The Impact of Sexism and Gender Stereotypes on the Legitimization of Women's Low Back Pain

BACKGROUND: Low back pain is the worldwide leading cause of disability and, even though women's pain experience is more severe, frequent, and enduring, female patients are often underdiagnosed and undertreated. Health professionals' gender stereotypes and social norms may underlie the downgrading of pain. AIM: This pilot study aimed to examine the legitimation of low back pain by health professionals in relation to the sex of the patient as well as their gender awareness and the relationship between them. METHOD: This study had a cross-sectional design. Eighty health professionals and students selected by convenience answered a 4-part online questionnaire. The eligibility criteria for participants were: aged >18 years, students in the last course of nursing/medicine or a physician/nurse, and Spanish-speaking. The questionnaire comprises: (1) a between-subjects virtual clinical low back pain case with four random versions (female/male patient and evidence/non-evidence of pathology); (2) the Spanish version of Nijmegen Gender Awareness Scale (S-NGAMS); (3) Ambivalent Sexism Inventory (ASI); and (4) Ambivalence toward Men Inventory (AMI). RESULTS: The total score of legitimation of low back pain correlated negatively with gender role ideology and sexism scales (when the virtual patient was female), as well as the subscales of willingness to offer support and credibility. CONCLUSIONS: Both sexism and gender role ideology could undermine the legitimation of low back pain, the willingness to offer support, and credibility only in female patients. The results showed a possible gender bias in low back pain assessment in health professionals. Low gender sensitivity and high sexism must be treated as modifiable risk factors for health inequities in pain care

Afasia como síntoma de presentación de una hepatitis A

Hepatitis A virus (HAV) rarely manifests with neurological alterations. There are some reported cases of Guillain-Barré syndrome, acute disseminated encephalomyelitis, epileptic seizures and meningoencephalitis. Cases of meningoencephalitis have some common characteristics. Its diagnosis is based on the presence of lymphocytic meningitis with positive IgM HAV serology. We describe a novel case due to the form of presenta- tion that has not been described yet in the context of HAV, with sudden onset of aphasia and the appearance of digestive symptoms in the following days. The studies performed ruled out other etiologies and the clinical course was favorable with supportive treatment.Raramente el virus de la hepatitis A (VHA) se manifiesta con alteraciones neurológicas. Existen casos reportados de síndrome de Guillain-Barré, encefalomielitis aguda diseminada, crisis epilépticas y meningoencefalitis. Los casos de meningoencefalitis presentan algunas características comunes. Su diagnóstico se apoya en la presencia de meningitis linfocitaria con serología IgM VHA positiva. Describimos un caso novedoso por la forma de presentación, hasta ahora no descrita, en el contexto de VHA, con afasia de inicio brusco y aparición de los síntomas digestivos en los días siguientes. Los estudios realizados descartaron otras etiologías, y la evolución fue favorable con tratamiento de soporte

Modificaciones epigenéticas en la migraña crónica: análisis de metilación de genes asociados a la migraña en los gwas y genes implicados en la respuesta al estrés en un estudio de casos y controles

RESUMEN: Los factores genéticos que confieren susceptibilidad a la migraña crónica (MC) y los mecanismos biológicos subyacentes son, a día de hoy, desconocidos. Existen varios factores ambientales que se relacionan con un mayor riesgo de MC, entre los cuales se encuentran los eventos vitales estresantes. Los mecanismos epigenéticos, que han adquirido un creciente interés en el estudio de la cronificación de la migraña, tienen el potencial de vincular las influencias del ambiente con cambios en la expresión de genes que podrían modificar el fenotipo de la enfermedad. En este estudio se realizó un análisis de la metilación de determinados genes candidatos en pacientes con MC, migraña episódica (ME) y controles sanos, y se investigó la frecuencia del trastorno por estrés postraumático (TEPT) en migrañosos. Los resultados muestran diferencias en la metilación de algunos de estos genes en sujetos con MC y ME, que podrían constituir mecanismos adaptativos, facilitadores o atenuadores, del dolor y estrés crónicos, y revelan una frecuente comorbilidad entre el TEPT y la migraña, sobre todo MC, que sugiere la necesidad de un abordaje específico en estos pacientes y respalda el estudio de las vías de estrés en la migraña.ABSTRACT: Genetic factors that confer susceptibility to chronic migraine (CM) and underlying biological mechanisms are currently unknown. There are several environmental factors related to an increased risk of CM, including stressful life events. Epigenetic mechanisms, that have gained growing interest in the study of migraine chronification, have the potential to link environmental influences with changes in gene expression that could modify disease phenotype. In this study, a methylation analysis of some candidate genes was performed in patients with CM or episodic migraine (EM) and healthy controls, and the frequency of post-traumatic stress disorder (PSTD) in migraineurs was investigated. Results show differences in the methylation level of some genes in CM and EM subjects, which could constitute adaptive, facilitating or attenuating mechanisms of chronic pain and stress, and also show a frequent comorbidity between PSTD and migraine, especially CM, which suggests the need for a specific approach in these patients and supports the study of stress pathways in migraine

