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2.
J Pain Res ; 17: 975-979, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38496342

RESUMO

In this article, we propose a new diagnostic paradigm known as Chronic Abdominal Discomfort Syndrome (CADS). Patient's presentation centers around chronic abdominal pain not explained by acute pathology with or without accompanying dyspepsia, bloating, nausea and vomiting among other symptoms. The pathophysiology is noted to be neurogenic, possibly stemming from visceral sympathetic nerves or abdominal wall afferent nerves. Diagnosis is supported by signs or symptoms traversing clinical, diagnostic and functional criteria. Included is a tool which can assist clinicians in diagnosing patients with CADS per those domains. We hope to facilitate primary care physicians' and gastroenterologists' utilization of our criteria to provide guidance for selecting which patients may benefit from further interventions or evaluation by a pain physician. The pain physician may then offer interventions to provide the patient with relief.

3.
Indian J Otolaryngol Head Neck Surg ; 76(1): 1361-1364, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38440458

RESUMO

Pleomorphic adenoma is a benign tumor of salivary glands which is relatively rare among head & neck neoplasms. Parotid gland is the most common site of occurrence whereas submandibular gland is rarely affected. We present a case of a giant pleomorphic adenoma of submandibular gland.

4.
Indian J Otolaryngol Head Neck Surg ; 76(1): 1314-1316, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38440542

RESUMO

A case of chronic suppurative otitis media, active squamosal variety on Examination under microscopy revealed grade 3 attic retraction. CT scan revealed soft tissue thickening and opacification in left middle ear cavity and mastoid. Surgery performed. Excised soft tissue on HPE revealed meningothelial meningioma.

5.
Artigo em Inglês | MEDLINE | ID: mdl-38367199

RESUMO

PURPOSE OF REVIEW: Tension-type headache (TTH) continues to be the most prevalent type of headache across all age groups worldwide, and the global burden of migraine and TTH together account for 7% of all-cause years lived with disability (YLDs). TTH has been shown to have a prevalence of up to 80% in several studies and presents a wide range and high variability in clinical settings. The aim of this review is to identify gaps in diagnostics, nosology, and variability in the treatment of children and adolescents who present with headaches without an identifiable etiology. RECENT FINDINGS: Migraine and TTH have been debated to have more similarities than distinctions, increasing chances of misdiagnosis and leading to significant cases diagnosed as probable TTH or probable migraine. The lack of specificity and sensitivity for TTH classification often leads to the diagnosis being made by negating associated migraine symptoms. Although pathology is not well understood, some studies have suggested a neurological basis for TTH, in need of further validation. Some research indicates that nitric oxide signaling plays an integral part in the pain mechanisms related to TTH. Analgesics and non-steroidal anti-inflammatories are usually the first lines of treatment for children with recurring headaches, and additional treatment options include medication and behavioral therapies. With high prevalence and socioeconomic burden among children and adolescents, it's essential to further study Tension-type headaches and secondary headaches without known cause and potential interventions. Treatment studies involving randomized controlled trials are also needed to test the efficacy of various treatments further.

6.
Life (Basel) ; 14(2)2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38398683

RESUMO

This narrative review aims to summarize evidence regarding the current utilization and future applications of neuromodulation in patients with headaches, with special attention paid to migraine and chronic cluster headache. A search was conducted in PubMed in August of 2023 to survey the current literature on neuromodulation for the treatment of headache. In total, the search yielded 1989 results, which were further filtered to include only systematic reviews published between 2022 to 2023 to capture the most up-to-date and comprehensive research on this topic. The citation lists of these articles were reviewed to find additional research on neuromodulation and supplement the results presented in this paper with primary literature. Research on the use of neuromodulation for the treatment of headache has predominantly focused on four neuromodulation techniques: peripheral nerve stimulation (PNS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and spinal cord stimulation (SCS). Outcome measures reported in this article include impact on migraine and headache frequency and/or pain intensity, adverse effects of the neuromodulation technique, and associated costs, when available. We found that neuromodulation has developed utility as an alternative treatment for both chronic cluster headaches and migraines, with a reduction in frequency and intensity of headache most elucidated from the articles mentioned in this review.

