KAMST - Simple method for patients with migraine screening.

Migraine is highly prevalent and disabling disorder, but despite that one of the main problems that remains in the clinical practice is delayed diagnosis and delayed specific treatment that has impact on patients' quality of life and productivity. There should be easy acceptable method to select those patients who might have migraine and who need to be referred to neurologist's consultation. We hypothesize that our created KAMST questionnaire is reliable method to select patients who might have migraine in primary care. To evaluate our hypothesis we made a research that consisted of two parts. Part A consisted of closed type questions made by The International Classification of Headache Disorders 3rd edition diagnostic criteria of migraine without aura. Part B was KAMST questionnaire. 298 patients were questioned. 209 (72%) of them were women and 89 (28%) - men. According to The International Classification of Headache Disorders 3rd edition migraine without aura diagnostic criteria, migraine was diagnosed for 42 (14,1%) patients, and according our KAMST questionnaire - 83 (27,9%). From 42 patients whom migraine was diagnosed with The International Classification of Headache Disorders 3rd edition criteria, 34 (81%) of these patients migraine was diagnosed with KAMST. From 256 patients whom migraine wasn't diagnosed with The International Classification of Headache Disorders 3rd edition criteria, 49 of them (19,1%) migraine was diagnosed with KAMST. We found statistically significant difference between questionnaires. KAMST sensitivity was - 81%, specificity - 81%, predictive positive value - 41%, predictive negative value - 96%, the Cronbach alpha for the total scale was 0,604. Our KAMST questionnaire of migraine is reliable and valid method for patients' screening but has some limitations.

Thirty-Five Years of Thyroid Cancer Experience in a Paediatric Population: Incidence Trends in Lithuania between 1980 and 2014.

BACKGROUND: Thyroid cancer (TC) is a rare condition in children. It may be associated with radiation, iodine deficiency or familial inheritance. AIMS: The objectives of this study were to analyse the prevalence and incidence trends over 3 decades and clinical features of TC in the paediatric population in Lithuania. METHODS: We reviewed all TC cases diagnosed in children aged less than 18 years during the period 1980-2014 using medical records from 3 main hospitals in Lithuania where such TC cases are managed. RESULTS: During the 35-year period (1980-2014) there were 57 cases (45 females) of TC in children in Lithuania. The mean age at the time of diagnosis was 14.51 ± 0.52 years. The crude incidence rate of TC ranged from 0 to 0.93 cases per 100,000 children per year and the mean annual increase was 5.26% (p < 0.001). Papillary carcinoma was the most common histological type (73.7%). No association was found between the incidence of TC and the reported areas of radioactive contamination after the Chernobyl accident. In total, 8.8% of patients had secondary TC after initial radiotherapy of a primary oncologic disease. CONCLUSION: The incidence of TC in the Lithuanian paediatric population between 1980 and 2014 ranged from 0 to 0.93 cases per 100,000 children per year and there was a 5.26% annual increase (p < 0.001), most probably related to the increased use of ultrasound testing.

Characteristics of headache in relation to the manifestation of Susac syndrome.

Susac syndrome is characterized by a clinical triad of encephalopathy, branch retinal artery occlusion, and hearing loss. Due to the absence of the whole complex of the triad in the majority of cases at disease presentation, the syndrome often remains underdiagnosed and untreated. Headache is estimated to affect up to 80% of Susac syndrome patients, but the relevance of headache characteristics and profile is not yet clear. The proposed diagnostic criteria of the European Susac Consortium acknowledge headache as a possible brain manifestation if it is new, described as migrainous or oppressive, and precedes the other symptoms by not more than 6 months. Herein, a case series of different migraine-like headache associations attributed to Susac syndrome is presented and discussed in relevance with previously published literature. Our patients experienced different presentations of migraine-like headache related with Susac syndrome: exacerbation and chronification of headache just before the manifestation of the first symptoms of Susac syndrome, the manifestation of headache during the first episode of the syndrome, and an increasing frequency of headache during the course of the disease. The diagnosis of Susac syndrome in all three cases was confirmed by typical clinical symptoms and findings in retinal fluorescein angiography, audiometry, and brain magnetic resonance imaging, based on the diagnostic criteria of the European Susac Consortium. Based on the analysis of our presented cases, we conclude that headache attributed to Susac's syndrome is of migraine-like type but could be of different presentations in relation to the onset of the syndrome.

Associations between peripheral vertigo and gastroesophageal reflux disease.

We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered ­ gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis.