Migraine preventive treatment failure: A cross-sectional study in a tertiary center in Brazil / Falha no tratamento preventivo da enxaqueca: um estudo transversal em um centro terciário no Brasil

BACKGROUND: In Brazil, there is a scarcity of evidence on migraine burden in patients who have experienced previous preventive treatment failure (PPTF). OBJECTIVE: To evaluate the associations between ≥ 3 PPTF and clinical, psychiatric, and medical history data. METHODS: In a retrospective, cross-sectional study, the medical records of migraine patients who first visited a tertiary specialized clinic were examined. We selected adults of both sexes aged ≥ 18 who attended their first appointment between March and July 2017. Ordinal logistic regression models estimated the associations between number of PPTF (no previous treatment, 1 PPTF, 2, and ≥ 3 PPTF) and chronic migraine, the number of diagnosis exams performed, abortive drugs classes used, and non-pharmacological treatments tried (all categorized as none, 1- 3, and ≥ 4), and severe depression (PHQ-9 ≥ 15) and anxiety (GAD-7 ≥ 15), adjusted for sex, age, and years with disease. RESULTS: Data from 440 patients (72.1 % female) with a mean (SD) age of 37.3 (13.0) years were analyzed. The frequency of no previous treatment was 37.7 % (166/440), while 31.8 % (140/440) showed ≥ 3 PPTF. In patients with ≥ 3 PPTF, 35.7 % (50/140) had episodic, and 64.3 % (90/140) had chronic migraine. Compared to no previous treatment, patients with ≥ 3 PPTF showed higher odds (95 % confidence interval) for chronic migraine [2.10 (1.47, 2.98)], ≥ 4 diagnosis exams [6.59 (3.38, 12.84)], ≥ 4 abortive drug classes [16.03 (9.53, 26.94)], ≥ 4 non-pharmacological treatments [5.91 (3.07,11.35)], and severe depression [1.75 (1.07, 2.88)] and anxiety [1.73 (1.05, 2.85)]. CONCLUSION: Patients first visiting a headache specialist had a high frequency of non-response treatment associated with higher migraine burden in terms of chronification, psychiatric comorbidity, acute medication and non-pharmacological treatment inefficacy, and unnecessary exams.

FUNDAMENTO: No Brasil, há escassez de evidências sobre a carga da enxaqueca em pacientes que apresentaram falha prévia no tratamento preventivo (FTPP). OBJETIVO: Avaliar as associações entre ≥ 3 PPTF e dados clínicos, psiquiátricos e de história médica. MÉTODOS: Em um estudo retrospectivo e transversal, foram examinados os prontuários de pacientes com enxaqueca que visitaram pela primeira vez uma clínica especializada terciária. Foram selecionados adultos de ambos os sexos com idade ≥ 18 anos que compareceram à primeira consulta entre março e julho de 2017. Modelos de regressão logística ordinal estimaram as associações entre número de PPTF (sem tratamento prévio, 1 PPTF, 2 e ≥ 3 PPTF) e enxaqueca crônica, o número de exames de diagnóstico realizados, classes de medicamentos abortivos utilizados e tratamentos não farmacológicos tentados (todos categorizados como nenhum, 1-3 e ≥ 4) e depressão grave (PHQ-9 ≥ 15) e ansiedade (GAD-7 ≥ 15), ajustado por sexo, idade e anos de doença. RESULTADOS: Foram analisados ​​dados de 440 pacientes (72,1% mulheres) com idade média (DP) de 37,3 (13,0) anos. A frequência de nenhum tratamento prévio foi de 37,7% (166/440), enquanto 31,8% (140/440) apresentaram ≥ 3 PPTF. Em doentes com ≥ 3 PPTF, 35,7% (50/140) tiveram enxaqueca episódica e 64,3% (90/140) tiveram enxaqueca crónica. Em comparação com nenhum tratamento anterior, pacientes com ≥ 3 PPTF apresentaram chances mais altas (intervalo de confiança de 95%) para enxaqueca crônica [2,10 (1,47, 2,98)], ≥ 4 exames de diagnóstico [6,59 (3,38, 12,84)], ≥ 4 classes de medicamentos abortivos [16,03 (9,53; 26,94)], ≥ 4 tratamentos não farmacológicos [5,91 (3,07;11,35)] e depressão grave [1,75 (1,07; 2,88)] e ansiedade [1,73 (1,05; 2,85)]. CONCLUSÃO: Os pacientes que consultaram pela primeira vez um especialista em dor de cabeça tiveram uma alta frequência de não resposta ao tratamento associada a maior carga de enxaqueca em termos de cronificação, comorbidade psiquiátrica, medicação aguda e ineficácia do tratamento não farmacológico e exames desnecessários.

