Subscribe: QJM - current issue
http://qjmed.oxfordjournals.org/rss/current.xml
Added By: Feedage Forager Feedage Grade B rated
Language: English
Tags:
asthma  cirrhosis  clinical  cohort  crohn’s disease  disease  lithium  patients  showed  study  therapy  treatment   
Rate this Feed
Rate this feedRate this feedRate this feedRate this feedRate this feed
Rate this feed 1 starRate this feed 2 starRate this feed 3 starRate this feed 4 starRate this feed 5 star

Comments (0)

Feed Details and Statistics Feed Statistics
Preview: QJM - current issue

QJM: An International Journal of Medicine Current Issue





Published: Mon, 18 Dec 2017 00:00:00 GMT

Last Build Date: Mon, 18 Dec 2017 05:51:17 GMT

 



Concussion and sport: players, coaches, doctors—an inconvenient truth

Mon, 18 Dec 2017 00:00:00 GMT

Maybe I’m stupid or whatever, but to me if I got a concussion, if I could see straight and could carry a football then I am not telling anybody



Hypoparathyroidism, deafness and renal dysplasia (HDR) syndrome and GATA3

Mon, 18 Sep 2017 00:00:00 GMT

Learning points for clinicians:Hypoparathyroidism, deafness and renal dysplasia (HDR) syndrome is a rare genetic disorder that has variable clinical expression and age of onset. The combination of hypoparathyroidism and deafness in a patient of any age strongly suggests a diagnosis of HDR syndrome, which can be confirmed by genetic testing.



Transient global amnesia: clinical and imaging features

Mon, 28 Aug 2017 00:00:00 GMT

We present the case of a 53-year-old female admitted to the emergency department of our institution with an acute amnesic episode. The patient was playing golf at the onset of symptoms and, at presentation, demonstrated amnesia to events for the preceding 10 h. She also reported a headache and nausea and asked questions repeatedly. Collateral history from a witness reported sudden onset of these symptoms and there was no loss of personal identity and no other focal neurological signs/symptoms. The patient did not demonstrate any seizure activity and had no history of recent head injury. Anterograde amnesia lasted for approximately 3 h, and the symptoms resolved after this time. Initial investigations including electrocardiogram, echocardiogram, non-contrast computed tomography (CT) of the brain and CT intracranial angiogram were unremarkable. Magnetic resonance imaging (MRI) of the brain performed 48 h after the onset of symptoms demonstrated focal dot-like diffusion restriction in the right and left hippocampi (Figure 1). With this clinical history and characteristic MRI findings, a diagnosis of transient global amnesia (TGA) was made.



Ultrasonographic findings as diagnostic and follow-up tool in cranial giant cell arteritis

Mon, 28 Aug 2017 00:00:00 GMT

A 79-year-old man presented with a 3-week history of fever, rapidly progressive declining visual acuity and jaw claudication. The biochemical profile showed elevated levels of C-reactive protein (CRP) (120 mg/L; normal < 3) and an erythrocyte sedimentation rate (ESR) (140 mm/h; normal < 10); results of testing for antineutrophil cytoplasmic antibodies and antinuclear antibody were negative. Blood cultures were negative. Hepatic and renal functions were normal. Physical examination showed palpable and funicular bilateral temporal arteries (Figure 1A, arrows). Longitudinal view of bilateral temporal arteries colour Doppler ultrasonography (US) features before treatment showed a hypoechogenic halo of the temporal artery and the presence of turbulent flow and weak flow because of the presence of halo sign corresponding to oedema of arterial wall (Figure 1B). Then, the biopsy of the left temporal artery demonstrated significant temporal arteritis with giant cells. The patient was diagnosed with cranial giant cell arteritis (GCA). Treatment with prednisolone was initiated. After treatment, his all symptoms resolved, and ESR and serum CRP levels became normal. His abnormal physical finding of palpable and funicular bilateral temporal artery also improved (Figure 1C). Similarly, longitudinal view of temporal artery colour Doppler US after treatment showed reduction of halo sign and turbulent flow and a stronger flow than before treatment that corresponds to a significant reduction of oedema of artery wall (Figure 1D). Recently, the clinical implications of high-resolution magnetic resonance imaging,1 positron emission tomography and computed tomography angiography2 and colour Doppler US3 have reported on diagnosis of GCA. In the present case, colour Doppler US is not only very useful in the diagnosis of cranial GCA but also useful in following up of patients after initiation of therapy. This case should remind readers to consider the assessment by colour Doppler US as convenient monitoring tool of disease activity in cranial GCA.



