The Mayo Clinic Arizona is a short term acute care hospital in Phoenix, Arizona. This out of state campus of the original Mayo Clinic in Rochester, Minnesota opened in June 1987. The hospital provides inpatient and outpatient services, as well as teaching and research. The Mayo Clinic Arizona has a nearby, associated Scottsdale campus which offers outpatient services and an Arizona branch of the Mayo Clinic Alix School of Medicine.
Medication overuse headache (MOH) is a secondary headache disorder that occurs in patients with pre-existing primary headache disorders who frequently use acute headache medications. While management strategies for MOH have been increasingly studied in adults, there remains limited data guiding diagnosis and treatment in children and adolescents. This review summarizes recent evidence on the epidemiology, medication patterns, and management strategies for pediatric MOH and compares these findings with the adult literature. Through our literature search over the past 5 years, we revealed only 2 studies evaluating treatment strategies in MOH in pediatrics. Recent epidemiologic studies of pediatric MOH revealed an increased impact to quality of life, time spent in ictal state, and absenteeism compared to peers with other primary headache disorders. Despite its impact on quality of life and school attendance, pediatric MOH remains understudied. Larger prospective studies are needed to determine optimal treatment strategies and improve evidence-based management in this population.
Background Radium-223 (Ra-223) has been approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC) with predominant osseous metastases. PSA flare phenomenon with Ra-223 limits its use as a prognostic tool to predict treatment response. Currently, there is a lack of diagnostic tools to predict treatment response to Ra-223. Therefore, we sought to investigate the role of mid treatment C-11 choline PET/CT scan in predicting overall response to Ra-223. In a single institute retrospective study, we identified 32 patients who were treated with a full course of 4-6 cycles of Ra-223 and were evaluated with PSA, and C-11 choline PET scan before treatment, at mid-treatment point, and after complete course of Ra-223 between 2013 and 2018. Ra-223 was used as a salvage therapy for their predominant bone disease after failing chemotherapy and 2nd generation hormone therapy. Blind repeat radiographic evaluation of patients' scans has been done by a radiologist specialized in nuclear medicine. Favorable response was defined by achieving partial response or stable disease on imaging, while unfavorable response was defined by showing progressive disease on imaging. Results Mean age (+/- SD) at starting Radium223 was 67.6 (+/- 7.1) years, median (IQR) primary Gleason score was 9 (8-9), and median (IQR) pretreatment PSA was 13.5 (5.4-39.6) ng/ml. 78% of the patients (n = 25) completed 6 cycles of Ra-223, and 15% of the patients (n = 5) completed 5 cycles while 6% (n = 2) received only 4 cycles. At mid treatment scanning, 25% of the patient (n = 8) showed favorable response (Group A), while 75% of the patients (n = 24) showed unfavorable response (B). After complete course of treatment, 50% of patients (n = 4) in Group (A) continued to show favorable response, versus only 8.3% of patients (n = 2) in Group (B) showed favorable response (p-value = 0.023). Conclusion Mid treatment evaluation with C-11 choline PET/CT scan can predict overall response to Radium 223. Patients with progressive disease at mid- treatment evaluation are very likely not going to respond to their treatment. Further studies and clinical trials are warranted.
Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. We aim to provide a comprehensive review of basic nutrition related concepts in chronic liver disease, review the implications of nutritional abnormalities and discuss current management recommendations. Malnutrition is an overarching concept related to an imbalance of nutrients. Frailty is related to reduction in physical strength function and is identified via hand grip strength, the liver frailty index and the six minute walk test. Sarcopenia is progressive reduction in skeletal muscle. Sarcopenia and VSO can be identified with the use of cross-sectional imaging and are associated with increased mortality and adverse health related outcomes in the pre- and posttransplantation settings. Glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide can prevent progression of disease in metabolic dysfunctionassociated steatotic liver disease, promote weight loss in chronic liver disease patients with obesity and VSO and are associated with decreased mortality in the pre post liver transplant settings. Bariatric and endobariatric interventions are being used to manage chronic liver disease patients with obesity and VSO in pre post-transplant. Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. GLP-1 RAs are effective in the pre post liver transplant settings; however, careful monitoring for the development of worsened or new sarcopenia is warranted. Further investigation into the role of surgical and endoscopic bariatric interventions in the pre post liver transplant settings is warranted.
BACKGROUND:As survival following solid organ transplantation (SOT) improves, attention has shifted to survivorship and quality of life (QoL) outcomes. Sexual function is an important component of women's health in transplant recipients. In the general population, sexual distress affects approximately 10%-15% of midlife women. Female SOT recipients may experience additional risk for sexual dysfunction related to surgery, body image, and immunosuppression. However, sexual health in this population remains understudied. This study assessed sexual function and its impact on QoL among female SOT recipients by menopausal status. METHODS:A cross-sectional study of female SOT recipients aged ≥ 18 years was conducted at a single tertiary transplant center from 2018 to 2023. Participants were within five years of kidney, liver, or pancreas transplantation. Validated questionnaires included female sexual function index (FSFI), female sexual distress scale (FSDS), menopause rating scale (MRS), linear analog scale assessment (LASA). Respondents were categorized as premenopausal or peri/postmenopausal. Sexual function, distress, and QoL were compared between groups, with exploratory analyses stratified by current sexual activity status. RESULTS:The survey response rate was approximately 30%. Among 277 respondents, peri/postmenopausal patients were less likely to be sexually active (48.9% vs 69.4%, p = 0.002). They reported lower desire, arousal, and lubrication scores, and higher sexual distress than premenopausal SOT recipients. While overall QoL was rated highly across both groups, sexual distress negatively correlated with QoL across menopausal groups. Among the entire cohort, most women (≈74%) had not been asked about sexual health by any provider in the past year. CONCLUSION:Sexual dysfunction is common among female SOT recipients and is associated with menopausal status, with higher rates observed than those reported in the general population. These findings highlight the importance of integrating sexual health into posttransplant survivorship care.
Symptoms that can be attributed to the gastroduodenal area are classified into 5 categories: (1) functional dyspepsia, with 2 subcategories that can overlap: postprandial distress syndrome, with meal-induced symptoms of postprandial fullness or early satiation and epigastric pain syndrome, with epigastric pain or burning that does not occur exclusively postprandially; (2) nausea and vomiting disorders, which include 3 subcategories: chronic nausea vomiting syndrome; cyclic vomiting syndrome; and cannabinoid hyperemesis syndrome; (3) excessive belching disorders, defined as audible escapes of air from the esophagus or the stomach and classified into 2 subcategories depending on the origin of the refluxed gas: gastric or supragastric belching; (4) inability to belch syndrome, a new category defined by the self-reported inability to belch; and (5) rumination syndrome, defined by the repetitive, effortless regurgitation of recently ingested food into the mouth, followed by the reswallowing or expulsion of the food bolus.
