The potential of lasmiditan in migraine

Lasmiditan, a highly selective 5-hydroxytryptamine receptor 1F (5-HT1F) agonist, is the first drug in its class and is lacking triptan-like vasoactive properties. The US Food and Drug Administration (FDA) has recently approved lasmiditan for the acute treatment of migraine in adults based on positive results of two pivotal phase III trials, which showed a significant difference to placebo in the proportion of patients achieving total migraine freedom within 2h. More patients with lasmiditan achieved headache freedom and, in addition, freedom from the most bothersome symptom, that is, photophobia, than with placebo. Treatmentrelated side effects seem to be related to the rapid penetration of the drug into the brain and include dizziness, paresthesia and drowsiness, mostly of mild to moderate intensity. Interim results from an ongoing long-term phase III trial suggest a decrease in the frequency of adverse events after multiple lasmiditan use. Lasmiditan is a promising acute anti-migraine therapy, in particular for patients with cardiovascular risk factors, contraindications, or unwanted side effects to triptans

Headache yesterday in Europe

BACKGROUND: Surveys enquiring about burden of headache over a prior period of time (eg, 3 months) are subject to recall bias. To eliminate this as far as possible, we focused on presence and impact of headache on the preceding day (“headache yesterday”). METHODS: Adults (18-65 years) were surveyed from the general populations of Germany, Italy, Lithuania, Luxembourg and the Netherlands, from a work-force population in Spain and from mostly non-headache patient populations of Austria, France and UK. A study of non-responders in some countries allowed detection of potential participation bias where initial participation rates were low. RESULTS: Participation rates varied between 11% and 59% (mean 27%). Non-responder studies suggested that, because of participation bias, headache prevalence might be overestimated in initial responders by up to 2% (absolute). Across all countries, 1,422 of 8,271 participants (15-17%, depending on correction for participation bias) had headache yesterday lasting on average for 6 hours. It was bad or very bad in 56% of cases and caused absence from work or school in 6%. Among those who worked despite headache, 20% reported productivity reduced by >50%. Social activities were lost by 24%. Women (21%) were more likely than men (12%) to have headache yesterday, but impact was similar in the two genders. CONCLUSIONS: With recall biases avoided, our findings indicate that headache costs at least 0.7% of working capacity in Europe. This calculation takes into account that most of those who missed work could make up for this later, which, however, means that leisure and social activities are even more influenced by headache

In vitro antimicrobial and antiproliferative activity of amphipterygium adstringens

Amphipterygium adstringens is a plant widely used in Mexican traditional medicine for its known anti-inflammatory and antiulcer properties. In this work, we evaluated the in vitro antimicrobial and antiproliferative activities of the methanolic extract of A. adstringens against oral pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Candida albicans, and Candida dubliniensis, using microdilution (MIC) and agar diffusion methods (MBC), and the antiproliferative activity evaluating total growth inhibition (TGI) by staining the protein content with sulforhodamine B (SRB), using nine human cancer cell lines. Crude extract (CE) of A. adstringens showed some degree of activity against one or more of the strains with a MIC from 0.125 mg/mL to 63 mg/mL and MBC from 1.6 to 6.3 mg/mL and cytotoxic activity, particularly against NCI-ADR/RES, (a)n ovarian cell line expressing multiple resistance drugs phenotype. The CE is a complex mixture of possible multitarget metabolites that could be responsible for both antimicrobial and antiproliferative activities, and further investigation is required to elucidate the identity of active compounds. Nevertheless the CE itself is useful in the development of new antimicrobial treatment based on natural products to prevent oral diseases and as alternative natural source for cancer treatment and prevention2015PROMEP, Mexic

Comparación de los requerimientos de sangre y estancia hospitalaria tras la implantación del protocolo fast track en prótesis total de rodilla.

Objectives. To analyse the differences in blood requirements and length of stay in patients undergoing total knee arthroplasty during the period before and after the implementation of the fast track protocol. Material and methods. Retrospective observational follow-up study or cohorts. The variables under study were: initial and minimum haemoglobin, number of patients and units transfused and days of hospital stay. For the comparisons, the chi-square and U-Mann Whitney statistics were calculated. Values of p?0.05 were considered significant. Results. A sample of 189 patients was studied. The pre- and post-implementation values for the variables under study were: minimum haemoglobin 10.2 vs. 11.2 (p = 0.0), percentage of patients who required blood transfusion 20.8 vs. 4.5% (p = 0.001), rate of anaemia 3.4 vs. 2.9 (p = 0.002) and lengths of hospital stay 5.9 vs. 3.8 days (p = 0.017). Conclusions. The fast track protocol significantly improved haemoglobin values and decreased the need for transfusion and length of sta