Adherence to Isoniazid Preventive Therapy (IPT) among Children in Close Contact with Adult Pulmonary Tuberculosis (PTB) Patients

Introduction:Tuberculosis (TB) is among the top ten leading cause of morbidity and mortality globally, and studies have shown that adherence to a six Month course of Isoniazid Preventive Therapy (IPT) reducesthe incidence of TB disease in HIV-negative/positive populations at risk of developing active TB disease.Objective:This study was carried out to identify active TB cases among children aged 0-5 years who are in close contact with adult cases of pulmonary TB (PTB), to determine the adherence rate to IPT among these close contacts thatdo not have active TB and to identify factors associated with non adherence if any. Methodology: This study was a prospective descriptive study carried out in Rivers state,Nigeria in two health facilities that offers services for TB diagnosis and treatment.Ethical approval for the study was obtained from the Rivers State Ministry of Health while verbal consent was obtained from the parents/caregivers of the children. Children aged 0-5 years who were in close contact with newly diagnosed PTB cases were recruited for the study. They were screened for HIV and evaluated for TB using clinical features and standard laboratory investigations. Those without active TB disease were commenced on isoniazid preventive therapy (IPT) for six months at a daily dose of 5mg/kg after adherence counselling and followed up at the health centres. Obtained data was analysed using Epi Info Version 7.2.3.1statistical software. Descriptive statistics was used while the test for association between variables was done with chi-square test at p ≤ 0.05 level of significance. Frequency tables were used for presentation of results.Results: A total of Sixty three children were recruited for the study 37 (58.7%) were males while 26 (41.3%) were females. Thirty two (50.8%) were children of index PTB patients while 29 (46.1%) belonged to lower socio-economic class. Their age ranged from 4 months to 4 years with a mean age of 2.84years ±1.27years. Six (16.2%) out of the 37 males and 2 (7.7%) out of the 26 females were confirmed to have active TB, giving a TB prevalence of 12.7%. The gender difference was not statistically significant (p= 0.32). Of the fifty five children that commenced INH in the first Month, only twenty four of them completed the six Month course of INH, giving an IPT adherence rate of 49.6%. Identified reasons for non adherence includes ‘My child is not sick’, ‘No transport Money’, ‘My child is writing exams”.“My child is tired of the drugs”, “the Health workers are not friendly’ and ‘long waiting time before collecting medications”.Conclusion: Early contact tracing is important for early detection of TB cases in children. Adherence to IPT in this study is low and strategies like community tracing of defaulters using trained social workers and community nurses as well as use of well-supervised and convenient ambulatory treatment centres that are manned by trained lower cadre health staff can improve adherence.

Leprosy Research and International Collaboration / 나학회지

Leprosy is still a public health problem in many geographical areas with annual reported cases over 200,000 worldwide in 2016. Despite a steady decrease in its overall incidence last ten years, there has been an increase in its reported cases in certain hot spots. In order to accelerate the control of leprosy, the World Health Organization(WHO) published “Global Leprosy Strategy 2016-2020: Accelerating towards a leprosy-free world.” In addition, WHO published recently for the first time “Guidelines for the Diagnosis, Treatment, and Prevention of Leprosy” in June 2018. For the preparation of the Guidelines, WHO formed a Guideline Development Group (GDG), and GDG reviewed the literatures on each subject above and issued recommendations for the topics only based on evidences with a sufficient and reasonable quality. For an example, none of the new diagnostic laboratory tests such as serological and molecular tests was recommended for the diagnosis of leprosy mainly because of lacking systemic field evaluation of a given test which is manufactured in a GMP facility. Likewise, any research related to new treatment regimens, preventive therapy, and vaccines for leprosy control needs to be designed to meet the international norm. In this review, therefore, the contents in the Guidelines were introduced along with research topics in each subject in order to accelerate leprosy control for leprosy-free world. Lastly, an importance of international collaboration for leprosy research and for maintenance of clinical management expertise of the disease in a country where new cases are diminishing was emphasized.

