Strategies for improved management of hypothyroidism.

Management is clear-cut-yet many patients don't reach treatment goals. To optimize quality of life, master the fine points of T4 replacement and address the impact of comorbidities.

COVID-19 through Adverse Outcome Pathways: Building networks to better understand the disease - 3rd CIAO AOP Design Workshop.

On April 28-29, 2021, 50 scientists from different fields of expertise met for the 3rd online CIAO workshop. The CIAO project "Modelling the Pathogenesis of COVID-19 using the Adverse Outcome Pathway (AOP) framework" aims at building a holistic assembly of the available scientific knowledge on COVID-19 using the AOP framework. An individual AOP depicts the disease progression from the initial contact with the SARS-CoV-2 virus through biological key events (KE) toward an adverse outcome such as respiratory distress, anosmia or multiorgan failure. Assembling the individual AOPs into a network highlights shared KEs as central biological nodes involved in multiple outcomes observed in COVID-19 patients. During the workshop, the KEs and AOPs established so far by the CIAO members were presented and posi­tioned on a timeline of the disease course. Modulating factors influencing the progression and severity of the disease were also addressed as well as factors beyond purely biological phenomena. CIAO relies on an interdisciplinary crowd­sourcing effort, therefore, approaches to expand the CIAO network by widening the crowd and reaching stakeholders were also discussed. To conclude the workshop, it was decided that the AOPs/KEs will be further consolidated, inte­grating virus variants and long COVID when relevant, while an outreach campaign will be launched to broaden the CIAO scientific crowd.

Systematic assessment of the quality of research studies of conventional and alternative treatment(s) of primary headache.

BACKGROUND: Diversity of treatments used for headache, and varied quality of research conduct and reporting make it difficult to accurately assess the literature and to determine the best treatment(s) for patients. OBJECTIVES: To compare the quality of available research evidence describing the effects and outcomes of conventional, and complementary and alternative medicine (CAM) approaches to treating primary (migraine, tension, and/or cluster-type) headache. STUDY DESIGN: A systematic review of quality of research studies of conventional and alternative treatment(s) of primary headache. METHODS: Randomized, controlled clinical trials (RCTs) of treatment(s) of chronic primary headache (in English between 1979 to June 2004) were searched through MEDLINE, PsycInfo, EMBASE, Cochrane Library, and the NIH databases. Studies were evaluated using standard approaches for assessing and analyzing quality indicators. RESULTS: 125 studies of conventional, and 121 CAM treatments met inclusion criteria. 80% of studies of conventional treatment(s) reported positive effects (p<0.05), versus 73% of studies of CAM approaches (chi(2) = 3.798, 1 df, p=0.051). Overall, the literature addressing the treatment of primary headache received a mean Jadad score of 2.72 out of 5 (SD 1.1). The mean Jadad score for studies of conventional therapeutics was significantly better than for those studies of CAM approaches: 3.21 +/- 0.9 vs 2.23 +/- 1.1 (t=7.72, 246 df, mean difference 0.98, p < 0.0005). CONCLUSIONS: Studies of conventional treatments scored higher on reporting quality than studies of CAM approaches. It is possible that these differences may reflect distinctions in 1) methodologic integrity, 2) therapeutic paradigm(s), and/or 3) bias(es) in the approach(es) used to evaluate certain types of therapies. Each of these possibilities -- and the implications -- is addressed and considered.

Frequency-Specific Microcurrent as Adjunctive Therapy for Three Wounded Warriors.

Background: Acupuncture is frequently offered for wounded warriors as a component of an integrated approach to pain and associated symptoms, with increasing availability at military treatment facilities and Veterans Administration hospitals. While medications can be effective for many patients, acupuncture and microcurrent therapies address the growing need to offer nonopiate, nonpharmaceutical therapeutics in integrative pain management. Frequency-specific microcurrent (FSM) is a newer, adjustable, microcurrent, electrical stimulation modality with applications for pain and other associated symptoms. Using low amperage, electrical current delivered transcutaneously affects and repairs tissues at the cellular level. Additionally, concomitant treatment with acupuncture is possible, which is particularly helpful when space and time limit the frequency with which acupuncture treatments can be provided. Cases: For 3 wounded warriors, FSM was combined with acupuncture treatments, resulting in more-rapid reduction of their pain and associated symptoms; including memory problems, mental sluggishness, and post-traumatic stress disorder. Results: FSM was found to be a safe, nonpainful, noninvasive treatment that could be administered concurrently and beneficially with acupuncture. Conclusions: While additional, more-rigorous studies are needed, this case series demonstrates the potential that FSM has within an integrated pain treatment program for wounded warriors.