8.
Am J Hosp Palliat Care ; : 10499091231225739, 2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-38171375

RESUMO

Background: The End-of-life Care Nursing Education Consortium (ELNEC) program aims to equip nurses with knowledge and skills in palliative and end-of-life care. While this program improves knowledge and attitudes of Indian nurses regarding palliative care and end-of-life care, its long-term impact on their knowledge, attitude, and clinical practice remains unknown. This study aims to assess ELNEC's long-term impact on knowledge, attitude, and practice of Indian nurses. Methods: A 18-month follow-up survey of practicing nurses at a tertiary care institute who completed ELNEC in September 2021. Data was collected between April-June 2023 via a questionnaire covering demographics, Palliative Care Quiz for Nurses (PCQN), Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B) and a clinical practice questionnaire developed and validated to access impact of ELNEC on clinical practice. Quantitative and qualitative data were assessed using Statistical package for social sciences and thematic analysis respectively. The 18-month follow-up PCQN and FATCOD-B scores were compared with the pre-ELNEC (baseline) and immediate post-ELNEC scores. Results: Out of 108 nurses, 69 responded with a response rate of 63.8%. The mean follow-up PCQN score was 9.03 ± 2.58; significantly higher than the pre-ELNEC (8.45 ± 1.88) but lower than the immediate post-ELNEC scores (10.2 ± 1.88). Attitudes toward end-of-life care declined over time but remained positive in the end-of-life care value and care of the dying. Thematic analysis of responses to open questions revealed that ELNEC motivated nurses to work in palliative care and care for patients with chronic life-limiting illnesses (n = 52, 75.3%), improved their nursing practice (n = 60, 86.9%), and helped enhance their communication skills (n = 51, 73.9%). Participants (n = 55, 79.7%) emphasized on regular palliative care training to reinforce their knowledge and skills. Conclusion: Compared with baseline, ELNEC leads to long-term improvement in practicing nurses' palliative care knowledge, clinical practice, communication skills and motivates them to work in palliative care.

9.
Forensic Sci Med Pathol ; 20(1): 106-116, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37071347

RESUMO

Forensic age assessments are crucial in the evaluation of criminal responsibility and preventing false age claims. Of all the methods available, the Greulich and Pyle (GP) atlas is most commonly used for age estimation purposes. Therefore, the current study sought to analyze the reliability and applicability of the GP standard and, additionally, to determine any possible association between the socioeconomic status (SES), food habits, and estimated skeletal maturity in the North Indian population. The study included 627 (334 males and 293 females) healthy children up to 19 years of age with varying SES and food habits. The skeletal age (SA) was estimated by three different evaluators using the GP atlas. The chronological mean age (CA) and SA were compared in different age cohorts. A paired t-test and a Pearson chi-square test were applied to show the difference between CA and estimated SA and the association of skeletal maturity with SES and food habits. The estimated skeletal age in males was retarded by 0.142 years or 1.72 months (p ≤ 0.05), whereas in females, it was retarded by 0.259 years or 3.12 months (p ≤ 0.05). In males, the GP method has significantly underestimated SA in age cohorts 3-4, 4-5, 6-7, 7-8, 8-9, and 12-13, whereas it overestimated in 10-11 and 18-19 years. However, in females, the SA was significantly underestimated in age groups 10-11, 12-13, and 14-15, respectively. Estimated skeletal maturity had no significant association with SES and food habits. The current study concludes that the GP atlas may not be applicable to North India's population. The observed difference in assessed skeletal maturity may be due to geographical region, genetics, hormonal effects, etc., which require further investigation. Hence, population-specific standards are necessary to determine the bone age of Indian children accurately.


