Clinical
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What Is the Risk of Hemorrhage During Pregnancy for a Woman with Brain Arteriovenous Malformation?
The risk of hemorrhage in a pregnant woman with a brain arteriovenous malformation (AVM) is uncertain and management is controversial.
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Deep Brain Stimulation May Offer Hope in Treating Post-stroke Pain
This trial of deep brain stimulation of the ventral striatum/anterior limb of the internal capsule improved several measures of the affective sphere of pain in those suffering from post-stroke pain, despite no significant improvement seen in the pain disability index.
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Migraine and the Blood-brain Barrier
During spontaneous attacks of migraine with visual aura, magnetic imaging studies indicate that the blood-brain barrier remains intact and the pons is activated.
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Omega-3 Polyunsaturated Fatty Acid Supplementation and Cognitive Decline
In a randomized, placebo-controlled trial of 1,680 participants aged 70 years or older, there was no significant difference in cognitive decline between any of the intervention groups taking omega-3 polyunsaturated fatty acid supplementation and/or multidomain intervention (physical activity, cognitive training, and nutritional advice) compared to the placebo group. However, exploratory post hoc analyses showed some promise for a protective effect with intervention in certain at-risk subgroups.
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Distinguishing the Neuropathy Associated with MGUS from POEMS
Nerve conduction and electromyography can help differentiate the neuropathy associated with monoclonal gammopathy of undetermined significance (MGUS) from polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS).
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Randomized Trial of Cannabidiol for Medically Refractory Seizures in Dravet Syndrome
In a double-blind study, 120 children and young adults with the Dravet syndrome and medically refractory seizures were assigned randomly to receive either cannabidiol or placebo, as well as their usual antiepileptic drugs/therapies. The primary finding was a significant decrease in convulsive seizure frequency during the 14-week treatment period for patients receiving cannabidiol compared to those receiving placebo.
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Stroke: Rehabilitation and Recovery
Rehabilitation is a critical component of stroke treatment, as most stroke survivors are left with significant neurological impairments and other sequelae, such as spasticity and pain. Stroke rehabilitation aims to reverse these impairments to the extent possible, maximize functionality through the use of compensatory approaches, prevent complications, and manage comorbidities. This article reviews the basic principles of rehabilitation, current practices, and evidence supporting various aspects of stroke rehabilitation.
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Infectious Disease Alert Updates
Antibiotic increases honeybee mortality; Sustained hepegivirus infection in injection drug users; Decrease SSIs: Take August off
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2016 Surviving Sepsis Guidelines Update
The Surviving Sepsis Campaign recently published an update to the 2012 guidelines for management of sepsis and septic shock. The document incorporates literature published through July 2016.
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Sepsis Management: What We Think We Know
In the Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM), 3,723 patients’ outcomes from the ProCESS, ARISE, and ProMISe randomized, controlled trials of early goal-directed therapy (EGDT) were evaluated. EGDT did not result in better outcomes than usual care and was associated with higher costs. The authors of a second study looked at outcomes of 49,331 patients with sepsis treated in New York from April 2014 to June 2016. More rapid completion of the three-hour sepsis bundle and antibiotic administration (but not rapid bolus administration of IV fluids) was associated with reduced in-hospital mortality.