Amitriptyline for post-COVID headache: effectiveness, tolerability, and response predictors.

BACKGROUND: Headache is one of the most frequently reported symptoms in post-COVID patients. The clinical phenotype of COVID-19 headache combines phenotypic features of both tension-type headache (TTH) and migraine. We aimed to assess the effectiveness, side effects and predictors of amitriptyline (AMT) response in a real-world study setting. METHODS: We performed an observational multicentric study with a retrospective cohort. All consecutive patients with confirmed COVID-19 infection who received AMT for post-COVID headache from March 2020 to May 2021 were included. Response was evaluated by the reduction in the number of headache days per month (HDM) between weeks 8 and 12, compared with the baseline. We explored which variables were associated with a higher probability of response to AMT. RESULTS: Forty-eight patients were eligible for the study, 40/48 (83.3%) females, aged 46.85 (SD: 13.59) years. Patients had history of migraine 15/48 (31.3%) or TTH 5/48 (10.4%). The mean reduction of HDM was 9.6 (SD: 10.9; 95% CI 6.5, 12.7) days. Only 2/48 (5%) of patients discontinued AMT due to poor tolerability. History of TTH (10.9, 95% CI 1.3, 20.6) and nausea (- 8.5, 95% CI - 14.6, - 2.5) were associated with AMT response. CONCLUSIONS: This study provides real-world evidence of the potential benefit of AMT in patients with post-COVID-19 headache, especially in patients with history of TTH and without concomitant nausea.

Assessment of Neutrophil Extracellular Traps in Coronary Thrombus of a Case Series of Patients With COVID-19 and Myocardial Infarction.

IMPORTANCE: Severe coronavirus disease 2019 (COVID-19) is characterized by the intense formation of neutrophil extracellular traps (NETs), leading to the occlusion of microvessels, as shown in pulmonary samples. The occurrence of ST-elevated myocardial infarction (STEMI) is a serious cardiac manifestation of COVID-19; the intrinsic mechanism of coronary thrombosis appears to still be unknown. OBJECTIVE: To determine the role of NETs in coronary thrombosis in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This was a consecutive series of patients with COVID-19 at an academic tertiary hospital in Madrid, Spain, who underwent primary coronary interventions for STEMI in which coronary aspirates were obtained in the catheterization laboratory using a thrombus aspiration device. Patients with COVID-19 who experienced a STEMI between March 23 and April 11, 2020, from whom coronary thrombus samples were aspirated during primary coronary intervention, were included in the analysis. These patients were compared with a series conducted from July 2015 to December 2015 of patients with STEMI. MAIN OUTCOMES AND MEASURES: The presence and quantity of NETs in coronary aspirates from patients with STEMI and COVID-19. The method for the analysis of NETs in paraffin-embedded coronary thrombi was based on the use of confocal microscopy technology and image analysis for the colocalization of myeloperoxidase-DNA complexes and citrullinated histone H3. Immunohistochemical analysis of thrombi was also performed. Clinical and angiographic variables were prospectively collected. RESULTS: Five patients with COVID-19 were included (4 men [80%]; mean [SD] age, 62 [14] years); the comparison group included 50 patients (44 males [88%]; mean [SD] age, 58 [12] years). NETs were detected in the samples of all 5 patients with COVID-19, and the median density of NETs was 61% (95% CI, 43%-91%). In the historical series of patients with STEMI, NETs were found in 34 of 50 thrombi (68%), and the median NET density was 19% (95% CI, 13%-22%; P < .001). All thrombi from patients with COVID-19 were composed of fibrin and polymorphonuclear cells. None of them showed fragments of atherosclerotic plaque or iron deposits indicative of previous episodes of plaque rupture. CONCLUSIONS AND RELEVANCE: In this small case series of patients with COVID-19 and myocardial infarction, NETs seem to play a major role in the pathogenesis of STEMI in COVID-19 disease. Our findings support the idea that targeting intravascular NETs might be a relevant goal of treatment and a feasible way to prevent coronary thrombosis in patients with severe COVID-19 disease.