Assuntos
Determinação da Idade pelo Esqueleto , Povo Asiático , Criança , Masculino , Feminino , Humanos , Lactente , Reprodutibilidade dos Testes , Determinação da Idade pelo Esqueleto/métodos
10.
CNS Spectr ; 29(1): 10-25, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37539695

RESUMO

The prevalence of autism spectrum disorder (ASD) continues to see a trend upward with a noticeable increase to 1 in 36 children less than 8 years of age in the recent MMWR. There are many factors linked to the substantially increased burden of seeking mental health services, and clinically these individuals are likely to present for impairments associated with co-occurring conditions. The advances in cutting-edge research and the understanding of co-occurring conditions in addition to psychosocial interventions have provided a window of opportunity for psychopharmacological interventions given the limited availability of therapeutics for core symptomatology. The off-label psychopharmacological treatments for these co-occurring conditions are central to clinical practice. However, the scattered evidence remains an impediment for practitioners to systematically utilize these options. The review collates the crucial scientific literature to provide stepwise treatment alternatives for individuals with ASD; with an aim to lead practitioners in making informed and shared decisions. There are many questions about the safety and tolerability of off-label medications; however, it is considered the best practice to utilize the available empirical data in providing psychoeducation for patients, families, and caregivers. The review also covers experimental medications and theoretical underpinnings to enhance further experimental studies. In summary, amidst the growing clinical needs for individuals with ASD and the lack of approved clinical treatments, the review addresses these gaps with a practical guide to appraise the risk and benefits of off-label medications.


Assuntos
Transtorno do Espectro Autista , Criança , Humanos , Transtorno do Espectro Autista/tratamento farmacológico , Transtorno do Espectro Autista/psicologia , Uso Off-Label , Prevalência
11.
Plant Sci ; 338: 111922, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37952767

RESUMO

One of the general consequences of stress in plants is the accumulation of reactive oxygen (ROS) and carbonyl species (like methylglyoxal) to levels that are detrimental for plant growth. These reactive species are inherently produced in all organisms and serve different physiological functions but their excessive accumulation results in cellular toxicity. It is, therefore, essential to restore equilibrium between their synthesis and breakdown to ensure normal cellular functioning. Detoxification mechanisms that scavenge these reactive species are considered important for stress mitigation as they maintain redox balance by restricting the levels of ROS, methylglyoxal and other reactive species in the cellular milieu. Stress tolerance imparted to plants by root-associated microbes involves a multitude of mechanisms, including maintenance of redox homeostasis. By improving the overall antioxidant response in plants, microbes can strengthen defense pathways and hence, the adaptive abilities of plants to sustain growth under stress. Hence, through this review we wish to highlight the contribution of root microbiota in modulating the levels of reactive species and thereby, maintaining redox homeostasis in plants as one of the important mechanisms of stress alleviation. Further, we also examine the microbial mechanisms of resistance to oxidative stress and their role in combating plant stress.


Assuntos
Antioxidantes , Aldeído Pirúvico , Espécies Reativas de Oxigênio/metabolismo , Aldeído Pirúvico/metabolismo , Antioxidantes/metabolismo , Estresse Oxidativo/fisiologia , Plantas/metabolismo , Oxirredução , Homeostase
12.
BJPsych Open ; 10(1): e11, 2023 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-38088185

