Visual snow syndrome after start of citalopram-novel insights into underlying pathophysiology

Purpose!#!Chronic pain is common in the older population and a significant public health concern. However, comprehensive studies on analgesics use in this age group from Germany are scarce. This study aims to give a comprehensive overview on the use of the most common therapeutic groups of analgesics in community-dwelling older adults from Germany.!##!Methods!#!A cross-sectional study was carried out using data from a German cohort of 2038 community-dwelling adults aged 63-89 years. Descriptive statistics and logistic regression models were applied to assess the utilization of analgesics by age, sex, pain severity, pain duration, and locations.!##!Results!#!One out of four study participants was suffering from high-intensity or disabling pain. Approximately half of those taking analgesics still reported to suffer from high-intensity or disabling pain. Among analgesics users, occasional non-steroidal anti-inflammatory drugs (NSAIDs) use was the most frequent pain therapy (in 43.6% of users), followed by metamizole (dipyrone) use (16.1%), regular NSAIDs use (12.9%), strong opioids use (12.7%), and weak opioids use (12.0%). In multivariate logistic regression models, higher age, higher pain severity, longer pain duration, abdominal pain, and back pain were statistically significantly associated with opioids use. Metamizole use was also statistically significantly associated with higher pain severity but inversely associated with pain duration.!##!Conclusions!#!A significant number of older German adults are affected by high-intensity and disabling chronic pain despite receiving analgesics. Long-term studies are needed to compare the effectiveness and safety of different treatments for chronic pain in older adults

A unique MRI-pattern in alcohol-associated Wernicke encephalopathy

There have been concerns about high rates of thus far undiagnosed SARS-CoV-2 infections in the health-care system. The COVID-19 Contact (CoCo) Study follows 217 frontline health-care professionals at a university hospital with weekly SARS-CoV-2-specific serology (IgA/IgG). Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 21% [median 15%, interquartile range (IQR) 5-30%]. In contrast, anti-SARS-CoV-2 IgG prevalence was about 1-2% at baseline. Regular anti-SARS-CoV-2 IgG testing of health-care professionals may aid in directing resources for protective measures and care of COVID-19 patients in the long run

Triptan efficacy does not predict onabotulinumtoxinA efficacy but improves with onabotulinumtoxinA response in chronic migraine patients

Chronic migraine (CM) is a highly disabling primary headache. Botulinum toxin (onabotulinumtoxinA) is effective for treatment of CM, with similar to 50% of patients responding after 24 weeks. A response predictor would prevent unnecessary treatments. Inhibiting calcitonin gene related peptide (CGRP) release from trigeminal nociceptive fibres is one of the modes of acting discussed for onabotulinumtoxinA in CM. Therefore, we hypothesized that the response to triptans might predict response to onabotulinumtoxinA. Contrariwise, onabotulinumtoxinA treatment might affect triptan efficacy. 49 CM patients scheduled for their first onabotulinumtoxinA treatment were included. Before (T0) and three months after (T1) onabotulinumtoxinA treatment, patients rated triptan efficacy and indicated number of headache days/month. At T1, patients additionally rated onabotulinumtoxinA efficacy. Headache days/month were on average reduced by 7.1 +/- 7.0 days from T0 to T1 (p < 0.001). Triptan efficacy ratings at T0 did not predict onabotulinumtoxinA efficacy ratings at T1 (p = 0.19) or reduction of headache days (p = 0.37). However, triptan efficacy significantly improved from T0 to T1 in onabotulinumtoxinA responders (p < 0.001) but not in non-responders (p = 1.00). Triptan efficacy did not predict response to onabotulinumtoxinA in CM. However, triptan efficacy increased after successful onabotulinumtoxinA treatment. This supports the hypothesis that efficacy of acute migraine treatment with triptans improves with effective migraine prophylaxis

Reflexive and Intentional Saccadic Eye Movements in Migraineurs

Background: Migraine has been postulated to lead to structural and functional changes of different cortical and subcortical areas, including the frontal lobe, the brainstem, and cerebellum. The (sub-)clinical impact of these changes is a matter of debate. The spectrum of possible clinical differences include domains such as cognition but also coordination. The present study investigated the oculomotor performance of patients with migraine with and without aura compared to control subjects without migraine in reflexive saccades, but also in intentional saccades, which involve cerebellar as well as cortical networks. Methods: In 18 patients with migraine with aura and 21 patients with migraine without aura saccadic eye movements were recorded in two reflexive (gap, overlap) and two intentional (anti, memory) paradigms and compared to 25 controls without migraine. Results: The main finding of the study was an increase of saccade latency in patients with and without aura compared to the control group solely in the anti-task. No deficits were found in the execution of reflexive saccades. Conclusions: Our results suggest a specific deficit in the generation of correct anti-saccades, such as vector inversion. Such processes are considered to need cortical networks to be executed correctly. The parietal cortex has been suggested to be involved in vector inversion processes but is not commonly described to be altered in migraine patients. It could be discussed that the cerebellum, which is recently thought to be involved in the pathophysiology of migraine, might be involved in distinct processes such as spatial re-mapping through known interconnections with parietal and frontal cortical areas

