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Pesquisa : C10.597.751.791.875 [Categoria DeCS]
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[PMID]:29254306
[Au] Autor:Lin Q; Hong XY; Zhang D; Jin HJ
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, the First Hospital of Jilin University, Changchun, China.
[Ti] Título:Preoperative evaluation and surgical technique of functional and cosmetic aspects in zygomatic complex fracture patients.
[So] Source:J Biol Regul Homeost Agents;31(4):1005-1012, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:The zygomatico-maxillary complex functions as the principle buttress of the face and is the cornerstone to an individual’s aesthetic appearance. Its fracture not only creates cosmetic deformities owing to its position and facial contour, but can also cause disruption of ocular and mandibular functions. The aim of this study was to evaluate the quality, efficacy and impact of internal fixation of zygomatic complex fractures on functional and cosmetic outcomes. A prospective study was carried out on 100 patients who were divided according to the classification and the severity of injury. Subjective evaluation was submitted based on the patient’s perception of signs and symptoms in the preoperative and postoperative periods. Intraoperative and postoperative assessment of bone reduction quality was made according to the type of the fracture and related difficulties; also, the difference between these groups was observed as functional and esthetic outcome. To optimize the treatment of zygomatic bone fractures, a pre-designed questionnaire was used for subjective evaluation of symptoms and treatment outcome. In 70% of cases, ophthalmologic consultation was taken and was most common in type VII fractures (100% cases). Neurosensory disturbance was the most common finding (60%), followed by diplopia (56R%), pain upon mouth opening (54%) and malar depression (50%). Out of all possible 400 fracture sites in 100 patients of zygomatic complex fractures, 266 (66.5%) fractures were detected by clinical examination, in contrast to 330 (82.5%) on radiological examination, which were highest at zygomatic-maxillary buttress (93%) followed by infraorbital rim (91%) and almost equal among fronto-zygomatic site (72%) and zygomatic arch (74%). The scores from the questionnaire for annoyance were significantly higher for paraesthesia (23%) than for trismus (10%), pain (8.5%), or deformity (8.25%). Residual deformity and pain significantly influenced the total satisfaction. Conclusively, there are many treatment modalities available for zygomatic complex fractures, and the preferred methods should be selected on the basis of fracture type, fracture severity, pre-operative signs and symptoms. Regarding the requirements of fracture site exposure and actual fixation, one priority should be to minimize postoperative complications, morbidity and residual deformities.
[Mh] Termos MeSH primário: Fixação Interna de Fraturas/métodos
Complicações Pós-Operatórias/fisiopatologia
Cirurgia Plástica/métodos
Zigoma/cirurgia
Fraturas Zigomáticas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Técnicas de Diagnóstico Oftalmológico
Diplopia/etiologia
Diplopia/patologia
Diplopia/fisiopatologia
Diplopia/psicologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Dor/etiologia
Dor/patologia
Dor/fisiopatologia
Dor/psicologia
Parestesia/etiologia
Parestesia/patologia
Parestesia/fisiopatologia
Parestesia/psicologia
Satisfação do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/patologia
Complicações Pós-Operatórias/psicologia
Estudos Prospectivos
Inquéritos e Questionários
Índices de Gravidade do Trauma
Resultado do Tratamento
Trismo/etiologia
Trismo/patologia
Trismo/fisiopatologia
Trismo/psicologia
Zigoma/lesões
Zigoma/fisiopatologia
Fraturas Zigomáticas/patologia
Fraturas Zigomáticas/fisiopatologia
Fraturas Zigomáticas/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:29172307
[Au] Autor:Kelleher MG; Rasaratnam L; Djemal S
[Ti] Título:The Paradoxes of Phantom Bite Syndrome or Occlusal Dysaesthesia ('Dysesthesia').
[So] Source:Dent Update;44(1):8-12, 15-20, 23-4, 26-8, 30-2, 2017 Jan.
[Is] ISSN:0305-5000
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Phantom bite syndrome was first described by Marbach over 40 years ago as a mono-symptomatic hypochondriacal psychosis. He used the term to describe a prolonged syndrome in which patients report that their 'bite is wrong' or that 'their dental occlusion is abnormal' with this causing them great difficulties. This strong belief about 'their bite' being the source of their problems leads to them demanding, and subsequently getting, various types of dentistry carried out by multiple dentists and 'specialists'. Sadly, even after exhaustive, painstaking, careful treatment, none of the dental treatments manages to solve their perceived 'bite problems'. This is because they suffer from a psychiatric illness involving a delusion into which they continue to lack insight, in spite of the failures of often sophisticated dental treatments.1,2,3 In summary, dental practitioners, or other specialists, who suspect that they might be dealing with such a problem should refer these patients early on for specialist management by an appropriate specialist within the secondary care settings, preferably before they get trapped into the time-consuming quagmire of their management. A 'Phantom Bite Questionnaire', which is available to download free, might help. Clinical relevance: This article aims to provide professionals in various fields with guidelines on detecting, diagnosing and managing patients with Phantom Bite Syndrome (PBS). This is desirable in order to prevent extensive, or unnecessarily destructive, or unstable dental treatment being undertaken on such patients in a vain attempt to solve their problems with 'dentistry' when, in fact, these are really due to underlying mental health issues.
[Mh] Termos MeSH primário: Hipocondríase
Má Oclusão
Parestesia
Transtornos Psicóticos
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Hipocondríase/diagnóstico
Hipocondríase/terapia
Má Oclusão/diagnóstico
Má Oclusão/psicologia
Parestesia/diagnóstico
Parestesia/psicologia
Parestesia/terapia
Transtornos Psicóticos/diagnóstico
Transtornos Psicóticos/terapia
Síndrome
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28930847
[Au] Autor:Rota E; Morelli N; Immovilli P; De Mitri P; Guidetti D
[Ad] Endereço:aNeurology Unit, Guglielmo da Saliceto Hospital, Piacenza bNeurology Unit, San Giacomo Hospital, Novi Ligure, Alessandria, Italy.
[Ti] Título:Guillain-Barré-like axonal polyneuropathy associated with Toscana virus infection: A case report.
[So] Source:Medicine (Baltimore);96(38):e8081, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Numerous cases of post-infectious Guillain-Barré syndrome (GBS) have been reported in the literature. Toscana virus (TOSV) is an arthropod-borne emerging pathogen in the Mediterranean area. PATIENT CONCERNS: A 40-year-old male patient was admitted to hospital for acute facial weakness, associated to numbness paraesthesias at lower and upper limbs. The neurological examination revealed facial diplegia and reduced tendon reflexes. The nerve conduction studies documented an acute motor and sensory axonal neuropathy (AMSAN); the lumbar puncture detected albuminocytologic dissociation. Serology for human immunodeficiency virus (HIV), Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), mumps, and Borrelia was negative, as was cerebrospinal fluid (CSF) polymerase chain reaction assay for Herpes virus, Borrelia, Mycoplasma pneumoniae, Cryptococcus, and Mycobacterium tubercolosis. Positivity for TOSV IgG antibodies was found on both CSF and serum; the patient remembered being recently exposed to mosquitoes. DIAGNOSES: The AMSAN subtype of GBS, subsequent to a TOSV infection, was diagnosed. INTERVENTIONS: The patient was treated with plasma-exchange with complete clinical recovery, but a relapse occurred 9 months later, when the nerve conduction studies confirmed the presence of an AMSAN, which benefited from oral steroids. OUTCOMES: A good clinical recovery was achieved after treatments. LESSONS: This is the first case, to the best of our knowledge, of a TOSV infection associated to a peripheral neuropathy mimicking a GBS syndrome, both clinically and electrophysiologically. The clinical spectrum of TOSV neurological complications seems to be wider than previously known: this should be taken into account by the scientific community and public health institutions.
[Mh] Termos MeSH primário: Infecções por Bunyaviridae/complicações
Síndrome de Guillain-Barré/complicações
Síndrome de Guillain-Barré/virologia
Vírus da Febre do Flebótomo Napolitano
[Mh] Termos MeSH secundário: Adulto
Infecções por Bunyaviridae/diagnóstico
Paralisia Facial/virologia
Síndrome de Guillain-Barré/diagnóstico
Seres Humanos
Imunoglobulina G/análise
Masculino
Parestesia/virologia
Vírus da Febre do Flebótomo Napolitano/imunologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunoglobulin G)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008081


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[PMID]:28723914
[Au] Autor:Tarcha EJ; Olsen CM; Probst P; Peckham D; Muñoz-Elías EJ; Kruger JG; Iadonato SP
[Ad] Endereço:Kineta Inc., Seattle, WA, United States of America.
[Ti] Título:Safety and pharmacodynamics of dalazatide, a Kv1.3 channel inhibitor, in the treatment of plaque psoriasis: A randomized phase 1b trial.
[So] Source:PLoS One;12(7):e0180762, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Dalazatide is a specific inhibitor of the Kv1.3 potassium channel. The expression and function of Kv1.3 channels are required for the function of chronically activated memory T cells, which have been shown to be key mediators of autoimmune diseases, including psoriasis. OBJECTIVE: The primary objective was to evaluate the safety of repeat doses of dalazatide in adult patients with mild-to-moderate plaque psoriasis. Secondary objectives were to evaluate clinical proof of concept and the effects of dalazatide on mediators of inflammation in the blood and on chronically activated memory T cell populations. METHODS: Patients (n = 24) were randomized 5:5:2 to receive dalazatide at 30 mcg/dose, 60 mcg/dose, or placebo twice weekly by subcutaneous injection (9 doses total). Safety was assessed on the basis of physical and neurological examination and laboratory testing. Clinical assessments included body-surface area affected, Psoriasis Area and Severity Index (PASI), and investigator and patient questionnaires. RESULTS: The most common adverse events were temporary mild (Grade 1) hypoesthesia (n = 20; 75% placebo, 85% dalazatide) and paresthesia (n = 15; 25% placebo, 70% dalazatide) involving the hands, feet, or perioral area. Nine of 10 patients in the 60 mcg/dose group had a reduction in their PASI score between baseline and Day 32, and the mean reduction in PASI score was significant in this group (P < 0.01). Dalazatide treatment reduced the plasma levels of multiple inflammation markers and reduced the expression of T cell activation markers on peripheral blood memory T cells. LIMITATIONS: The study was small and drug treatment was for a short duration (4 weeks). CONCLUSION: This study indicates that dalazatide is generally well tolerated and can improve psoriatic skin lesions by modulating T cell surface and activation marker expression and inhibiting mediators of inflammation in the blood. Larger studies of longer duration are warranted.
[Mh] Termos MeSH primário: Canal de Potássio Kv1.3/antagonistas & inibidores
Bloqueadores dos Canais de Potássio/efeitos adversos
Proteínas/efeitos adversos
Psoríase/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Método Duplo-Cego
Feminino
Seres Humanos
Hipestesia/induzido quimicamente
Masculino
Meia-Idade
Parestesia/induzido quimicamente
Bloqueadores dos Canais de Potássio/farmacologia
Bloqueadores dos Canais de Potássio/uso terapêutico
Proteínas/farmacologia
Proteínas/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE I; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Kv1.3 Potassium Channel); 0 (Potassium Channel Blockers); 0 (Proteins); 0 (Shk-186 peptide)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180762


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Martelli, Celina Maria Turchi
Texto completo SciELO Brasil
[PMID]:28700057
[Au] Autor:Tassara MP; Guilarde AO; Rocha BAMD; Féres VCR; Martelli CMT
[Ad] Endereço:Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil.
[Ti] Título:Neurological manifestations of dengue in Central Brazil.
[So] Source:Rev Soc Bras Med Trop;50(3):379-382, 2017 May-Jun.
[Is] ISSN:1678-9849
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: : The incidence of dengue has increased throughout the 2000s with a consequent global increase in atypical clinical forms. METHODS: : This study reports a series of cases of neurological dengue out of 498 confirmed cases of laboratory dengue in Goiânia, Brazil. Cases were confirmed based on viral RNA detection via polymerase chain reaction or IgM antibody capture. RESULTS: : Neurological symptoms occurred in 5.6% of cases, including paresthesia (3.8%), encephalitis (2%), encephalopathy (1%), seizure (0.8%), meningoencephalitis (0.4%), and paresis (0.4%). DENV-3 was the predominant circulating serotype (93%). CONCLUSIONS: : We reported dengue cases with neurological manifestations in endemic area.
[Mh] Termos MeSH primário: Dengue/complicações
Encefalite Viral/virologia
Meningoencefalite/virologia
Parestesia/virologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Anticorpos Antivirais/sangue
Brasil/epidemiologia
Pré-Escolar
Dengue/epidemiologia
Vírus da Dengue/genética
Vírus da Dengue/imunologia
Encefalite Viral/epidemiologia
Ensaio de Imunoadsorção Enzimática
Feminino
Seres Humanos
Masculino
Meningoencefalite/epidemiologia
Meia-Idade
Parestesia/epidemiologia
Reação em Cadeia da Polimerase
RNA Viral/genética
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Viral); 0 (RNA, Viral)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE


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[PMID]:28653390
[Au] Autor:Nieto Estrada VH; Molano Franco D; Medina RD; Gonzalez Garay AG; Martí-Carvajal AJ; Arevalo-Rodriguez I
[Ad] Endereço:Department of Critical Care Medicine, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
[Ti] Título:Interventions for preventing high altitude illness: Part 1. Commonly-used classes of drugs.
[So] Source:Cochrane Database Syst Rev;6:CD009761, 2017 06 27.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: High altitude illness (HAI) is a term used to describe a group of cerebral and pulmonary syndromes that can occur during travel to elevations above 2500 metres (8202 feet). Acute hypoxia, acute mountain sickness (AMS), high altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE) are reported as potential medical problems associated with high altitude. In this review, the first in a series of three about preventive strategies for HAI, we assess the effectiveness of six of the most recommended classes of pharmacological interventions. OBJECTIVES: To assess the clinical effectiveness and adverse events of commonly-used pharmacological interventions for preventing acute HAI. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), LILACS and trial registries in January 2017. We adapted the MEDLINE strategy for searching the other databases. We used a combination of thesaurus-based and free-text terms to search. SELECTION CRITERIA: We included randomized-controlled and cross-over trials conducted in any setting where commonly-used classes of drugs were used to prevent acute HAI. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. MAIN RESULTS: We included 64 studies (78 references) and 4547 participants in this review, and classified 12 additional studies as ongoing. A further 12 studies await classification, as we were unable to obtain the full texts. Most of the studies were conducted in high altitude mountain areas, while the rest used low pressure (hypobaric) chambers to simulate altitude exposure. Twenty-four trials provided the intervention between three and five days prior to the ascent, and 23 trials, between one and two days beforehand. Most of the included studies reached a final altitude of between 4001 and 5000 metres above sea level. Risks of bias were unclear for several domains, and a considerable number of studies did not report adverse events of the evaluated interventions. We found 26 comparisons, 15 of them comparing commonly-used drugs versus placebo. We report results for the three most important comparisons: Acetazolamide versus placebo (28 parallel studies; 2345 participants)The risk of AMS was reduced with acetazolamide (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.39 to 0.56; I = 0%; 16 studies; 2301 participants; moderate quality of evidence). No events of HAPE were reported and only one event of HACE (RR 0.32, 95% CI 0.01 to 7.48; 6 parallel studies; 1126 participants; moderate quality of evidence). Few studies reported side effects for this comparison, and they showed an increase in the risk of paraesthesia with the intake of acetazolamide (RR 5.53, 95% CI 2.81 to 10.88, I = 60%; 5 studies, 789 participants; low quality of evidence). Budenoside versus placebo (2 parallel studies; 132 participants)Data on budenoside showed a reduction in the incidence of AMS compared with placebo (RR 0.37, 95% CI 0.23 to 0.61; I = 0%; 2 studies, 132 participants; low quality of evidence). Studies included did not report events of HAPE or HACE, and they did not find side effects (low quality of evidence). Dexamethasone versus placebo (7 parallel studies; 205 participants)For dexamethasone, the data did not show benefits at any dosage (RR 0.60, 95% CI 0.36 to 1.00; I2 = 39%; 4 trials, 176 participants; low quality of evidence). Included studies did not report events of HAPE or HACE, and we rated the evidence about adverse events as of very low quality. AUTHORS' CONCLUSIONS: Our assessment of the most commonly-used pharmacological interventions suggests that acetazolamide is an effective pharmacological agent to prevent acute HAI in dosages of 250 to 750 mg/day. This information is based on evidence of moderate quality. Acetazolamide is associated with an increased risk of paraesthesia, although there are few reports about other adverse events from the available evidence. The clinical benefits and harms of other pharmacological interventions such as ibuprofen, budenoside and dexamethasone are unclear. Large multicentre studies are needed for most of the pharmacological agents evaluated in this review, to evaluate their effectiveness and safety.
[Mh] Termos MeSH primário: Acetazolamida/uso terapêutico
Doença da Altitude/prevenção & controle
Edema Encefálico/prevenção & controle
Budesonida/uso terapêutico
Inibidores da Anidrase Carbônica/uso terapêutico
Dexametasona/uso terapêutico
Glucocorticoides/uso terapêutico
Hipertensão Pulmonar/prevenção & controle
[Mh] Termos MeSH secundário: Acetazolamida/efeitos adversos
Adolescente
Adulto
Idoso
Doença da Altitude/complicações
Doença da Altitude/epidemiologia
Edema Encefálico/epidemiologia
Edema Encefálico/etiologia
Inibidores da Anidrase Carbônica/efeitos adversos
Dexametasona/efeitos adversos
Seres Humanos
Hipertensão Pulmonar/epidemiologia
Meia-Idade
Parestesia/induzido quimicamente
Viés de Publicação
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Carbonic Anhydrase Inhibitors); 0 (Glucocorticoids); 51333-22-3 (Budesonide); 7S5I7G3JQL (Dexamethasone); O3FX965V0I (Acetazolamide)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009761.pub2


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[PMID]:28535555
[Au] Autor:De Carolis G; Paroli M; Tollapi L; Doust MW; Burgher AH; Yu C; Yang T; Morgan DM; Amirdelfan K; Kapural L; Sitzman BT; Bundschu R; Vallejo R; Benyamin RM; Yearwood TL; Gliner BE; Powell AA; Bradley K
[Ad] Endereço:Anesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy.
[Ti] Título:Paresthesia-Independence: An Assessment of Technical Factors Related to 10 kHz Paresthesia-Free Spinal Cord Stimulation.
[So] Source:Pain Physician;20(4):331-341, 2017 May.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spinal cord stimulation (SCS) has been successfully used to treat chronic intractable pain for over 40 years. Successful clinical application of SCS is presumed to be generally dependent on maximizing paresthesia-pain overlap; critical to achieving this is positioning of the stimulation field at the physiologic midline. Recently, the necessity of paresthesia for achieving effective relief in SCS has been challenged by the introduction of 10 kHz paresthesia-free stimulation. In a large, prospective, randomized controlled pivotal trial, HF10 therapy was demonstrated to be statistically and clinically superior to paresthesia-based SCS in the treatment of severe chronic low back and leg pain. HF10 therapy, unlike traditional paresthesia-based SCS, requires no paresthesia to be experienced by the patient, nor does it require paresthesia mapping at any point during lead implant or post-operative programming. OBJECTIVES: To determine if pain relief was related to technical factors of paresthesia, we measured and analyzed the paresthesia responses of patients successfully using HF10 therapy. STUDY DESIGN: Prospective, multicenter, non-randomized, non-controlled interventional study. SETTING: Outpatient pain clinic at 10 centers across the US and Italy. METHODS: Patients with both back and leg pain already implanted with an HF10 therapy device for up to 24 months were included in this multicenter study. Patients provided pain scores prior to and after using HF10 therapy. Each patient's most efficacious HF10 therapy stimulation program was temporarily modified to a low frequency (LF; 60 Hz), wide pulse width (~470 mus), paresthesia-generating program. On a human body diagram, patients drew the locations of their chronic intractable pain and, with the modified program activated, all regions where they experienced LF paresthesia. Paresthesia and pain drawings were then analyzed to estimate the correlation of pain relief outcomes to overlap of pain by paresthesia, and the mediolateral distribution of paresthesia (as a surrogate of physiologic midline lead positioning). RESULTS: A total of 61 patients participated across 11 centers. Twenty-eight men and 33 women with a mean age of 56 ± 12 years of age participated in the study. The average duration of implantable pulse generator (IPG) implant was 19 ± 9 months. The average predominant pain score, as measured on a 0 - 10 visual analog scale (VAS), prior to HF10 therapy was 7.8 ± 1.3 and at time of testing was 2.5 ± 2.1, yielding an average pain relief of 70 ± 24%. For all patients, the mean paresthesia coverage of pain was 21 ± 28%, with 43% of patients having zero paresthesia coverage of pain. Analysis revealed no correlation between percentage of LF paresthesia overlap of predominant pain and HF10 therapy efficacy (P = 0.56). Exact mediolateral positioning of the stimulation electrodes was not found to be a statistically significant predictor of pain relief outcomes. LIMITATIONS: Non-randomized/non-controlled study design; short-term evaluation; certain technical factors not investigated. CONCLUSION: Both paresthesia concordance with pain and precise midline positioning of the stimulation contacts appear to be inconsequential technical factors for successful HF10 therapy application. These results suggest that HF10 therapy is not only paresthesia-free, but may be paresthesia-independent.
[Mh] Termos MeSH primário: Dor Crônica/terapia
Parestesia/terapia
Estimulação da Medula Espinal
[Mh] Termos MeSH secundário: Adulto
Idoso
Animais
Feminino
Seres Humanos
Itália
Masculino
Meia-Idade
Medição da Dor
Estudos Prospectivos
Medula Espinal/cirurgia
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


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[PMID]:28535116
[Au] Autor:Mullins ME; Hoffman RS
[Ad] Endereço:a Division of Emergency Medicine , Washington University School of Medicine , Saint Louis , MO , USA.
[Ti] Título:Is mannitol the treatment of choice for patients with ciguatera fish poisoning?
[So] Source:Clin Toxicol (Phila);55(9):947-955, 2017 Nov.
[Is] ISSN:1556-9519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:CONTEXT: Ciguatera fish poisoning arises primarily from consumption of carnivorous reef fish caught in tropical and sub-tropical waters. Ciguatoxins, a class of tasteless, heat-stable, polycyclic toxins produced by dinoflagellates, accumulate through the food chain and concentrate in various carnivorous fish, such as groupers, barracudas, wrasses, amberjack, kingfishes, and eels. Characteristics of ciguatera fish poisoning include early nausea, vomiting, and diarrhea in the first one to two days post ingestion, followed by the appearance of sensory disturbances. The classic dysaesthesia is cold allodynia, often described as reversal of hot and cold sensation, but a more accurate description is burning pain on exposure to cold. OBJECTIVE: To discuss and appraise the evidence regarding the use of mannitol or other drugs in treating ciguatera framed in the historical context of the last four decades. METHODS: We searched PubMed and Embase for all years from 1966 to March 31, 2017 with search terms "ciguatera", "mannitol", and "treatment". These searches identified 85 articles, of which 36 were relevant to the review question. We searched Google Scholar to supplement the primary search and reviewed the references of articles for sources overlooked in the original searches. These secondary searches identified another 23 references. We excluded six clinical reports (two case series and four case reports) which did not clearly describe ciguatera or which lacked information on treatment or outcome. Fifty-three clinical articles remained for review. We searched PubMed using "ciguatera" AND "treatment" NOT "mannitol" to better identify reports describing other treatments. The search identified 128 articles, of which nine described specific pharmacological treatments and their outcomes. We combined our findings into a consensus review of the evidence both for and against the use of mannitol or other medications for ciguatera fish poisoning. Early human evidence of effectiveness of mannitol: A 1988 report described an unexpected discovery that intravenous mannitol could rapidly and effectively treat ciguatera fish poisoning. Several other uncontrolled case series and case reports appeared to support the use of mannitol. In 2002, a small randomized, controlled trial reported no significant difference between mannitol and normal saline. Subsequent case reports have cited this study as the reason for or to withhold mannitol. Thus, some controversy exists regarding whether mannitol is useful or not for treating ciguatera fish poisoning. Basic science and animal research on ciguatera and mannitol: In vitro experiments of isolated neurons demonstrate that ciguatoxins produce neuronal edema, open certain sodium channels, block potassium channels, cause uncontrolled and repetitive action potentials after a stimulus. Addition of mannitol decreases the edema and reduces the uncommanded action potentials. However, intraperitoneal injection of ciguatoxin in rats increases neuronal refractory period and slows nerve conduction velocity. Treatment with mannitol fails to correct these effects. Comparative trials of mannitol: Evidence supporting mannitol for ciguatera fish poisoning includes four uncontrolled case series, one prospective, unblinded comparative trial and several case reports. Evidence against mannitol consists of one RCT, which has a small sample size and several potential limitations. Empirical human experience with other treatments: Evidence regarding other treatments consists only of ten case reports and three overlapping case series that describe using amitriptyline, fluoxetine, duloxetine, gabapentin, pregabalin, or tocainide. For each of these, a long duration of treatment appears to be necessary to maintain symptomatic improvement. None of these treatments has been shown to be superior to mannitol. CONCLUSIONS: It is reasonable to consider using intravenous mannitol in cases of acute ciguatera fish poisoning. Medications used in other neuropathic syndromes appear to suppress the paresthesiae of persistent ciguatera cases. However, the human evidence is of low quality for all treatments.
