Obesity and Fast-Food

Obesity is one of the most significant public health challenges and becomes a public health problem. Consumption of fast-food, which have high energy densities and glycemic loads, and expose customers to excessive portion size, is frequently associated with weight gain, therefore, it is hypothesized that relative availability of fast-food is a risk for obesity

Ischemic Stroke in Young Adults: Practical Diagnosis Guide

With its increasing incidence in younger population and as a leading cause of disability, ischemic stroke represents a real public health problem. This chapter aims to evaluate the most common risk factors and causes for ischemic stroke in the young. Though some are identical to those found in older patients, most of them are specific to this population segment. Furthermore, another objective is to provide some guidance in approaching the case based on some important clinical clues. Due to the lack of universal management guidelines, it is up to the physician to judge the particularities of each case and to carry out the variety of investigations necessary for determining the cause

Safety, tolerability, and efficacy of subcutaneous efgartigimod in patients with chronic inflammatory demyelinating polyradiculoneuropathy (ADHERE): a multicentre, randomised-withdrawal, double-blind, placebo-controlled, phase 2 trial

Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune disease of the peripheral nervous system that can lead to severe disability from muscle weakness and sensory disturbances. Around a third of patients do not respond to currently available treatments, and many patients with a partial response have residual neurological impairment, highlighting the need for effective alternatives. Efgartigimod alfa, a human IgG1 antibody Fc fragment, has demonstrated efficacy and safety in patients with generalised myasthenia gravis. We evaluated the safety, tolerability, and efficacy of subcutaneous efgartigimod PH20 in adults with CIDP. Methods: ADHERE, a multistage, double-blind, placebo-controlled trial, enrolled participants with CIDP from 146 clinical sites from Asia-Pacific, Europe, and North America. Participants with evidence of clinically meaningful deterioration entered an open-label phase of weekly 1000 mg subcutaneous efgartigimod PH20 for no longer than 12 weeks (stage A). Those with confirmed evidence of clinical improvement (ECI; treatment responders) entered a randomised-withdrawal phase of 1000 mg subcutaneous efgartigimod PH20 weekly treatment versus placebo for a maximum of 48 weeks (stage B). Participants were randomised (1:1) through interactive response technology and stratified by their adjusted Inflammatory Neuropathy Cause and Treatment (aINCAT) score change during stage A and their most recent CIDP medication within 6 months before screening. Investigators, the clinical research organisation, and participants were masked to the treatment. The primary endpoint in stage A, evaluated in the stage A safety population, was confirmed ECI (≥1 points aINCAT decrease, ≥4 points [centile metric] Inflammatory Rasch-built Overall Disability Scale increase, or ≥8 kPa grip strength increase after four injections and two consecutive visits). The primary endpoint in stage B, evaluated in the modified intention-to-treat population, was the risk of relapse (time to first aINCAT increase of ≥1 points). ADHERE is registered with ClinicalTrials.gov (NCT04281472) and EudraCT (2019-003076-39) and is completed. Findings: Between April 15, 2020, and May 11, 2023, 629 participants were screened; 322 (114 female, 208 male) entered stage A, of whom 214 (66%, 95% CI 61·0-71·6) had confirmed ECI. In stage B, 221 participants were randomised (79 female, 142 male; 111 to subcutaneous efgartigimod PH20, 110 to placebo). Subcutaneous efgartigimod PH20 significantly reduced the risk of relapse versus placebo (hazard ratio 0·39 [95% CI 0·25-0·61]; p<0·0001). 31 (27·9% [19·6-36·3]) participants given subcutaneous efgartigimod PH20 had a relapse versus 59 (53·6% [44·3-63·0]) given placebo. In stage A, treatment-emergent adverse events (TEAEs) occurred in 204 (63%) participants and serious TEAEs in 21 (7%). In stage B, TEAEs occurred in 71 (64%) participants on subcutaneous efgartigimod PH20 and 62 (56%) participants on placebo, and serious TEAEs in six (5%) on subcutaneous efgartigimod PH20 and six (5%) on placebo. Three deaths occurred: two in stage A (one non-related and one unlikely related to treatment) and one in stage B (placebo group). Interpretation: ADHERE showed the efficacy of subcutaneous efgartigimod PH20 in reducing the risk of relapse versus placebo in people with CIDP who responded to treatment. Further studies are needed to provide data on the longer-term effects of efgartigimod alfa and how it compares with currently available treatment options. Funding: argenx

Comparative Evaluation of Pregabaline, Gabapentine, Sertraline and Duloxetine in Painful Diabetic Non Insulin-dependent Neuropathy

AbstractThere are numerous studies that compare different drugs in painful diabetic neuropathy (Bansal et al., 2009; Goldstein et al., 2005; Morello, et al,1999; Wernicke et al., 2007) but our study tries to make a comparison between all four drugs and evaluate the associated depression. The study shows the results of drug therapy for painful diabetic non-insulin-dependent neuropathy after 6 months. Four drugs are compared for their efficiency and also the global perception of change by the patients. Another aspect is the reduction in depression symptoms caused by unsuccessful therapy before using the drugs used in this study. The study shows how the drugs are similar in efficiency in pairs of two, one pair of drugs being more efficient than the other

Neuropsychiatric Symptoms in Demyelination Disorders

Inflammatory demyelinating diseases are defined as being a miscellaneous group of disorders that develop as a consequence of an acute or chronic inflammatory process. The types of demyelinating disease with a high prevalence are multiple sclerosis, neuromyelitis optica and acute-disseminated encephalomyelitis. Patients with multiple sclerosis frequently experience depressive and anxiety symptoms including cognitive impairments. Depression is correlated with an unsatisfatory quality of life, having a conceivably important psychological impact on all the aspects of the patient’s live, including less efficient coping mechanisms and a decreased compliance with disease-modifying drugs. As a general rule among population, depression in multiple sclerosis patients is regularly correlated with anxiety. The clinical importance of neuropsychiatric symptoms should not be neglected because multiple sclerosis patients are more prone to be affected in all the aspects of life, in view of the morbidity that these symptoms bring in patients with neurodegenerative diseases

Spirituality in Brain Death

AbstractIntroductionComatose patients may have irrevocably lost all brain function and determination of brain death is standardized in hospital policies, and protocols have been developed. The clinical diagnosis of brain death implies that the person has died. Material and methods: Information collections regarding newspapers, television, screen writer, the internet and coma, and the portrayal of coma in motion pictures. Results: Different opinions of the Catholic Church, Orthodox Church, Judaism, Muslim, Buddhism, Jainism, and Sikhism where general principles and analyzed and distinct voices that proclaim that most of these comatose states do not truly exist. Conclusions: Unfortunately, the legal cases are surrounded by misinformation and reluctance to understand the implications of these comatose states. The physician involved with the care of comatose patients should understand and respect different values but maintain optimal professionalism