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The efficacy and safety of a fixed-dose tablet containing sumatriptan succinate and naproxen sodium relative to efficacy was evaluated along with the safety of each monotherapy and placebo for the acute treatment of migraine. A single tablet of 85 mg sumatriptan plus 500 mg naproxen sodium for acute treatment of migraine resulted in more favorable clinical benefits compared with either monotherapy with an acceptable and well-tolerated adverse effect profile.

Introduction: Atypical femoral fractures (AFF) are a rare type of subtrochanteric stress fracture associated with long term bisphosphonate use. Though rare, incidence rises after 5 years of therapy affecting up to 1 in 800 patients. AFF can be incomplete but can propagate transversely or obliquely, with little or no comminution (complete AFF). Fracture may occur with little or no trauma, be preceded by prodromal pain and affect the contralateral femur (25%). However, optimal management of patients with AFF is not clearly established. We report on a case series of patients with AFF at our hospital. Methods: We searched our bone heath database (within the last 10 years) for patients with a diagnosis of AFF (complete or incomplete). All cases were reviewed to ensure the diagnosis was consistent with ASBMR criteria. We then collated relevant clinical data regarding presentation, duration of bisphosphonate use and patient treatment. Results: We identified 12 patients, all were female, and mean age for AFF was 71.5 years (range 54 to 83). Ten were on oral bisphosphonates and two on intravenous therapy. Mean duration of treatment was 8.7 years (range 4 to 12). 10 presented with complete AFF and 2 incomplete AFF. However, contralateral incomplete AFF was identified in 5 patients who presented with a completed fracture and in one with incomplete AFF. Seven patients reported prior prodromal thigh pain. Of complete AFFs, 9 were sustained from a simple fall while one was spontaneous. All complete AFFs were treated with surgical fixation and six with teriparatide, though three stopped due to side effects. All patients with incomplete AFF were considered for prophylactic femoral nailing - 2 had it done, 2 healed on teriparatide alone and 4 remain under close monitoring. One patient had non-union of a complete AFF after surgery despite two years of teriparatide therapy. Conclusion: These cases are a reminder of the need for judicious use of bisphosphonates beyond five years. It also highlights the importance of identifying incomplete AFF in any patients with thigh pain and who is on bisphosphonate therapy. Some evidence supports a role for teriparatide in reducing time to healing in patients with complete AFF though non-union can still occur. Prophylactic femoral nailing should generally be done in incomplete AFF, especially if there is a visible fracture line, pain or ongoing use of steroids, though healing may occur spontaneously on withdrawal of bisphosphonates. [ABSTRACT FROM AUTHOR]

The aberrant processing of salience is thought to be a fundamental factor underlying psychosis. Cannabis can induce acute psychotic symptoms, and its chronic use may increase the risk of schizophrenia. We investigated whether its psychotic effects are mediated through an influence on attentional salience processing.~Context~Background~To examine the effects of ¿9-tetrahydrocannabinol (¿9-THC) and cannabidiol (CBD) on regional brain function during salience processing.~Objective~Objective~Volunteers were studied using event-related functional magnetic resonance imaging on 3 occasions after administration of ¿9-THC, CBD, or placebo while performing a visual oddball detection paradigm that involved allocation of attention to infrequent (oddball) stimuli within a string of frequent (standard) stimuli.~Design~Methods~University center.~Setting~Methods~Fifteen healthy men with minimal previous cannabis use.~Participants~Methods~Symptom ratings, task performance, and regional brain activation.~Main Outcome Measures~Methods~During the processing of oddball stimuli, relative to placebo, ¿9-THC attenuated activation in the right caudate but augmented it in the right prefrontal cortex. ¿9-Tetrahydrocannabinol also reduced the response latency to standard relative to oddball stimuli. The effect of ¿9-THC in the right caudate was negatively correlated with the severity of the psychotic symptoms it induced and its effect on response latency. The effects of CBD on task-related activation were in the opposite direction of those of ¿9-THC; relative to placebo, CBD augmented left caudate and hippocampal activation but attenuated right prefrontal activation.~Results~Results~¿9-Tetrahydrocannabinol and CBD differentially modulate prefrontal, striatal, and hippocampal function during attentional salience processing. These effects may contribute to the effects of cannabis on psychotic symptoms and on the risk of psychotic disorders.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

It is well established that nuclear factor kappa B (NF-[kappa]B) is a central regulator of the immune response and that dysregulation of NF-[kappa]B contributes to the pathogenesis of many autoimmune and inflammatory diseases. The food supplement Aquamin is a natural multi-mineral derived from the red algae Lithothamnion corallioides, rich in calcium, magnesium and 72 other trace minerals. This study describes an anti-inflammatory role for Aquamin in inhibiting NF-[kappa]B activation through reducing the phosphorylation and degradation of its upstream inhibitor I[kappa]B[alpha]. Aquamin inhibition of NF-[kappa]B activation results in significantly reduced cyclo-oxygenase-2 gene expression following treatment of macrophage cells with lipopolysaccharide. These data suggest that nutritional supplements such as Aquamin may play an important role in regulating the inflammatory response by modulating the nuclear factor kappa B signalling pathway. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Academic neurology departments across the country have been rapidly adding diversity, equity, and inclusion (DEI) programs over the past 5-10 years. These programs frequently come with leadership roles that carry a variety of names and responsibilities, such as vice chair of DEI or diversity officer. Furthermore, there are roles for members of the department to be involved with DEI work without being designated the departmental DEI leader. This article provides a framework for understanding the different responsibilities that are typically associated with each of these roles, along with reasonable expectations to associate with the respective job titles. Our goal is to prevent departments from asking too much or expecting too little based on the job title and support provided to the people in these positions. Likewise, we hope to empower DEI leaders who are currently asked to perform duties beyond their scope to obtain the title and support they have earned. For each departmental DEI role, we review prerequisites to success and potential impediments.

Objective: HIV infection is an important stroke risk factor in sub-Saharan Africa.  However, data on stroke risk factors in the era of antiretroviral therapy (ART) are sparse. We aimed to determine if stroke risk factors differed by HIV serostatus in Uganda., Methods: We conducted a matched cohort study, enrolling persons living with HIV (PWH) with acute stroke, matched by sex and stroke type to HIV uninfected (HIV-) individuals. We collected data on stroke risk factors and fitted logistic regression models for analysis., Results: We enrolled 262 participants:105 PWH and 157 HIV-. The median ART duration was 5 years, and the median CD4 cell count was 214 cells/uL. PWH with ischemic stroke had higher odds of hypertriglyceridemia (AOR 1.63; 95% CI 1.04, 2.55, p=0.03), alcohol consumption (AOR 2.84; 95% CI 1.32, 6.14, p=0.008), and depression (AOR 5.64; 95%CI 1.32, 24.02, p=0.02) while HIV- persons with ischemic stroke were more likely to be > 55 years of age (AOR 0.43; 95%CI 0.20-0.95, p=0.037), have an irregular heart rhythm (AOR 0.31; 95%CI 0.10-0.98, p=0.047) and report low fruit consumption (AOR 0.39; 95%CI 0.18-0.83, p=0.014).  Among all participants with hemorrhagic stroke (n=78) we found no differences in the prevalence of risk factors between PWH and HIV-., Conclusions: PWH with ischemic stroke in Uganda present at a younger age, and with a combination of traditional and psychosocial risk factors. By contrast, HIV- persons more commonly present with arrhythmia. A differential approach to stroke prevention might be needed in these populations., Competing Interests: Declaration of Competing Interest None, (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction Denosumab is commonly used to treat osteoporosis. However, discontinuation results in rebound bone loss and increased vertebral fracture risk. We report a clinical case series, illustrating the dilemma in deciding the best treatment should denosumab be stopped. Cases In eight patients aged 56-89 years, zolendronic acid after stopping denosumab resulted in BTM rises and BMD decline.  In a 68-year-old, two years of oral bisphosphonate after three years of denosumab resulted in elevated bone turnover markers (BTM) and decline in bone mineral density (BMD), necessitating a switch to zoledronic acid.  In a 79-year-old, two annual doses of zolendronic acid after three years of denosumab failed to suppress high BTM, with BMD dropping and denosumab being restarted.  In a 60-year-old, on stopping denosumab after 10 years of oral bisphosphonate, BMD remained stable despite no further therapy. Conclusion Drug holidays are not an option with denosumab, with a risk of bone loss even on transitioning to bisphosphonates. Risk is greater with longer duration of treatment6 and may be mitigated by prior bisphosphonate use. Standard dose zoledronic acid does not prevent bone loss in a significant proportion of patients. BTM may help in monitoring treatment and need for further bisphosphonates., Competing Interests: The authors confirm that they have no conflicts of interest to declare.

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi-elective procedures. For allergic children in Ireland, already waiting up to 4 years for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative, there were approx 900 children on the Children's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short-term (6 weeks) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive (HSE), Ireland. The aim of this study was to achieve the rapid roll-out of an offsite OFC service, delivering high throughput of long waiting patients, while aligning with existing hospital policies and quality standards, international allergy guidelines and national social distancing standards., Methods: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant paediatric allergists, consultant paediatricians, trainees and allergy clinical nurse specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, pulse and oxygen saturation) and bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardized food challenge protocols were created. Access to the onsite hotel chef facilitated food preparation. A risk register was established., Results: After 6 weeks of planning, the remote centre became operational on 7/9/2020, with the capacity of 27 OFC/day. 474 challenges were commenced: 465 (98%) were completed and 9 (2%) were inconclusive. 135 (29%) OFCs were positive, with 25 (5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days., Conclusions: Oral food challenges remain a vital tool in the care of allergic children, with their cost saving and quality-of-life benefits negatively affected by a delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy-in-even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era., (© 2021 The Authors. Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Rhabdomyolysis is a rare and complex condition that involves injury of the skeletal muscle fibres, resulting in the release of substances such as creatine kinase and myoglobin. It is associated with acute kidney injury and mortality. This article describes the case of a 40-year-old man who presented to the emergency department after an overdose of tramadol hydrochloride. It uses critical reflection to explore traumatic and non-traumatic causes of rhabdomyolysis and reviews the literature relating to the diagnosis of rhabdomyolysis through laboratory and point-of-care testing. To ensure the timely identification of patients at risk of deterioration, emergency nurses need to be aware of the potential causes and the clinical signs and symptoms of rhabdomyolysis., Competing Interests: None declared, (©2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Introduction: Acute cerebral injuries, such as cerebral ischemic or hemorrhagic events, have been repeatedly correlated with sudden electrocardiogram (ECG) changes, such as cardiac arrhythmias, QT prolongation, and T-wave inversion (the "cerebral T-wave"). Injuries to the insular cortex have been reported in the literature to result in such changes, possibly due to increased sympathetic tone to the cardiac system., Case Report: A 65-year-old gentleman presented with an acute right middle cerebral artery territory infarction, and was found to have ECG abnormalities and left ventricular dysfunction, which improved after the acute phase of the stroke., Conclusions: Acute ischemic infarcts, particularly to the right insular cortex, can result in ECG abnormalities, such as QT prolongation and T-wave inversion, as well as acute systolic heart failure; all of which may be reversible after the acute phase of the stroke.