1) This study analyzed the effects of dosing growth hormone (GH) based on insulin-like growth factor I (IGF-I) levels compared to conventional weight-based dosing in short children over 2 years.
2) The results showed that dosing GH to target an IGF-I level of 0 SDS was the most dose-sparing regimen, requiring lower GH doses to achieve growth effects.
3) Dosing to a 0 SDS IGF-I target also resulted in the fewest instances of high IGF-I levels above +2 SDS, indicating it may provide a safer therapy approach than conventional weight-based dosing.
This clinical practice guideline from the Endocrine Society provides recommendations for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA). FHA is a form of chronic anovulation caused by stress, weight loss, excessive exercise or a combination thereof, rather than identifiable organic causes. The guideline recommends excluding other causes through medical history, examination and laboratory tests before diagnosing FHA. Treatment involves correcting energy imbalance through increased caloric intake and/or decreased exercise, as well as psychological support. Short-term hormone therapy may be considered if menses do not return with lifestyle changes alone.
- Ocrelizumab (OCR) significantly reduced disability progression and disease activity in patients with primary progressive multiple sclerosis (PPMS) compared to placebo in the ORATORIO clinical trial.
- Evaluation of efficacy in subgroups of patients with and without T1 gadolinium-enhancing (Gd+) lesions at baseline was a key objective. OCR reduced disability progression and disease activity in both subgroups.
- Specifically, OCR reduced the risk of 12-week and 24-week confirmed disability progression by 24-25% in the overall population and in both subgroups. It also reduced the worsening of walking ability and brain lesion volume over 120 weeks compared to placebo.
This randomized controlled trial examined the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence, and treatment outcomes in patients undergoing low back pain rehabilitation. 48 military personnel with low back pain were randomly assigned to an experimental goal setting group, a therapist-led exercise group, or a non-therapist led exercise group. Adherence was higher in the experimental goal setting group compared to the non-therapist led group. Self-efficacy was also higher in the experimental group compared to the other two groups. However, treatment outcomes did not differ significantly between the groups. The findings provide partial support for using goal setting to enhance adherence in clinical rehabilitation.
The antibody aducanumab reduces amyloid beta (Aβ) plaques in patients with Alzheimer's disease in a dose- and time-dependent manner according to interim results from a phase 1b clinical trial. Monthly intravenous infusions of aducanumab for one year reduced brain Aβ plaques as measured by PET imaging in patients with prodromal or mild Alzheimer's disease. This Aβ reduction was accompanied by a slowing of clinical decline on measures of cognition and function. The main safety finding was amyloid-related imaging abnormalities that generally resolved over time and did not require hospitalization. These results support further development of aducanumab as a potential disease-modifying therapy for Alzheimer's disease.
1) A phase 3 clinical trial evaluated the efficacy of ocrelizumab in reducing disability progression in patients with primary progressive multiple sclerosis (PPMS) with and without T1 gadolinium-enhancing lesions at baseline.
2) Results showed that ocrelizumab reduced the risk of 12-week and 24-week confirmed disability progression by 24% and 25% respectively compared to placebo in the overall study population.
3) When analyzing subgroups based on presence of T1 lesions at baseline, ocrelizumab reduced risk of disability progression in both subgroups, though the results did not reach statistical significance in the subgroup with lesions at baseline.
Thriving, not just surviving after critical illnessCoda Change
1. Many ICU survivors experience long-term physical and mental disability after discharge, impacting their quality of life.
2. A study of 262 Australian ICU survivors found 57% experienced disability 6 months after discharge, with highest impairment in physical activity. Predictors included a history of anxiety/depression, separated/divorced marital status, and more days on mechanical ventilation.
3. Clinicians believe strategies like early mobilization, improved sedation practices, nutrition protocols, and enhancing family support could help ICU survivors recover and thrive after discharge.
Enzalutamide showed significant benefits over placebo in preserving health-related quality of life in patients with metastatic castration-resistant prostate cancer based on EQ-5D data from the PREVAIL trial. Specifically, enzalutamide slowed the decline in EQ-5D index and visual analogue scale scores compared to placebo. Analysis of individual EQ-5D dimensions found that enzalutamide was associated with significantly less deterioration in pain/discomfort and anxiety/depression. Enzalutamide also showed benefits over placebo for time to worsening health status according to the EQ-5D.
This clinical practice guideline from the Endocrine Society provides recommendations for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA). FHA is a form of chronic anovulation caused by stress, weight loss, excessive exercise or a combination thereof, rather than identifiable organic causes. The guideline recommends excluding other causes through medical history, examination and laboratory tests before diagnosing FHA. Treatment involves correcting energy imbalance through increased caloric intake and/or decreased exercise, as well as psychological support. Short-term hormone therapy may be considered if menses do not return with lifestyle changes alone.
- Ocrelizumab (OCR) significantly reduced disability progression and disease activity in patients with primary progressive multiple sclerosis (PPMS) compared to placebo in the ORATORIO clinical trial.
- Evaluation of efficacy in subgroups of patients with and without T1 gadolinium-enhancing (Gd+) lesions at baseline was a key objective. OCR reduced disability progression and disease activity in both subgroups.