Risk factors associated with mortality from vascular thromboembolic events in patients diagnosed with non-small cell lung cancer: a population-based analysis

Thu, 24 Aug 2017 00:00:00 GMT

Abstract
Background
Lung cancer patients are at increased risk for vascular events possibly due to cancer induced hypercoagulation.
Aim
The purpose of this study was to evaluate risk factors associated with the mortality from vascular thromboembolic events in patients diagnosed with non-small cell lung cancer (NSCLC).
Design
Retrospective population-based analysis.
Methods
We used Surveillance, Epidemiology and End Results Program for 2004–13 and evaluated 199 337 patients with NSCLC. Univariate and multivariate subdistribution hazard regression models were used to identify potential risk factors for mortality from vascular thromboembolic events. Stratification analysis against clinical stage was performed to determine if the severity of the disease influenced the identified associations.
Results
Multivariate Cox regression analysis demonstrated that increased risk of mortality due to vascular thromboembolic events was associated with age, black race, non-adenocarcinoma histology, surgical treatment alone (all, P < 0.001) and north central region of SEER registry (P = 0.003). Female gender (P < 0.001), Asian or Pacific Islander race (P = 0.001), multiple co-existing primary cancers and late cancer stages (both, P < 0.001) were associated with significantly lower risk of mortality due to vascular thromboembolic events. The significant predictors of mortality from the vascular thromboembolic event were dependent on the stages of the disease.
Conclusions
Risk factors associated with mortality from the vascular thromboembolic events in NSCLC patients identified in this study can promote awareness and may help to identify groups of patients that can benefit from anti-thrombotic prophylaxis measures.



Increased risk of subdural hematoma in patients with liver cirrhosis

Thu, 24 Aug 2017 00:00:00 GMT

Abstract
Background
Subdural hematoma (SDH) is associated with a high mortality rate. The risk of SDH in cirrhotic patients has not been well studied.
Aim
The aim of the study was to examine the risk of SDH in cirrhotic patients.
Design
A retrospective study from a universal insurance claims database of Taiwan.
Methods
A cohort of 9455 liver cirrhotic patients from 2000 to 2011 and an age-and sex-matched control cohort of 35992 subjects without cirrhosis were identified. The severity of liver cirrhosis was classified into uncomplicated and complicated according to presence of complications or not. The incidence and hazard ratio of SDH were measured by the end of 2011.
Results
The mean follow-up years were 4.34 ± 3.45 years in the cirrhosis cohort and 6.36 ± 3.28 years in the non-cirrhosis cohort. The incidence of SDH was 2.73-fold higher in the cirrhosis cohort than in the control cohort (29.3 vs. 10.9 per 10 000 person-years), with an adjusted hazard ratio of 2.73 (95% CI = 2.19–3.42), 2.42 (95% CI = 1.89–3.08), and 5.07 (95% CI = 3.38–7.60) in the all liver cirrhosis, the uncomplicated liver cirrhosis, and the complicated liver cirrhosis patients compared to the control cohort. The adjusted hazard ratios were 2.65 (95% CI = 2.06–3.41) for traumatic SDH and 3.09 (95% CI 1.91–5.02) for non-traumatic SDH in liver cirrhosis patients, compared to the controls.
Conclusions
This study demonstrates that patients with cirrhosis are at higher risk of both traumatic and non-traumatic SDH than individuals without cirrhosis. The risk increases further in patients with complicated liver cirrhosis.



