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2.
Rev. chil. pediatr ; 91(1): 46-50, feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092786

ABSTRACT

Resumen: Introducción: La migraña abdominal (MA) es infrecuente y poco estudiada. Nuestro objetivo fue investigar el diagnóstico y tratamiento de niños y adolescentes con MA y compararlos entre gastroen terólogos y neurólogos pediatras. Pacientes y Método: Todos los cuadros de MA (1-18 años) de un hospital de EE. UU, con diagnóstico de MA o sus variantes (ICD-9 346.2 o IC-10 G43.D, G43.D0, G43.D1) entre 2011-2017 fueron revisados. La información sobre diagnóstico, intervalo desde inicio de síntomas, criterios diagnósticos, pruebas diagnósticas, tratamiento y resultado se analizaron. Re sultados: Sesenta y nueve historias médicas fueron identificadas. La edad media al diagnóstico fue 9,7 años. El 48% de los pacientes fueron del sexo femenino. Cincuenta (72,4%) pacientes fueron tratados solo por gastroenterólogos pediatras, y 10/69 (14,5%) por neurológos pediatras exclusivamente. 6/69 (8,7%) fueron inicialmente evaluados por gastroenterología y posteriormente referidos a neurología, y 2/69 (2,9%) fueron inicialmente evaluados por neurología y luego referidos a gastroenterología. 3/10 (30%) de las MA diagnosticadas por neurólogos no mencionaban que el paciente tuviera dolor abdominal, sin embargo, todos los diagnósticos realizados por gastroenterólogos presentaron dicho síntoma (p=0,0035). 5/50 (10%) de las historias médicas de gastroenterología y ninguna de las histo rias de neurología mencionaban los criterios de Roma. Conclusiones: La mayoría de los niños fueron diagnosticados por pediatras gastroenterólogos. Los gastroenterólogos rara vez utilizaron los criterios de Roma. Pacientes evaluados por neurología son frecuentemente diagnosticados con MA, incluso sin presentar dolor abdominal (criterio necesario para el diagnóstico). Se recomienda educación para el correcto y oportuno diagnóstico de la migraña abdominal.


Abstract: Introduction: Abdominal migraine (AM) is uncommon and understudied. Our objective was to investigate the diagnosis and treatment of children and adolescents with AM and compare with that of pediatric gastroenterologists and neurologists. Patients and Method: All AM cases (1-18 years) from a USA hospital with diagnosis of abdominal migraine or its variants (ICD-9 346.2 or IC-10 G43.D, G43.D0, G43.D1) between 2011 and 2017 were reviewed. Information on diagnosis, interval from onset of symptoms, diagnostic criteria, diagnostic tests, treatment, and outcome were analyzed. Results: 69 medical records were identified. The mean age at diagnosis was 9.7 years, and 48% of patients were female. 50/69 (72.4%) patients were exclusively treated by a pediatric gastroenterologist and 10/69 (14.5%) exclusively by a pediatric neurologist. 6/69 (8.7%) were initially evaluated by gas troenterology and referred to neurology, and 2/69 (2.9%) were initially evaluated by neurology and then referred to gastroenterology. 3/10 (30%) of the AM diagnosed by neurologists did no report ab dominal pain (AP), however, all diagnoses made by gastroenterologists did (p = 0.0035). 5/50 (10%) of the gastroenterology medical records and no neurology medical records mentioned Rome criteria. Conclusions: Most of the children were diagnosed by pediatric gastroenterologists. Gastroenterolo gists rarely use the Rome criteria. Patients evaluated by neurologists are frequently diagnosed with AM even without AP (a criterion that is required for its diagnosis). Education is recommended for the correct and timely diagnosis of AM.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Practice Patterns, Physicians'/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Gastroenterology , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Neurology , Referral and Consultation , United States , Abdominal Pain/etiology , Follow-Up Studies , Practice Guidelines as Topic , Guideline Adherence/statistics & numerical data , Diagnosis, Differential , Diagnostic Errors , Migraine Disorders/complications
3.
Rev. medica electron ; 41(4): 889-898, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094096

ABSTRACT

RESUMEN Introducción: La neumonía adquirida en la comunidad constituye un importante problema de salud a nivel global, en Cuba es la cuarta causa de muerte. Los índices pronósticos ayudan a detectar tempranamente los pacientes de alto riesgo, pero esto tiene baja sensibilidad y especificidad. Objetivo: determinar durante la anamnesis factores pronósticos de mortalidad en la neumonía adquirida en la comunidad. Materiales y métodos: estudio analítico longitudinal retrospectivo con un grupo donde se aplicaron pruebas no paramétricas y cálculo de riesgo relativo. Resultados: edad de 78 ± 10 años con 53 % femeninas. La mortalidad global de 57 % antecedentes de diabetes mellitus, 53 % enfermedad cerebro vascular anterior 34 %, el 42 % estaba encamados. El 38 % tenían más de cinco días enfermos y el 69 % estaba consumiendo antimicrobianos antes del ingreso. El 23 % padecían de insuficiencia cardiaca congestiva y el 73 % de enfermedad pulmonar obstructiva crónica. El síndrome confusional fue un buen predictor de mortalidad (x2=0,05) (RR=2,8). El encamamiento prolongado no predijo mortalidad a los cinco días (x2=0,43). El uso de antimicrobianos previos incremento el riesgo en (RR=0,8) con (x2=0,05). La insuficiencia cardiaca fue el mejor predictor (x2=0,006) (RR=1,2). La enfermedad pulmonar obstructiva crónica predijo con(x2=0,019) y (RR=1,47). Conclusiones: se considera como factores fuertemente predictivos el antecedente de insuficiencia cardiaca, de enfermedad pulmonar obstructiva crónica y el paciente que acude con síndrome confusional.