- Specifically, OCR reduced the risk of 12-week and 24-week confirmed disability progression by 24-25% in the overall population and in both subgroups. It also reduced the worsening of walking ability and brain lesion volume over 120 weeks compared to placebo.
This randomized controlled trial examined the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence, and treatment outcomes in patients undergoing low back pain rehabilitation. 48 military personnel with low back pain were randomly assigned to an experimental goal setting group, a therapist-led exercise group, or a non-therapist led exercise group. Adherence was higher in the experimental goal setting group compared to the non-therapist led group. Self-efficacy was also higher in the experimental group compared to the other two groups. However, treatment outcomes did not differ significantly between the groups. The findings provide partial support for using goal setting to enhance adherence in clinical rehabilitation.
The antibody aducanumab reduces amyloid beta (Aβ) plaques in patients with Alzheimer's disease in a dose- and time-dependent manner according to interim results from a phase 1b clinical trial. Monthly intravenous infusions of aducanumab for one year reduced brain Aβ plaques as measured by PET imaging in patients with prodromal or mild Alzheimer's disease. This Aβ reduction was accompanied by a slowing of clinical decline on measures of cognition and function. The main safety finding was amyloid-related imaging abnormalities that generally resolved over time and did not require hospitalization. These results support further development of aducanumab as a potential disease-modifying therapy for Alzheimer's disease.
1) A phase 3 clinical trial evaluated the efficacy of ocrelizumab in reducing disability progression in patients with primary progressive multiple sclerosis (PPMS) with and without T1 gadolinium-enhancing lesions at baseline.
2) Results showed that ocrelizumab reduced the risk of 12-week and 24-week confirmed disability progression by 24% and 25% respectively compared to placebo in the overall study population.
3) When analyzing subgroups based on presence of T1 lesions at baseline, ocrelizumab reduced risk of disability progression in both subgroups, though the results did not reach statistical significance in the subgroup with lesions at baseline.
Thriving, not just surviving after critical illnessCoda Change
1. Many ICU survivors experience long-term physical and mental disability after discharge, impacting their quality of life.
2. A study of 262 Australian ICU survivors found 57% experienced disability 6 months after discharge, with highest impairment in physical activity. Predictors included a history of anxiety/depression, separated/divorced marital status, and more days on mechanical ventilation.
3. Clinicians believe strategies like early mobilization, improved sedation practices, nutrition protocols, and enhancing family support could help ICU survivors recover and thrive after discharge.
Enzalutamide showed significant benefits over placebo in preserving health-related quality of life in patients with metastatic castration-resistant prostate cancer based on EQ-5D data from the PREVAIL trial. Specifically, enzalutamide slowed the decline in EQ-5D index and visual analogue scale scores compared to placebo. Analysis of individual EQ-5D dimensions found that enzalutamide was associated with significantly less deterioration in pain/discomfort and anxiety/depression. Enzalutamide also showed benefits over placebo for time to worsening health status according to the EQ-5D.
Methyl prednisolone in infantile spasm journal presentationshukur ullah
1. This study investigated the short-term effects of intravenous methylprednisolone (MPD) pulse therapy as a first-line treatment for 14 patients with newly diagnosed infantile spasms.
2. 64.3% of patients achieved cessation of spasms within 3 days on average. 55.6% remained spasm-free after 3 months, and the overall spasm freedom rate was 78.6%.
3. Adverse effects were minor, with irritability in 3 patients and lower respiratory infection in 1 patient. MPD pulse therapy shows promise as a safe and effective initial treatment for infantile spasms.
New Perspectives on Alzheimer’s Disease and NutritionNutricia
This document summarizes a roundtable discussion on the role of nutrition in Alzheimer's disease (AD). The discussion focused on how being overweight or obese in midlife may increase the risk of developing AD decades later, though evidence is conflicting. After midlife, higher body weight and BMI are associated with lower dementia risk. Weight loss and underweight in late life are linked to higher dementia risk. The natural trajectory of BMI over the lifespan differs between those who do and do not develop dementia. Changes in BMI and weight loss may also be associated with clinical progression of AD. Further research is needed to better understand these complex relationships between nutritional status and AD risk and progression.
Efficacy of a medical food in mild Alzheimer’s disease: A randomized, control...Nutricia
1. This randomized, double-blind, controlled trial investigated the effects of a medical food supplement called Souvenaid on cognitive function in 225 patients with mild Alzheimer's disease over 12 weeks.
2. The study found a statistically significant improvement in delayed verbal recall, the primary outcome measure, in the group receiving Souvenaid compared to the control group at 12 weeks.
3. Secondary measures of cognitive function, behavior, functional abilities, and quality of life did not differ between the groups. The medical food was well-tolerated with high compliance among patients.
An Internet questionnaire to predict the presence or absence of organic patho...Nelson Hendler
The Pain Validity Test, developed by a team of physicians from Johns Hopkins Hospital, is available over the Internet, at www.MarylandClinicalDiagnostics.com. The test can predict, with 95% accuracy, which patient will have abnormalities on medical tersting, i.e. who has a valid complaint of pain. The test takes only 5 minutes to set up a patient, 15 minutes for a patient to take the test, and results are available immediately after completion. The test has been admitted as evidence in court cases in over 30 cases in 8 states.