Potential Clinical Benefits of CBD-Rich Cannabis Extracts Over Purified CBD in Treatment-Resistant Epilepsy: Observational Data Meta-analysis.

This meta-analysis paper describes the analysis of observational clinical studies on the treatment of refractory epilepsy with cannabidiol (CBD)-based products. Beyond attempting to establish the safety and efficacy of such products, we also investigated if there is enough evidence to assume any difference in efficacy between CBD-rich extracts compared to purified CBD products. The systematic search took place in February/2017 and updated in December/2017 using the keywords "epilepsy" or "Dravet" or "Lennox-Gastaut" or "CDKL5" combined with "Cannabis," "cannabinoid," "cannabidiol," or "CBD" resulting in 199 papers. The qualitative assessment resulted in 11 valid references, with an average impact factor of 8.1 (ranging from 1.4 to 47.8). The categorical data of a total of 670 patients were analyzed by Fischer test. The average daily dose ranged between 1 and 50 mg/kg, with treatment length from 3 to 12 months (mean 6.2 months). Two thirds of patients reported improvement in the frequency of seizures (399/622, 64%). There were more reports of improvement from patients treated with CBD-rich extracts (318/447, 71%) than patients treated with purified CBD (81/175, 46%), [corrected] with statistical significance (p < 0.0001). Nevertheless, when the standard clinical threshold of a "50% reduction or more in the frequency of seizures" was applied, only 39% of the individuals were considered "responders," and there was no difference (p = 0.52) [corrected] between treatments with CBD-rich extracts (122/330, 37%) [corrected] and purified CBD (94/223, 42%). Patients treated with CBD-rich extracts reported lower average dose (6.0 mg/kg/day) [DOSAGE ERROR CORRECTED] than those using purified CBD (25.3 mg/kg/day). [DOSAGE ERROR CORRECTED] The reports of mild (158/216 76% vs. 148/447, 33% p < 0.001) and severe (41/155, 26% vs. 23/328, 7% p < 0.0001) [corrected] adverse effects were more frequent in products containing purified CBD than in CBD-rich extracts. CBD-rich extracts seem to present a better therapeutic profile than purified CBD, at least in this population of patients with refractory epilepsy. The roots of this difference is likely due to synergistic effects of CBD with other phytocompounds (aka Entourage effect), but this remains to be confirmed in controlled clinical studies.

Corrigendum: Potential Clinical Benefits of CBD-Rich Cannabis Extracts Over Purified CBD in Treatment-Resistant Epilepsy: Observational Data Meta-analysis.

[This corrects the article DOI: 10.3389/fneur.2018.00759.].

Genetic variation for growth and selection in adult plants of Eucalyptus badjensis.

The aim of this study was to evaluate Eucalyptus badjensis concerning the genetic variation for growth traits and the potential of the species in supporting a breeding programme. The field trial was a provenance/progeny test established in Campina da Alegria, Santa Catarina, Brazil (latitude 26°52'05.1″ S, longitude 51°48'47.5″ W, altitude 1,015 m) in a soil classified as Latossolic Alumino-Ferric Brown Nitosol. The experiment comprised 60 open-pollinated progenies from the provenances Glenbog and Badja State Forest, New South Wales, Australia. Ten replicates and plots with six plants in row were used. At the age of 17 years, 279 trees were assessed for diameter of the bole at breast height (DBH), total tree height (H) and volume of wood with bark (Vol). After submitting the data to statistical genetic analysis, the overall means for DBH, H and Vol were 45.17 cm, 33.30 m and 2.84 m3, and the estimates of additive coefficient of variation [ C V a(%)] were 12.59%, 5.91% and 26.51%, respectively. Heritability coefficients of additive effects ( h a 2) were also estimated and the following values were found: 0.443, 0.312 and 0.358. Thirty-nine trees from 25 different progenies were selected. The expected means of the provenances after improvement were 50.02 cm, 34.35 m and 3.47 m3 for DBH, H and Vol, respectively.