RESUMO

AIMS: To update and examine available literature germane to the recognition, assessment and treatment of comorbid autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption, with a predominant focus on children, adolescents and emerging adults. BACKGROUND: Considerable overlaps exist among ASD, ADHD and sleep disruption. Literature and guidance for clinicians, administrators, policy makers and families have been limited, as such deliberations were rarely considered until 2013. METHOD: This narrative review of the literature addressing sleep disruption issues among those with ASD, ADHD and comorbid ASD and ADHD involved searching multiple databases and use of reverse citations up to the end of September 2022. Emphasis is placed on secondary sources and relevant data for clinical practice. RESULTS: Complex clinical presentations of ASD/ADHD/sleep disruption are frequently encountered in clinical practice. Prior to 2013, prevalence, clinical presentation, pathophysiology, prognosis, other sleep-related factors and interventions were determined separately for each disorder, often with overlapping objective and subjective methods employed in the process. High percentages of ADHD and ASD patients have both disorders and sleep disruption. Here, the extant literature is integrated to provide a multidimensional understanding of the relevant issues and insights, allowing enhanced awareness and better care of this complex clinical population. Database limitations are considered. CONCLUSIONS: Assessment of ASD symptomatology in youth with ADHD, and the reverse, in cases with disrupted sleep is critical to address the special challenges for case formulation and treatment. Evidence-based approaches to treatment planning and multi-treatment modalities should consider combining psychosocial and biological interventions to address the complexities of each case.

13.
BJPsych Open ; 10(1): e7, 2023 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-38057143

RESUMO

The SARS-CoV-2 virus and its variants have had and are having serious implications for the mental health of the public. The critical limitations in the published literature for children, adolescents and young adults raise doubts about their clinical utility and overall generalisability. Amidst these gaps in knowledge, a twin study (Rimfeld et al) addresses several of these issues in relation to heritable individual differences and responses to environmental stressors. Besides calculating genetic correlation, the longitudinal study also compares symptoms at four different time points during the pandemic. These findings reflect a counterintuitive understanding of the role of resilience in the mental health of young adults in the UK. Unlike prior studies, this study focuses on methodological designs and underscores the applications of accurate statistical measures in observing these complex phenomena.

14.
BMC Anesthesiol ; 23(1): 406, 2023 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-38082217

RESUMO

BACKGROUND: Sympathetic stimulation associated with laryngoscopy and endotracheal intubation (ETI) may lead to adverse cardio-/cerebro-vascular events in susceptible patients. Nebulization is a novel route for dexmedetomidine administration providing a large surface area for absorption while avoiding bradycardia and hypotension associated with intravenous route. We aimed to evaluate the efficacy and safety of dexmedetomidine nebulization for attenuating hemodynamic response to ETI in adult patients undergoing surgery under general anaesthesia. METHODS: This systematic review was registered prospectively in the International Prospective Register of Systematic Reviews (CRD42023403624). PubMed, Embase (OvidSP), Cochrane library, Scopus (Elsevier), Web of Science (Clarivate) and Google Scholar were systematically searched from database inception until March 31, 2023. Two reviewers independently screened titles, abstracts and then full text against pre-specified eligibility criteria. Randomized controlled trials (RCTs) assessing effect of dexmedetomidine nebulization on hemodynamic response to ETI in adult patients undergoing surgeries under general anaesthesia were included. All studies reporting heart rate and systolic blood pressure at baseline and various time points after ETI were included. A pre-piloted data extraction form, Cochrane revised risk-of-bias tool (ROB 2) tool, GRADE approach and RevMan 5.4.1 (Cochrane Collaboration, Copenhagen, Denmark) were used for data extraction, risk of bias assessment, rating certainty of evidence and data synthesis respectively. Mean difference and relative risk with 95% Confidence Interval (CI) were used for continuous and dichotomous variables respectively. RESULTS: Six RCTs randomized 480 patients with ASA I/II patients aged < 60 years of age and undergoing elective surgeries to receive either dexmedetomidine (n = 240) or saline nebulization (n = 240). Except for one RCT which used 2 µg/kg, all other RCTs used dexmedetomidine dose of 1 µg /kg. Heart rate, systolic, diastolic and mean blood pressure were significantly lower in the dexmedetomidine group at all the measured time points after laryngoscopy and ETI with the only exception being systolic blood pressure at 3 min [mean difference -13.86 (95% CI -30.01 to 2.99), p = 0.09]. Bradycardia and hypotension as adverse effects were absent across the included studies. However, only one-third of the included studies had a low risk of bias and strength of evidence was very low according to the GRADE assessment. CONCLUSIONS: Compared to placebo, premedication with dexmedetomidine nebulization was associated with lower HR and BP following ETI without any risk of bradycardia and hypotension. However, the strength of evidence was very poor and came from just one country. Future well designed and conducted studies in different populations are warranted. TRIAL REGISTRATION: PROSPERO Registration number: CRD42023403624.