Tuberculosis contact tracing among children and adolescent referred to children's hospital in Rio de Janeiro, Brazil

Objective: To describe the investigation of latent tuberculosis infection and indication for isoniazid preventive therapy in children and adolescents evaluated at the children's hospital. Methods: This retrospective study examines all latent tuberculosis infection subjects with indication for isoniazid preventive therapy attended during 2002-2009 at the pulmonology outpatient clinic from children's hospital in Rio de Janeiro, Brazil. The subjects were classified into three groups by origin: (G1) primary and secondary health units; (G2) children's hospital-pulmonology outpatient clinic; and (G3) children's hospital-specialty outpatient clinics. The association between the variables examined and G1 was analyzed using uni- variate analysis. Results: Of the 286 latent tuberculosis infection cases included 169 (59.1%) were from G1, 56 (19.6%) from G2, and 61 (21.3%) from G3. Latent tuberculosis infection diagnosis without isoniazid preventive therapy prescription was present in 142 (49.6%) cases before arrival at the pulmonology outpatient clinic: 135 (95.1%) from G1, three (2.1%) from G2, and four (2.8%) from G3. Variables associated with G1 were presence of isoniazid preventive therapy criteria before attending the pulmonology outpatient clinic (OR: 62.3; 26.6-146.2), negative HIV infection status (OR: 9.44; 1.16-76.3); contact with pulmonary tuberculosis (OR: 5.57; 1.99-15.5), and residing in Rio de Janeiro city (OR: 1.89; 1.04-3.44). Conclusion: Strategies that increase latent tuberculosis infection identification and isoniazid preventive therapy prescription in primary and secondary health units are urgently needed. .

Assessment of the Use of Malaria Prophylaxis, (Intermittent Preventive Therapy) and Its Related Outcome among Pregnant Women in Imo State, Nigeria.

Aims: The aim of this study was to assess the use of malaria prophylaxis and its related outcome among pregnant women in Imo state. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Six health facilities; the most prominent one from the urban and rural areas of each of the three geopolitical zones of the state was selected, between August and November 2013. Methodology: Pregnant women in their third trimester attending ante-natal care clinics were involved, and for multiparas only those who used the present facility during their last pregnancy were studied. All eligible parturient who gave consent (432) were studied using a pretested, interviewer administered questionnaire. Data analysis was done with SPSS statistical software; version 20 and significance level was set at p value of less than 0.05. Results: The mean age of the parturient was 27.9±6.1 years. Though majority of the pregnant women (64%) used sulfadoxine-pyrimethamine for malaria prophylaxis, a sizeable proportion (9.8%) used chloroquine. Most of the pregnant women (94.7%) used one form of malaria prophylaxis or the other, the major reason given by the non users was erroneously that they felt healthy (56.5%). Primigravidas were more likely to use malaria prophylaxis compared to multigravidas (OR = 0.44, 95% CI: 0.40 – 0.49). Use of malaria prophylaxis had a protective effect on parturient against malaria episodes (OR = 0.08, 95% CI: 0.03 – 0.23) and low birth weight babies (OR= 0.70, 95% CI: 0.55 – 0.89). Conclusion: Malaria prophylaxis in pregnancy was found to be useful in protecting against malaria episodes and in minimizing incidence of low birth weight babies. A sizeable proportion did not use the recommended regimen, and this calls for persistent health education and public enlightenment campaign especially targeted at the pregnant women.

Comparison of effects of isoniazid plus ART and ART only regimen on the incidence of tuberculosis and HIV progression in HIV positive patients: a retrospective cohort study at two hospitals in Addis Ababa, Ethiopia.

Background: Tuberculosis is a major opportunistic complication of HIV-infection. Antiretroviral therapy (ART) lowers incidence of tuberculosis (TB) but may not be sufficient to control HIV-related tuberculosis, implying a need for additional interventions. The aim of this study was to compare the effects of isoniazid preventive therapy (IPT) plus ART and ART only regimens on the incidence of active TB and HIV progression in HIV positive patients. Methods: The retrospective cohort study was conducted at Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital on 185 patients receiving IPT plus ART and 557 patients receiving ART only. Incidence rates (IR) were used to determine incidence rates of tuberculosis. Time to AIDS and TB event were compared using student t-test. Risks of the outcomes were identified using regression models. Results: The study showed a reduced tuberculosis incidence rate from 7.44 to 1.8 cases/100 person-years [PYs] by IPT plus ART compared to ART only. In reference to ART alone, the IPT plus ART significantly reduced risks of active TB (adjusted odds ratio [AOR] 0.24; 95% CI 0.09–0.63; P=0.004) and had about 16 months of TB protection (P<0.001). In addition, the IPT plus ART delayed HIV progression to AIDS more significantly than the ART only (P=0.029). However, it increased risks of adverse events (AOR 3.33; 95% CI 1.35–8.19; P=0.01) more than the ART only. Conclusions: The wider use of IPT with ART impacts more on incidence of tuberculosis and time to AIDS while simultaneously increasing risks of adverse events than the ART only.

