What is the best treatment for analgesic rebound headaches?

Abrupt discontinuation of the offending analgesic(s), and treating rebound headaches with dihydroergotamine (DHE) as needed, results in significant improvement for most patients (strength of recommendation [SOR]: C; based on case series). Amitriptyline does not affect the frequency or severity of rebound headaches, but it may improve quality of life (SOR: B, low-powered randomized controlled trial). Prednisone or naratriptan (Amerge) lessen acute withdrawal symptoms from analgesics and reduce the need for rescue medications during the first 6 days of treatment; however, they do not affect headache frequency or severity (SOR: B, low-quality randomized controlled trial)

What illnesses contraindicate immunization?

The Advisory Council on Immunization Practices (ACIP) reports that the only contraindication for all vaccines is a history of severe allergic reaction to a previous vaccine or vaccine constituent (strength of recommendations: C, based predominantly on case series, case reports, and expert opinion)

Which blood tests are most helpful in evaluating pelvic inflammatory disease?

No individual or combination of blood tests can reliably diagnose pelvic inflammatory disease (PID)(strength of recommendation [SOR]: A, metaanalysis). The combination of white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and vaginal white blood cells can reliably exclude PID if results for all 4 tests are normal (sensitivity=100%) (SOR: B, cohort study, reference standard not uniformly applied)

Is methylphenidate useful for treating adolescents with ADHD?

Methylphenidate (Ritalin) is effective in the shortterm treatment of attention deficit/hyperactivity disorder (ADHD) (strength of recommendation [SOR]: A, multiple randomized control trials). Though the immediate-release preparation is the best studied of methylphenidate formulations, extended-release methylphenidate (Concerta) has similar benefits, with a dosing regimen that may better suit an adolescent lifestyle (SOR: B, based on extrapolation of 1 randomized controlled trial and expert opinion)

Does stimulant therapy help adult ADHD?

Central nervous system stimulants improve symptoms of attention deficit-hyperactivity disorder (ADHD) in adults (strength of recommendation: B, based on an older, inconclusive systematic review, a lesser-quality systematic review, and several newer small randomized controlled trials). Although not the focus of this question, nonstimulant medications (including buproprion, modafinil, and guanfacine) have also been studied in the treatment of ADHD in adults. Recently, atomoxetine became the only nonstimulant medication to receive approval by the US Food and Drug Administration for the treatment of ADHD

In menopausal women, does fatigue indicate disease?

Though fatigue is a commonly reported symptom, high-quality studies evaluating it as a marker for diseases among menopausal women are lacking. Middle-aged women who report fatigue are more apt to screen positive for clinical depression or anxiety (strength of recommendation [SOR]: B, case series). Fatigue may signal obstructive sleep apnea (SOR: B, retrospective cohort). For menopausal women with cardiac risk factors, extreme fatigue may be a sign of coronary artery disease (SOR: C, review without critical appraisal)

Should the varicella vaccine be given to all children to prevent chickenpox?

Healthy, unimmunized children who have not had varicella infection should be vaccinated (strength of recommendation: A, based on randomized controlled trials). Use of the vaccine in immunocompromised children is still being studied and has not been approved by the Food and Drug Administration (FDA)

Management of Cervical Lymphadenitis in Children

Cervical lymphadenitis, defined as an acute symptomatic enlargement of the cervical lymph nodes, is a common condition in children of all ages. Most cases of cervical lymphadenitis in children are self-limited and can safely be monitored for spontaneous resolution over four to six weeks. (Strength of Recommendation [SOR]: C, based on expert opinion)

Young people's views on the design of adrenaline auto-injectors: A qualitative study

Background: Young people’s compliance with carriage of adrenaline auto-injectors (AAI) may be as low as 41%, yet we lack research exploring their preferences regarding these devices. Objective: This qualitative study explored young people’s ideas about AAI design and features which may facilitate their carriage and use. Methods: Young people aged 13-18 years prescribed an AAI for severe allergic reaction were invited to participate in in-depth, semi-structured, face-to-face interviews about AAI design. Interviews were recorded, transcribed verbatim and analyzed using thematic content analysis. Results: From 23 interviews, seven major themes were identified: accessibility and carriage, comprehensibility of instructions, indication of correct administration, safety, speed of administration, visibility and identification and precise drug delivery. Young people made several suggestions for how AAIs may be adapted to improve carriage, including reduced size to enable pocket-carriage. Comprehensibility was thought to be enhanced by the use of pictographic instructions and audio-prompts to encourage prompt and accurate administration. Needle guards were seen as beneficial to reduce needle phobia, prevent accidental injury and provide reassurance that the device had been administered. Young people were conflicted between wanting a device which enabled discreet carriage, versus an AAI which was bold and clearly identifiable as a medical device in case of emergency. Conclusion: This study identified key AAI features important to young people, together with design issues deterring day-to-day carriage of AAIs and their emergency, time-pressured usage. We demonstrated considerable scope for AAI design modifications to improve young peoples’ perception of devices and facilitate their carriage and use

SbcCD regulation and localization in Escherichia coli

The SbcCD complex and its homologues play important roles in DNA repair and in the maintenance of genome stability. In Escherichia coli, the in vitro functions of SbcCD have been well characterized, but its exact cellular role remains elusive. This work investigates the regulation of the sbcDC operon and the cellular localization of the SbcC and SbcD proteins. Transcription of the sbcDC operon is shown to be dependent on starvation and RpoS protein. Overexpressed SbcC protein forms foci that colocalize with the replication factory, while overexpressed SbcD protein is distributed through the cytoplasm