Assuntos
Dexmedetomidina , Hipotensão , Adulto , Humanos , Pessoa de Meia-Idade , Dexmedetomidina/farmacologia , Laringoscopia/efeitos adversos , Bradicardia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Anestesia Geral/efeitos adversos , Hemodinâmica , Hipotensão/induzido quimicamente , Intubação Intratraqueal/efeitos adversos
15.
Pain Physician ; 26(7S): S7-S126, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38117465

RESUMO

BACKGROUND: Opioid prescribing in the United States is decreasing, however, the opioid epidemic is continuing at an uncontrollable rate. Available data show a significant number of opioid deaths, primarily associated with illicit fentanyl use. It is interesting to also note that the data show no clear correlation between opioid prescribing (either number of prescriptions or morphine milligram equivalent [MME] per capita), opioid hospitalizations, and deaths. Furthermore, the data suggest that the 2016 guidelines from the Centers for Disease Control and Prevention (CDC) have resulted in notable problems including increased hospitalizations and mental health disorders due to the lack of appropriate opioid prescribing as well as inaptly rapid tapering or weaning processes. Consequently, when examined in light of other policies and complications caused by COVID-19, a fourth wave of the opioid epidemic has been emerging. OBJECTIVES: In light of this, we herein seek to provide guidance for the prescription of opioids for the management of chronic non-cancer pain. These clinical practice guidelines are based upon a systematic review of both clinical and epidemiological evidence and have been developed by a panel of multidisciplinary experts assessing the quality of the evidence and the strength of recommendations and offer a clear explanation of logical relationships between various care options and health outcomes. METHODS: The methods utilized included the development of objectives and key questions for the various facets of opioid prescribing practice. Also utilized were employment of trustworthy standards, and appropriate disclosures of conflicts of interest(s). The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed. The recommendations were developed after the appropriate review of text and questions by a panel of multidisciplinary subject matter experts, who tabulated comments, incorporated changes, and developed focal responses to questions posed. The multidisciplinary panel finalized 20 guideline recommendations for prescription of opioids for chronic non-cancer pain. Summary of the results showed over 90% agreement for the final 20 recommendations with strong consensus. The consensus guidelines included 4 sections specific to opioid therapy with 1) ten recommendations particular to initial steps of opioid therapy; 2) five recommendations for assessment of effectiveness of opioid therapy; 3) three recommendations regarding monitoring adherence and side effects; and 4) two general, final phase recommendations. LIMITATIONS: There is a continued paucity of literature of long-term opioid therapy addressing chronic non-cancer pain. Further, significant biases exist in the preparation of guidelines, which has led to highly variable rules and regulations across various states. CONCLUSION: These guidelines were developed based upon a comprehensive review of the literature, consensus among expert panelists, and in alignment with patient preferences, and shared decision-making so as to improve the long-term pain relief and function in patients with chronic non-cancer pain. Consequently, it was concluded - and herein recommended - that chronic opioid therapy should be provided in low doses with appropriate adherence monitoring and understanding of adverse events only to those patients with a proven medical necessity, and who exhibit stable improvement in both pain relief and activities of daily function, either independently or in conjunction with other modalities of treatments.