Endocrinopathies and renal outcomes in lithium therapy: impact of lithium toxicity

Thu, 24 Aug 2017 00:00:00 GMT

Abstract
Background
Lithium is the mainstay of treatment for bipolar disorder, mania and an augmentation therapy in patients with treatment resistant depression. It has a narrow therapeutic index, with recognized adverse multi-system and endocrine side effects.
Aim
To assess the impact of lithium therapy, in particular lithium toxicity, on the development of endocrine and renal disorders in a cohort of patients in a single tertiary referral centre in Ireland.
Study design
A retrospective analysis was performed of the prevalence of lithium toxicity and renal, thyroid and parathyroid dysfunction in our study population.
Methods
We collected laboratory data from the Clinical Chemistry department of the Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. Our study population included all patients who had at least one serum lithium measurement from January 1st 2000 to December 31st 2014 inclusive.
Results
A total of 580 patients were included in the study. Among our study group, 70 patients (12.1%) had 1 toxic lithium measurement (lithium level >1.2 mmol/l). 27.8% (n > 161) of patients developed stage 3 Chronic kidney Disease (CKD) or higher, which was commoner in those patients who developed toxic lithium levels (P < 0.0001) and in those who developed hypernatraemia (P > 0.0001). 16.2% of patients (n > 94) had one serum sodium >145 mmol/l during follow up. 60 patients(10.3%) had a TSH >10 mU/l, while complete suppression of TSH (<0.05 mU/l) was observed in 22 patients (3.8%) during follow-up. 4% (n > 37) of the study population had ≥1 serum corrected calcium level > 2.55 mmol/l, and 4 patients had biochemical confirmation of primary hyperparathyroidism but PTH levels were only performed in 2.8% (n > 16) of the studypopulation.
Conclusion
Stage 3 CKD is common in patients receiving lithium therapy. Lithium toxicity is associated with CKD and hypernatraemia. Thyroid dysfunction and hypercalcaemia are common in patients receiving lithium therapy. Patients receiving lithium therapy require surveillance of renal, thyroid and bone biochemistry.



Atypical macrophages in disseminated Mycobacterium intracellulare infection

Thu, 24 Aug 2017 00:00:00 GMT

A 28-year-old human immunodeficiency virus (HIV)-1-infected man was admitted to the hospital because of nausea, vomiting and diarrhea for 4 days. On physical examination, he was found to have mild fever, tachycardia and splenomegaly. The initial laboratory results were as follows: (i) white blood cells (WBC): 2.3 × 109/l; hemoglobin: 118 g/l; platelets: 126 × 109/l; (ii) C-reaction protein: 69 mg/l; erythrocyte sedimentation rate: 57 mm/h; (iii) plasma Epstein–Barr virus and cytomegalovirus viral load: undetectable; (iv) negative tuberculosis interferon-gamma release assay; (v) blood and stool cultures: negative; and (vi) CD4 cell count: 12 cells/μl; plasma HIV viral load: 379 copies/ml. After admission, the patient began to have high fever, non-productive cough and severe abdominal pain that did not response to biapenem treatment. A repeat blood routine test 11 days after admission showed pancytopenia (WBC: 1.0 × 109/l; hemoglobin: 77 g/l; platelets: 49 × 109/l). Wright’s stain of the bone marrow aspirate showed that half of the monocytes/macrophages were filled with poorly stained rod-like elements (atypical macrophages, Figure 1A). Ziehl–Nielsen stain of the bone marrow aspirate showed a predominantly intracellular localization of acid-fast bacilli (Figure 1B). Mycobacterium intracellulare DNA fragments (16S–23S internal transcribed spacer) were amplified from the DNA extraction of bone marrow aspirate. Both blood and bone marrow aspirate mycobacterial culture grew M.intracellulare. The patient was treated with azithromycin (0.5 g/day), ethambutol (1.0 g/day), rifabutin (0.15 g/day) and amikacin (0.4 g/day, i.v.). There was a slow improvement of fever and diarrhea, but no improvement of the abdominal pain. Computed-tomography scan showed progression of splenomegaly with scattered multiple low-density lesions. The patient was discharged after having received 1 month’s anti-mycobaterial therapy and died 3 weeks later.