Efficacy of Souvenaid in Mild Alzheimer’s Disease: Results from a Randomized,...Nutricia
1) This randomized controlled trial found that consumption of Souvenaid, a medical food containing nutrients to support synaptic function, led to improved memory performance over 24 weeks in patients with mild Alzheimer's disease compared to a control group.
2) The primary outcome measure, the memory domain z-score of the Neuropsychological Test Battery, was significantly higher in the Souvenaid group than the control group after 24 weeks.
3) Secondary EEG measures showed significantly different functional brain connectivity in the delta band between the groups over 24 weeks, supporting the hypothesis that Souvenaid affects synaptic activity.
This study aimed to assess the long-term outcomes of lumbar fusion versus non-specific physiotherapy for chronic low back pain. 294 patients were randomized to fusion or physiotherapy and followed for an average of 12.8 years.
Using various analytic approaches, success rates based on patient's global assessment of improvement were in the 65% range for fusion patients, compared to 31-37% for physiotherapy patients. However, secondary outcomes like disability and pain scales showed similar levels of improvement between groups. The discrepancies between primary and secondary outcomes means the study provides only Level II evidence regarding recommending fusion for non-specific low back pain.
Hypothermia for Neonatal Hypoxic Ischemic EncephalopathyMaged Zakaria
This review article summarizes the current evidence on therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy (HIE) from randomized controlled trials. The review identified 7 trials including 1214 newborns that compared therapeutic hypothermia to normothermia. The results showed that therapeutic hypothermia reduced the risk of death or major neurodevelopmental disability at 18 months and increased the rate of survival with normal neurological function. Both total body cooling and selective head cooling were effective in reducing these risks. The review concludes that hypothermia improves outcomes for newborns with moderate to severe HIE and should be considered as part of routine clinical care for these newborns.
This randomized controlled trial evaluated whether pre-hospital administration of hypertonic saline or hypertonic saline plus dextran improved 6-month neurological outcomes in patients with severe traumatic brain injury without hypovolaemic shock compared to normal saline. Over 1300 patients were randomized to receive one of the three study fluids. The primary outcome of an extended Glasgow Outcome Scale score of ≤4 at 6 months was not significantly different between groups. Secondary outcomes including 28-day survival were also not significantly different between groups. The study was terminated early due to futility in showing benefit of the hypertonic fluids over normal saline.
Brain Derived Neurotrophic Factor increases during recovery from psychologica...inventionjournals
Objective: To study the levels of plasma BDNF during recovering from psychological stress. Methods: Blood samples from thirty eight participants in a stress treatment project were analyzed for BDNF in plasma before and after 3 months treatment. Symptom levels were assessed by SCL92, work ability index and a question on stress. Physiological and behavioral measures were collected, all at baseline and after treatment. Results: BDNF increased significantly during the follow up, but the levels of BDNF were not correlated to blood pressure, se-cholesterol, HbA1C, se-fibrinogen or salivary cortisol even if the two latter decreased significantly. BDNF increase was inversely associated with improvement in depression symptoms contrary to the expected. Conclusion: Plasma BDNF increased during treatment for psychological stress, but was not associated with physiological stressmarkers or improvement of stress symptoms.
This study aimed to compare the ability of serial cranial ultrasounds (CUS) and early MRI scans in detecting preterm brain injuries. The study found that CUS allowed for more scans due to better feasibility in the NICU, and was better at detecting grade I-II intraventricular hemorrhages and perforator strokes. MRI was superior for identifying smaller cerebellar hemorrhages and provided more quantitative data. Overall, the combination of serial CUS and MRI provided the highest sensitivity for detecting common preterm brain injuries, though MRI could not be performed in the sickest infants.
This study investigated hyperreflexia in Guillain-Barré syndrome (GBS) and its relation to acute motor axonal neuropathy (AMAN) and anti-GM1 antibodies. The study found that some GBS patients with the AMAN pattern, anti-GM1 antibodies, and milder weakness developed hyperreflexia. Specifically, 33% of AMAN patients showed hyperreflexia compared to 12% of acute inflammatory demyelinating polyneuropathy patients. Hyperreflexia was associated with increased motor neuron excitability. The mechanism is unknown but may involve dysfunction of spinal inhibitory interneurons or upper motor neurons due to anti-GM1 antibodies. Hyperreflexia indicates less severe motor ax
Food for Thought: Souvenaid® in Mild Alzheimer’s DiseaseNutricia
1) A 24-week clinical trial tested the medical food Souvenaid, which contains nutrients thought to support synaptic function, in 259 patients with mild Alzheimer's disease.
2) The study achieved its primary outcome by showing a statistically significant difference in memory scores between the Souvenaid and placebo groups over 24 weeks.
3) Secondary analyses found some additional cognitive tests favored the Souvenaid group, while others showed no difference. EEG measures also showed some differences between groups. Souvenaid was well tolerated with few adverse effects.
1) The study compared outcomes of severely head injured patients who received early enteral nutrition within 48 hours of injury versus those who received delayed enteral nutrition based on current practices.
