Reduced flexion rotation test in women with chronic and episodic migraine

ObjectiveTo compare flexion rotation test and global active cervical mobility in women with chronic migraine, episodic migraine, and headache-free controls. The influence of neck pain-related disability on the flexion rotation test was also analyzed.MethodsWomen with chronic migraine (n = 25), episodic migraine (n = 30), and those who were headache-free (n = 30) were evaluated. Upper cervical mobility was measured using the flexion rotation test and global active mobility was assessed using the cervical range of motion device. Neck pain related-disability was assessed using the Neck Disability Index. Statistical analyses were performed using a MANOVA test, prevalence ratios, and linear regression.ResultsChronic (right, MD: ?15°; 95%CI: ?21° to ?11°; left, MD: ?13°; 95%CI: ?20° to ?12°) and episodic (right, MD: ?8°; 95%CI: ?13° to ?4°; left, MD: ?8°; 95%CI: ?12° to ?5°) migraine groups achieved lower flexion rotation test mobility bilaterally than headache-free women. Only chronic migraine was associated with a lower global cervical range of motion compared to that of headache-free women during flexion, (MD: ?8°; 95%CI: ?15° to ?1°), extension (MD: ?13°; 95%CI: ?20° to ?4°), right lateral flexion (MD: ?4°; 95%CI: ?9° to ?0.2°), left lateral flexion (MD: ?6°; 95%CI: ?10° to ?2°), right rotation (MD: ?9°; 95%CI: ?15° to ?4°), and left rotation (MD: ?8°; 95%CI: ?13° to ?2°). Migraine was associated with a 2.85-fold increase in the risk of a positive flexion rotation test. Flexion Rotation Test was influenced by disability-related neck pain (R² = 19.1; p = 0.001).ConclusionWomen with migraine have a lower upper cervical range of motion than headache-free women. Women with chronic migraine demonstrated reduced global cervical range of motion when compared to headache-free women. Migraine was associated with in increased likelihood of a positive Flexion Rotation Test. Reduction in mobility was influenced by migraine frequency and disability-related neck pain.     

Evaluation of Lung Function in Liver Transplant Candidates

Introduction

A wide variety of pulmonary conditions are found in cirrhotic patients and may compromise the pleura, diaphragm, parenchyma, and pulmonary vasculature, influencing the results of liver transplantation.

Case report: The efficacy and safety of lomitapide in a homozygous familial hypercholesterolemic child

We report for the first time the efficiency and safety of a 49-month compassionate use of the microsomal transfer protein inhibitor lomitapide in a child with homozygous familial hypercholesterolemia. On average, 20 mg of lomitapide caused a 37% reduction in low-density lipoprotein cholesterol levels on top of ezetimibe and atorvastatin. The drug was well tolerated with no changes in liver enzymes and occurrence of steatosis on hepatic ultrasound. The patient presented adequate growth and sexual maturation. Nonetheless, there was progression in either subclinical atherosclerotic carotid or aortic valve diseases. Further studies are necessary to test the impact and safety of lomitapide in children with homozygous familial hypercholesterolemia.     

In vitro activity of carvacrol,cinnamaldehyde and thymol combined with antifungals against Malassezia pachydermatis

Malassezia pachydermatis is an important opportunistic agent of dermatitis and otitis in dogs. M. pachydermatis is generally treated with topical therapies using combinations of antifungal, antimicrobial and anti-inflammatory agents. We investigated the in vitro activities of carvacrol (CRV), cinnamaldehyde (CIN) and thymol (THY) alone and in combination with antifungal agents (fluconazole, itraconazole, ketoconazole, clotrimazole, miconazole, terbinafine and nystatin) against M. pachydermatis. The assays were performed according to the Clinical and Laboratory Standards Institute (CLSI), using Sabouraud dextrose broth and checkerboard microdilution. The mean fractional inhibitory concentration index (FICI) showed primary synergies for the combinations carvacrol + nystatin, thymol + nystatin, and carvacrol + miconazole (80%). In conclusion, the results obtained indicate that the phytochemicals tested showed relevant in vitro anti-M. pachydermatis activity. Future in vivo experiments are needed to elucidate the safety and therapeutic potential of these combinations.     

Spectrum of Disease Severity in Nonsyndromic Patients With Mutations in the CEP290 Gene: A Multicentric Longitudinal Study

PurposeThe purpose of this study was to perform a detailed longitudinal phenotyping and genetic characterization of 32 Italian patients with a nonsyndromic retinal dystrophy and mutations in the CEP290 gene.MethodsWe reviewed the clinical history and examinations of 32 patients with a nonsyndromic retinal dystrophy due to mutations in the CEP290 gene, followed up (mean follow-up: 5.9 years) at 3 Italian centers. The clinical examinations included: best corrected visual acuity (BCVA), optical coherence tomography (OCT), and full-field electroretinogram (ERG).ResultsPatients (mean age = 19.0 ± 3.4 years) had a mean BCVA of 1.73 ± 0.20 logMAR. Longitudinal analysis of BCVA showed a nonsignificant decline. Central retinal thickness (CRT) declined significantly with age at an exponential rate of 1.0%/year (P = 0.001). At disease onset, most patients (19/32; 49.4%) had nystagmus. The absence of nystagmus was significantly associated with better BCVA and more preserved CRT (P < 0.05). ERG showed undetectable responses in most patients (64.0%), whereas reduced scotopic and photopic responses were observed in four patients (16.0%) who had no nystagmus. We identified 35 different variants, among which 12 were novel. Our genotype-phenotype correlation analysis shows a significantly worse BCVA in patients harboring a loss-of-function mutation and the deep-intronic variant c.2991+1655A>G.ConclusionsOur study highlights a mild phenotype of the disease, characterized by absence of nystagmus, good visual acuity, considerably preserved retinal morphology, and recordable ERG, confirming the wide spectrum of CEP290-related retinal dystrophies. Finally, in our cohort, the deep intronic variant c.2991+1655A>G was associated with a more severe phenotype.