Crohn’s disease: bamboo joint-like appearance

Wed, 23 Aug 2017 00:00:00 GMT

A 50-year-old man presented to the outpatient clinic with a 1-week history of epigastric abdominal pain. He was previously diagnosed with Crohn’s disease. His vital signs were normal. On physical examination, he exhibited mild tenderness of his epigastrium without guarding or rebound tenderness. A plain radiograph showed no abnormality. An upper gastrointestinal endoscopic examination showed a bamboo joint-like appearance in the cardia (Figure 1) and erosions in the antrum of the stomach. Colonoscopy showed serpiginous ulcers, a cobblestone appearance and stenosis in the terminal ileum suggestive of Crohn’s disease. Crohn’s disease is a chronic inflammatory bowel disease characterized by inflammation of the digestive, or gastrointestinal, tract from the mouth to the anus. Crohn’s disease has been less common heretofore in Asia and Africa. However, the number of Crohn’s disease patients has been dramatically increasing in these areas since the 1970s.1 A bamboo joint-like appearance is the most characteristic gastroduodenal endoscopic finding for Crohn’s disease, and was first reported by Yokota et al.2 in 1997. Recent innovation in biologic therapy has shown that early induction with infliximab is effective for reducing the relapse rate compared with conventional therapies. Thus, early identification of Crohn’s disease can reduce serious complications. Therefore, when the bamboo joint-like appearance is present, clinicians should consider Crohn’s disease as a possible differential diagnosis.



Shiitake dermatitis

Wed, 23 Aug 2017 00:00:00 GMT

An 81-year-old Japanese man presented with gradual onset of extensive pruritic skin eruption. He had well-controlled diabetes and he denied any systemic symptoms or recent exposure to new medication. The patient reported eating a large amount of half-cooked shiitake mushroom (Lentinula edodes) as an ingredient of Sukiyaki in 12 h before developing the cutaneous lesions. On physical examination, pruritic erythematous to violaceous streaks were distributed in a flagellate pattern symmetrically mainly on the trunk without mucosal lesions (Figure 1). Based on the typical history and the specific rash resembling a whiplash mark, he was diagnosed with shiitake dermatitis caused by shiitake mushrooms. Shiitake is the second most consumed mushroom in the world and its intake can cause shiitake dermatitis about 5–60 h after consumption of raw or half cooked. Typical linear flagellated erythema is usually self-limited and only requires symptomatic treatment with antihistamines.



Sodium phosphate enemas do not worsen renal function among hospitalized patients with mild to moderate renal failure: a matched, case–control study

Wed, 16 Aug 2017 00:00:00 GMT

Abstract
Background
Sodium phosphate enemas (SPEs) are widely used among hospitalized patients despite their potential to worsen renal failure.
Aim
We decided to assess the extent to which this side effect is clinically relevant.
Design
We conducted a matched case–control, retrospective study in a cohort of hospitalized patients.
Methods
Patients treated and untreated with SPEs were matched for age, gender, baseline creatinine, usage of certain medications and several background diagnoses. Three groups of matched patients (whole study cohort, patients with baseline creatinine > 1.5 mg/dl and those with baseline creatinine > 2 mg/dl) were compared with regards to their creatinine and blood electrolyte concentrations during 3 consecutive hospitalization days after SPE application.
Results
Four hundred and twelve patients were included in this study of which 206 were treated by single SPEs. Exact matching was done for the whole study cohort, for 108 patients with baseline creatinine > 1.5 mg/dl and for 58 patients with baseline creatinine > 2 mg/dl. During 3 consecutive days after SPEs, the maximal blood concentrations of creatinine, phosphor and potassium did not differ significantly between treated patients and matched controls, in all three patients' groups.
Conclusion
Application of SPEs neither seem to worsen mild to moderate renal failure, nor are associated with hyperphosphatemia or hyperkalemia in patients hospitalized in internal medicine departments.



