Russomarcus3195

We compared the reduction in pain and opioid consumption in patients with chronic spinal pain on concomitant gabapentinoids and opioids with patients using opioids only.

This was a retrospective chart review of patients with chronic neck or low back pain who were on opioids with at least 24-month follow-up.

Single-center pain clinic in an urban setting.

167 patients with chronic spinal pain lasting at least 6 months.

Patients on gabapentin or pregabalin were included in the gabapentinoid group, while the other patients were included in the non-gabapentinoid group. Primary outcome was assessment of pain scores measured via a numeric rating scale (NRS), and secondary outcomes were response to the treatment (>2 point reduction on NRS) and daily opioid use measured in morphine milliequivalents.

Pain scores were reduced in the first 6 months and plateaued after that in both groups. At the end of 24 months, the average pain score was 6.71 in the gabapentinoid group, while the average pain score was 7 find any significant difference in daily opioid usage between the two groups.Conclusion Gabapentinoids may not lead to reduction in pain or opioid consumption in patients with chronic spinal pain. A careful approach must be adopted while prescribing gabapentinoids in the chronic spinal pain patient population.

Opioids, often prescribed for chronic non-cancer pain, may adversely affect cognition. Research has not been synthesized in recent years, during which time academic interest has increased. This study presents meta-analyses on cognitive performance in people taking opioids for chronic non-cancer pain (CNCP).

We ran systematic literature searches in EMBASE, Medline, and PsycINFO. Eligible studies included people taking opioids for CNCP, an opioid-free group (i.e., case-control) or session (e.g., pre-post), and objective cognitive assessments. Using random-effects meta-analyses, we computed pooled effect sizes for differential task performance for each study design across five domains (motor performance, attention, working memory, executive functions, memory).

Seventeen studies were included. Case-control studies covered three control types (healthy, CNCP, taper-off). Pre-post studies were grouped into five follow-ups (four to six and six to nine weeks; three, six, and 12 months). Effect sizes ranged from more so than opioids.The vast majority of theoretically possible polypeptide chains do not fold, let alone confer function. Hence, protein evolution from preexisting building blocks has clear potential advantages over ab initio emergence from random sequences. In support of this view, sequence similarities between different proteins is generally indicative of common ancestry, and we collectively refer to such homologous sequences as "themes." At the domain level, sequence homology is routinely detected. However, short themes which are segments, or fragments of intact domains, are particularly interesting because they may provide hints about the emergence of domains, as opposed to divergence of preexisting domains, or their mixing-and-matching to form multi-domain proteins. Here we identified 525 representative short themes, comprising 20-80 residues that are unexpectedly shared between domains considered to have emerged independently. Among these "bridging themes" are ones shared between the most ancient domains, for example, Rossmann, P-loop NTPase, TIM-barrel, flavodoxin, and ferredoxin-like. We elaborate on several particularly interesting cases, where the bridging themes mediate ligand binding. Ligand binding may have contributed to the stability and the plasticity of these building blocks, and to their ability to invade preexisting domains or serve as starting points for completely new domains.Fibroblast growth factor-23 (FGF23) is a circulating hormone derived from the bone whose release is controlled by many factors and exerts a multitude of systemic actions. There are congenital and acquired disorders of increased and decreased FGF23 levels. In chronic kidney disease, elevations of FGF23 levels can be 1000-fold above the upper physiological limit. It is still under debate whether this high FGF23 in chronic kidney disease is a biomarker or causally related to morbidity and mortality. Data from human association studies supports pathogenicity, while experimental data is less robust. Knowledge of the biology and pathobiology of FGF23 have generated a whole plethora of means to reduce FGF23 bioactivity at many levels that will be useful for therapeutic translations. This manuscript summarize these approaches and addressed several critical questions that still need to be addressed.

There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum and symptoms or disease in non-pregnant women. However, testing and reporting of these organisms frequently occurs, in-part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum and U. parvum were associated with symptoms and/or signs in non-pregnant women attending a sexual health service.

Eligible women attending Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum and U. parvum, and four non-viral STIs using a commercial multiplex-PCR.