ABSTRACT Introduction: community acquired pneumonia is an important health problem around the world, and in Cuba it is the fourth cause of death. Prognostic indexes help to detect early the patients at high risk, but they have low sensibility and specificity. Objective: to determine the mortality prognostic factors in the community acquired pneumonia during the anamnesis. Material and methods: analytic, retrospective, longitudinal study in a group applying non-parametric tests and relative risk calculation. Results: age: 78 ± 10 years; 53 % of women. Global mortality of 57 %; 53 % had antecedents of diabetes mellitus; 34 % had previous cerebro-vascular disease, and 42 % were bedridden patients. 38 % was sick more than five days and 69 % took antimicrobials before being admitted. 23 % suffered congestive heart failure and 73 % chronic obstructive pulmonary disease. Confusional syndrome was a good predictor of mortality (x2=0.05) (RR=2.8). Long confinement to bed did not predict mortality at the fifth day (x2=0.43). The previous use of antimicrobials increased the risk (RR=0.8) con (x2=0.05). Heart failure was the best predictor (x2=0.006) (RR=1.2). Chronic obstructive pulmonary disease predicted with (x2=0.019) y (RR=1.47). Conclusions: antecedents of heart failure and chronic obstructive pulmonary disease, and the patient arriving with confusional syndrome are considered strongly predictive factors.


Subject(s)
Humans , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/mortality , Pneumonia/prevention & control , Prognosis , Mortality , Patient Acuity , Medical History Taking , Retrospective Studies , Longitudinal Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Emergency Medical Services , Analytical Epidemiology , Heart Failure/diagnosis , Inpatients , Intensive Care Units , Migraine Disorders/diagnosis
4.
Arq. neuropsiquiatr ; 77(7): 509-520, July 2019. tab
Article in English | LILACS | ID: biblio-1011369

ABSTRACT

ABSTRACT Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.


RESUMO A migrânea (enxaqueca) crônica determina uma carga pessoal, social e econômica significativa e é caracterizada por dor de cabeça presente em quinze ou mais dias por mês por ao menos três meses, com no mínimo oito dias de cefaleia migranosa a cada mês. É frequentemente associada ao uso excessivo de medicação analgésica ou antimigranosa aguda e isso não deve ser negligenciado. Este consenso foi elaborado por um grupo de membros da Sociedade Brasileira de Cefaleia, para descrever as evidências atualmente disponíveis e fornecer recomendações relacionadas ao tratamento farmacológico e não farmacológico da migrânea crônica. Estratégias de retirada na cefaleia por uso excessivo de medicamentos também são descritas, assim como os riscos dos tratamentos durante a gravidez e a amamentação. O topiramato oral e as injeções de toxina onabotulínica A são os únicos tratamentos que receberam a recomendação classe A, enquanto que o valproato, a gabapentina e a tizanidina receberam recomendação classe B, juntamente com acupuntura, biofeedback e mindfulness. Os anticorpos monoclonais anti-CGRP ou anti-CGRPr, ainda não disponíveis no Brasil, são novos fármacos promissores, já aprovados em outros países para o tratamento profilático da migrânea, cuja eficácia na migrânea crônica ainda está por ser definitivamente comprovada.


Subject(s)
Humans , Societies, Medical , Consensus , Migraine Disorders/therapy , Brazil , Chronic Disease , Migraine Disorders/classification , Migraine Disorders/diagnosis
6.
Rev. cuba. enferm ; 34(3): e1395, jul.-set. 2018. tab
Article in Spanish | LILACS, BDENF, CUMED | ID: biblio-1099051

ABSTRACT

RESUMEN Introducción: La cefalea es uno de los trastornos más comunes del sistema nervioso en todo el mundo, frecuentemente es signo de otras enfermedades. Mientras la medicina occidental trata los síntomas con medicamentos, los médicos alternativos tratan la causa con acupuntura para proporcionar alivio duradero. Objetivo: Evaluar la efectividad de la acupuntura con microsistema de cara como tratamiento de pacientes con cefalea migrañosa. Métodos: Estudio cuasiexperimental de tipo casos-controles con 100 pacientes que asistieron a la Clínica del Dolor del Hospital "Dr. Ambrosio Grillo Portuondo", en Santiago de Cuba, con diagnóstico de cefalea migrañosa, desde enero de 2014 a noviembre de 2015. Al grupo estudio se aplicó acupuntura con microsistema de cara; al grupo control, medicamentos. La información se obtuvo de las historias clínicas, el dolor se valoró con la escala analógica visual del dolor. Se aplicó Ji cuadrado de homogeneidad para la identificar diferencias significativas entre las proporciones de efectividad de uno y otro tratamiento, con un nivel de significación (α;= 0,05). Resultados: Predominó el sexo femenino (70,00 por ciento), el grupo etareo 18-39 años, de ellos 40 en el grupo estudio (80,00 por ciento), 43 en el control (86,00 por ciento). En el grupo estudio el 82,00 por ciento de los pacientes quedó sin dolor desde la primera sesión del tratamiento, el 18,00 por ciento con dolor disminuido. Al final del tratamiento el 98,00 por ciento del grupo estudio quedó sin dolor contra el 96,00 por ciento del grupo control. Conclusión: La acupuntura con microsistema de cara es un método alternativo efectivo en el tratamiento de la cefalea migrañosa(AU)


ABSTRACT Introduction: Headache is one of the most common nervous system disorders worldwide. It is frequently a sign of other diseases. While Western medicine treats symptoms with medications, alternative practitioners treat the cause with acupuncture to provide long-lasting relief. Objective: To evaluate the effectiveness of acupuncture with a facial microsystem as a treatment for patients with migraine headache. Methods: Quasiexperimental case-control study with 100 patients who attended the Pain Clinic at Dr. Ambrosio Grillo Portuondo Hospital in Santiago de Cuba, with a diagnosis of migraine headache, from January 2014 to November 2015. The study group was applied acupuncture with a facial microsystem. The control group was treated with medicines. The information was obtained from the medical records. The pain was assessed using the Visual Analogue Scale. Chi-square test of homogeneity was applied in order to identify significant differences between the proportions of effectiveness of one treatment and another, with a level of significance α =0.05. Results: There was predominance of the female sex (70.00 percent), age group 18-39 years, among them 40 in the study group (80.00 percent) and 43 in the control group (86.00 percent). In the study group, 82.00 percent of patients remained without pain from the first session of treatment and 18.00 percent with pain decreased. At the end of the treatment, 98.00 percent of the study group remained without pain in opposition to 96.00 percent of the control group. Conclusion: Acupuncture with a facial microsystem is an effective alternative method in the treatment of migraine headache(AU)


Subject(s)
Humans , Female , Adult , Acupuncture Therapy/methods , Pain Clinics , Evaluation of the Efficacy-Effectiveness of Interventions , Migraine Disorders/diagnosis , Acupuncture Analgesia/adverse effects , Treatment Outcome , Medicine, Chinese Traditional/methods
7.
Arq. neuropsiquiatr ; 76(9): 582-587, Sept. 2018. tab
Article in English | LILACS | ID: biblio-973948

ABSTRACT

ABSTRACT The objective of the present study was to assess the presence of cognitive deficits in patients with chronic migraine, and to assess the main factors that trigger cognitive disorders, such as comorbidities or the use of medications. Methods: Chronic migraine and control groups were interviewed in a case-control study. The frequency and intensity of the headache, medication used and associated comorbidities were determined. All patients were submitted to an extended neuropsychological assessment. Results: The chronic migraine group (n = 30) had a worse performance in the Montreal Cognitive Assessment Test (p = 0.00), Verbal Fluency (p = 0.00), Stroop (p = 0.00), Clock Drawing Test (p = 0.00), Digit Span (p = 0.00) and Matrix Reasoning (p = 0.01). After statistical adjustment by linear regression, migraine continued to be the only relevant factor in the poorer performance in the Montreal Cognitive Assessment, Verbal Fluency, Clock Drawing and Stroop tests. Conclusion: Patients with chronic migraine have cognitive deficits in multiple tasks, regardless of the presence of comorbidities or the use of medications.


RESUMO O objetivo do presente estudo foi avaliar a presença de déficits cognitivos em pacientes com migrânea crônica e avaliar os principais fatores que desencadeiam transtornos cognitivos, como comorbidades e uso de medicações. Métodos: Pacientes com migrânea crônica (n = 30) e controles foram entrevistados, em um estudo caso-controle. A frequência e intensidade da cefaleia, medicações utilizadas e comorbidades associadas foram determinadas. Todos os pacientes foram submetidos a uma avaliação neuropsicológica estendida. Resultados: Os pacientes com migrânea crônica apresentaram uma pior performance no Montreal Cognitive Assessment (p = 0.00), Fluência Verbal (p = 0.00), Teste de Stroop (p = 0.00), Teste do Relógio (p = 0.00), Subteste Dígitos (p = 0.00) e Raciocínio matricial da WAIS-III (p = 0.01). Após ajuste estatístico através de Regressão Linear, a migrânea se manteve como único fator relevante para pior desempenho em MoCA, Fluência verbal, Teste do relógio e Teste de Stroop. Conclusão: Pacientes com migrânea crônica apresentam déficits cognitivos incluindo múltiplas tarefas, independentes da presença de comorbidades e uso de medicações.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Cognitive Dysfunction/psychology , Migraine Disorders/psychology , Neuropsychological Tests , Verbal Behavior/physiology , Case-Control Studies , Linear Models , Chronic Disease , Cross-Sectional Studies , Educational Status , Cognitive Dysfunction/complications , Migraine Disorders/diagnosis
8.
Arq. neuropsiquiatr ; 75(7): 446-450, July 2017. tab, graf
Article in English | LILACS | ID: biblio-888291

