine intensity was 6.9±2.3 (due to VAS
scaling). Participants were randomly allocated into
two treatment groups (cinnarizine n=20; topiramate
n=20). There were no statistically significant differences
between the treatment groups regarding the participant
age, the baseline mean of monthly migraine frequency,
and the baseline mean of monthly migraine intensity
(p= 0.46, p = 0.81, and p = 0.30, respectively) (Table 1)
represents demographic data and baseline characteristics
of the study participants.
Table1. Demographic Data and Baseline Characteristics of Participants
Cinnarizine Topiramate
Age,
mean SD, year
range, year
9.3± 2.43
5–13
8.7± 3.03
4–15
Gender, n (%)
Male
Female
12 (60)
8 (40)
11 (55)
9 (45)
Mean migraine frequency
(per month) SD
8.0 ± 7.98 7.5 ± 6.43
Mean migraine intensity
(per month) SD
7.3 ± 2.12 6.5 ± 2.42
5. 22 Iran J Child Neurol. 2014Autumn Vol 8 No 4
Efficacy measures
After 4 weeks of treatment, 35% of the cinnarizine
group participants and 30% of the topiramate group
participants showed 50% responder rate; which was
statistically significant for both groups (p = 0.007, 95%
CI 0.70-3.90; p = 0.008, 95% CI 0.57-3.33; respectively).
A significant reduction in the mean of monthly migraine
intensity for cinnarizine (p < 0.001, 95% CI 1.15-2.25)
and topiramate (p = 0.002, 95% CI 0.50-1.90) groups
was also found as opposed to the baseline values.
At the second visit during the double-blind phase (week
8), statistically significant changes were also observed.
Both treatment groups showed a statistically significant
50% responder rate (cinnarizine: 55%, p = 0.004, 95%
CI 1.26-5.74; topiramate: 50%, p = 0.001, 95% CI 1.70-
5.40). The same was found for the mean of monthly
migraine intensity (cinnarizine: p < 0.001, 95% CI 2.10-
3.90; topiramate: p < 0.001, 95% CI 1.24-3.16). After 8
weeks of treatment compared with the baseline values,
reduction of monthly migraine frequency, and intensity
demonstrated no statistically significant differences
between the cinnarizine and topiramate groups (p> 0.05).
The mean of monthly migraine frequency and intensity
at the end of the 8th week of treatment in comparison
to the end of the 4th week significantly lowered within
treatment groups (p <0.05), but no significant differences
were found for the cinnarizine versus the topiramate
group(s) (p> 0.05).
At the last visit during the double-blind phase (week 12),
85% of the cinnarizine group and 65% of the topiramate
group were associated with significant 50% responder
rate (p= 0.001, 95% CI 2.88-9.12; p= 0.001, 95% CI
2.18-7.32; respectively). The reduction in the mean
of monthly migraine intensity was also significant for
both groups (cinnarizine: p < 0.001, 95% CI 3.67-5.73;
topiramate: p <0.001, 95% CI 1.80-4.20) compared
with the baseline values. The reduction of monthly
migraine frequency showed no significant differences
for the cinnarizine group versus the topiramate group
(p> 0.05), whereas monthly migraine intensity in the
cinnarizine group reached a significant reduction in
comparison to the topiramate group (p < 0.05). During
the last 4 weeks of treatment, the reduction in monthly
migraine frequency and intensity was significant for
both treatment groups (p<0.05); however, these values
demonstrated no differences between the cinnarizine
and the topiramate group (p> 0.05).
Table 2 shows the mean of monthly migraine frequency
and intensity in the baseline phase and during the double-
blind phase (after 4, 8, and 12 weeks of treatment)
regarding the treatment groups.
Figure(s) 1 and 2 show the reduction in the mean of
monthly migraine frequency and intensity from the
baseline through the double-blind phase compared to
the responses to the cinnarizine and the topiramate
treatments.
Fig 1. Mean of monthly migraine frequency over time cinnarizine versus topiramate
0
1
2
3
4
5
6
7
8
9
prospective
baseline
4 weeks 8 weeks 12 weeks
Mean of monthly migraine frequency
Cinnarizine
Topiramate
6
7
8
ine intensity
Figure 2. Mean of monthly migraine intensity over time
cinnarizine versus topiramate
Cinnarizine in Preventing Pediatric Migraine
6. 23Iran J Child Neurol. 2014Autumn Vol 8 No 4
Table2. Reduction in Monthly Migraine Frequency and Intensity Over Time that Compares the Treatment Groups
Cinnarizine
(N = 20)
Topiramate
(N = 20)
Prospective baseline period
Migraine frequency, (per month)
MeanSD
Migraine intensity, (per month)
Mean SD
8.0 ± 7.98
7.3 ± 2.12
7.5 ± 6.43
6.5 ± 2.42
After 4 weeks of double-blind phase
Migraine frequency, (per month)
MeanSD
P (vs. baseline)*
Migraine intensity, (per month)
Mean SD
P (vs. baseline)*
5.7 ± 5.70
0.007
5.6 ± 2.01
< 0.001
5.5 ± 6.02
0.008
5.3 ± 2.77
0.002
After 8 weeks of double-blind phase
Migraine frequency, (per month)
MeanSD
P (vs. baseline)*
Migraine intensity, (per month)
Mean SD
P (vs. baseline)*
4.5 ± 4.57
0.004
4.3 ± 2.15
< 0.001
3.9 ± 3.91
0.001
4.3 ± 2.62
< 0.001
After 12 weeks of double-blind phase
Migraine frequency, (per month)
MeanSD
P (vs. baseline)*
Migraine intensity, (per month)
Mean SD
P (vs. baseline)*
2.0 ± 2.47
0.001
2.6 ± 2.37
< 0.001
2.7 ± 3.26
0.001
3.5 ± 2.74
< 0.001
*P values are measured using sample (paired) t test, from the comparison between baseline phase values and 4, 8, and 12 weeks
of treatment during the double-blind phase values.
