Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 4 (2) 2017 - 5 Articles


1 - Oral versus intravenous steroid therapy for relapses in patients with multiple sclerosis: an updated meta-analysis of six randomized controlled trials

Wenjing Luo; Min Han; Chunying Wei; Bo Liu; Yi Du

MEDICALEXPRESS 2017;4(2):M170201

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PURPOSE: To systematically evaluate whether oral steroids can be used with the same efficacy and safety in comparison with the intravenous regimen for treatment of multiple sclerosis relapses.
METHOD: We searched Medline, Embase and Cochrane Library and systematically reviewed articles comparing outcomes of oral versus intravenous steroids for acute relapses in patients with a clinically definite diagnosis of multiple sclerosis.
RESULTS: Six articles with 414 participants in total were analyzed. Five of the included trials reported the proportion of patients experiencing improvement in Expanded Disability Status Scale after receiving either oral or intravenous methylprednisolone treatment at four weeks; the pooled results showed that there was no statistically significant difference (OR 0.96; 95% CI 0.60, 1.54; p=0.86) between treatments. Three trials reported the detailed results of adverse events, indicating the two treatments appear to be equally safe. Two trials revealed that there was no significant difference in gadolinium enhancement activity on magnetic resonance imaging. One trial showed that the mean area under the concentration-time curve (AUC) at 24 and 48 hours did not differ between groups.
CONCLUSION: No significant differences were found in terms of clinical (benefits and adverse events), radiological and pharmacological outcomes in multiple sclerosis relapses in patients after oral or intravenous steroids treatment. Our meta-analysis provides evidence that oral steroid therapy is not inferior to intravenous steroid therapy. Thus oral administration may be a favorable substitute for intravenous medication of multiple sclerosis relapses.

Keywords: Multiple sclerosis, relapses, methylprednisolone, meta-analysis.


2 - Customized footwear for motion control to treat anterior knee pain among runners

David Sadigursky; Natallia Andrade Mota Santos; Gustavo Castro de Queiroz; Leandro Oliveira; Marcio Pinheiro de Souza; Rogério Jamil Fernandes Carneiro; Paulo Oliveira Colavolpe

MEDICALEXPRESS 2017;4(2):M170202

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BACKGROUND: Street running is extremely popular worldwide. Despite its benefits, there is evidence that stressful physical activity contributes to the development of lesions on the patellofemoral joint, leading, to anterior knee pain. As an attempt to attain pain control and to improve performance, specific footwear is being developed, aiming to suit particular types of foot strike, and therefore to reduce the risk of injury.
OBJECTIVE: To evaluate the effectiveness of the use of customized shoes, based on baropodometric test, for the remission of anterior knee pain among amateur street runners.
METHODS: This is a cross-sectional study, using questionnaires based on anthropometric and anatomical data of the runner, type of training, individualized footwear based on baropodometric test and diagnosis of anterior knee pain. In total, 40 athletes were studied, which were divided into two groups: Group 1, with 19 athletes who wore specific shoes for their activity, according to the type of foot strike, and, Group 2, with 21 athletes who used neutral shoes, not prescribed by healthcare professionals. All athletes practiced at the same running field.
RESULTS: Most of the athletes were female (70%), The pain remission had no overall statistically significant difference between the two groups. However, significant differences were found between groups A and B regarding the time of occurrence and the extent of AKP.
CONCLUSION: The data analysis showed that the use of customized running shoes, based exclusively on baropodometric exams, does not reduce anterior knee pain in amateur street runners, which is consistent with current literature. The improvement of pain with customized shoes, when present, appeared to have a short duration of around three month.

Keywords: Running; Knee; Anterior Knee Pain Syndrome.

3 - Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

Thammi de Matos Amorim; Carlos Kiyoshi Furuya Junior; Sergio Barbosa Marques; Samuel Katsuyuki Shinjo

MEDICALEXPRESS 2017;4(2):M170204

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OBJECTIVE: To endoscopically assess the upper digestive tract of adult patients with newly diagnosed dermatomyositis; to correlate possible changes in the gastrointestinal tract with demographic, clinical and laboratory features in this population.
METHOD: A cross-sectional study evaluating 65 newly diagnosed dermatomyositis cases from 2004 to 2015 was carried out. We excluded patients with clinically amyopathic dermatomyositis, overlap dermatomyositis, polymyositis, liver diseases, prior gastric surgery, upper gastrointestinal tract symptoms (except for upper dysphagia), systemic infections, alcohol consumption and smoking.
RESULTS: Mean age of patients was 44.9 years, with disease duration of four months. Endoscopic findings were observed in 70.8% of patients. (1) Esophageal disease/gastric distress was documented in 18.5% of patients: erosive distal esophagitis (16.9%) and non-erosive distal esophagitis distal (1.5%); (2) gastric distress in 63.1% of cases: antral gastritis (42.3%) and pangastritis (27.8%); (3) duodenal involvement in 15.4% of patients: bulbar duodenitis (10.9%) and duodenal ulcers (7.7%). There were no neoplasic lesions. On multivariate analysis, erosive distal esophagitis was less associated with older patients. Males had a higher prevalence of erosive gastritis. Enanthematous pangastritis was less associated with lesions with "V-neck" sign lesions.
CONCLUSIONS: This study provides the first estimates of the prevalence of high endoscopic findings in adult patients with newly diagnosed dermatomyositis. The results may be relevant to guide conduct in digestive disorders with upper digestive endoscopy, and point to the need for pharmacological prevention of digestive tract lesions in these patients. Further studies are needed to validate this data and evaluate patients with dyspeptic symptoms.

Keywords: Dermatomyositis, dyspepsia, gastrointestinal endoscopy, myositis.

4 - Could C-reactive protein and erythrocyte sedimentation rate support monitoring of dermatomyositis and polymyositis activity?

Renata Miossi; Fernando Henrique Carlos de Souza; Samuel Katsuyuki Shinjo

MEDICALEXPRESS 2017;4(2):M170205

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OBJECTIVES: To evaluate serum levels of C-reactive protein and erythrocyte sedimentation rates in patients with untreated newly diagnosed dermatomyositis or polymyositis and their correlation with clinical and laboratory parameters.
METHODS: A cross-sectional study including 48 consecutive patients with untreated newly diagnosed dermatomyositis and polymyositis reviewed between 2002 and 2015 was conducted. Fifty healthy subjects were enrolled as controls.
RESULTS: Patients with dermatomyositis and polymyositis had higher levels of C-reactive protein and erythrocyte sedimentation rate than healthy controls, but these values were not associated with clinical or laboratory parameters of disease activity either for dermatomyositis or for polymyositis. Additionally, erythrocyte sedimentation rate values correlated with pulmonary involvement as evidenced through computer tomography imaging (OR 1.15; 95%CI 1.01-1.31) only in patients with polymyositis.
CONCLUSIONS: Although elevated, C-reactive protein and erythrocyte sedimentation rate are not sensitive parameters for measuring clinical and laboratory activity of dermatomyositis nor for polymiositis. However, erythrocyte sedimentation rate may be a valid parameter for screening pulmonary involvement, particularly in patients with polymyositis.

Keywords: Dermatomyositis; polymyositis; C-reactive protein; erythrocyte sedimentation rate.

5 - Treatment outcomes in patients with Internet Addiction and anxiety

Veruska Santos; Rafael Freire; Morená Zugliani; Patricia Cirillo; Hugo H.K. Santos; Antonio Egidio Nardi; Anna Lucia Spear King

MEDICALEXPRESS 2017;4(2):M170206

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OBJECTIVE: To investigate the effectiveness of a treatment for Internet addiction and anxiety disorders, using cognitive behavioral therapy combined with medication, and to analyze the relationship between anxiety and Internet addiction.
METHOD: An open clinical trial included 84 patients (42 in the "comorbidities" group; 42 in the "no comorbidities" group) seeking treatment for anxiety symptoms and/or Internet Addiction. The subjects responded to The Mini International Neuropsychiatric Interview 5.0; the Hamilton Anxiety Scale (HAM-A), the Hamilton Depression Scale (HDRS), Clinical Global Impressions Severity and Improvement (CGI-S and CGI-I) and the Young Internet Addiction Scale (IAT). Patients who had only Internet addiction received psychoeducation on conscious internet use and bibliotherapy; they were defined as the group without comorbidities; patients diagnosed with Internet addiction and anxiety disorder (the group with comorbidities) were forwarded for pharmacotherapy and psychotherapy.
RESULTS: Both Internet Addiction and anxiety decreased after treatment; the average of Hamilton Anxiety Scale of the "comorbidities" group at the beginning was 33.9 ± 7.6, suggesting severe anxiety, and at the end of treatment it was 15.0 ± 5.1, suggesting mild anxiety and a significant improvement. The average Internet Addiction score at the beginning was 67.8 ± 9.0; at the end of the psychotherapy an average score of 37.7 ± 11.4 was registered, indicating a notable and highly significant improvement.
CONCLUSIONS: The relationship between anxiety and Internet Addiction existed and was strong. Treatment significantly improved both.

Keywords: Internet Addiction, Anxiety, Cognitive Behavioral Therapy.