Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Assessment of eutrophication and cyanobacterial occurrences in a Freshwater Lake, in Turkey

Cyanobacterial dominance in lakes has received much attention in the past because of frequent bloom formation in lakes of higher trophic levels. Study area (Lake Kovada) has been used for recreational purposes; fishing, swimming, garden watering etc. As far to our knowledge, cyanobacterial occurrence, especially Microcystis aeruginosa dominance in the lake never has been reported before. Hence intracellular microcystin analyses were performed by immunoassay from filtrate samples where M aeruginosa observed high in numbers. In total eighteen species belonging to 10 genera were identified in the lake. Some indicators of water quality in Lake Kovada were also measured in order to characterise the trophic status of the lake. An average of 6 months for soluble reactive phosphate analysis was measured as 109.8±0.04 µg l-1. These findings are even exceeding the limits for total phosphate concentration to control cyanobacterial bloom and mean ammonia was detected 668±58 µg l-1.Water quality criteria for free NH3 was suggested to be 20 µg l-1 by USEPA. According to the results which were obtained from the water quality analyses, the lake water is polluted and under risk of being highly populated with cyanobacteria. The effective monitoring programmes for the reduction of cyanobacterial toxin problems in waters require the identification and use of appropriate guidelines worldwide

Importance in dairy technology of bacteriocins produced by dairy starter cultures

Bacteriocins produced by Lactic acid bacteria (LAB) and propionic acid bacteria (PAB) are heterogeneous group of peptide inhibitors which include lantibiotics (class I, e. g. nisin), small heat-stable peptides (class II, e. g. pediocin PA-1) and large heat-labile proteins (class III, e. g. helveticin J). Many bacteriocins belonging to the first two groups can be successfully used to inhibit undesirable microorganisms in foods, but only nisin is produced industrially and is used as a food preservative. LAB and PAB develops easily in milk and milk products. LAB and PAB growth in dairy products can cause microbial interference to spoilage and pathogenic bacteria through several metabolits, specially bacteriocins. The review deals with the description of milk-borne bacteriocins and their application in milk and milk products either to extend the shelf life or to inhibit milk pathogens