Migraine treatment throughout the lifecycle

The treatment of migraine headache is often suboptimal despite significant advances in our understanding of the pathophysiology and treatment of migraine. Children, adolescents, women and the elderly are particularly at risk of receiving inadequate or inappropriate therapy. In this review, the reader is brought up-to-date with changes to the International Headache Society diagnostic criteria for migraine. The pathophysiology of migraine is also reviewed, with a special emphasis on the evolving concept of central sensitization and cutaneous allodynia since this concept has led to a paradigm shift in the way migraines are managed. A review of the evidence supporting the benefits of early treatment before pain becomes moderate-to-severe is provided. Recommendations for acute and prophylactic treatments throughout the lifecycle are made in light of clinical practice guidelines and more recent evidence. Lastly, the current optimal treatment of migraine is provided and the potential role of calcitonin gene-related peptide antagonists in the future is discussed.     

The future of real-time cardiac magnetic resonance imaging

Dynamic changes in cardiac structure and function are usually examined by real-time imaging techniques such as angiography or echocardiography. MRI has many advantages compared with these established cardiac imaging modalities. However, system hardware and software limitations have limited cardiac MRI to gated acquisitions that are lengthy and often result in failed acquisitions and examinations. Recently, MRI has evolved into a technique capable of imaging dynamic processes in real time. Improvements in hardware, pulse sequences, and image reconstruction algorithms have enabled real-time cardiac MRI with high spatial resolution, high temporal resolution, and various types of image contrast without requiring cardiac gating or breath-holding. This article provides an overview of current capability and highlights key technical and clinical advances. The future prospects of real-time cardiac MRI will depend on 1) the development of techniques that further improve signal to noise ratio, contrast, spatial resolution, and temporal resolution, without introducing artifacts; 2) the development of software infrastructure that facilitates rapid interactive examination; and 3) the development and validation of several new clinical assessments.     

Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials

OBJECTIVE: To review the relative efficacy and safety of enteral vs intravenous (IV) rehydration therapy in treating childhood gastroenteritis. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register databases were searched. Known investigators and expert bodies were contacted to locate unpublished and ongoing studies. STUDY SELECTION: Studies were selected based on the following criteria: randomized or quasi-randomized trials; children younger than 15 years with a clinical diagnosis of gastroenteritis of less than 1-week duration; interventions comprising enteral and IV treatment arms; and at least 1 of the following: major adverse event rates, treatment failure rates, weight gain with treatment, measurement of ongoing losses, length of hospital stay, costs of treatment, and satisfaction with treatment. DATA EXTRACTION: Data were extracted from eligible studies, which were then combined using a random-effects model. DATA SYNTHESIS: Sixteen trials involving 1545 children and conducted in 11 countries were identified. Compared with children treated with IV rehydration, children treated with oral rehydration had significantly fewer major adverse events, including death or seizures (relative risk, 0.36; 95% confidence interval [CI], 0.14-0.89), and a significant reduction in length of hospital stay (mean, 21 hours; 95% CI, 8-35 hours). There was no difference in weight gain between the 2 groups (mean, -26 g; 95% CI, -61 to 10 g). The overall failure rate of enteral therapy was 4.0% (95% CI, 3.0%-5.0%). CONCLUSIONS: For childhood gastroenteritis, enteral rehydration is as effective if not better than IV rehydration. Enteral rehydration by the oral or nasogastric route is associated with significantly fewer major adverse events and a shorter hospital stay compared with IV therapy and is successful in most children.