2) Patients who received early enteral nutrition had a significantly lower rate of poor outcomes (61.1% vs 100%) and higher rate of good outcomes (35.3% vs 0%) compared to the delayed nutrition group.
3) The study concludes that early and appropriate nutritional support can improve outcomes for severely head injured patients possibly by decreasing infections and preventing multiple organ failure.
Treat to target in inflammatory diseases SMMI 2018SMMI2015
In conclusion, treat to target is a new paradigm that involves regular disease assessment, therapy adaptation, and consideration of patient factors. Integration into daily
Short-term effects of teriparatide versus placebo on bone biomarkers, structu...Ellen Almirol
This pilot study evaluated the effects of 8 weeks of teriparatide (TPTD) versus placebo treatment on bone biomarkers, structure, and stress fracture healing in premenopausal women with lower-extremity stress fractures. The study found that TPTD treatment led to greater increases in bone formation markers and a larger "anabolic window" compared to placebo. TPTD treatment also showed improvements in bone structure at weight-bearing sites on imaging. A higher percentage of stress fractures showed improvement or healing with TPTD versus placebo on MRI, though the results were not statistically significant. The study provides preliminary evidence that TPTD may help hasten stress fracture healing in premenopausal women.
Brain Health: The Importance of Recognizing Cognitive Impairment: An IAGG Con...Nutricia
This document summarizes the conclusions of an expert panel convened by the International Association of Gerontology and Geriatrics to discuss early detection of cognitive impairment. The panel agreed that:
1) Validated screening tests that take 3 to 7 minutes can identify early cognitive impairment.
2) The most effective approach is to use both patient-reported and informant-reported screening tools.
3) Early cognitive impairment may have treatable components, and emerging evidence supports interventions like medical treatment, nutrition changes, and physical/cognitive exercise to delay or reduce decline.
This study evaluated the use of sirolimus, an mTOR inhibitor, in 4 patients with diffuse hyperinsulinemic hypoglycemia that was unresponsive to standard treatments with diazoxide and octreotide. Patients received sirolimus with dose adjustments to achieve target serum levels. Glycemic control improved in all patients after starting sirolimus. The study suggests mTOR inhibitors may provide an alternative treatment option for severe hyperinsulinemic hypoglycemia unresponsive to other therapies, but larger and longer-term studies are still needed to fully evaluate efficacy and safety.
- This randomized controlled trial studied the effect of erythropoietin treatment in 941 extremely preterm infants between 24 and 27 weeks gestation. Infants received either erythropoietin or placebo intravenously for 6 doses then subcutaneously until 32 weeks postmenstrual age.
- The primary outcome of death or severe neurodevelopmental impairment at 2 years was not significantly different between the erythropoietin and placebo groups. No meaningful differences in serious adverse events were found.
- Unlike previous studies, this larger trial found that high-dose erythropoietin treatment did not reduce the risk of death or improve neurodevelopmental outcomes in extremely preterm infants compared to placebo.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
1. Short stature can be defined as a height more than 2 standard deviations below the mean height for age and gender.
2. Evaluation of a child with short stature includes assessing height, mid-parental height, bone age, basic lab tests, growth hormone stimulation tests, and IGF-1 and IGFBP-3 levels.
3. Causes of short stature include growth hormone deficiency, Turner syndrome, chronic renal insufficiency, and being small for gestational age. Growth hormone treatment dosages vary depending on the underlying cause.
Sp1_Lessons for judicious use of insulin – Perspective on timely insulin init...SenthilRaja79
1. A study analyzed data from 185 Indian patients with type 2 diabetes who initiated or switched to insulin degludec/insulin aspart (IDegAsp) in a real-world clinical setting.
2. After 36 weeks, patients experienced a mean reduction in HbA1c of 1.6% from a baseline of 9.8%, as well as a mean reduction in fasting plasma glucose of 49 mg/dL from a baseline of 190 mg/dL.
3. The initiation of IDegAsp was associated with significantly lower rates of hypoglycemia compared to prior treatment.
Methyl prednisolone in infantile spasm journal presentationshukur ullah
1. This study investigated the short-term effects of intravenous methylprednisolone (MPD) pulse therapy as a first-line treatment for 14 patients with newly diagnosed infantile spasms.
2. 64.3% of patients achieved cessation of spasms within 3 days on average. 55.6% remained spasm-free after 3 months, and the overall spasm freedom rate was 78.6%.
3. Adverse effects were minor, with irritability in 3 patients and lower respiratory infection in 1 patient. MPD pulse therapy shows promise as a safe and effective initial treatment for infantile spasms.
New Perspectives on Alzheimer’s Disease and NutritionNutricia
This document summarizes a roundtable discussion on the role of nutrition in Alzheimer's disease (AD). The discussion focused on how being overweight or obese in midlife may increase the risk of developing AD decades later, though evidence is conflicting. After midlife, higher body weight and BMI are associated with lower dementia risk. Weight loss and underweight in late life are linked to higher dementia risk. The natural trajectory of BMI over the lifespan differs between those who do and do not develop dementia. Changes in BMI and weight loss may also be associated with clinical progression of AD. Further research is needed to better understand these complex relationships between nutritional status and AD risk and progression.
