Evaluation of serum and urinary cystatin C concentrations and their relationship with EDSS in patients with multiple sclerosis

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Diagnosis of multiple sclerosis (MS), as a major cause of neurological disability in young adults, is difficult to establish, especially at the onset of the disease process, due to lack of reliable molecular markers. The goal of the present study was to evaluate serum and urinary concentrations of cystatin C and to find their relationship with patients' expanded disability status scale (EDSS)."n"nMethods: Based on McDonald's criteria, 54 adult patients with M.S. (11 males and 43 females, with a mean age of 32.18±8.37 years) were enrolled as the case group and 24 age and sex-matched healthy, non-M.S. individuals (7 males and 17 females, with a mean age of 34.31±10.07 years) were recruited as the controls. Serum and urinary concentrations of cystatin C were measured in all the participants."n"nResults: The means of serum cystatin C concentrations (mg/Lit) in the case and control groups respectively were 0.90±0.01 and 0.89±0.02, (p=0.84) and the means for its urinary concentrations were 25.37±1.91 and 21.11±2.54 (p=0.18). The means of serum and urinary cystatin C concentrations were 0.90±0.01 and 25.11±2.33 in patients whose EDSS was ≤2.5 and 0.90±0.03 and 26.30±2.84 in patients whose EDSS was ≥2.5, respectively, although, the differences between the two groups of patients were not statistically significant (p=0.80 and 0.74, respectively for serum and urinary concentrations of cystatin C)."n"nConclusions: This study showed that serum and urinary cystatin C concentrations cannot be used for multiple sclerosis diagnosis or even as a marker in its treatment follow ups or for the determination of disease severity

A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache

OBJECTIVE: To compare the effectiveness and side effects of migraine prophylactic medications. DESIGN: We performed a network meta-analysis. Data were extracted independently in duplicate and quality was assessed using both the JADAD and Cochrane Risk of Bias instruments. Data were pooled and network meta-analysis performed using random effects models. DATA SOURCES: PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 18 May 2014. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included randomized controlled trials of adults with migraine headaches of at least 4 weeks in duration. RESULTS: Placebo controlled trials included alpha blockers (n = 9), angiotensin converting enzyme inhibitors (n = 3), angiotensin receptor blockers (n = 3), anticonvulsants (n = 32), beta-blockers (n = 39), calcium channel blockers (n = 12), flunarizine (n = 7), serotonin reuptake inhibitors (n = 6), serotonin norepinephrine reuptake inhibitors (n = 1) serotonin agonists (n = 9) and tricyclic antidepressants (n = 11). In addition there were 53 trials comparing different drugs. Drugs with at least 3 trials that were more effective than placebo for episodic migraines included amitriptyline (SMD: -1.2, 95% CI: -1.7 to -0.82), -flunarizine (-1.1 headaches/month (ha/month), 95% CI: -1.6 to -0.67), fluoxetine (SMD: -0.57, 95% CI: -0.97 to -0.17), metoprolol (-0.94 ha/month, 95% CI: -1.4 to -0.46), pizotifen (-0.43 ha/month, 95% CI: -0.6 to -0.21), propranolol (-1.3 ha/month, 95% CI: -2.0 to -0.62), topiramate (-1.1 ha/month, 95% CI: -1.9 to -0.73) and valproate (-1.5 ha/month, 95% CI: -2.1 to -0.8). Several effective drugs with less than 3 trials included: 3 ace inhibitors (enalapril, lisinopril, captopril), two angiotensin receptor blockers (candesartan, telmisartan), two anticonvulsants (lamotrigine, levetiracetam), and several beta-blockers (atenolol, bisoprolol, timolol). Network meta-analysis found amitriptyline to be better than several other medications including candesartan, fluoxetine, propranolol, topiramate and valproate and no different than atenolol, flunarizine, clomipramine or metoprolol. CONCLUSION: Several drugs good evidence supporting efficacy. There is weak evidence supporting amitriptyline\u27s superiority over some drugs. Selection of prophylactic medication should be tailored according to patient preferences, characteristics and side effect profiles