ABSTRACT

ABSTRACT Objective To analyze the applicability of the Portuguese version of ID-MigraineTM in a sample of Brazilian patients. Methods Patients with headache were recruited from the neurology outpatient clinic of a tertiary hospital and submitted to the ID-MigraineTM questionnaire. The diagnosis of headache was made according to the ICHD-2 criteria. Results Of the 232 patients, 86% had migraine. The questionnaire showed a sensitivity of 92% (95%CI, 88% to 95%), specificity of 60% (95%CI, 43% to 77%) and a positive predictive value of 93% (95%CI, 89% to 96%). Discussion Our results were similar to other international studies of the ID-MigraineTM application. The Portuguese version is considered easy to use, and an appropriate screening tool for migraine diagnosis in our sample. Conclusion Considering the characteristics of our health system, we can infer that this questionnaire would be beneficial in a Brazilian primary care setting; however, more studies are necessary.


RESUMO Objetivo Analisar a aplicabilidade da versão em Português do ID-MigraineTM em uma amostra de pacientes brasileiros. Métodos Pacientes com cefaleia foram recrutados no Ambulatório de Neurologia de um hospital terciário e submetidos ao questionário ID-MigraineTM. O diagnóstico de cefaleia foi feito de acordo com os critérios da ICHD-2. Resultados Dos 232 pacientes, 86% tinham enxaqueca. O questionário apresentou sensibilidade de 92% (IC de 95% 88% a 95%), especificidade de 60% (IC de 95% 43% a 77%) e valor positivo preditivo positivo de 93% (IC 95 89% a 96%). Discussão Nossos resultados foram similares a outros estudos mundiais de aplicação do ID-MigraineTM. A versão em Português é considerada de fácil utilização, sendo uma ferramenta adequada para triagem diagnóstica de migrânea em nossa amostra. Conclusão Considerando as características do nosso sistema de saúde, podemos inferir que este questionário seria útil nos serviços primários de saúde brasileiros, porém mais estudos são necessários.


Subject(s)
Humans , Male , Female , Adult , Surveys and Questionnaires , Migraine Disorders/diagnosis , Brazil , Cross-Sectional Studies , Predictive Value of Tests , Reproducibility of Results , Sensitivity and Specificity
9.
Autops. Case Rep ; 7(2): 61-68, Apr.-June 2017. ilus, tab
Article in English | LILACS | ID: biblio-905252

ABSTRACT

Migraine is a neurological entity and a well-known independent risk factor for cerebral infarction, which mostly afflicts the young female population. Researching focal neurological signs in this subset of the population with the diagnosis of a neurological ischemic event should always take into account the migraine as the etiology or as an associated factor. The etiology of central nervous system (CNS) ischemia is considerable. Migraine, although rare, also may be included in this vast etiological range, which is called migrainous infarction. In this setting, the diagnostic criteria required for this diagnosis is extensive. Herein, we present the case of a female adolescent who submitted to the emergency facility complaining of diplopia, dysarthria, and imbalance, which started concomitantly with a migrainous crisis with aura­a challenging clinical case that required extensive research to address all possible differential diagnoses.


Subject(s)
Humans , Female , Adolescent , Brain Ischemia/diagnosis , Cerebral Infarction/etiology , Migraine Disorders/diagnosis , Ocular Motility Disorders/diagnosis , Diagnosis, Differential , Risk Factors
10.
Rev. medica electron ; 39(1): 4-14, ene.-feb. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-845384

ABSTRACT

Introducción: la cefalea es toda sensación dolorosa que tiene lugar en la parte superior de la cabeza, desde el reborde orbitario hasta la nuca. Constituye la primera causa de acudir al neurólogo y uno de los motivos más frecuentes en consultas de Medicina Interna. La cefalea tipo tensión es frecuente en la práctica diaria y la más invalidante desde los puntos de vistas físico, social, económico y psicológico. Objetivo: mostrar la actuación de Enfermería en el alivio de la migraña y describir la efectividad de la digitopuntura en pacientes con cefalea migrañosa, del Policlínico Contreras, primer trimestre de 2014. Materiales y métodos: estudio observacional, descriptivo y transversal. El grupo de estudio, 120 pacientes que acudieron a la consulta de Medicina Natural y Tradicional. Resultados: la edad de mayor incidencia 25-34 años, con 47.4 %. Prevaleció el sexo femenino, en un 70 %; la duración del dolor mostró un 43.3 % de afectación. Transcurrió entre las 4 y 8 horas, y siempre tuvo relación con el estrés, en 44.2 %; en un 69.2 % existió relación del dolor con la ingestión de alimentos. Se alivió con el sueño el 61.7 %, y el 52,5 % alcanzaron estado evolutivo excelente. Conclusiones: la aplicación de la digitopuntura a pacientes con cefalea migrañosa contribuyó a que los casos estudiados evolucionaran satisfactoriamente, expresando alivio del dolor. El tratamiento demostró efectividad y contribuyó a la disminución de drogas utilizadas en esta entidad, disminución de gastos económicos que implica el consumo de las mismas; lograr reincorporar a la vida laboral y social en un menor tiempo al paciente (AU).