Pemphigus vulgaris

Wed, 16 Aug 2017 00:00:00 GMT

A 36-year-old female presented with burning sensation of the gingiva which increased on consumption of spicy foodstuff. Intraoral examination revealed severe generalized erythema with detachment of superficial layer of gingiva (Figure 1A, black arrow). Extraoral examination of the skin of hand revealed multiple bullae (Figure 1B, black arrows) with positive Nikolsky sign 1 and Asboe—Hansen sign or Nikolsky sign 2. Perilesional biopsy samples from gingiva and skin showed suprabasal acantholytic blisters and intercellular edema in the lower epithelium. Direct immunofluorescence demonstrated IgG in the intercellular regions of the epithelium. Desmoglein 3 ELISA test was positive for anti desmoglein 3 antibodies in the serum. Based on the above investigations, the diagnosis arrived was Pemphigus vulgaris. Treatment instituted was topical application of 0.1% triamcinolone acetonide on the oral lesions for 4 weeks and systemic prednisolone 80 mg for 2 weeks. Systemic prednisolone was reduced in a staggered manner for further 4 weeks; oral and skin lesions regressed after 6 weeks. Gingival and skin lesions healed completely without scarring at 1-year follow-up visit. Pemphigus vulgaris is an autoimmune, intraepithelial, blistering disease affecting the skin and mucous membranes.1 The incidence rate of pemphigus is 1–16 cases per year per million people.2 Pemphigus vulgaris is associated with the binding of IgG autoantibodies to desmoglein 3, a transmembrane glycoprotein adhesion molecule present on desmosomes resulting in loss of intercellular adhesion and separation of cells called as acantholysis in lower layers of stratum spinosum which ultimately results in the formation of suprabasilar bulla.3 The differential diagnosis of pemphigus vulgaris includes aphthous stomatits, lichenplanus, oral candidiasis and pemphigoid which can identified by clinical findings, immunofluorescence tests, histopathological examination and periodic acid Schiff test using smear samples for candidial hyphae. Treatment consists of systemic and topical steroids with constant follow-up visits to prevent the recurrence of the disease.



‘Sleeping under the starry sky’—cysticercal encephalitis

Fri, 04 Aug 2017 00:00:00 GMT

Learning points for clinicians• Cysticercal encephalitis is a rare complication of neurocysticercosis associated with high mortality.• Prompt diagnosis and appropriate therapy can result in better outcome in this fatal neurological disorder.• However, in this acute condition control of raised intracranial pressure and seizures are the main stay of management.



Blue sclera secondary to severe iron deficiency anemia

Fri, 04 Aug 2017 00:00:00 GMT

Learning points for cliniciansBlue sclera in childhood could represent a genetic disease such as osteogenesis imperfecta, but the presence of blue sclera in adult patients should alert physicians about the possibility of the presence of severe iron deficiency and guide management early on.



Acute ocular ischemic syndrome

Wed, 02 Aug 2017 00:00:00 GMT

Learning points for cliniciansOcular ischemic syndrome (OIS) is a sight-threatening condition due to ocular hypoperfusion subsequent to severe stenosis or occlusion of the carotid arteries. Acute OIS occurring simultaneously with stroke is rare. It is necessary for clinicians to be familiar with OIS and its underlying etiology to make an accurate diagnosis and initiate appropriate treatment.



Referral of patients with fever of unknown origin to an expertise center has high diagnostic and therapeutic value