Age- and frequency-dependent changes in dynamic contrast perception in visual snow syndrome

OBJECTIVE Patients with visual snow syndrome (VSS) suffer from a debilitating continuous (\textquotedblTV noise-like\textquotedbl) visual disturbance. They report problems with vision at night and palinopsia despite normal visual acuity. The underlying pathophysiology of VSS is largely unknown. Currently, it is a clinical diagnosis based on the patient's history, an objective test is not available. Here, we tested the hypothesis that patients with VSS have an increased threshold for detecting visual contrasts at particular temporal frequencies by measuring dynamic contrast detection-thresholds. METHODS Twenty patients with VSS were compared to age-, gender-, migraine- and aura-matched controls in this case-control study. Subjects were shown bars randomly tilted to the left or right, flickering at six different frequencies (15 Hz, 20 Hz, 25 Hz, 30 Hz, 35 Hz, 40 Hz). The contrast threshold (CT) for detection of left or right tilt was measured in a two-alternative adaptive forced-choice procedure (QUEST). The threshold was defined as the Michelson contrast necessary to achieve the correct response in 75% of the cases. RESULTS The CT increased for higher flicker frequencies (ANOVA: main effect frequency: F (5,180) = 942; p < 0.001), with an additional significant frequency*diagnosis interaction (ANOVA: F (5,180) = 5.00; p < 0.001). This interaction effect was due to an increased CT at a flicker frequency of 15 Hz in the VSS cohort (VSS: MC = 1.17%; controls: MC = 0.77%). At the other frequencies, group comparisons revealed no differences. Furthermore, in the VSS cohort we observed an increase of CT with higher age (r = 0.69; p < 0.001), which was not seen in controls (r = 0.30; p = 0.20). CONCLUSIONS This study demonstrates a lower visual contrast sensitivity exclusively at 15 Hz in VSS patients and demonstrates frequency-dependent differences in dynamic contrast vision. The peak sensitivities of both parvo- and magnocellular visual pathways are close to a frequency of about 10 Hz. Therefore, this frequency seems to be of crucial importance in everyday life. Thus, it seems plausible that the impairment of contrast sensitivity at 15 Hz might be an important pathophysiological correlate of VSS. Furthermore, the overall age-related decrease in contrast sensitivity only in VSS patients underscores the vulnerability of dynamic contrast detection in VSS patients. Dynamic CT detection seems to be a promising neurophysiological test that may contribute to the diagnosis of VSS

Kriz halinde ve krizleriyle mimarlık eğitim ortamı

Beklenmedik bir anda ortaya çıkan ve genellikle olumsuz gelişmeleri nitelendirmek için kullanılan “kriz” kavramı, yeni fırsatlar yaratılmasına olanak tanınması bağlamında olumlu çağrışımlar da yapmaktadır. Tıp alanında yaygın olarak kullanılan kriz, hastalıklardaki dönüm noktasına işaret eder; bu dönemeç iyiye de kötüye de evrilme potansiyeline sahiptir. Köken olarak “karar vermek” anlamına gelen kriz, geçmişe ve geleceğe yönelik kararların yeniden sorgulanması gerektiğini de gündeme getirmektedir. Marc J. Neveu, “Crisis, Crisis, Everywhere” başlıklı yazısında Edmund Husserl’in 1936 yılında yazdığı “The Crisis of European Sciences and Transcendental Phenomenology” metnine referans vererek krizin öznel dünyamızla ilişkisini açıklamaya çalışır.(1) Husserl’in kısaca eleştirdiği şey, “bilimlerin nesnel modeli doğru olsa bile müşterek deneyimimizin zenginliğinin nedenini açıklayamamaları”dır. Husserl, bilimin sözde nesnel dünya görüşünü temel alan kavramın “yaşam dünyası” (lebenswelt)-müşterek yaşanan dünya- kavramı olduğunu öne sürer. Konuya bu perspektiften bakılırsa, öznelle nesnel arasında net bir ayrım yoktur. Krizde, nesnel olan yıkıldığında, bilim öncesi yaşam dünyası kalır ve Husserl’e göre bu, varoluş hissini iyileştirebilir. Dolayısıyla içinde yaşadığımız tek bir dünyadan bahsetmek yerine kendi deneyimlerimizle ürettiğimiz çoklu dünyalardan söz etmek mümkündür. Kriz anlarının bu çoklu dünyaların keşfini olanaklı hale getirdiği söylenebilir.İçinde bulunduğumuz zaman diliminin en güncel kavramlarından biri olan kriz, mimarlık eğitimi bağlamında da çeşitli konuların tartışılmasına aracılık eder: Dünyada yaşanan ekonomik, politik, ekolojik vb. krizlerin mimarlık mesleğine ve eğitimine yansımaları nelerdir? Eğitimde yaşanan krizler nelerdir? Eğitim pedagojileri öğrencilerin yaşadıkları krizleri aşmalarına ne kadar yardımcı olabilmektedir? Krizde üretim yapmak mümkün müdür? Bilginin erişiminin ve paylaşımının arttığı günümüzde, etik meseleler bir krize dönüşmekte midir? Türkiye özelinde yeni açılan üniversite ve yetersiz akademisyen ilişkisi nasıl bir krizi tetiklemektedir? Mimarlık eğitiminde dikte edilen standartlar ile aynılaşma bir tür krize mi işaret etmektedir? Ekonomik krizle yeni mezun mimarlar nasıl baş edebilirler? 2-3 Kasım 2018 tarihlerinde MEF Üniversitesi Sanat Tasarım ve Mimarlık Fakültesi’nde düzenlediğimiz 47. Mimarlık Bölüm Başkanları İletişim Grubu (MOBBİG) toplantısında(2) bu ve benzeri sorular eş zamanlı yuvarlak masa toplantılarında, mimarlık eğitiminin tüm aktörleri ile birlikte yatay bir organizasyonla dünya, eğitim, üretim, akademisyenlik, öğrenci olmak başlıkları altında tartışıldı. Bu yazı, 47. MOBBİG toplantısının tüm aşamaları boyunca bizim zihinlerimizde tetiklediği sorular ışığında mimarlık eğitimindeki olası kriz hallerini olumlu ve olumsuz yönleriyle ortamın halleri, eğitimci olmak ve öğrenci olmak ara başlıkları ile tartışmayı hedefliyor