Assuntos
Dor Crônica , Humanos , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Fentanila , Padrões de Prática Médica , Prescrições
16.
Pain physician ; 7S: 57-126, 20231226. tab
Artigo em Inglês | BIGG | ID: biblio-1537633

RESUMO

Opioid prescribing in the United States is decreasing, however, the opioid epidemic is continuing at an uncontrollable rate. Available data show a significant number of opioid deaths, primarily associated with illicit fentanyl use. It is interesting to also note that the data show no clear correlation between opioid prescribing (either number of prescriptions or morphine milligram equivalent [MME] per capita), opioid hospitalizations, and deaths. Furthermore, the data suggest that the 2016 guidelines from the Centers for Disease Control and Prevention (CDC) have resulted in notable problems including increased hospitalizations and mental health disorders due to the lack of appropriate opioid prescribing as well as inaptly rapid tapering or weaning processes. Consequently, when examined in light of other policies and complications caused by COVID-19, a fourth wave of the opioid epidemic has been emerging. In light of this, we herein seek to provide guidance for the prescription of opioids for the management of chronic non-cancer pain. These clinical practice guidelines are based upon a systematic review of both clinical and epidemiological evidence and have been developed by a panel of multidisciplinary experts assessing the quality of the evidence and the strength of recommendations and offer a clear explanation of logical relationships between various care options and health outcomes. The methods utilized included the development of objectives and key questions for the various facets of opioid prescribing practice. Also utilized were employment of trustworthy standards, and appropriate disclosures of conflicts of interest(s). The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed. The recommendations were developed after the appropriate review of text and questions by a panel of multidisciplinary subject matter experts, who tabulated comments, incorporated changes, and developed focal responses to questions posed


Assuntos
Humanos , Transtornos Relacionados ao Uso de Substâncias/terapia , Dor Crônica/tratamento farmacológico , Programas de Monitoramento de Prescrição de Medicamentos
17.
Indian J Otolaryngol Head Neck Surg ; 75(4): 3565-3574, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37974819

RESUMO

Aim & objectives-To assess and compare the nasal obstruction in patients before and after undergoing FESS using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy. Introduction- Chronic Rhinosinusitis with, or without nasal polyps can lead to nasal obstruction. Patients refractory to medical treatment undergo Functional endoscopic sinus surgery (FESS). FESS has been shown to improve subjective quality of life outcomes and objective endoscopic improvement. Material & methods- A prospective study conducted in the department of Ear, Nose & Throat, of a tertiary care medical college and associated Hospital between January 2021 and October 2022. Subjective and objective assessment of nasal obstruction was done using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy before and after surgery at 1st, 3rd and 6th month. Results- Post FESS, there was a significant improvement in nasal obstruction on Visual analogue scale, sinuses were healthy and drainage was adequate on Diagnostic nasal endoscopy, statistically significant (P < 0.05) decrease in nasal resistance was seen on Rhinomanometry. Conclusion- A good subjective outcome on Visual analogue scale and a good objective outcome on Diagnostic nasal endoscopy and Rhinomanometry can be obtained with FESS in patients with Chronic Rhinosinusitis.