Eficacia y seguridad de la acupuntura y kinesioterapia en la rehabilitación del paciente con gonartrosis / Effectiveness and security of acupuncture and kinesiotherapy in rehabilitation of patients with gonartrosis

Se realiza un ensayo clínico controlado, aleatorizado, fase II, en 60 pacientes con el diagnóstico de Gonartrosis sin criterio quirúrgico que acuden a la Consulta de Fisiatría del Hospital Provincial Universitario Carlos Manuel de Céspedes de Bayamo, Granma remitidos por los médicos especialistas en Ortopedia y Reumatología en el período comprendido entre septiembre de 2006 a septiembre de 2007 con el objetivo de evaluar la eficacia y seguridad de la combinación de la Acupuntura y Kinesioterapia en la rehabilitación de pacientes con Gonartrosis. Los pacientes fueron asignados mediante una tabla de asignación aleatoria a dos grupos de tratamiento: Control y Experimental, con 30 cada uno. El primer grupo recibe un tipo de tratamiento convencional con Diatermia Onda Corta Continua y Kinesioterapia y en el segundo se sustituye la Diatermia por la Acupuntura. Los datos se recogieron en una planilla de recolección de datos y se empleó la prueba Chi Cuadrado (X2c) para verificar el comportamiento entre ambos grupos respecto a las variables objeto de estudio; además de la prueba de diferencia de proporciones para determinar el comportamiento de la amplitud de movimiento articular referente a la flexión y la extensión. Se trabajó con un nivel de significación 0,05; lo que permitió arribar a la conclusión de que la aplicación combinada de la acupuntura y la kinesioterapia logra desaparecer el dolor, alcanzar la máxima amplitud de movimiento articular y la capacidad funcional muscular con un menor número de sesiones sin la aparición de eventos adversos en la rehabilitación del paciente con Gonartrosis(AU)

It was performed a clinical, control, aleatorized essay, type II, in 60 patients with gonarthrosis and without surgical treatment. They came to the Physiatric consult at Carlos Manuel de Cespedes Province Hospital in Bayamo. They were remitted by Orthopedists and Reumatologists, since September 2006 to September 20007 with the objective to evaluate the effectiveness and security of Acupuncture and Kinesiotherapy in rehabilitation for patients with gonarthrosis. The patients were assigned through a table of aleatory design for two groups of treatment: the control and the experimental, with 30 patients each group. The first group received a conventional treatment with Short wave diathermy and Kinesiotherapy and the second group substituted Diathermy by acupuncture. The data was gathered and it was applied the Chi square test to verify the behavior between both groups according to the variables object of study, it was also applied the test for difference between proportions to determine the behavior of the enlargement of the articular movement according to flexion and extension. The level of significance was about 0,05, concluding that the combined application of acupuncture and kinesiotherapy dissapears the pain, obtains the highest enlargement of the articular movement and the functional muscle capacity with less number of sessions without the presence of adverse events in the rehabilitation of patients with Gonarthrosis(EU)

Consenso sobre la terapia de Resincronización Cardíaca / Spanish Society of Cardiology Cardiac Resynchronization Working Group Consensus on Indications for, Programing of and Follow-Up Resynchronization Devices

Dentro del arsenal terapéutico de la insuficiencia cardíaca, la resincronización cardíaca cada vez está adquiriendo un papel más importante como coadyuvante del tratamiento médico. Se ha demostrado ampliamente que en los pacientes con insuficiencia cardíaca avanzada y bloqueo de rama izquierda, la estimulación biventricular produce una mejoría hemodinámica y clínica, así como un remodelado inverso del ventrículo izquierdo. Algunos estudios sugieren también una disminución de la mortalidad. Sin embargo, es una terapia costosa y compleja que no está libre de complicaciones y con un porcentaje de pacientes que no mejoran. Por ello, para su correcta aplicación es necesaria una colaboración multidisciplinaria. El Grupo de Trabajo de Resincronización Cardíaca de la Sociedad Española de Cardiología ha redactado el presente documento de consenso con especial interés por exponer las indicaciones de esta terapia, así como la correcta selección de los dispositivos y su adecuada técnica de implante y seguimiento (AU)

Cardiac resynchronization is an increasingly important therapeutic option for a subgroup of patients with heart failure. It has been shown that biventricular pacing produces significant hemodynamic and clinical improvements and results in left ventricular remodeling in patients with severe heart failure and left bundle branch block. Some studies also indicate that cardiovascular mortality is decreased. However, this form of treatment is expensive and complex, it is not free of complications, and there are a significant number of non-responders. Therefore, multidisciplinary collaboration is necessary if it is to be used correctly. The Spanish Society of Cardiology Cardiac Resynchronization Working Group has produced this consensus document with the aim of establishing current indications for therapy, and ensuring that device selection is appropriate and that implantation and follow-up are carried out correctly (AU)

La medicina familiar, su impacto en Granma, 1984-2002 / The familiar medicine. Its impact in Granma. 1984-2002

Se realizó un estudio en la provincia Granma con el propósito de describir el impacto de la medicina familiar desde 1984-2002, para lo que se revisaron datos estadísticos y se realizaron entrevistas a médicos de familia y dirigentes del sector para analizar las variables recursos humanos, tasas de mortalidad infantil y materna, índice de bajo peso, así como las principales causas de muerte, se concluyó que éstas disminuyeron considerablemente y que las principales causas de muerte se mantienen, aumentando las causadas por las enfermedades crónicas no transmisibles y que ha sido muy positivo el trabajo de la medicina familiar en la provincia(AU)

It was performed a study in Granma province with the purpose to describe the impact of the family medicine since 1984-2002, for which there were reviewed statistical data and there were performed interviews to family doctors and leaders of the sector to analyze the variables: human resources, infant mortality and maternal rates, low weight index, as well as the main causes of death, it was concluded that these causes diminished considerably and that the main causes of death persisted , increasing the ones caused by the non transmitted chronic illnesses and it can be said that the work of the familiar medicine in the province had been positive(EU)

El alcoholismo: algunos aspectos epidemiológicos y sociales en la población atendida en 2 consultorios del médico de la familia / Alcoholism: some epidemiologic and social aspects in a target population of two family physician practices

Se realiza un estudio epidemiológico en 2 consultorios del Médico de la Familia correspondientes al Policlínico Docente "Bayamo Oeste" municipio Bayamo, provincia Granma, sobre el alcoholismo, en pacientes dispensarizados como tales. Se estudiaron distintas variables como edad, sexo, ocupación, nivel educacional, estado civil y edad de comienzo de la ingestión del tóxico. Predominó el sexo masculino entre 20 a 40 años, en el nivel educacional secundario y en el grupo de los solteros. Se encontró un gran porcentaje de desocupados y llamó la atención que comenzaron a ingerir las bebidas alcohólicas antes de los 25 años en el 89,5 % de la muestra

El alcoholismo: algunos aspectos epidemiológicos y sociales en la población atendida en 2 consultorios del médico de la familia / Alcoholism: some epidemiologic and social aspects in a target population of two family physician practices

Se realiza un estudio epidemiológico en 2 consultorios del Médico de la Familia correspondientes al Policlínico Docente "Bayamo Oeste" municipio Bayamo, provincia Granma, sobre el alcoholismo, en pacientes dispensarizados como tales. Se estudiaron distintas variables como edad, sexo, ocupación, nivel educacional, estado civil y edad de comienzo de la ingestión del tóxico. Predominó el sexo masculino entre 20 a 40 años, en el nivel educacional secundario y en el grupo de los solteros. Se encontró un gran porcentaje de desocupados y llamó la atención que comenzaron a ingerir las bebidas alcohólicas antes de los 25 años en el 89,5

de la muestra