Coronary artery calcification score in migraine patients

Epidemiological studies have shown an increased risk of cardiovascular events in migraineurs. The pathophysiological mechanisms of this observation remain largely unknown. Recent genetic and epidemiologic studies suggest, that atherosclerosis might be the overlapping pathophysiological mechanism in migraine and coronary heart disease. The aim of the present study was to evaluate if the increased cardiovascular risk in migraineurs is attributed to an increased coronary artery calcification. For this the coronary artery calcium score was assessed by computed tomography of the heart in 1.437 patients of which 337 were migraineurs. All patients had a similar cardiovascular risk profile, so that the risk for coronary calcifications could be considered similar between migraineurs and non-migraineurs. The results showed no significant differences in the amount of coronary calcifications in patients with or without migraine. This suggests that a more pronounced coronary artery calcification, as a surrogate marker of coronary atherosclerosis, does not underlie the increased cardiovascular risk in migraineurs. A distinct common pathophysiological mechanism in migraine and coronary heart disease such as endothelial dysfunction or vasospasm should be discussed instead. However, it has to be considered, that the coronary artery calcification score does not indicate the total risk of atherosclerotic changes in the coronary arteries

Diagnosis and follow-up evaluation of central nervous system vasculitis: an evaluation of vessel-wall MRI findings

OBJECTIVE To approach the clinical value of MRI with vessel wall imaging (VWI) in patients with central nervous system vasculitis (CNSV), we analyzed patterns of VWI findings both at the time of initial presentation and during follow-up. METHODS Stenoocclusive lesions, vessel-wall contrast enhancement (VW-CE) and diffusion-restricted lesions were analyzed in patients with a diagnosis of CNSV. On available VWI follow-up, progression, regression or stability of VW-CE were evaluated and correlated with the clinical status. RESULTS Of the 45 patients included, 28 exhibited stenoses visible on MR angiography (MRA-positive) while 17 had no stenosis (MRA-negative). VW-CE was found in 2/17 MRA-negative and all MRA-positive patients (p < 0.05). 79.1% (53/67) of stenoses showed VW-CE. VW-CE was concentric in 88.3% and eccentric in 11.7% of cases. Diffusion-restricted lesions were found more frequently in relation to stenoses with VW-CE than without VW-CE (p < 0.05). 48 VW-CE lesions in 23 patients were followed over a median time of 239.5~days. 13 VW-CE lesions (27.1%) resolved completely, 14 (29.2%) showed partial regression, 17 (35.4%) remained stable and 4 (8.3%) progressed. 22/23 patients received immunosuppressive therapy for the duration of follow-up. Patients with stable or progressive VW-CE were more likely (p < 0.05) to have a relapse (14/30 cases) than patients with partial or complete regression of VW-CE (5/25 cases). CONCLUSION Concentric VW-CE is a common finding in medium/large-sized vessel CNSV. VW-CE might represent active inflammation in certain situations. However, follow-up VWI findings proved ambiguous as persisting VW-CE despite immunosuppressive therapy and clinical remission was a frequent finding