[Mh] Termos MeSH primário: Intoxicação por Ciguatera/tratamento farmacológico
Manitol/administração & dosagem
Parestesia/tratamento farmacológico
Alimentos Marinhos/parasitologia
[Mh] Termos MeSH secundário: Administração Intravenosa
Animais
Intoxicação por Ciguatera/parasitologia
Intoxicação por Ciguatera/fisiopatologia
Seres Humanos
Manitol/efeitos adversos
Parestesia/parasitologia
Parestesia/fisiopatologia
Alimentos Marinhos/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
3OWL53L36A (Mannitol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE
[do] DOI:10.1080/15563650.2017.1327664


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[PMID]:28483185
[Au] Autor:Sant'Anna CBM; Zuim PRJ; Brandini DA; Guiotti AM; Vieira JB; Turcio KHL
[Ad] Endereço:Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, Univ Estadual Paulista-UNESP, Brazil. Electronic address: crischina.s@terra.com.br.
[Ti] Título:Effect of Acupuncture on Post-implant Paresthesia.
[So] Source:J Acupunct Meridian Stud;10(2):131-134, 2017 Apr.
[Is] ISSN:2093-8152
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Paresthesia is defined as an alteration in local sensibility, associated with numbness, tingling, or unpleasant sensations caused by nerve lesions or irritation. It can be temporary or permanent. The treatment protocol for facial paresthesia is primarily based on the use of drugs and implant removal, which may not be completely effective or may require other risk exposure when there is no spontaneous regression. However, other therapeutic modalities such as acupuncture can be used. The aim of this study is to report a case of a patient with paresthesia of the inferior alveolar nerve and pain caused by an implant surgery performed 2 years earlier. The patient received acupuncture treatment during 4 months of weekly sessions. Six points were used: Large Intestine (LI4), Large Intestine (LI11), Stomach (ST36), Liver (LR3), Extra Head and Neck (E-HN-18), and Stomach (ST5). The visual analog scale was used before and after each session for the analysis of paresthesia and pain, together with assessment of the paresthesia by delimitation of the desensitized region of the skin and presented discomfort. Pain remission and reduction in the size of the paresthesia area occurred after four sessions.
[Mh] Termos MeSH primário: Terapia por Acupuntura/métodos
Implantes Dentários/efeitos adversos
Parestesia/etiologia
Parestesia/terapia
[Mh] Termos MeSH secundário: Animais
Feminino
Seres Humanos
Nervo Mandibular/fisiopatologia
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dental Implants)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170510
[St] Status:MEDLINE


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[PMID]:28404567
[Au] Autor:Chansky PB; Werth VP
[Ad] Endereço:Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
[Ti] Título:Accidental hydroxychloroquine overdose resulting in neurotoxic vestibulopathy.
[So] Source:BMJ Case Rep;2017, 2017 Apr 12.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Hydroxychloroquine is an oral antimalarial medication commonly used off-label for a variety of rheumatological conditions, including systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and dermatomyositis. We present a case of a 64-year-old woman who presented with acute onset headache, bilateral tinnitus, and left-sided facial numbness and tingling in the setting of accidentally overdosing on hydroxychloroquine. By the next morning, the patient began to experience worsening in the tingling sensation and it eventually spread to her left arm, thigh and distal extremities. The patient also complained of new onset blurring of her peripheral vision and feeling 'off balance.' Despite a complete neurological and ophthalmological work-up with unremarkable imaging and blood work, the patient has had no improvement in her tinnitus, left-sided paresthesias, visual disturbance or ataxia. This is a unique case of hydroxychloroquine overdose resulting in permanent neurotoxic vestibulopathy.
[Mh] Termos MeSH primário: Ataxia/induzido quimicamente
Overdose de Drogas/complicações
Hidroxicloroquina/efeitos adversos
Parestesia/induzido quimicamente
Zumbido/induzido quimicamente
Transtornos da Visão/induzido quimicamente
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
4QWG6N8QKH (Hydroxychloroquine)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170628
[Lr] Data última revisão:
170628
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE



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