Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study.

BACKGROUND: Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. METHODS: A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. RESULTS: Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients' mean age was 42.85 ± 14.89 (18-95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). CONCLUSIONS: The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions.

Clinical classification of SARS-CoV-2 positive patients;evaluation of laboratory and radiological findings

Introduction: The sudden emergence and rapid spread of the Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has dangered global health. For this reason, there has been an urgent need to develop strategies to control the spread of the virus. In this study, we aimed to evaluate the clinical, laboratory and chest computed tomography (CT) findings of COVID-19 cases with positive results of SARS-CoV-2 reverse transcription quantitative polymerase chain reaction (RT-qPCR). Materials and Methods: A total of 278 patients aged 18 years and over who had positive SARS-CoV-2 RT-qPCR results and had access to laboratory and chest CT examinations between 15 April 2020 and 31 August 2020 were included in the study. Clinical classification of patients was performed as asymptomatic, mild and severe. Demographic information, laboratory tests and chest CT results of the patients were created with the data obtained from the hospital system and the relevant branch physicians. The data were analyzed statistically. Results: In the study, 150 (54%) of the patients were males and 128 (46%) were females. Forty-two (15%) of these patients were classified as asymptomatic, 200 (72%) as mild and 36 (13%) as severe cases. Mean age of the patients was found to be 45.5 ± 17.5 years and 72 (25.9%) patients were found to have at least one comorbidity. Findings consistent with COVID-19 pneumonia were observed in the chest CT examinations of 42.4% (118/278) of the patients. The rate of findings in chest CT of severe patients (91.7%) was found higher than mild (38.5%) and asymptomatic cases (19%) (p< 0.05). When we examined the laboratory findings;59.4% of the patients had elevated CRP, 42.1% lymphopenia, 41.1% elevated LDH, 40.6% elevated creatinine, 36% elevated AST, 20.1% leukopenia, 8% elevated ALT, 7.2% elevated leukocyte, 5.4% elevated troponin I and 3.3% elevated CK-MB were detected. In severe patients, lymphopenia (83.3%), neutrophil elevation (41.7%), CRP elevation (97.2%), LDH elevation (91.3%), troponin I elevation (21.4%) and AST elevation (63.9%) findings were observed at a higher rate than asymptomatic and mild cases (p< 0.05). Conclusion: In our study, it was shown that the findings of high age, hypertension, diabetes mellitus, dyspnea, lymphopenia and the increase in neutrophil, CRP, LDH, troponin I and AST values were associated with severe clinical presentation. These findings are thought to be helpful in understanding the differences between clinical classes in COVID-19 patients.