Introduction: cephalalgia is any painful sensation occurring in the superior part of the head, from the orbital ridge to the nape. It is the first cause of visiting a neurologist and one of the most frequent causes of Internal Medicine consultations. The tension-kind cephalalgia is frequent in daily practice and the most invaliding one from the physical, social, economic and psychological point of view. Aim: to show Nursery behavior in migraine alleviation and to describe the digitopuncture effectiveness in patients with migrainous cephalalgia from Contreras Policlinic in the first trimester of 2014. Materials and methods: observational, descriptive, cross-sectional study. The studied group was 120 patients assisting the consultation of Natural and Traditional Medicine. Outcomes: the 25-34 age group was the one that showed higher incidence, with 47.4 %. The female sex prevailed with 70 %; pain lasting had 44.3 % of affectation. It lasted between 4 and 8 hours, always related to stress in 44.2 %. There it was a relation between pain and food intake in 69.2 %. 61.7 % of the cases were lessened with sleep, and 52.5 % achieved an excellent evolving status. Conclusions: Acupuncture application to patients with migrainous cephalalgia contributed to the satisfactory evolution of the studied cases: The patients expressed pain relieve. The treatment showed effectiveness and facilitated the decrease of drug usage in this entity, also diminishing the economic expenses its use implies; the patients reincorporated to social and working life in a shorter time period (AU).


Subject(s)
Humans , Male , Female , Adult , Acupuncture/methods , Migraine Disorders/diagnosis , Migraine Disorders/nursing , Migraine Disorders/rehabilitation , Nursing Care/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Study , Psychological Distress , Massage/nursing , Medicine, Chinese Traditional/methods
11.
Arq. neuropsiquiatr ; 74(8): 626-631, Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-792507

ABSTRACT

ABSTRACT Objectives Inflammatory molecules and neurotrophic factors are implicated in pain modulation; however, their role in primary headaches is not yet clear. The aim of this study was to compare the levels of serum biomarkers in migraine and tension-type headache. Methods This was a cross-sectional study. We measured serum levels of adiponectin, chemokines, and neurotrophic factors in patients with migraine and tension-type headache. Depression and anxiety symptoms, headache impact and frequency, and allodynia were recorded. Results We included sixty-eight patients with migraine and forty-eight with tension-type headache. Cutaneous allodynia (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), and ADP (p = 0.017) were significantly higher in migraine than in tension-type headache. The differences occurred independently of anxiety and depressive symptoms, frequency and impact of headache, and the presence of pain. Conclusions This study showed higher CCL3/MIP-1α, CCL5/RANTES, and ADP levels in migraine in comparison with tension-type headache. Our findings suggest distinctive roles of these molecules in the pathophysiology of these primary headaches.


RESUMO Objetivos Moléculas inflamatórias e fatores neurotróficos estão implicados na modulação dolorosa, contudo, seu papel nas cefaleias primárias não é claro. O objetivo do presente estudo foi comparar níveis de biomarcadores séricos na migrânea e cefaleia do tipo tensional. Métodos Este foi um estudo transversal, no qual foram avaliados níveis de adiponectina, quimiocinas e fatores neurotróficos em pacientes com migrânea e cefaleia do tipo tensional. Sintomas depressivos e ansiosos, o impacto e a frequência da cefaleia e alodínea foram registrados. Resultados Foram incluídos 68 pacientes com migrânea e 48 pacientes com cefaleia do tipo tensional. A alodínia cutânea (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), e adiponectina (p = 0.017) foram maiores na migrânea, independentemente de sintomas depressivos e ansiosos, frequência e impacto da cefaleia. Conclusões Níveis de CCL3/MIP-1α, CCL5/RANTES e adiponectina foram maiores na migrânea do que na cefaleia do tipo tensional, sugerindo papeis distintos destas moléculas na fisiopatologia destas duas cefaleias primárias.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tension-Type Headache/diagnosis , Chemokine CCL5/blood , Brain-Derived Neurotrophic Factor/blood , Chemokine CCL3/blood , Migraine Disorders/diagnosis , Biomarkers/blood , Cross-Sectional Studies , Tension-Type Headache/blood , Migraine Disorders/blood
12.
Braz. j. otorhinolaryngol. (Impr.) ; 82(4): 397-402, July-Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-794990

ABSTRACT

ABSTRACT INTRODUCTION: Vestibular migraine (VM) is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. OBJECTIVE: To analyze the clinical and epidemiological profile of patients with VM. METHODS: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. RESULTS: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years; 65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. CONCLUSION: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism.