1,272 women were analysed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR=2.70, 95%CI1.92-3.79),ting for M. hominis, U. urealyticum and U. parvum in non-pregnant women.A few days after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled the first group of recommendations for the care of patients with inflammatory rheumatic diseases in light of SARS-CoV-2/coronavirus disease 2019 (COVID-19). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registries, cross-sectional studies, case reports and case series are available, the DGRh has developed a timely update. This update is based on a literature search of publications available through 15 June 2020 and addresses preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. Driven by the commitment to let patients benefit from these new evidence-based recommendations as quickly as possible, the DGRh published the update in German on its homepage and in the Zeitschrift für Rheumatologie immediately after completion. Here we report the key recommendations to make them available to the international community, provide the scientific methodology used to develop the recommendations, give additional thoughts and advice for the management of patients with rheumatic diseases during the COVID-19 pandemic and discuss our recommendations in the context of other international recommendations.

Limited evidence exists to guide treatment of refractory vasculitic neuropathy. While rituximab and intravenous immune globulin (IVIG) have both been proposed as individual treatment options for these patients, combination therapy has never been reported.

Written informed consent was obtained from three patients with refractory vasculitic neuropathy who were treated with combination rituximab and IVIG. Their electronic medical records were reviewed, and clinical and functional outcomes were reported.

Two male patients with nonsystemic vasculitic neuropathy (NSVN) and one male patient with granulomatosis with polyangiitis (GPA) were treated with combination rituximab and IVIG therapy. All three patients demonstrated clinical improvement with at least partial functional recovery and reduction in corticosteroid dose. This combination was generally well tolerated.

Combination rituximab and IVIG therapy may be a safe and effective treatment option for patients with refractory vasculitic neuropathy. Further studies are needed to better characterize the risks and benefits of this combination.

Combination rituximab and IVIG therapy may be a safe and effective treatment option for patients with refractory vasculitic neuropathy. Further studies are needed to better characterize the risks and benefits of this combination.Platinum-based drugs are a mainstay of cancer chemotherapy. However, their mutagenic effect can increase tumour heterogeneity, contribute to the evolution of treatment resistance and also induce secondary malignancies. We coupled whole genome sequencing with phenotypic investigations on two cell line models to compare the magnitude and examine the mechanism of mutagenicity of cisplatin, carboplatin and oxaliplatin. Cisplatin induced significantly more base substitution mutations than carboplatin or oxaliplatin when used at equitoxic concentrations on human TK6 or chicken DT40 cells, and also induced the highest number of short insertions and deletions. The analysis of base substitution spectra revealed that all three tested platinum drugs elicit both a direct mutagenic effect at purine dinucleotides, and an indirect effect of accelerating endogenous mutagenic processes, whereas the direct mutagenic effect appeared to correlate with the level of DNA damage caused as assessed through histone H2AX phosphorylation and single-cell agarose gel electrophoresis, the indirect mutagenic effects were equal. The different mutagenicity and DNA-damaging effect of equitoxic platinum drug treatments suggest that DNA damage independent mechanisms significantly contribute to their cytotoxicity. Thus, the comparatively high mutagenicity of cisplatin should be taken into account in the design of chemotherapeutic regimens.

To determine the impact of difficult-to-treat rheumatoid arthritis (D2T RA) on (costs related to) health care utilisation, other resource use and work productivity.

Data regarding health care utilisation, other resource use and work productivity of 52 D2T (according to the EULAR definition) and 100 non-D2T RA patients were collected via a questionnaire and an electronic patient record review during a study visit. Annual costs were calculated and compared between groups. GSK690693 Multivariable linear regression analysis was performed to assess whether having D2T RA was associated with higher costs.

Mean (95% confidence interval) annual total costs were €37,605 (€27,689-50,378) for D2T and €19,217 (€15,647-22,945) for non-D2T RA patients (p < 0.001). D2T RA patients visited their rheumatologist more frequently, were more often admitted to day care facilities, underwent more laboratory tests and used more drugs (specifically tsDMARDs), compared with non-D2T RA patients (p < 0.01). In D2T RA patients, the main contributors to total costs were informal help of family and friends (28%), drugs (26%) and loss of work productivity (16%).After adjustment for physical functioning (health assessment questionnaire (HAQ)), having D2T RA was no longer statistically significantly associated with higher total costs. HAQ was the only independent determinant of higher costs in multivariable analysis.

The economic burden of D2T RA is significantly higher than that of non-D2T RA, indicated by higher health care utilisation and higher annual total costs. Functional disability is a key determinant of higher costs in RA.

The economic burden of D2T RA is significantly higher than that of non-D2T RA, indicated by higher health care utilisation and higher annual total costs. Functional disability is a key determinant of higher costs in RA.