Biochemical biomarkers for multiple sclerosis

Introduction: Multiple sclerosis (MS) is the most frequent demyelinating disease of the central nervous system. Although there is currently no definite cure for MS, new therapies have recently been developed based on a continuous search for new biomarkers. Development: MS diagnosis relies on the integration of clinical, imaging and laboratory findings as there is still no single pathognomonic clinical feature or diagnostic laboratory biomarker. The most commonly laboratory test used is the presence of immunoglobulin G oligoclonal bands (OCB) in cerebrospinal fluid of MS patients. This test is now included in the 2017 McDonald criteria as a biomarker of dissemination in time. Nevertheless, there are other biomarkers currently in use such as kappa free light chain, which has shown higher sensitivity and specificity for MS diagnosis than OCB. In addition, other potential laboratory tests involved in neuronal damage, demyelination and/or inflammation could be used for detecting MS. Conclusions: CSF and serum biomarkers have been reviewed for their use in MS diagnosis and prognosis to stablish an accurate and prompt MS diagnosis, crucial to implement an adequate treatment and to optimize clinical outcomes over time

Enfermedades psiquiátricas y trabajo. Revisión bibliográfica y jurisprudencial (Trastornos esquizofrénicos, trastorno bipolar y trastornos ansioso-depresivos)

Las enfermedades psiquiátricas en su conjunto y, algunas de ellas de forma específica, constituyen un problema de salud pública en todos los países y conllevan un coste económico asociado, tanto directo como indirecto. Pero además, cuando la persona enferma ejerce su derecho al trabajo ello comporta, en ocasiones, más allá de su diagnóstico y su tratamiento, la necesidad de tomar unas acciones en las empresas, limitantes adaptativas o restrictivas, para el trabajador afectado y la adopción de medidas socio-laborales con repercusión posterior administrativa y jurídica. Se revisarán en este trabajo las publicaciones médicas recogidas en la base de datos de referencia (Pub-Med) relativa a estas patologías, su diferenciación en cuanto a los aspectos clínico asistenciales y su comparativa con los socio-laborales. De igual forma se realiza en este trabajo una revisión del impacto de estas patologías en la base de datos jurídica (Westlaw Insignis) y su diferenciación según cada patología y área del derecho correspondiente. Sirvan los resultados para, a través del conocimiento actual de la situación, basada en estos datos, elaborar posibles estrategias preventivas de futuro ante conflictos médico legales y de nuevos enfoques más coordinados entre todos los agentes implicados.Psychiatric disorders as a whole and some of them in a specific way constitute a public health problem in all countries and entail an economic cost associated, both directly and indirectly. In addition, some issues are to be considered when the sick person exercises his right to work, beyond diagnosis and treatment of his/her disease. Companies need to take some actions whether adaptive or restrictive for the affected employee, and the adoption of socio-labor measures which will have administrative and legal impact. The medical publications listed in the reference database (Pub-Med) concerning these pathologies will be reviewed in this article with emphasis in those clinical aspects that correlate health care with socio-labor implications. Paralelly, this work reviews the impact of these diseases in the legal databases (Westlaw Insignis) and their differentiation according to each disorder and its corresponding area of the law.The conclusions of this work, through the current knowledge of the situation, will serve to develop possible preventive strategies to address future medico-legal conflicts as well as to develop more coordinated approaches among all the stakeholders

Eleven-month longitudinal study of antibodies in SARS-CoV-2 exposed and naïve primary health care workers upon COVID-19 vaccination

We evaluated the kinetics of antibody responses to Two years into the COVID-19 pandemic and 1 year after the start of vaccination rollout, the world faced a peak of cases associated with the highly contagious Omicron variant of concern (VoC) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) and nucleocapsid (N) antigens over five cross-sectional visits (January-November 2021), and the determinants of pre-booster immunoglobulin levels, in a prospective cohort of vaccinated primary health care workers in Catalonia, Spain. Antibodies against S antigens after a full primary vaccination course, mostly with BNT162b2, decreased steadily over time and were higher in pre-exposed (n = 247) than naive (n = 200) individuals, but seropositivity was maintained at 100% (100% IgG, 95.5% IgA, 30.6% IgM) up to 319 days after the first dose. Antibody binding to variants of concern was highly maintained for IgG compared to wild type but significantly reduced for IgA and IgM, particularly for Beta and Gamma. Factors significantly associated with longer-term antibodies included age, sex, occupation, smoking, adverse reaction to vaccination, levels of pre-vaccination SARS-CoV-2 antibodies, interval between disease onset and vaccination, hospitalization, oxygen supply, post COVID and symptomatology. Earlier morning vaccination hours were associated with higher IgG responses in pre-exposed participants. Symptomatic breakthroughs occurred in 9/447 (2.01%) individuals, all among naive (9/200, 4.5%) and generally boosted antibody responses. Additionally, an increase in IgA and/or IgM seropositivity to variants, and N seroconversion at later time points (6.54%), indicated asymptomatic breakthrough infections, even among pre-exposed. Seropositivity remained highly stable over almost a year after vaccination. However, gradually waning of anti-S IgGs that correlate with neutralizing activity, coupled to evidence of an increase in breakthrough infections during the Delta and Omicron predominance, provides a rationale for booster immunization