The H-Wave® device is an effective and safe non-pharmacological analgesic for chronic pain: a meta-analysis

INTRODUCTION: This meta-analysis was conducted to systematically review the efficacy and safety of the H-Wave(R) (Electronic Waveform Lab, Inc, Huntington Beach, CA, USA) device and programme as a non-pharmacological analgesic treatment in chronic soft tissue inflammation and neuropathic pain. METHODS: Five studies related to pain relief, reduction in pain medication and increased functionality obtained with the H-Wave device were included in the analysis. Data were analysed using the random effects model, including adjustment to evaluate variability, size of study and bias in effect size. A total of 6535 participants were included in the meta-analysis; there were 8065 participants' outcomes measured due to multiple measurements per participant. RESULTS: The H-Wave device decreased pain ratings across various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.59, and the estimated effect size variance was 0.00003 (95% confidence intervals [CI]: 0.580, 0.600). The H-Wave device also decreased the intake of pain medication in patients with various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.56, and the estimated effect size variance was 0.000013 (95% CI: 0.553, 0.567). Patient functionality was also improved with use of the H-Wave device. The mean weighted effect size was 0.70, and the estimated effect size variance was 0.00002 (95% CI: 0.691, 0.709). A chi-square test for homogeneous effect sizes found highly significant (P<0.00001) variability, indicating a robust significant effect size for increased functionality relative to both pain relief and reduction in pain medication. There was little to no evidence of any adverse effects associated with the use of the H-Wave device. CONCLUSION: The findings indicate a moderate to strong effect of the H-Wave device in providing pain relief, reducing the requirement for pain medication and increasing functionality. The most robust effect was observed for improved functionality, suggesting that the H-Wave device may facilitate a quicker return to work and other related daily activities.     

Fulminant Staphylococcus lugdunensis septicaemia following a pelvic varicella-zoster virus infection in an immune-deficient patient: a case report

INTRODUCTION: the deadly threat of systemic infections with coagulase negative Staphylococcus lugdunensis despite an appropriate antibiotic therapy has only recently been recognized. The predominant infectious focus observed so far is left-sided native heart valve endocarditis, but bone and soft tissue infections, septicaemia and vascular catheter-related bloodstream infections have also been reported. We present a patient with a fatal Staphylococcus lugdunensis septicaemia following zoster bacterial superinfection of the pelvic region. case presentation: a 71-year old male diagnosed with IgG kappa plasmocytoma presented with a conspicuous weight loss, a hypercalcaemic crisis and acute renal failure. After initiation of haemodialysis treatment his condition improved rapidly. However, he developed a varicella-zoster virus infection of the twelfth thoracic dermatome requiring intravenous acyclovir treatment. Four days later the patient presented with a fulminant septicaemia. Despite an early intravenous antibiotic therapy with ciprofloxacin, piperacillin/combactam and vancomycin the patient died within 48 hours, shortly before the infective isolate was identified as Staphylococcus lugdunensis by polymerase chain reaction. CONCLUSION: despite S. lugdunensis belonging to the family of coagulase-negative staphylococci with an usually low virulence, infections with S. lugdunensis may be associated with an aggressive course and high mortality. This is the first report on a Staphylococcus lugdunensis septicaemia following a zoster bacterial superinfection of the pelvic region.     

Migraine trigger factors in a non-clinical Mexican-American population in San Diego county: implications for etiology

We conducted an investigation of migraine headache in a general population of Mexican-Americans living in San Diego county. Specific headache triggers were reported and analyzed, the most frequently reported for females with migraine being missing meals (58.9%), weather changes (54.4%), menstruation (53.6%), post-crisis letdown (52.7%), and fatigue (51.8%). The most frequently reported trigger factors for migraines reported by males were fatigue (58.8%), sleep (as a precipitating factor) (56.3%), post-crisis letdown (41.2%), and weather changes (37.5%). Trigger factors were further evaluated using stratification by presence or absence of Raynaud's phenomenon (RP), menstrual migraine, family history of migraine, and by migraine type. Odds ratios and 95% confidence intervals were calculated. These results suggest that subjects with migraine and RP (perhaps indicative of a systematic vascular tone disorder) and those with menstrual migraine (indicative of sensitivity to hormonal changes) may overall be more sensitive to certain environmental stimuli, particularly those involving change in the internal environment.     