Efficacy of a medical food in mild Alzheimer’s disease: A randomized, control...Nutricia
1. This randomized, double-blind, controlled trial investigated the effects of a medical food supplement called Souvenaid on cognitive function in 225 patients with mild Alzheimer's disease over 12 weeks.
2. The study found a statistically significant improvement in delayed verbal recall, the primary outcome measure, in the group receiving Souvenaid compared to the control group at 12 weeks.
3. Secondary measures of cognitive function, behavior, functional abilities, and quality of life did not differ between the groups. The medical food was well-tolerated with high compliance among patients.
An Internet questionnaire to predict the presence or absence of organic patho...Nelson Hendler
The Pain Validity Test, developed by a team of physicians from Johns Hopkins Hospital, is available over the Internet, at www.MarylandClinicalDiagnostics.com. The test can predict, with 95% accuracy, which patient will have abnormalities on medical tersting, i.e. who has a valid complaint of pain. The test takes only 5 minutes to set up a patient, 15 minutes for a patient to take the test, and results are available immediately after completion. The test has been admitted as evidence in court cases in over 30 cases in 8 states.
Efficacy of Souvenaid in Mild Alzheimer’s Disease: Results from a Randomized,...Nutricia
1) This randomized controlled trial found that consumption of Souvenaid, a medical food containing nutrients to support synaptic function, led to improved memory performance over 24 weeks in patients with mild Alzheimer's disease compared to a control group.
2) The primary outcome measure, the memory domain z-score of the Neuropsychological Test Battery, was significantly higher in the Souvenaid group than the control group after 24 weeks.
3) Secondary EEG measures showed significantly different functional brain connectivity in the delta band between the groups over 24 weeks, supporting the hypothesis that Souvenaid affects synaptic activity.
This study aimed to assess the long-term outcomes of lumbar fusion versus non-specific physiotherapy for chronic low back pain. 294 patients were randomized to fusion or physiotherapy and followed for an average of 12.8 years.
Using various analytic approaches, success rates based on patient's global assessment of improvement were in the 65% range for fusion patients, compared to 31-37% for physiotherapy patients. However, secondary outcomes like disability and pain scales showed similar levels of improvement between groups. The discrepancies between primary and secondary outcomes means the study provides only Level II evidence regarding recommending fusion for non-specific low back pain.
Hypothermia for Neonatal Hypoxic Ischemic EncephalopathyMaged Zakaria
This review article summarizes the current evidence on therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy (HIE) from randomized controlled trials. The review identified 7 trials including 1214 newborns that compared therapeutic hypothermia to normothermia. The results showed that therapeutic hypothermia reduced the risk of death or major neurodevelopmental disability at 18 months and increased the rate of survival with normal neurological function. Both total body cooling and selective head cooling were effective in reducing these risks. The review concludes that hypothermia improves outcomes for newborns with moderate to severe HIE and should be considered as part of routine clinical care for these newborns.
This randomized controlled trial evaluated whether pre-hospital administration of hypertonic saline or hypertonic saline plus dextran improved 6-month neurological outcomes in patients with severe traumatic brain injury without hypovolaemic shock compared to normal saline. Over 1300 patients were randomized to receive one of the three study fluids. The primary outcome of an extended Glasgow Outcome Scale score of ≤4 at 6 months was not significantly different between groups. Secondary outcomes including 28-day survival were also not significantly different between groups. The study was terminated early due to futility in showing benefit of the hypertonic fluids over normal saline.
Brain Derived Neurotrophic Factor increases during recovery from psychologica...inventionjournals
Objective: To study the levels of plasma BDNF during recovering from psychological stress. Methods: Blood samples from thirty eight participants in a stress treatment project were analyzed for BDNF in plasma before and after 3 months treatment. Symptom levels were assessed by SCL92, work ability index and a question on stress. Physiological and behavioral measures were collected, all at baseline and after treatment. Results: BDNF increased significantly during the follow up, but the levels of BDNF were not correlated to blood pressure, se-cholesterol, HbA1C, se-fibrinogen or salivary cortisol even if the two latter decreased significantly. BDNF increase was inversely associated with improvement in depression symptoms contrary to the expected. Conclusion: Plasma BDNF increased during treatment for psychological stress, but was not associated with physiological stressmarkers or improvement of stress symptoms.
This study aimed to compare the ability of serial cranial ultrasounds (CUS) and early MRI scans in detecting preterm brain injuries. The study found that CUS allowed for more scans due to better feasibility in the NICU, and was better at detecting grade I-II intraventricular hemorrhages and perforator strokes. MRI was superior for identifying smaller cerebellar hemorrhages and provided more quantitative data. Overall, the combination of serial CUS and MRI provided the highest sensitivity for detecting common preterm brain injuries, though MRI could not be performed in the sickest infants.
This study investigated hyperreflexia in Guillain-Barré syndrome (GBS) and its relation to acute motor axonal neuropathy (AMAN) and anti-GM1 antibodies. The study found that some GBS patients with the AMAN pattern, anti-GM1 antibodies, and milder weakness developed hyperreflexia. Specifically, 33% of AMAN patients showed hyperreflexia compared to 12% of acute inflammatory demyelinating polyneuropathy patients. Hyperreflexia was associated with increased motor neuron excitability. The mechanism is unknown but may involve dysfunction of spinal inhibitory interneurons or upper motor neurons due to anti-GM1 antibodies. Hyperreflexia indicates less severe motor ax
Food for Thought: Souvenaid® in Mild Alzheimer’s DiseaseNutricia
1) A 24-week clinical trial tested the medical food Souvenaid, which contains nutrients thought to support synaptic function, in 259 patients with mild Alzheimer's disease.