Clinical Course and Prognosis of Migraine Headache in Childhood and Adolescence / 대한소아신경학회지

PURPOSE: The purpose of this study was to evaluate the clinical course and prognosis of migraines in childhood and adolescence, and the influence of preventive therapy on them. METHODS: We recruited 110 children and adolescents with migraines who had been newly diagnosed and treated. Treatment was composed of observation after consultation, acute symptomatic treatment, and preventive therapy. We prescribed topiramate for preventive therapy. The recipients of preventive therapy were those patients who complained of disturbance in daily life due to severe headache. The clinical course was evaluated on the basis of changes in the frequency of migraine attack and was divided into three groups: complete recovery, partial recovery, and non-recovery. The prognosis of migraine was classified into those free from migraine attack, decreased, and persistant. RESULTS: Forty-six (41.8%) of 110 patients completely recovered, and 70 (63.6%) were free from migraine attack. In those suffering from migraines without aura, 38.3% of the patients completely recovered and 59.6% were free from migraine attack. Regarding migraines with aura, 58.5% of the patients completely recovered and 70.7% were free from migraine attack. With respect to cases of probable migraine, 18.2% completely recovered and 59.6% were free from migraine attack. In those receiving preventive treatment, 80.0% of all patients completely recovered and 85.0% were free from migraine. According to migraine type, 66.7% of patients with migraine without aura completely recovered and 80% were free from migraine. In those with migraine and aura, 88.8% of patients completely recovered and 88.8% were free from migraine attack. CONCLUSION: It was estimated that the clinical course and prognosis of migraine patients who were treated by pediatric neurologists were generally good. The clinical course was better in the preventive therapy group. In particular, the effect of preventive treatment and prognosis were optimal in patients with migraine with aura.

The Effect of Preventive Medication on the Improvement of Associated Symptoms in Pediatric Migraine / 대한소아신경학회지

PURPOSE: Migraine is a common disorder in childhood. Its associated symptoms such as nausea or dizziness etc. are frequently complained about and worsen discomfort in cases of pediatric migraine. This study aimed to investigate the relieving effect of preventive therapy on the associated symptoms as well as headache-related characteristics. METHODS: We reviewed the clinical data of subjects aged seven to eighteen years who were diagnosed with migraine and had received prophylactic medication for more than two months. The headache-related characteristics and associated symptoms were analysed with prophylactic drugs at one month and three months after medication. RESULTS: The gender ratio was 11:10 and the mean age was 10.8 years. One month after medication, the duration of headache was reduced in ten of nineteen, a reduction in frequency was observed in fourteen, and improvement in headache intensity in nine. The duration time was shortened in three of eight subjects three months after initiation of medication, the frequency reduced in five, and decreased intensity in seven. Nausea was absent in eight of fifteen one month after treatment, abdominal pain in seven of thirteen, dizziness in five of sixteen, photophobia in six of seventeen, and phonophobia in seven of sixteen. The ratio of disappearance of associated symptoms increased three months after initiation of treatment. CONCLUSION: Prophylactic medication may be effective in relieving migraine-associated symptoms as well as improving headache-related characteristics.

Abordagem profilática contra tuberculose em pacientes infectados pelo HIV em serviço ambulatorial de hospital filantrópico / Prophylactic app roach against tuberculosis in HIV-infected patients in the outpatient service of philanthropic hospital

Introdução: a tuberculose é uma das principais doenças oportunistas que acometem pacientes com HIV/aids. Para reduzir o risco de adoecimento por tuberculose nestes pacientes, o Ministério da Saúde recomenda a realização anual de teste tuberculínico, visando a instituição oportuna de terapia preventiva (TP). Esta abordagem pode ser considerada um parâmetro de avaliação de qualidade de um serviço. Objetivo: analisar a abordagem profilática contra tuberculose em pacientes infectados pelo HIV em serviço ambulatorial de hospital filantrópico. Métodos: estudo retrospectivo de prontuários dos pacientes com HIV/aids que estavam em acompanhamento no Ambulatório de Doenças Infecciosas e Parasitárias da Santa Casa de Misericórdia de Vitória, em dezembro de 2007. Foram explorados fatores que pudessem condicionar a solicitação de PPD e fez-se análise descritiva dos casos em que se realizou TP, bem como dos casos de tuberculose. Resultados: da população de estudo, de 361 pacientes, foram excluídos os que tiveram tuberculose antes ou até os primeiros 3 meses do início do acompanhamento e selecionou-se uma amostra de 334 pacientes. A média de tempo de acompanhamento foi de 5,77 anos e o número médio de PPD por paciente foi de 1,42, observando-se 23,35% dos pacientes sem nenhuma solicitação de PPD. De 178 resultados do primeiro PPD registrados em prontuário, houve 22 exames positivos. Foi instituída TP em 37 casos e ocorreram 15 casos de tuberculose pós-seguimento, correspondendo a uma incidência de 4,5%. Conclusão: foram observadas falhas na abordagem preventiva contra tuberculose, bem como precariedade de registro em prontuário, afetando diretamente a qualidade do atendimento. É importante aprimorar a abordagem médica dirigida à redução do risco de tuberculose nos pacientes com HIV/aids.