18.
Pain Physician ; 26(7): 575-584, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37976486

RESUMO

BACKGROUND: Chronic, intractable, neuropathic pain is readily treatable with spinal cord stimulation (SCS). Technological advancements, including device miniaturization, are advancing the field of neuromodulation. OBJECTIVES: We report here the results of an SCS clinical trial to treat chronic, low back and leg pain, with a micro-implantable pulse generator (micro-IPG). STUDY DESIGN: This was a single-arm, prospective, multicenter, postmarket, observational study. SETTING: Patients were recruited from 15 US-based comprehensive pain centers. METHODS: This open-label clinical trial was designed to evaluate the performance of the Nalu™ Neurostimulation System (Nalu Medical, Inc., Carlsbad, CA) in the treatment of low back and leg pain. Patients, who provided informed consent and were successfully screened for study entry, were implanted with temporary trial leads. Patients went on to receive a permanent implant of the leads and micro-IPG if they demonstrated a >= 50% reduction in pain during the temporary trial period. Patient-reported outcomes (PROs), such as pain scores, functional disability, mood, patient impression of change, comfort, therapy use profile, and device ease of use, were captured. RESULTS: At baseline, the average pain Visual Analog Scale (VAS) score was 72.1 ± 17.9 in the leg and 78.0 ± 15.4 in the low back. At 90 days following permanent implant (end of study), pain scores improved by 76% (VAS 18.5 ± 18.8) in the leg and 75% (VAS 19.7 ± 20.8) in the low back. Eighty-six percent  of both leg pain and low back pain patients demonstrated a >= 50% reduction in pain at 90 days following implant. The comfort of the external wearable (Therapy Disc and Adhesive Clip) was rated 1.16 ± 1.53, on average, at 90 days on an 11-point rating scale (0 = very comfortable, 10 = very uncomfortable). All PROs demonstrated statistically significant symptomatic improvement at 90 days following implant of the micro-IPG. LIMITATIONS:   Limitations of this study include the lack of long-term results (beyond 90 days) and a relatively small sample size of 35 patients who were part of the analysis; additionally, there was no control arm or randomization as this was a single-arm study, without a comparator, designed to document the efficacy and safety of the device. Therefore, no direct comparisons to other SCS systems were possible. CONCLUSIONS: This clinical study demonstrated profound leg and low back pain relief in terms of overall pain reduction, as well as the proportion of therapy responders. The study patients reported the wearable aspects of the system to be very comfortable.


Assuntos
Dor Crônica , Dor Lombar , Neuralgia , Dor Intratável , Estimulação da Medula Espinal , Humanos , Dor Lombar/terapia , Estudos Prospectivos , Resultado do Tratamento , Medição da Dor/métodos , Dor Crônica/terapia , Estimulação da Medula Espinal/métodos , Neuralgia/terapia , Medula Espinal
20.
Biotechnol Biofuels Bioprod ; 16(1): 150, 2023 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-37794424

RESUMO

BACKGROUND: Penicillium funiculosum NCIM1228 is a filamentous fungus that was identified in our laboratory to have high cellulolytic activity. Analysis of its secretome suggested that it responds to different carbon substrates by secreting specific enzymes capable of digesting those substrates. This phenomenon indicated the presence of a regulatory system guiding the expression of these hydrolyzing enzymes. Since transcription factors (TFs) are the key players in regulating the expression of enzymes, this study aimed first to identify the complete repertoire of Carbohydrate Active Enzymes (CAZymes) and TFs coded in its genome. The regulation of CAZymes was then analysed by studying the expression pattern of these CAZymes and TFs in different carbon substrates-Avicel (cellulosic substrate), wheat bran (WB; hemicellulosic substrate), Avicel + wheat bran, pre-treated wheat straw (a potential substrate for lignocellulosic ethanol), and glucose (control). RESULTS: The P. funiculosum NCIM1228 genome was sequenced, and 10,739 genes were identified in its genome. These genes included a total of 298 CAZymes and 451 TF coding genes. A distinct expression pattern of the CAZymes was observed in different carbon substrates tested. Core cellulose hydrolyzing enzymes were highly expressed in the presence of Avicel, while pre-treated wheat straw and Avicel + wheat bran induced a mixture of CAZymes because of their heterogeneous nature. Wheat bran mainly induced hemicellulases, and the least number of CAZymes were expressed in glucose. TFs also exhibited distinct expression patterns in each of the carbon substrates. Though most of these TFs have not been functionally characterized before, homologs of NosA, Fcr1, and ATF21, which have been known to be involved in fruiting body development, protein secretion and stress response, were identified. CONCLUSIONS: Overall, the P. funiculosum NCIM1228 genome was sequenced, and the CAZymes and TFs present in its genome were annotated. The expression of the CAZymes and TFs in response to various polymeric sugars present in the lignocellulosic biomass was identified. This work thus provides a comprehensive mapping of transcription factors (TFs) involved in regulating the production of biomass hydrolyzing enzymes.

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