2) The study achieved its primary outcome by showing a statistically significant difference in memory scores between the Souvenaid and placebo groups over 24 weeks.
3) Secondary analyses found some additional cognitive tests favored the Souvenaid group, while others showed no difference. EEG measures also showed some differences between groups. Souvenaid was well tolerated with few adverse effects.
1) The study compared outcomes of severely head injured patients who received early enteral nutrition within 48 hours of injury versus those who received delayed enteral nutrition based on current practices.
2) Patients who received early enteral nutrition had a significantly lower rate of poor outcomes (61.1% vs 100%) and higher rate of good outcomes (35.3% vs 0%) compared to the delayed nutrition group.
3) The study concludes that early and appropriate nutritional support can improve outcomes for severely head injured patients possibly by decreasing infections and preventing multiple organ failure.
Treat to target in inflammatory diseases SMMI 2018SMMI2015
In conclusion, treat to target is a new paradigm that involves regular disease assessment, therapy adaptation, and consideration of patient factors. Integration into daily
Short-term effects of teriparatide versus placebo on bone biomarkers, structu...Ellen Almirol
This pilot study evaluated the effects of 8 weeks of teriparatide (TPTD) versus placebo treatment on bone biomarkers, structure, and stress fracture healing in premenopausal women with lower-extremity stress fractures. The study found that TPTD treatment led to greater increases in bone formation markers and a larger "anabolic window" compared to placebo. TPTD treatment also showed improvements in bone structure at weight-bearing sites on imaging. A higher percentage of stress fractures showed improvement or healing with TPTD versus placebo on MRI, though the results were not statistically significant. The study provides preliminary evidence that TPTD may help hasten stress fracture healing in premenopausal women.
Brain Health: The Importance of Recognizing Cognitive Impairment: An IAGG Con...Nutricia
This document summarizes the conclusions of an expert panel convened by the International Association of Gerontology and Geriatrics to discuss early detection of cognitive impairment. The panel agreed that:
1) Validated screening tests that take 3 to 7 minutes can identify early cognitive impairment.
2) The most effective approach is to use both patient-reported and informant-reported screening tools.
3) Early cognitive impairment may have treatable components, and emerging evidence supports interventions like medical treatment, nutrition changes, and physical/cognitive exercise to delay or reduce decline.
This study evaluated the use of sirolimus, an mTOR inhibitor, in 4 patients with diffuse hyperinsulinemic hypoglycemia that was unresponsive to standard treatments with diazoxide and octreotide. Patients received sirolimus with dose adjustments to achieve target serum levels. Glycemic control improved in all patients after starting sirolimus. The study suggests mTOR inhibitors may provide an alternative treatment option for severe hyperinsulinemic hypoglycemia unresponsive to other therapies, but larger and longer-term studies are still needed to fully evaluate efficacy and safety.
- This randomized controlled trial studied the effect of erythropoietin treatment in 941 extremely preterm infants between 24 and 27 weeks gestation. Infants received either erythropoietin or placebo intravenously for 6 doses then subcutaneously until 32 weeks postmenstrual age.
- The primary outcome of death or severe neurodevelopmental impairment at 2 years was not significantly different between the erythropoietin and placebo groups. No meaningful differences in serious adverse events were found.
- Unlike previous studies, this larger trial found that high-dose erythropoietin treatment did not reduce the risk of death or improve neurodevelopmental outcomes in extremely preterm infants compared to placebo.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
1. Short stature can be defined as a height more than 2 standard deviations below the mean height for age and gender.
2. Evaluation of a child with short stature includes assessing height, mid-parental height, bone age, basic lab tests, growth hormone stimulation tests, and IGF-1 and IGFBP-3 levels.
3. Causes of short stature include growth hormone deficiency, Turner syndrome, chronic renal insufficiency, and being small for gestational age. Growth hormone treatment dosages vary depending on the underlying cause.
Sp1_Lessons for judicious use of insulin – Perspective on timely insulin init...SenthilRaja79
1. A study analyzed data from 185 Indian patients with type 2 diabetes who initiated or switched to insulin degludec/insulin aspart (IDegAsp) in a real-world clinical setting.
2. After 36 weeks, patients experienced a mean reduction in HbA1c of 1.6% from a baseline of 9.8%, as well as a mean reduction in fasting plasma glucose of 49 mg/dL from a baseline of 190 mg/dL.
3. The initiation of IDegAsp was associated with significantly lower rates of hypoglycemia compared to prior treatment.
This study compared cardiovascular responses to exercise between normotensive offspring of normotensive parents and normotensive offspring of hypertensive parents. It found that resting diastolic blood pressure was significantly higher in offspring of hypertensive parents. During a 6-minute walk test, there was a decreased diastolic blood pressure response to exercise in offspring of hypertensive parents. However, the distance covered during the test did not differ between groups. The study concludes there is an early trend toward higher blood pressure in offspring of hypertensive parents and an abnormal pattern of heart rate and blood pressure recovery from exercise.