Serum alpha and beta-CGRP levels in chronic migraine patients before and after monoclonal antibodies against CGRP or its receptor

Objective: To analyse the evolution of alpha and beta-CGRP circulating levels throughout CGRP monoclonal antibodies (mAb) treatment in chronic migraine (CM) patients. Methods: We recruited CM patients beginning mAb along with sex and age paired healthy controls (HC). Blood was extracted before, two-weeks (M0.5) and three months (M3) after first dose of mAb, always in free-migraine periods, and once for HCs. Alpha and beta-CGRP serum levels were measured using ELISAs specific for each isoform. Results: Baseline alpha-CGRP levels were significantly elevated in 103 CM patients (median [95% CI]: 50.3 [40.5-57.0] pg/mL) compared to 78 HC (37.5 [33.9-45.0] pg/mL; 95% CI of differences: 2.85-17.08 pg/mL) and significantly decreased (n=96) over the course of mAb treatment (M0.5: 40.4 [35.6-48.2] pg/mL; M3: 40.9 [36.3-45.9] pg/mL). Absolute decrease of alpha-CGRP throughout the treatment positively correlated with the decrease in monthly migraine days. Negative modulation of alpha-CGRP significantly associated with positive scores at the patient global impression of change scale and with analgesic overuse reversal. Beta-CGRP did not differ at baseline between CM patients (4.2 [3.0-4.8] pg/mL) and HC (4.4 [3.4-5.6] pg/mL; -1.09 to 0.60) nor was modulated by mAb treatment (n=96) (M0.5: 4.5 [3.5-5.2] pg/mL; M3: 4.6 [3.7-5.2] pg/mL). Interpretation: Treatment with mAb, regardless of its target, is able to progressively normalize basally increased alpha-CGRP levels in CM and this effect correlates with efficacy measures, which supports a role of this neuropeptide as the first CM biomarker

Serum alpha-CGRP levels are increased in COVID-19 patients with headache indicating an activation of the trigeminal system

Background Headache is among the most frequent symptoms of acute COVID-19 infection. Its mechanisms remain obscure, but due to its migraine-like characteristics, the activation of the trigeminal system could account for its underlying pathophysiology. Methods Our aim was to compare the serum levels of CGRP, as a theoretical marker of trigemino-vascular activation, in 25 COVID-19 inpatients with lung involvement experiencing headache, against 15 COVID-19 inpatients without headache and with those of 25 matched healthy controls with no headache history. Results Morning serum alpha-CGRP levels, as measured by ELISA (Abbexa, UK), were increased in COVID-19 patients with headache (55.2±34.3 pg/mL) vs. controls (33.9±14.0 pg/mL) (p<0.01). Alpha-CGRP levels in COVID-19 patients without headache were also significantly increased (43.3±12.8 pg/mL; p=0.05) versus healthy controls, but were numerically lower (-28.2%; p=0.36) as compared to COVID-19 patients with headache. Conclusion CGRP levels are increased in COVID-19 patients experiencing headache in the acute phase of this disease, which could explain why headache frequently occurs in COVID-19 and strongly supports a role for trigeminal activation in the pathophysiology of headache in this viral infection.Funding: This work was supported by grants from the Instituto de Salud Carlos III (PI20/01358) and IDIVAL (INNVAL 20/25 and 21/31) Acknowledgements: We thank the nurses of our hospital who collaborated in obtaining the blood sample