Resumo Introdução: Migrânea vestibular (MV) corresponde a um dos mais frequentes diagnósticos em otoneurologia, o que justifica a importância de seu estudo, embora tenha sido apenas recentemente reconhecida como entidade nosológica. Objetivo: Analisar os perfis clínico e epidemiológico dos pacientes atendidos em um ambulatório de migrânea vestibular. Método: Estudo retrospectivo, observacional e descritivo, com análise de prontuários dos pacientes do ambulatório de MV. Resultados: O ambulatório é composto por 94,1% de mulheres e 5,9% de homens, com média de idade 46,1 anos. O tempo de cefaleia foi superior ao de vertigem em 65,6% dos pacientes. Observou-se correlação entre os sintomas e o período menstrual. A maioria (61,53%) dos indivíduos apresentou algum sintoma auditivo, sendo o zumbido o mais frequente, embora a audiometria tenha sido normal em 68,51%. A vectoeletronistagmografia apresentou-se normal em 67,34%, enquanto 10,20% apresentaram hiporreflexia e 22,44% hiperreflexia vestibular. Exames eletrofisiológicos não mostraram alterações na maioria dos pacientes. Glicemia dejejum e curva glicêmica foram normais para a maioria dos pacientes, enquanto a curva insulinêmica mostrou-se alterada em 75% dos indivíduos. 82% dos indivíduos com MV apresentaram alguma alteração relativa ao metabolismo dos carboidratos. Conclusão: Migrânea vestibular acomete, predominantemente, mulheres de meia idade, com cefaleia migranosa e vertigem, sendo a primeira de instalação mais precoce. O exame físico no período intercrise, bem como as avaliações auditiva e vestibular, mostram-se, geralmente, normais. O tipo de alteração vestibular mais observado foi a hiperreflexia labiríntica. A maioria os indivíduos avaliados apresentou alterações relativas ao metabolismo dos carboidratos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Vestibular Diseases/epidemiology , Migraine Disorders/epidemiology , Audiometry, Pure-Tone , Vestibular Function Tests , Brazil/epidemiology , Vestibular Diseases/diagnosis , Cross-Sectional Studies , Retrospective Studies , Vestibular Evoked Myogenic Potentials , Migraine Disorders/diagnosis
13.
Arq. neuropsiquiatr ; 74(5): 416-422, May 2016. tab, graf
Article in English | LILACS | ID: lil-782032

ABSTRACT

ABSTRACT Approximately 1% of the general population suffers from vestibular migraine. Despite the recently published diagnostic criteria, it is still underdiagnosed condition. The exact neural mechanisms of vestibular migraine are still unclear, but the variability of symptoms and clinical findings both during and between attacks suggests an important interaction between trigeminal and vestibular systems. Vestibular migraine often begins several years after typical migraine and has a variable clinical presentation. In vestibular migraine patients, the neurological and neurotological examination is mostly normal and the diagnosis will be based in the patient clinical history. Treatment trials that specialize on vestibular migraine are scarce and therapeutic recommendations are based on migraine guidelines. Controlled studies on the efficacy of pharmacologic interventions in the treatment of vestibular migraine should be performed.


RESUMO Cerca de 1% da população apresentam o diagnóstico de migrânea vestibular. Apesar dos critérios diagnósticos terem sido publicados recentemente, ainda é uma condição subdiagnosticada. Os mecanismos neurais exatos da migrânea vestibular ainda não estão claros, mas a variabilidade dos sintomas e achados clínicos durante e entre os ataques sugere uma interação importante entre os sistemas trigeminal e vestibular. A migrânea vestibular geralmente começa alguns anos após a migrânea típica e tem apresentação clínica variável. Em pacientes com migrânea vestibular, o exame neurológico e otoneurológico são geralmente normais e o diagnóstico é baseado na história clínica do paciente. Estudos sobre tratamento da migrânea vestibular são escassos e recomendações terapêuticas são baseadas em diretrizes do tratamento da migrânea. Estudos controlados sobre a eficácia das intervenções farmacológicas para o tratamento da migrânea vestibular devem ser realizados.


Subject(s)
Humans , Vestibular Diseases/diagnosis , Migraine Disorders/diagnosis , Vestibular Diseases/complications , Vestibular Diseases/physiopathology , Vestibular Diseases/drug therapy , Vertigo/complications , Neurotransmitter Agents/therapeutic use , Diagnosis, Differential , Dizziness/complications , Migraine Disorders/complications , Migraine Disorders/physiopathology , Migraine Disorders/drug therapy
14.
Arq. neuropsiquiatr ; 73(12): 1005-1008, Dec. 2015. graf
Article in English | LILACS | ID: lil-767617

ABSTRACT

Objective The objective of this study was to prospectively evaluate the International Classification of Headache Disorders I (ICHD-I) diagnostic criteria for migraine in children and adolescents. Methods 150 pain diaries were analyzed during an initial consultation. The duration of migraine headache attacks were divided into 2 groups: Group I, for attacks lasting > 2 hours, and Group II, for attacks lasting < 2 hours.The two groups were statistically compared using Fisher’s exact test (p < 0.05). Results In this study, 51(34%) subjects were male and 99 (66%) were female, aged 7–15 years. Fisher’s exact test demonstrated that the ICHD-3 beta had a 58% sensitivity for Group I diagnoses and a 94% sensitivity for Group II diagnoses (p < 0.001). Conclusion The current ICHD-3 beta classification improves and advances migraine diagnosis in children and adolescents; however, more research is needed to identify additional characteristics of headache in this age group.