The document summarizes a clinical trial that evaluated the efficacy and safety of the herbal supplement Tribulus terrestris for male sexual dysfunction. 180 men with mild-to-moderate erectile dysfunction were randomized to receive either Tribulus terrestris or a placebo for 12 weeks. The primary outcome was a change in the International Index of Erectile Function score from baseline to end of study. Secondary outcomes included changes in other domains of sexual function, safety assessments, and lipid and hormone levels. Results indicated that Tribulus terrestris significantly improved erectile function and overall sexual satisfaction compared to placebo, without significant safety issues.
Several studies have compared basal-bolus insulin regimens using basal insulin plus oral agents to premixed insulin regimens in patients with type 2 diabetes:
- Studies found basal-bolus regimens were more effective at achieving glycemic targets and reducing HbA1c levels compared to premixed regimens.
- Basal-bolus regimens resulted in less hypoglycemia and weight gain.
- Physicians and patients reported greater treatment satisfaction with basal-bolus regimens due to their increased flexibility compared to fixed-ratio premixed regimens.
This 3-paragraph summary provides the key information from the 3-page document:
The document discusses a study comparing the effects of the statin drug Rosuvastatin and Indian dates (jujubes) on blood pressure and cholesterol levels in hyperlipidemic patients over 2 months. Rosuvastatin significantly decreased both systolic and diastolic blood pressure as well as LDL-C and increased HDL-C, while Indian dates only significantly decreased systolic blood pressure and LDL-C but did not significantly affect diastolic blood pressure or HDL-C. The results indicate that Rosuvastatin is a more potent agent for reducing blood pressure and modifying lipid profiles compared to Indian dates. However, herbal medicines like Indian dates
Adherence in growth hormone therapy & approach to improve it!!Abdulmoein AlAgha
This document discusses adherence to growth hormone (GH) therapy and approaches to improve it. It notes that poor adherence is a major challenge and reduces the effectiveness of GH treatment. Some factors that contribute to non-adherence include the need for daily injections, treatment duration, complex devices, and cost. Strategies to improve adherence include educating patients and families on treatment benefits, using easy-to-use devices, monitoring adherence, and developing long-acting GH therapies that require less frequent dosing.
GH therapy has been used successfully to treat growth disorders since the 1950s. While early forms of GH carried safety risks, modern recombinant GH is highly purified and safe. GH administration has been shown to significantly increase growth rates in children with deficiencies or disorders like GHD, Turner syndrome, and SGA. Close monitoring is required due to potential side effects involving glucose metabolism, slipped capital femoral epiphysis, and intracranial hypertension in a small percentage of patients.
2. Simplifying insulin therapy with Co-Formulation Insulin salinan-1 copy.pptxMuhammadAdriWansah1
This document summarizes the results of the STEP BY STEP trial which compared the efficacy and safety of insulin degludec/insulin aspart (Ryzodeg®) to insulin glargine U100 plus insulin aspart in patients with type 2 diabetes treated with basal insulin. The trial found that Ryzodeg® provided similar reductions in HbA1c from baseline to 26 weeks and 38 weeks compared to basal-plus, with fewer daily injections (1 vs 2). Ryzodeg® also resulted in significantly lower rates of nocturnal hypoglycemia over 38 weeks.
Tirzepatide versus Semiglutide Once Weekly in Patients with Type 2 Diabetes.pdfHaramaya University
This randomized controlled trial compared the efficacy and safety of three doses of tirzepatide (5 mg, 10 mg, and 15 mg), a dual GLP-1 and GIP receptor agonist, to semaglutide (1 mg), a GLP-1 receptor agonist, in 1879 patients with type 2 diabetes inadequately controlled with metformin alone. The primary outcome was the change in HbA1c from baseline to 40 weeks. Key secondary outcomes included changes in body weight and achievement of HbA1c targets. Tirzepatide at all doses resulted in greater reductions in HbA1c and body weight compared to semaglutide and was found to be noninferior and
Mid-parental height is used to estimate a child's genetically determined height potential. It is calculated differently for boys and girls based on the average of the parents' heights. This value is plotted on a growth chart at age 18-20 to estimate the child's target height percentile. Evaluating short stature involves ruling out common causes through blood tests and imaging. If these are normal, tests are done to check for growth hormone deficiency, hypothyroidism, and Turner syndrome. Growth hormone therapy can increase final adult height by 20-30 cm for children with growth hormone deficiency.
Crianças com baixa estatura que querem crescer mais devem efetuar exames bem ...Van Der Häägen Brazil
Considerações similares são relacionadas aos testes fisiológicos, como exercícios monitorados e amostras sequenciais noturnas (que dependem de internamento). Ainda mais, a pouca especificidade destes testes, a falta de padronização e os valores diagnósticos aceitos, além da extrema variabilidade entre os testes laboratoriais para a dosagem do GH faz com que estes testes tenham baixa efetividade, para uma grande percentagem de pacientes
This document discusses safety data from the NordiNet IOS and ANSWER Program studies on growth hormone replacement therapy. It finds that the therapy has an overall favorable safety profile with low risks of adverse events and serious adverse events. However, risk is higher in certain high risk patient groups. Monitoring of IGF-1 levels is important to ensure levels remain within the normal range and to mitigate risks like benign intracranial hypertension and malignancy.