Introduction: tuberculosis is one of the main opportunistic diseases which affect HIV/aids patients. In order to reduce the risk of developing tuberculosis in these patients, the Brazilian Health Ministry recommends an annual tuberculin skin test, aimed at establishing oportune preventive therapy (PT). This approach can be considered a parameter of evaluation of the quality of a health service. Objective: analysing the prophylactic approach against tuberculosis in HIV-infected patients in an outpatient clinic of philanthropic hospital. Methods: retrospective study of HIV/aids patients' medical records which were monitored in the Infectious and Parasitary Diseases Ambulatory of the Santa Casa da Misericordia in the city of Vitoria, in December, 2007. Factors that could condition the solicitation of PPD were explored and descriptive analisys was made of the cases in which PT was done, and of tuberculosis cases as well. Results: within the study population of 361, those that had tuberculosis before or up until the first three months from the beginning of themonitoring were excluded and 334 patients were selected. The average monitoring time was 5.77 years and the average number of PPD per patient was 1.42, considering that 23.35% of the patients had no solicitation for PPD. Out of 178 results of the first PPD recorded, 22 were positive. PT was established in 37 cases and there was an occurrence of 15 cases of tuberculosis post-monitoring, corresponding to an incidence of 4.5%. Conclusion: failures in the preventive approach against tuberculosis were observed, as well as the precariousness of medical record keeping, affecting the quality of care directly. Improving the medical approach in reducing the risk of tuberculosis in HIV/aids patients is important.

Preventive treatment of migraine / Tratamiento preventivo de la migraña

Many of the patients with migraine require a preventive therapy to reduce frequency, severity and duration of the crisis, to improve the quality of life, and to improve the responsse to abortive theraphy of attacks. The treatment can be pharmacological, non pharmacological, or the combination of both. This article reviews the indications for the prophylaxis of migraine, the different drugs that are, their mechanisms of actions, their adverse effects therapeutic limitations, and cautions when combining the abortive and prophylactic therapy of migraine.

Muchos de los pacientes con migraña requieren un tratamiento preventivo, para disminuir la frecuencia, la intensidad y la duración de las crisis, mejorar la calidad de vida, y mejorar la respuesta a los tratamientos abortivos para los ataques. El tratamiento puede ser farmacológico, no farmacológico, o la combinación de ambos. En este artículo se revisan las indicaciones para la prevención de la migraña, los diferentes medicamentos que se utilizan, sus mecanismos de acción, efectos adversos y limitaciones terapéuticas, y las precauciones que se deben tener al combinar la terapia abortiva y preventivo de la migraña.

Preventive effect of bionic pulsed electromagnetic fields on bone mineral density / 第三军医大学学报

Objective To observe the short-term and long-term effect of preventive therapy of bionic pulsed electromagnetic fields(BEMF) on the osteoporosis model of Wistar rats.Methods Thirty-two 3-month-old female Wistar rats were randomly divided into 4 groups with 8 rats in each group: control group(group A),desamethasone group(group B),calcitonin group(group C) and BEMF group(group D).Rats in group A were raised normally and received normal saline.Rats in group B were injected with desamethasone only(1 mg/kg,intramuscularly,twice a week).Rats in group C were injected with calcitonin(2 IU/kg,subcutaneously,once a day) and rats in group D were irradiated with BEMF for preventive therapy,simultaneouly all rats were injected with desamethasone(1 mg/kg,intramuscularly,twice a week).The rat bone mineral density(BMD) was measured under narcosis at 4,8,12 weeks after starting preventive therapy.Results No significant differences in BMD were found among all groups 4 weeks later.The significant differences in BMD were observed between group D and group B 8 weeks later and lasted to 12 weeks(P