Generalized pustular psoriasis responsive to PUVA and oral cyclosporin therapy

A patient with acute generalized pustular psoriasis was successfully treated with a combination of oral cyclosporin (6 mg/kg per day) and photochemotherapy (PUVA). Although early inpatient treatment with weak topical steroids and PUVA produced initial improvement, the patient's clinical condition fluctuated, with the subsequent development of erythroderma. The addition of oral cyclosporin produced dramatic improvement within 1 week of its commencement. The patient remained in remission 12 months following cessation of therapy.     

Oncoplacental protein SP1--a constitutive and inducible late differentiation marker of the human myelomonocytic lineage

The oncoplacental protein SP1 is found in large quantities in human placenta, amniotic fluid, and pregnancy serum. Low levels have been reported in association with malignancy but also in healthy nonpregnant individuals. By indirect immunofluorescence, fluorescence-activated cell sorting, and immunoprecipitation we here demonstrate the presence of SP1 both on the surface and in the cytoplasm of human granulocytes but not in earlier myeloid progenitor cells in bone marrow. Lymphocytes did not contain the protein, and only trace amounts could be found in the cytoplasm of blood monocytes. A major glycoprotein with an apparent mol wt of 90,000 was obtained by immunoprecipitation of surface-labeled granulocytes. Cultivated blood monocytes, while adhering to surfaces or forming multinuclear giant cells, displayed a strong membrane and cytoplasmic expression of SP1. Treatment of the myeloid leukemia cell line ML-2 with tetraphorbol acetate (TPA) strongly induced SP1 in the membrane and cytoplasm as revealed by immunofluorescence and polyacrylamide gel electrophoresis (PAGE) of immunoprecipitates from lysates of surface radiolabeled cells. The induction of synthesis of SP1 in TPA-treated cells was confirmed by immunoprecipitation from lysates of cells metabolically labeled with 35S-methionine. Human lymphoblastoid and erythroleukemic cell lines did not express SP1 either before or after induced differentiation. Thus SP1 provides a late differentiation marker for the myelomonocytic lineage and is strongly induced during macrophage differentiation or by TPA treatment of ML-2 cells.     

Early post-traumatic seizures in children: Clinical and radiological aspects of injury

Objective : To determine the type and outcome of early post-traumatic seizures in children and the factors associated with it.
Methodology : A prospective observational study on all consecutive children with head injuries at the General Hospital Kuala Lumpur between November 1993 and December 1994. The onset, type and frequency of seizures occurring within the first week of injury were documented. Using inpatients as a cohort, logistic regression analysis was used to determine clinical and radiological variables significantly associated with seizures. The outcome 6 months post-injury was assessed using the Glasgow Outcome Scale.
Results : Fifty-three of 966 children (5.5%) developed seizures within the first week of trauma. Seven (13.2%) occurred within 1 h of injury, 30 (56.6%) between 1 and 24 h and 16 (30.2%) after 24 h. Factors significantly associated with early post-traumatic seizures were female sex, age less than 2 years, loss of consciousness for more than 24 h and acute subdural haematoma ( P <0.01). Children with seizures had a poorer outcome (death or severe disability) man inpatients without seizures (21/53 vs 19/182, P <0.001). The outcome was worst in children with recurrent partial seizures, who had a longer injury-seizure interval and were more likely to have focal neurologic deficits compared to those with sporadic or generalized seizures.
Conclusions : Anticonvulsant prophylaxis to minimize the adverse effects of early seizures in head injury should be considered for young children (less than 2 years old) with subdural haematoma and a prolonged duration of coma. Prompt and effective control of recurrent seizures is recommended.     

Comparison of the rehabilitation status of continuous ambulatory peritoneal dialysis and in-centre haemodialysis in Chinese patients