Obesity and hyperlipidemia is international /worldwide problem causing heart disease leading to major predisposing factor for morbidity and death. Conventional medicine used in allopathy include statins, fibrates, niacin and resins but are going to defame due to their adverse effects. Herbal medicine ginger has proved itself as one of the potent anti hyperlipidemic and anti obesity herb with least adverse effects. We did try to compare its hypolipidemic effects with placebo effects when used in mild to moderate hyperlipidemic patients. It was placebo-controlled single blind research study. Research was conducted at National hospital, Lahore, from July to November 2016. Consent was taken from sixty hyperlipidemic patients age range from 25 to 60 years. Both gender male and female patients were enrolled. Patients were randomly divided in two groups, 30 patients were on drug ginger pasted-powder advised to take 5 grams in divided doses with their normal diet for the period of three months. Thirty patients were on placebo pasted-wheat powder, with same color as of ginger powder, advised to take 5 grams in divided doses with their normal diet for the period of three months. Their base line lipid profile and body weight was recorded at start of treatment and were advised to come for check-up, fortnightly.
International Journal of Medical Science in Clinical Research and Review Vol 03, Issue 02,April – 2020 Page |
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When duration of study was over, their lipid profile and body weight was measured and compared statistically with pre-treatment values. Three months treatment with 5 grams of ginger decreased total cholesterol from 233.11±1.53 mg/dl to 198.44±1.23 mg/dl, LDL cholesterol reduced from 202.21±1.88 mg/dl to 187.72± 1.98 mg/dl, reduced body weight from 76.01±2.66 kg to 72.80±1.87 kg. Both plasma total cholesterol and LDL cholesterol reduction was statistically significant, but body weight decrease was non-significant when analyzed biostatistically.
This study examined how gout and other health factors impacted patients' quality of life using generic and gout-specific questionnaires. The researchers found that worse quality of life was associated with frequent gout attacks, current attacks, joint-affecting attacks, other pain conditions, anxiety, depression, not drinking alcohol, and certain medical conditions like diabetes and kidney disease. Non-white patients and those with more gout symptoms reported lower gout-specific quality of life. Both generic and gout-specific questionnaires identified impacts of gout features, but generic tools best captured effects of comorbidities. The study provides insight into how gout and related health issues reduce patients' quality of life in primary care settings.
Basal bolus insulin therapy resulted in improved glycemic control compared to sliding scale insulin therapy for hospitalized patients with type 2 diabetes, according to the RABBIT 2 trial. The mean daily blood glucose was 27 mg/dL lower in patients receiving basal glargine plus prandial glulisine compared to those receiving sliding scale regular insulin. Both regimens resulted in a similar rate of hypoglycemia and length of hospital stay. Basal bolus insulin provided better glycemic control and achieved target blood glucose levels under 140 mg/dL in more patients than sliding scale insulin alone.
This study compared the effects of two treatment regimens for type 2 diabetes: dual therapy of metformin and glimepiride (Group A) versus triple therapy of metformin, glimepiride, and voglibose (Group B). Both regimens led to significant decreases in BMI, fasting blood glucose, post-prandial blood glucose, and HbA1c after 3 months of treatment. However, the triple therapy was more effective at lowering post-prandial glucose and had protective effects on kidney function. The results suggest that adding voglibose to metformin and glimepiride dual therapy provides better glucose control and management of diabetes.
Journal club solid organ transplant (New Onset Diabetes)Daniel Le
This study compared the risk of new onset diabetes after transplantation (NODAT) in kidney transplant recipients receiving either early corticosteroid withdrawal (CSWD) or chronic corticosteroid (CCS) therapy. Over 5 years of follow up:
- There was no difference in patient survival or graft loss between the CSWD and CCS groups.
- Rates of death and graft loss were also not different for those with or without NODAT.
- However, insulin use was significantly higher at 5 years in the CCS group (11.1%) compared to the CSWD group (6.3%).
- For the other 8 definitions of NODAT, there were no significant differences
This study analyzed cephalometric features in 9 adults (7 males and 2 females, average age 37.8 years) with isolated growth hormone deficiency (IGHD) from a large Brazilian kindred carrying a homozygous mutation causing complete GH deficiency.
The results showed that all linear craniofacial measurements were reduced in the IGHD subjects, with total maxillary length being the most affected. Angular measurements were in the normal range except for an increased gonial angle. Facial height ratios were not different from references.
This suggests that untreated congenital IGHD causes proportional blunting of craniofacial growth, reducing all linear dimensions but maintaining normal angular relationships and facial proportions.
How Barcodes Can Be Leveraged Within Odoo 17Celine George
In this presentation, we will explore how barcodes can be leveraged within Odoo 17 to streamline our manufacturing processes. We will cover the configuration steps, how to utilize barcodes in different manufacturing scenarios, and the overall benefits of implementing this technology.
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إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
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تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
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Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,