Objetivo O objetivo deste estudo foi avaliar prospectivamente os critérios diagnósticos da Classificação Internacional das Cefaleias 3 beta (CIC-3) de enxaqueca em crianças e adolescentes. Métodos 150 diários de dor foram analisados durante a consulta inicial. A duração dos episódios de enxaqueca foram divididos em dois grupos: Grupo I, para episódios com duração > 2 horas, e Grupo II, para os episódios < 2 horas. Os dois grupos foram comparados estatisticamente pelo teste exato de Fisher (p < 0,05). Resultados Neste estudo, 51 (34%) pacientes eram do sexo masculino e 99 (66%) eram do sexo feminino, com idade entre 7-15 anos. O teste exato de Fisher demonstrou que a CIC-3 beta teve sensibilidade de 58% para o diagnóstico do Grupo I e 94% para o diagnóstico do Grupo II (p < 0,001). Conclusão A atual classificação CIC-3 beta melhora e avança diagnóstico de enxaqueca em crianças e adolescentes; no entanto, mais pesquisas são necessárias para identificar as características adicionais de cefaléia nessa faixa etária.


Subject(s)
Adolescent , Child , Female , Humans , Male , International Classification of Diseases , Migraine Disorders/diagnosis , Migraine Disorders/classification , Migraine Disorders/complications , Pain Measurement , Prospective Studies , Sensitivity and Specificity
15.
Braz. j. otorhinolaryngol. (Impr.) ; 81(5): 485-490, Sept.-Oct. 2015. tab
Article in English | LILACS | ID: lil-766295

ABSTRACT

ABSTRACT INTRODUCTION: There is a strong association between vertigo and migraine. Vestibular migraine (VM) was described in 1999, and diagnostic criteria were proposed in 2001 and revised in 2012. OBJECTIVE: To compare the diagnostic criteria for VM proposed in 2001 with 2012 criteria with respect to their diagnostic power and therapeutic effect of VM prophylaxis. METHODS: Clinical chart review of patients attended to in a VM clinic. RESULTS: The 2012 criteria made the diagnosis more specific, restricting the diagnosis of VM to a smaller number of patients, such that 87.7% of patients met 2001 criteria and 77.8% met 2012 criteria. Prophylaxis for VM was effective both for patients diagnosed by either set of criteria and for those who did not meet any of the criteria. CONCLUSIONS: The 2012 diagnostic criteria for VM limited the diagnosis of the disease to a smaller number of patients, mainly because of the type, intensity, and duration of dizziness. Patients diagnosed with migraine and associated dizziness demonstrated improvement after prophylactic treatment of VM, even when they did not meet diagnostic criteria.


RESUMO Introdução: Há forte associação entre vertigem e enxaqueca. A migrânea vestibular (MV) foi descrita em 1999 e critérios diagnósticos foram propostos em 2001 e revisados em 2012. Objetivo: Comparar os critérios diagnósticos para MV propostos em 2001 com os de 2012, através de seu poder diagnóstico e efeito terapêutico da profilaxia da MV. Método: Revisão de prontuários de pacientes atendidos em uma clínica de MV. Resultados: Os critérios de 2012 tornaram o diagnóstico mais específico, restringindo a MV a um número menor de pacientes, sendo que 87,7% dos pacientes preencheram os critérios de 2001 e 77,8% preencheram os critérios de 2012. O tratamento profilático para MV foi eficaz tanto para pacientes diagnosticados por algum dos critérios quanto para aqueles que não se enquadravam em qualquer critério. Conclusões: Os critérios diagnósticos de 2012 para MV restringiram o diagnóstico da doença para um menor número de pacientes, principalmente por causa do tipo de tontura, a sua intensidade e duração. Pacientes com enxaqueca diagnosticada e tontura associada apresentaram melhora após o tratamento profilático da MV mesmo quando não preenchem critérios diagnósticos. (c) 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.


Subject(s)
Female , Humans , Male , Middle Aged , Migraine Disorders/diagnosis , Vertigo/diagnosis , Vestibule, Labyrinth/physiopathology , Cross-Sectional Studies , Migraine Disorders/physiopathology , Pain Measurement , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Vertigo/physiopathology
16.
Rev. méd. Chile ; 143(1): 47-55, ene. 2015. tab
Article in Spanish | LILACS | ID: lil-742550

ABSTRACT

Background: Health care workers are exposed to high stress levels and psychosocial risks. The imbalance between the invested efforts and received rewards acquires special importance in this setting. Aim: To assess the psychosocial risk level and its relationship with depression, distress and psychotropic drug use among health care workers. Material and Methods: Seven hundred eighty two workers (602 females; 180 males) answered self-administered questionnaires to measure psychosocial risk and mental health. Results: Twenty five percent of respondents used psychotropic drugs, 34% had a high level of distress and 23% had depressive symptoms. They also reported a low level of decisional latitude (48%), high emotional demands (47%), low social support (41%) and a significant effort-reward imbalance (67%). Those exposed to job strain (high demands and low decisional latitude), iso-strain (job strain plus low social support), and effort-reward imbalance were twice as likely to suffer symptoms of depression and elevated distress compared to non-exposed subjects. Conclusions: There are high levels of psychosocial stress among health care workers.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Epilepsy/diagnosis , Epilepsy/epidemiology , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Cohort Studies , Diagnosis, Differential , Emergency Service, Hospital/statistics & numerical data , Epilepsy/mortality , Ischemic Attack, Transient/mortality , Longitudinal Studies , Myocardial Infarction/epidemiology , Prevalence , Prognosis , Prospective Studies , Retrospective Studies , Risk Assessment , Survival Rate , Stroke/epidemiology , Time Factors
17.
Biomédica (Bogotá) ; 34(4): 506-513, oct.-dic. 2014. tab
Article in Spanish | LILACS | ID: lil-730933

ABSTRACT

La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum , cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente.


Histoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.


Subject(s)
Child , Humans , Male , Diagnostic Errors , Histoplasmosis/diagnosis , Meningitis, Fungal/diagnosis , Acute Kidney Injury/etiology , Amphotericin B/adverse effects , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Cerebrospinal Fluid/microbiology , Device Removal , Headache/etiology , Histoplasma/immunology , Histoplasma/isolation & purification , Histoplasmin/blood , Histoplasmin/cerebrospinal fluid , Histoplasmosis/complications , Histoplasmosis/cerebrospinal fluid , Histoplasmosis/drug therapy , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Hydrocephalus/surgery , Hypokalemia/etiology , Immunocompetence , Itraconazole/therapeutic use , Meningitis, Fungal/complications , Meningitis, Fungal/cerebrospinal fluid , Meningitis, Fungal/drug therapy , Meningitis, Fungal/microbiology , Migraine Disorders/diagnosis , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/microbiology , Staphylococcal Infections/etiology , Staphylococcus epidermidis/drug effects , Vancomycin Resistance , Ventriculoperitoneal Shunt/adverse effects
18.
Arq. neuropsiquiatr ; 72(2): 99-103, 02/2014. tab
Article in English | LILACS | ID: lil-702550

ABSTRACT

Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. Objectives : To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Method : Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Results : Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). Conclusion : TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center. .


A diferenciação clínica entre as cefaleias primárias e as disfunções temporomandibulares (DTM) pode ser desafiadora. Objetivos : Investigar a relação entre DTM e cefaleias primárias conduzindo uma avaliação face a face entre pacientes de um centro de dor orofacial e de um centro terciário de cefaleia. Método : A amostra consistiu de 289 indivíduos avaliados consecutivamente em um centro terciário de cefaleia e 78 indivíduos de uma clínica orofacial. Resultados : A migrânea foi diagnosticada em 79,8% dos pacientes do centro de cefaleia e 25,6% dos pacientes do centro de dor orofacial. A cefaleia do tipo tensional esteve presente em 20,4% e 46,1%, enquanto as DTM dolorosas ocorreram em 48,1% e 70,5% respectivamente (p<0,001). Conclusão : DTM é uma comorbidade importante da migrânea e difícil de distinguir clinicamente da cefaleia do tipo tensional, tanto que esta cefaleia foi mais frequente no centro odontológico do que no centro médico. .


Subject(s)
Adult , Female , Humans , Male , Migraine Disorders/etiology , Temporomandibular Joint Disorders/complications , Tension-Type Headache/etiology , Chronic Disease , Educational Status , Migraine Disorders/diagnosis , Temporomandibular Joint Disorders/diagnosis , Tension-Type Headache/diagnosis
19.
Cuad. Hosp. Clín ; 55(2): 9-16, 2014. ilus
Article in Spanish | LILACS | ID: biblio-972730

ABSTRACT

Pregunta de la investigación ¿Serán factores de riesgo para migraña con aura y sin aura, todos los mencionados en la literatura (psicológicos, hormonales, alimentarios, ambientales, sueño, fármacos) que puedan presentarse en estudiantes universitarios comprendidos entre los 18 a 35 años de edad de la Facultad de Medicina? Objetivos General Determinar si son factores de riesgo para migraña el tipo de alimentación, la altura de 3600 o 4100 m.s.n.m, cambios hormonales, aspectos psicológicos, el sueño y factores ambientales en los estudiantes universitarios de 18 a 35 años de edad pertenecientes a la Facultad de Medicina. Diseño o tipo de estudio Diseño de Casos y Controles de casos incidentes Material y métodos El tamaño de muestra es de 212 pacientes, estudiantes universitarios comprendidos entre los 18 a 35 años...


Research questions Will they be factors of risk for migraine with aura and without aura, all the mentioned ones in the literature (psychological, hormonal, food, environmental, dream, medicaments) that could appear in university students understood between the 18 to 35 years of age of the Faculty of Medicine? Objectives To determine if they are factors ofrisk for migraine the type ofsupply, hormonal changes, psychological aspects, the dream and environmental factors in the university students from 18 to 35 years of age...


Subject(s)
Risk Factors , Migraine Disorders/diagnosis
20.
Arq. neuropsiquiatr ; 71(7): 478-486, July/2013. tab
Article in English | LILACS | ID: lil-679168

ABSTRACT

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.


A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.


Subject(s)
Humans , Migraine Disorders/therapy , Chronic Disease , Comorbidity , Latin America , Migraine Disorders/diagnosis , Risk Factors
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