Fig 2. Mean of monthly migraine intensity over time cinnarizine versus topiramate
Safety measures
Mild treatment related adverse effects were reported in 4 subjects of the cinnarizine group, which was
mild sleepiness. In the topiramate group, 6 subjects experienced mild treatment related adverse effects
that included mild sedation (71.4%) and mild appetite decrease (14.3%). One subject in the topiramate
group had serious adverse effects, which were severe decrease in appetite and weight loss (2 Kg, after
1-month treatment). The serious adverse effects did not result in withdrawal, but adjustment of the
dose of topiramate. In total 27.5% of subjects (11/40) experienced mild treatment related adverse
effects of which the most common was sedation (22.5%) (Table 3).No life-threatening side effects
were reported during the double-blind phase in both treatment groups.
The analysis revealed no statistically significant differences between the cinnarizine group and the
topiramate group for treatment related adverse effects (p = 0.29).
0
prospective
baseline
4 weeks 8 weeks 12 weeks
0
1
2
3
4
5
6
7
8
prospective
baseline
4 weeks 8 weeks 12 weeks
Mean of monthly migraine intensity
Figure 2. Mean of monthly migraine intensity over time
cinnarizine versus topiramate
Cinnarizine
Topiramate
Cinnarizine in Preventing Pediatric Migraine
7. 24 Iran J Child Neurol. 2014Autumn Vol 8 No 4
but adjustment of the dose of topiramate. In total 27.5%
of subjects (11/40) experienced mild treatment related
adverse effects of which the most common was sedation
(22.5%) (Table 3). No life-threatening side effects were
reported during the double-blind phase in both treatment
groups.
The analysis revealed no statistically significant
differences between the cinnarizine group and the
topiramate group for treatment related adverse effects
(p= 0.29).
Safety measures
Mild treatment related adverse effects were reported
in 4 subjects of the cinnarizine group, which was
mild sleepiness. In the topiramate group, 6 subjects
experienced mild treatment related adverse effects
that included mild sedation (71.4%) and mild appetite
decrease (14.3%). One subject in the topiramate group
hadseriousadverseeffects,whichwereseveredecreasein
appetite and weight loss (2 Kg, after 1-month treatment).
The serious adverse effects did not result in withdrawal,
Table 3. Incidence of Adverse Effects During the Ddouble-blind Phase for the Treatment Groups
Adverse effect
Cinnarizine
(N = 20)
n (%)
Topiramate
(N = 20)
n (%)
Mild sedation 4 (20) 5 (25)
Sever sedation 0 (0) 0 (0)
Mild appetite decrease 0 (0) 1 (5)
Sever appetite decrease 0 (0) 1 (5)
Weight loss 0 (0) 1 (5)
Discussion
In the current study, we evaluated the frequency and
intensity of monthly migraine attacks in children and
adolescents aged 4–17 years before and after (during a
12 weeks treatment period) receiving the cinnarizine or
the topiramate treatment; and compared the results of the
treatment groups with each other. We also assessed the
responder rate to cinnarizine and topiramate treatment
by comparing with the baseline and every 4 weeks of
treatment (up to 12 weeks). In addition, frequency of
probable adverse effects related to the cinnarizine and
the topiramate treatment and the safety of the treatments
were evaluated.
We demonstrated that the cinnarizine and topiramate
treatments resulted in significant reductions in the
frequency and intensity of monthly migraine attacks
from the baseline through 12 weeks of treatment. The
reduction in the mean of monthly migraine frequency
and intensity showed no significant differences for
cinnarizine versus topiramate treatments from the
baseline through 12 weeks of treatment with exception
that cinnarizine was significantly more effective than
topiramate in the reduction of monthly migraine intensity
for the last 4 weeks of double-blind phase compared
with the baseline. The responder rate (50%) was also
significant for both treatment groups from the baseline
through 12 weeks of treatment. With regard to the safety
measures, both treatments were well tolerated and no
life-threatening side effects were reported.
