Myofascial trigger points in cluster headache patients: a case series

Active myofascial trigger points (MTrPs) have been found to contribute to chronic tension-type headache and migraine. The purpose of this case series was to examine if active trigger points (TrPs) provoking cluster-type referred pain could be found in cluster headache patients and, if so, to evaluate the effectiveness of active TrPs anaesthetic injections both in the acute and preventive headache's treatment. Twelve patients, 4 experiencing episodic and 8 chronic cluster headache, were studied. TrPs were found in all of them. Abortive infiltrations could be done in 2 episodic and 4 chronic patients, and preemptive infiltrations could be done in 2 episodic and 5 chronic patients, both kind of interventions being successful in 5 (83.3%) and in 6 (85.7%) of the cases respectively. When combined with prophylactic drug therapy, injections were associated with significant improvement in 7 of the 8 chronic cluster patients. Our data suggest that peripheral sensitization may play a role in cluster headache pathophysiology and that first neuron afferent blockade can be useful in cluster headache management

Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease

BACKGROUND: The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. METHODS: In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12,092 patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to 365 days, cerebrovascular atherosclerotic disease, peripheral vascular arterial disease, or diabetes mellitus with coronary artery disease. Patients were randomly assigned to receive either evacetrapib at a dose of 130 mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina. RESULTS: At 3 months, a 31.1% decrease in the mean LDL cholesterol level was observed with evacetrapib versus a 6.0% increase with placebo, and a 133.2% increase in the mean HDL cholesterol level was seen with evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned 1670 primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in 12.9% of the patients in the evacetrapib group and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.11; P=0.91). CONCLUSIONS: Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of cardiovascular events than placebo among patients with high-risk vascular disease. (Funded by Eli Lilly; ACCELERATE ClinicalTrials.gov number, NCT01687998 .)

Concentración sérica de leptina en población escolar de cinco departamentos del centro-oriente colombiano y su relación con parámetros antropométricos y perfil lipídico

Introducción. La leptina es una proteína reguladora del peso corporal que modifica sus concentraciones según distintos factores; ha sido asociada con el síndrome metabólico, la diabetes mellitus y la enfermedad cardiovascular. Objetivo. Evaluar las concentraciones de leptina en un grupo de escolares colombianos y su relación con la edad, sexo, índice de masa corporal, pliegue trícipital y lípidos sanguíneos. Materiales y métodos. Se determinó el índice de masa corporal y las reservas de grasa corporal, así como las concentraciones de leptina y el perfil lípidico. Resultados. La concentración media de leptina fue de 8,3±8,9 ng/ml, las concentraciones variaron según la edad y el sexo pero también, por la composición corporal, con valores más elevados en los escolares con mayor índice de masa corporal y reserva de grasa. En los niños con valores aumentados de colesterol y en las niñas con triglicéridos elevados las concentraciones de leptina también fueron mayores. Conclusión. Las variaciones de leptina se deben a la edad o el sexo pero también a cambios hormonales o a diferencias en la alimentación que deben ser evaluados posteriormente. Por otro lado, los escolares con sobrepeso y obesidad probablemente tienen hiperleptinemia, correlacionada con el riesgo de síndrome metabólico, diabetes mellitus tipo 2 y enfermedad cardiovascular que es importante de estudiar. La asociación específica del sexo con el colesterol total, los triglicéridos y la leptina sugiere una correlación compleja, dependiente de las diferencias biológicas y hormonales, y de la diversidad del medio ambiente de vida que deben ser igualmente estudiadas

Description of clinical and genetic features of 122 patients included in the Spanish Pompe registry

\ua9 2023Pompe disease is a rare genetic disorder with an estimated prevalence of 1:60.000. The two main phenotypes are Infantile Onset Pompe Disease (IOPD) and Late Onset Pompe Disease (LOPD). There is no published data from Spain regarding the existing number of cases, regional distribution, clinical features or, access and response to the treatment. We created a registry to collect all these data from patients with Pompe in Spain. Here, we report the data of the 122 patients registered including nine IOPD and 113 LOPD patients. There was a high variability in how the diagnosis was obtained and how the follow-up was performed among different centres. Seven IOPD patients were still alive being all treated with enzymatic replacement therapy (ERT) at last visit. Ninety four of the 113 LOPD patients had muscle weakness of which 81 were receiving ERT. We observed a progressive decline in the results of muscle function tests during follow-up. Overall, the Spanish Pompe Registry is a valuable resource for understanding the demographics, patient\u27s journey and clinical characteristics of patients in Spain. Our data supports the development of agreed guidelines to ensure that the care provided to the patients is standardized across the country