Summary: In Hong Kong, dialysis treatment has become more accessible in recent years. Due to a shortage of kidney donors patients are required to stay on dialysis for longer periods. the rehabilitation status of 181 end-stage renal failure (ESRF) patients on dialysis, 34 on in-centre haemodialysis (ICHD) and 147 on continuous ambulatory peritoneal dialysis (CAPD), at the Prince of Wales Hospital was studied. There was no statistically significant difference in physical functioning due to treatment type; however, CAPD patients were shown to be more socially active and had a better family life than ICHD patients (P < 0.01). There were no statistically significant correlations between physical functioning, social life or family life and the duration of dialysis in both ICHD and CAPD patients. In both groups of patients 52.9% of ICHD and 52.4% of CAPD patients had decreased employment status. All the patients were assessed by doctors-in-charge on their physical fitness for employment, 85.7% (n= 6) of the unemployed ICHD patients and 71% (n= 44) of the unemployed CAPD patients were considered to be physically fit to work. Due to the ageing of the general population and greater availability of dialysis treatment and higher survival rate of the chronically ill have led to an increase in the number of elderly patients on dialysis (aged 60 years and over). the proportion of elderly dialysis patients in our renal centre increased from 7–23% in the past 5 years. Continuous ambulatory peritoneal dialysis patients aged less than 60 years were found to be significantly more physically active and socially active than CAPD patients aged over 60 years (P < 0.01). In the aspect of a better family life for these patients, no statistically significant difference was found between the two groups. Rehabilitation of ESRF patients can be achieved by renal replacement therapy. It is concluded that CAPD patients have better adaptation in social life and family life than ICHD patients.     

Improvement in appropriate autologous donations with local education: 1987 to 1989

Preoperative autologous blood donation for elective surgery patients at university hospitals was underused in the past. More recently, national educational efforts have been made. To test the impact of local surgeon interviews and education, in 1988 the same local educational program was instituted at three university hospitals; three community hospitals were used as controls. Donation by appropriate patients of interviewed surgeons (elective surgery, crossmatch recommended, no contraindications to donation) increased from 24 percent (44/180) to 40 percent (88/222) (p = 0.002) and 15 percent (21/143) to 32 percent (41/127) (p = 0.001) at two university hospitals where the investigator-educators were on site, but not at the three community hospitals. Between 1987 and 1989, donation rates at all six hospitals remained low among patients for whom autologous donation was (probably) less appropriate. Donation rates for type and screen procedures were 3.0 percent (131/4587) in 1987 and 3.0 percent (199/6606) in 1989 (p = 0.67). Donation rates for "no blood order" procedures were 0.2 percent (15/9429) in 1987 and 0.1 percent (9/11,239) in 1989 (p = 0.14). It can be concluded that appropriate autologous blood donations increased at university hospitals where surgeons were individually interviewed and educated by an investigator on site. However, despite this increase, apparently eligible elective surgery patients in 1989 still failed to donate. This situation deserves additional investigation.     

Effect of Bifidobacterium longum and inulin on gut bacterial metabolism and carcinogen-induced aberrant crypt foci in rats

The effect of Bifidobacterium longum (4 x 10(8) viable cells/g diet) and a derivative of inulin ('Raftiline HP'; 5% w/w in diet) on colonic aberrant crypt foci (ACF) induced by the colon carcinogen azoxymethane (AOM) has been studied. The concentration of ammonia, a putative tumour promoter produced by bacterial degradation of protein and urea, and the activities of certain bacterial enzymes thought to play a role in colon carcinogenesis, beta-glucuronidase and beta-glucosidase were also assayed. Consumption of either B. longum or inulin was associated with a decrease (26 and 41%, respectively) in AOM-induced small ACF (i.e. those comprising 1-3 aberrant crypts per focus). Combined administration of the bifidobacterium and inulin resulted in more potent inhibition of ACF than administration of the two separately, achieving 80% inhibition of small ACF. Furthermore, the combined administration significantly decreased the incidence (by 59%) of large ACF (>4 aberrant crypts per focus), which are considered to be predictive of eventual tumour incidence. Since the dietary treatments were started 1 week after the carcinogen dose, the results suggest that B. longum and inulin may be affecting the early promotion phase of the carcinogenic process. Consumption of diets containing B. longum, inulin or both were also associated with decreases in beta-glucuronidase activity and ammonia concentration in the caecal contents. Both these factors have been associated with carcinogenesis of the colon in experimental animal models. In rats given inulin-containing diets (with or without B. longum) an increase in caecal wt and beta-glucosidase activity and a decrease in caecal pH were observed. The results suggest that consumption of B. longum or inulin was associated with potentially beneficial changes in caecal physiology and bacterial metabolic activity in relation to tumour risk and in the incidence of putative preneoplastic lesions in the colon. The results also indicated that combined treatment with the two agents was more effective in reducing colonic lesions.