Two previous controlled trials and a pooled analysis of
three pivotal trials have been reported in this study and
the significant effect of topiramate to reduce monthly
migraine frequency (12, 13, 15). Another controlled trial
has reported that the topiramate effect in the reduction
of monthly migraine frequency was not significant;
however, the trend of the results was toward significance
14. A number of uncontrolled trials also supported the
idea of the effectiveness of topiramate in the reduction
of monthly migraine frequency (16-19).
A reported 50% responder rate to the topiramate
Cinnarizine in Preventing Pediatric Migraine
8. 25Iran J Child Neurol. 2014Autumn Vol 8 No 4
our study on the effectiveness and safety of cinnarizine
as a preventive treatment of migraine headaches among
children and adolescents are incomparable with the
limited data of previous studies on the effectiveness of
cinnarizine in migraine prevention among adults (20-
22).
A limitation of our study was that it had no placebo
group. Since our probable participants who met the
primary criteria to enter the baseline period of the study
had migraine characteristics that make it impossible to
manage migraines with using no preventive medications.
It was immoral to randomize them into an additional
group in which the participants would receive a placebo.
In this regard, further studies evaluating the effectiveness
of cinnarizine and/or topiramate on migraine prevention
in comparison to a control group (which is receiving a
placebo) should be conducted.
There is a lack of evidence in the literature about the
effectiveness and safety of cinnarizine treatment either
in children and adolescents or in adults. In addition,
there is no approved medication yet available for
migraine prevention in children and adolescents. Further
open-label and controlled trials should be conducted on
investigating the effectiveness and safety of cinnarizine
treatment in migraine prevention with special regard to
children and adolescents.
In conclusion, both cinnarizine and topiramate
treatments demonstrated efficacy in the prevention
of migraine headaches in children and adolescents.
Cinnarizine can be considered as an effective and novel
preventive treatment for pediatric migraines. Overall,
both treatments were well-tolerated and safe.
Acknowledgment
The study was conducted at the Children’s Medical
Center affiliated with the Tehran University of Medical
Sciences from February 2010 to October 2010. The
authors would like to thank the staff of this children
center and for their kind cooperation. In addition, the
authors would like to specially thank Dr Foad Taghdiri
for his kind help in editing the article and its submission.
Author Contribution:
Z. Najafi and K. Heidari helped in data gathering,
preparing a database, article searching, preparing, and
writing the manuscript. M.R. Ashrafi and M. Togha
treatment varies in different studies, from 43.1–95.2%
(12-14,17). There are some studies in Iran that show the
efficacy and safety of topiramate for the prophylaxis of
childhood migraines (24, 25). In the current study, 50%
responder rate was reported to be 30%, 50%, and 65%
for the duration of treatment with topiramate (4, 8, and
12 weeks, respectively). This variety probably derives
from the differences in administrated topiramate doses,
duration of treatment with topiramate, and the baseline
frequency of patient migraine headaches (13, 14, 26).
The effectiveness of topiramate on the reduction of
monthly migraine intensity has been reported by
different studies (12,16-18). Two studies measured the
migraine intensity by using Pediatric Migraine disability
assessment score (PedMIDAS) (12,18), which is
incomparable to our study intensity values, because our
measurement for migraine intensity used VAS. Hershey
et al used VAS scaling for the assessment of migraine
intensity and reported significant reductions in migraine
intensity 17 with the same found in our study.
The frequency of side effects related to topiramate
administration varied considerably among studies from
14–81% (measured as the percentage of participants
that experienced at least one adverse effect during the
treatment period of the study) (12, 13, 16-18). The most
frequent reported side effects were weight loss, anorexia,
abdominal pain, sedation, paresthesia, and difficulties
in concentration (12-19). Withdrawal from the study
caused by adverse effects was low (13, 14). We reported
that the frequency of the side effects was 30% and the
most frequent side effects were sedation and appetite
decrease among the participants of the topiramate group.
No dropouts occurred in our study due to adverse effects.
The variety in the frequency of adverse effects among
different studies may be due to the administrated dose
of topiramate. In total, topiramate was well tolerated
by patients in previous studies (13-18) as in this study.
Although, further controlled studies should be carried
out to assess the frequency of side effects of topiramate
as preventive treatment of migraine headaches with
regard to the different daily doses of topiramate.
To the best of our knowledge, the current study is the first
study that investigates the effectiveness of cinnarizine
treatment as a prophylaxis of migraine headaches among
children and adolescents. In this regard, the results of
Cinnarizine in Preventing Pediatric Migraine
9. 26 Iran J Child Neurol. 2014Autumn Vol 8 No 4
Cinnarizine in Preventing Pediatric Migraine
planed the study, confirmed the patients’ diagnosis,
helped in article searching, preparing, and writing the
manuscript. M. Shafiei helped in preparing a database,
data analyzing, article searching, preparing, and writing
the manuscript. All authors read and approved the final
manuscript.
Conflict of interest: The authors declare that there are
no conflicts of interest.
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