Fri, 28 Jul 2017 00:00:00 GMT

Abstract
Background
up to 50% of patients with fever of unknown origin (FUO) remain undiagnosed despite extensive evaluation. In expertise centers, at least 25–63% of these patients are referred after evaluation in another hospital. The diagnostic and therapeutic yields of referral to an expertise center are currently unknown.
Aim
To determine the diagnostic and therapeutic yield of referral of patients with fever of unknown origin (FUO) that remain undiagnosed in non-expertise hospitals.
Design
Data on workup, outcome, treatment and prognosis were extracted from medical records of all 236 patients referred to the Radboud university medical center‘s department of internal medicine because of FUO between January 2005 and June 2014.
Results
A final diagnosis could be made in 110 of 192 tertiary referred FUO patients. The rate of diagnosis did not differ between patients referred for first opinion or after tertiary referral (68.2 vs. 57.3%, P = 0.234). Over half of undiagnosed tertiary referred patients were treated, and fever resolved in half of these patients. Of 96 undiagnosed patients, two died (2.1)% and in both death was considered unrelated to the febrile disease.
Conclusion
The diagnostic rate in patients with FUO does not differ between patients that are tertiary referred and patients that have not been previously evaluated in another hospital. With a total diagnostic value of 57.3% and an additional therapeutic yield of 10.9% in undiagnosed patients, tertiary referral should therefore be considered in patients that remain undiagnosed in a non-expertise center.



Bony changes in primary hyperparathyroidism

Fri, 28 Jul 2017 00:00:00 GMT

A 51-year-old man presented to his general practitioner (GP) with right hip and left knee pain having had intermittent joint pain for 6 years. X-ray of his left knee showed architectural distortion and a lytic lesion suggesting a metabolic or infiltrative bone disease (Figure 1A). His blood tests showed a serum calcium of 3.7 mmol/l (reference range 2.05–2.55), alkaline phosphatase 1027 iu/l (30–130), parathyroid hormone (PTH) 229.1 pmol/l (1.6–6.9), 25-hydroxy vitamin D 38 nmol/l (36–60) and a negative myeloma screen, consistent with a biochemical diagnosis of primary hyperparathyroidism. He underwent an urgent parathyroidectomy of a right inferior parathyroid adenoma in another hospital.



Generalized finger clubbing reveals the cause of secondary gout

Wed, 26 Jul 2017 00:00:00 GMT

Learning points for cliniciansPolycythemia from cyanotic congenital heart disease may lead to secondary gout. Despite the rarity and complexity of these conditions, most of the key diagnostic information can be obtained through careful history taking and physical examination.



Patients’ emotions: reacting is not enough

Wed, 26 Jul 2017 00:00:00 GMT

Physicians tend to focus on biomedical issues and often neglect their patients’ emotional concerns even in vulnerable situations (oncology clinics, intensive care units) and despite explicit patient-initiated ‘clues’.1,2



Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD

Mon, 24 Jul 2017 00:00:00 GMT

Abstract
Background
Beta-blockers remain underused in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease.
Aim
We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD.
Design
A randomized, open label, cross-over study.
Methods
We compared the cardiopulmonary interactions of bisoprolol 5 mg qd or carvedilol 12.5 mg bid for 6 weeks in conjunction with: (i) triple: inhaled corticosteroid/long acting beta-agonist/long acting muscarinic antagonist (ICS + LABA + LAMA), (ii) dual: ICS + LABA and (iii) ICS alone.
Results
Eighteen patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 s (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity and lung compliance (AX) were significantly lower with carvedilol vs. bisoprolol while taking concomitant ICS/LABA (P < 0.05) but not ICS/LABA/LAMA.
Conclusions
In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone. Registered at clinicaltrials.gov: NCT01656005.



An outbreak of community-acquired pseudomonas aeruginosa pneumonia in a setting of high water stress

Thu, 20 Jul 2017 00:00:00 GMT

Community acquired pneumonia (CAP) remains a cause of considerable morbidity and mortality throughout the world. Mortality is improved by early initiation of antibiotics to which the causative organism(s) are susceptible, which most often is empiric and guided by local susceptibility patterns.1



Preliminary asthma-related outcomes following glucagon-like peptide 1 agonist therapy

