The Tricky Diagnosis of Nummular Headaches: Description of Two Cases and Literature Review.

Nummular headaches are a rare and relatively newly characterized primary headache disorder. The epidemiology is largely unknown due to likely underdiagnosis and a small population of all headache patients in outpatient presentation. Though our understanding of nummular headaches continues to evolve, they remain a diagnostic challenge for physicians and the underlying pathophysiology is poorly understood. Hypotheses consider neuralgia stemming from epicranial tissues as well as undergoing observation of varying prevalence of autoimmune markers. Peripheral nociception versus central sensitization needs to be evaluated as well, with cases not having consistent direction. Selecting treatment options can be challenging due to limited efficacy, the vague nature of reported symptoms, the rarity of the diagnosis, and the range of presentations. Several treatment modalities have been utilized including non-steroidal anti-inflammatory drugs (NSAIDs), beta-blockers, botulinum toxin injection, transcutaneous nerve stimulation, or even simple reassurance. A case-by-case analysis must be undertaken to best develop treatment options for affected individuals as high-quality randomized quality trials for nummular headaches are very few. We detail two novel cases of patients presenting with nummular headaches that highlight the challenges and importance of making the diagnosis and weighing treatment options for improved levels of patient care, which is followed by a literature review.

Cancer Survivor Health Needs for Women.

As a result of better diagnostics and treatment of cancer, the number of survivors is on the rise. Health care needs for female cancer survivors encompass several domains that include surveillance, prevention, management of short/long-term side effects of cancer, and cancer therapy. Primary care health providers (PCHPs) can play an important role in their health care. There is a need for PCHPs to acquire knowledge and understand the complexity involved in caring for this population. They also should be familiar with the guidelines for following cancer survivor patients.

Risk of obstructive sleep apnea in patients with type 2 diabetes mellitus.

BACKGROUND AND OBJECTIVES: Type 2 diabetes mellitus (DM) and obstructive sleep apnea (OSA) share several clinical findings: obesity, hypertension, and impaired glucose tolerance. OSA may be an under-recognized comorbidity of DM. The purpose of this study is to estimate the proportion of patients with type 2 DM at risk for OSA and describe factors associated with that risk. METHODS: This cross-sectional study enrolled 297 adults, ages 18 years and older, with type 2 DM from a university-based Family Medicine Center. Participants completed a research questionnaire recording sociodemographic information, medical history, and clinical data including medications and hemoglobin A1C. OSA risk was determined using the Berlin Questionnaire. Relationships between risk of OSA and sociodemographic and clinical variables were evaluated using bivariate analyses and covariate adjusted logistic regression models. RESULTS: Thirty-seven participants (12.5%) had a prior diagnosis of OSA. Based on the Berlin Questionnaire, 124 (48.6%) of the remaining patients were classified as high risk for OSA. Patients less than age 60 years were at increased risk for OSA, adjusted OR=2.67 (1.57, 4.54; 95% CI). Non-Hispanic whites, adjusted OR=1.76 (1.01, 3.06; 95% CI), and patients with symptoms of depression, adjusted OR=2.64 (1.60, 4.52; 95% CI), were also at higher risk. Gender and hemoglobin A1C were not associated with increased risk of OSA. CONCLUSIONS: Nearly half of adults with type 2 DM may be at high risk for OSA, and many may be undiagnosed. In a primary care setting, the Berlin Questionnaire is an easily applied screening instrument that identifies patients at increased risk of OSA who may benefit from further diagnostic studies and treatment of OSA.

The biopsychosocial milieu of type 2 diabetes: an exploratory study of the impact of social relationships on a chronic inflammatory disease.

OBJECTIVE: The aim of this study was to investigate the association between psychosocial variables, biomarker hemoglobin A1C (HbA1C), and immune modulatory cytokine mediators among diabetic patients in marital or committed long-term relationships. METHOD: This is a cross-sectional study of adult patients with Type 2 diabetes mellitus (T2DM) presenting at a university-based ambulatory medical clinic. Social/interpersonal constructs were assessed using measures of dyadic adjustment, interpersonal sensitivity and social functioning, and expressed emotion. HbA1c and cytokines were measured from blood samples using standard laboratory tests. Associations of relational systems constructs with biomarkers were assessed using bivariate tests. RESULTS: Dyadic adjustment was significantly associated with cytokine IL-8. Interpersonal relationship functioning was significantly associated with biomarker HbA1c, and cytokines TNF-alpha, and IL-1ra. Social functioning was significantly correlated with cytokines IL-17, IL-1ra, IL-2r, IL-6, and eotaxin. Depression was significantly correlated with HbA1C. CONCLUSIONS: Although preliminary in nature, findings revealed significant relationships between molecular mediators of the inflammatory and immune systems and variables measuring the relational context patients with T2DM. The initial findings suggest a next step in understanding and exploring the complex but important biopsychosocial pathways in Type 2 DM.

Use of Echinacea in upper respiratory tract infection.

The significant burden of upper respiratory tract infection in adults and children, coupled with a lack of specific treatment options, invites the use of alternative therapies. Echinacea is an herb widely used for the prevention or treatment of upper respiratory tract infection. This review article examines the mechanism of action, dose, and types of Echinacea used for these purposes. The principal mode of action of Echinacea is through immunostimulation. Most Echinacea studies were done in Germany, but their results are difficult to interpret because of variability of experimental parameters. Types of Echinacea commonly used are Echinacea purpurea, E pallida, and E angustifolia. Both the plant's upper parts and roots are used. For oral administration, tablets, extracts, fresh pressed juice, teas, and tinctures have been used. Though studies show a beneficial effect, clear conclusions and recommendations of Echinacea use cannot be made due to a lack of standard product, variability in dose, and variability in outcome measures. Therefore, well-designed studies with consistent standardized measures are required.

Roseomonas gilardii infection: case report and review.

Roseomonas gilardii is a bacterium that has been indicated as a rare cause of human infections. The case of a patient presenting with cellulitis and bacteremia secondary to R. gilardii is described together with the clinical characteristics of infection with this organism obtained from a review of cases previously reported.