ID-Migraine™ questionnaire and accurate diagnosis of migraine / Questionário ID-Migraine™ e o adequado diagnóstico da migrânea

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.

Toxoplasma gondii antibody profile in HIV-1-infected and uninfected pregnant women and the impact on congenital toxoplasmosis diagnosis in Rio de Janeiro, Brazil

OBJECTIVE: Compare the anti-T. gondii IgG titer between HIV-1 infected and non HIV-1 infected pregnant women and report three cases of congenital toxoplasmosis resulting from reactivation of infection during pregnancy of HIV-1 infected women. METHODS: This study was conducted among 2,270 pregnant women with chronic Toxoplasma gondii infection (absence of IgM and presence of IgG), including 82 HIV-1 infected and 2,188 non-infected women. RESULTS: The average anti-T. gondii IgG titer was 127 for the 2,188 non-HIV-1 infected women, and 227 for the 82 HIV-1-infected women (p = 0,007). These results suggested that higher anti-T. gondii IgG titers in HIV-1-infected pregnant women may not be indicative of an elevated risk for fetal infection. In this study three cases of congenital toxoplasmosis that resulted from infection reactivation during pregnancy of HIV-1-infected women were manifested by fetal death, symptomatic infection, and infant without symptoms, respectively. In two of these women, a ten-fold increase in IgG levels above used cutoff was observed (2,320 UI/mL and 3,613 UI/mL, respectively). In the third pregnant women anti-T. gondii IgG titers during pregnancy did not rise despite the occurrence of congenital toxoplasmosis (204; 198; 172 UI/mL). CONCLUSIONS: Congenital toxoplasmosis resulting reactivation of infection during pregnancy in the studied group leads us to believe that it is a public health problem, especially in our population, in which seroprevalence of T. gondii infections is high. These findings also suggest that special attention is necessary during pregnancy, because the serologic diagnosis may not be indicative of toxoplasmosis reactivation.