Wed, 28 Jun 2017 00:00:00 GMT

The QJM has recently published reviews of novel therapies in chronic airways disease.1 There is a potentially novel role for glucagon-like peptide 1 (GLP-1) agonists in obesity-related, metabolic asthma, though clinical trial data are lacking.2 On the basis of work with other inflammatory states, we hypothesised that clinically-indicated use of GLP-1 agonists for glycaemic control in type 2 diabetes mellitus (T2DM) would be safe in those with concomitant asthma, potentially leading to improved asthma control and fewer asthma exacerbations.3 In a pilot observational cohort study, we prospectively identified nine patients with pulmonologist-diagnosed asthma (never-smokers) and concomitant T2DM who were about to be initiated on clinically-indicated liraglutide for T2DM in the course of routine clinical care, and assessed them for asthma-related indices at baseline and 52 weeks after initiating liraglutide. All received routine asthma care. Baseline characteristics of the study cohort are as shown (Table 1). Seven of the nine subjects who commenced therapy with liraglutide remained on therapy for the 52 week duration of the study (i.e. ‘adherent’), while two subjects (‘non-adherent’) came off liraglutide before 8 weeks due to non-asthma-related side effects (diarrhoea, epigastric discomfort, night sweats, hypoglycaemia and headaches) but were included in the analysis. At week 52 of liraglutide therapy, the mean weight loss was 4.9 kg (5.6% of baseline mean weight) with median weight loss value of 2.9 kg. HbA1c at week 52 fell to 51.9 mmol/mol (mean). Over the 52 weeks of therapy, the greatest falls in weight and HbA1c were in those who remained adherent to liraglutide, accompanied by clinically significant improvements in asthma control including asthma symptoms and exacerbations (Figure 1). No subject adherent to liraglutide had a clinically significant deterioration of asthma. One non-fatal severe exacerbation occurred, which happened several weeks subsequent to early discontinuation of liraglutide in the (non-adherent) subject, who had 2.9 kg of weight loss in the study. This could reflect withdrawal of liraglutide or poor-adherence to other asthma controller medicines. The changes in asthma-related outcomes could not be linked to changes in dosage of other asthma controller medicines. We conclude that use of liraglutide to treat concomitant T2DM was safe and potentially helpful for co-morbid overweight/obese asthma. This is consistent with animal/invitro/exvivo studies that have assessed the effects of GLP-1 analogues in asthma, but could also be coincidental or represent an observer effect in a small uncontrolled cohort study.4,5 Given the growing clinical exposure of patients to GLP-1 agonists, the proof of concept data herein provides a further imperative for large randomised controlled studies assessing the role of GLP-1 analogues in overweight/obese asthma patients with and without T2DM. Table 1Baseline demographic and other clinical variables among T2DM participants with concomitant asthma completing 52 weeks of follow upParameterValueN9Gender (male/female)4/5Age (yr)61.9 ± 2.3Smoking status (never/former/current)9/0/0Family history of asthma (yes/no)3/6Asthma onset (youth onset/late onset5/4Weight (kg)88 ± 5BMIaa (kg/m2)32.3 ± 2.5Asthma acute exacerbation rate (annual)2.6 ± 0.62Asthma controllers, n on any ICSbb8GINAcc treatment step (step 1/2/3/4/5)1/1/3/4/0ACQdd score1.03 ± 0.1AQLQee overall score5.[...]



Challenging concussed athletes: the future of balance assessment in concussion

Fri, 30 Dec 2016 00:00:00 GMT

Abstract
The assessment and management of sports-related concussion has become a contentious issue in the field of sports medicine. The current consensus in concussion evaluation involves the use of a subjective examination, supported by multifactorial assessment batteries designed to target the various components of cerebral function. Balance assessment forms an important component of this multifactorial assessment, as it can provide an insight into the function of the sensorimotor subsystems post-concussion. In recent times, there has been a call to develop objective clinical assessments that can aid in the assessment and monitoring of concussion. However, traditional static balance assessments are derived from neurologically impaired populations, are subjective in nature, do not adequately challenge high functioning athletes and may not be capable of detecting subtle balance disturbances following a concussive event. In this review, we provide an overview of the importance of assessing motor function following a concussion, and the challenges facing clinicians in its assessment and monitoring. Additionally, we discuss the limitations of the current clinical methods employed in balance assessment, the role of technology in improving the objectivity of traditional assessments, and the potential role inexpensive portable technology may play in providing objective measures of more challenging dynamic tasks.