Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais

ResumoObjetivoAvaliar a frequência dos diferentes diagnósticos de cefaleias do Ambulatório de Cefaleias do Hospital das Clínicas da Universidade Federal de Minas Gerais (AmbCef-UFMG).MétodosEstudo transversal e descritivo com 289 pacientes atendidos consecutivamente no AmbCef-UFMG. O diagnóstico da cefaleia baseou-se nos critérios da Classificação Internacional das Cefaleias (ICDH-2004).ResultadosA idade média dos pacientes foi 42,6 anos, sendo a maioria do sexo feminino (86,9%) e com menos de nove anos de escolaridade. As cefaleias primárias foram as mais comuns, sendo a migrânea encontrada em 79,8% dos casos e a cefaleia do tipo tensional (CTT), em 20,4%. Entre as secundárias, o tipo mais comum foi a cefaleia por uso excessivo de analgésicos (16,6%), seguido de casos menos comuns como a hipertensão intracraniana idiopática. A cefaleia crônica diária (CCD) esteve presente em 31,8% dos casos.ConclusãoEste estudo confirma dados da literatura que mostram a migrânea como a cefaleia mais comum em centros terciários. O número expressivo de casos de CCD e de uso excessivo de analgésicos indica que, desde o nível primário de atenção, os pacientes deveriam ser orientados a evitar o uso abusivo de medicação sintomática.SummaryObjectiveTo assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG).MethodsCross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004).ResultsThe average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases.ConclusionThis study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs

Brazilian cross-cultural translation and adaptation of the Questionnaire of Life Quality Specific for Myasthenia Gravis-15 items

Objective: To translate and to perform the cross-cultural adaptation of the Questionnaire of Life Quality Specific for Myasthenia Gravis - 15 items (MG-QOL15). Method: the original English version of the questionnaire was translated into Portuguese. This version was revised and translated back into English. Later, both English versions were compared and the divergences were corrected in the Portuguese text. At a second stage, ten patients with MG followed at the Neuromuscular Diseases Clinic from the University Hospital, Universidade Federal de Minas Gerais answered the questionnaire. the authors analyzed the difficulties and misunderstandings in the application of the questionnaire. Results: the questions 8, 13 and 15 were considered difficult to understand and were modified in the final Portuguese version. Most patients (70%) had a total score above 25, and the statements 3, 8 and 9 showed the highest scores. Conclusion: the Brazilian version of the questionnaire MG-QOL15 seems to be a promising tool for the assessment of Brazilian patients with MG.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Univ Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Hosp Clin, Neurol Serv, Belo Horizonte, MG, BrazilUniv Virginia, Charlottesville, VA USAUniv Fed Minas Gerais, Universidade Federal de São Paulo, Dept Fonoaudiol, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Prof Fac Med, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Universidade Federal de São Paulo, Dept Fonoaudiol, Belo Horizonte, MG, BrazilWeb of Scienc

Hospital-acquired intestinal toxemia botulism in a newly diagnosed adult colon cancer patient

This manuscript reports a case of intestinal toxemia botulism in an adult with recently diagnosed metastatic colon cancer in whom botulism symptoms began 23 days after hospital admission. Representing the rarest form of botulism presentation in clinical practice, this infectious disease may have developed due to a cluster of predisposing factors that favored Clostridium botulinum colonization and the endogenous production of neurotoxins, among which are previous use of broad-spectrum antibiotics and colon changes related to the development of the neoplasia. This case highlights the importance of considering intestinal toxemia botulism in the differential diagnosis of a patient presenting with symmetrical descending flaccid paralysis, since immediate treatment with botulinum antitoxin may improve clinical outcomes

IL-6 levels are associated with clinical status in patients with Myasthenia Gravis

Background: Myasthenia gravis (MG) is an autoimmune disease marked by fluctuating course of muscle weakness. Objectives: The current study was designed to evaluate plasma levels of cytokines (IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL17A) in patients with MG and controls and to investigate whether cytokines levels are associated with clinical parameters. This study was conducted at the Neuromuscular Diseases Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil. Methods: Peripheral blood was drawn, and plasma levels of cytokines were measured by cytometric bead array (CBA) in 80 treated patients with MG and 50 controls. The MG Composite (MGC) was used to evaluate muscle weakness and severity of typical motor symptoms of MG. Results: Patients with MG undergoing treatment exhibit lower levels of all evaluated cytokines compared to controls. There was a negative correlation between IL-6 levels and the MG Composite score, indicating that higher levels of IL-6 were associated with better control of the disease. Conclusion: This exploratory study suggests that IL-6 is associated with MG clinical status, as assessed by the MG

Determinants of quality of life in Brazilian patients with myasthenia gravis

OBJECTIVES: The aims of the current study were 1) to evaluate the reliability and validity of the Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale and 2) to investigate the quality of life of Brazilian patients with myasthenia gravis and its determinants. METHODS: This cross-sectional study included 69 patients with myasthenia gravis who underwent neurological evaluation and completed questionnaires regarding quality of life (the 36-item Short Form of the Medical Outcomes Study and the 15-item Myasthenia Gravis Quality of Life Scale), anxiety and depressive symptoms. RESULTS: The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale showed high internal consistency and good concurrent validity with the 36-item Short Form of the Medical Outcomes Study and its subscales. Determinants of quality of life in Brazilian patients with myasthenia gravis included the current status of myasthenia gravis as assessed by the Myasthenia Gravis Composite, the current prednisone dose and the levels of anxiety and depression. CONCLUSION: The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale is a valid instrument. Symptom severity, prednisone dosage and anxiety and depression levels impact the quality of life of patients with myasthenia gravis

Increased MRI-based Brain Age in chronic migraine patients

Introduction: Neuroimaging has revealed that migraine is linked to alterations in both the structure and function of the brain. However, the relationship of these changes with aging has not been studied in detail. Here we employ the Brain Age framework to analyze migraine, by building a machine-learning model that predicts age from neuroimaging data. We hypothesize that migraine patients will exhibit an increased Brain Age Gap (the difference between the predicted age and the chronological age) compared to healthy participants. Methods: We trained a machine learning model to predict Brain Age from 2,771 T1-weighted magnetic resonance imaging scans of healthy subjects. The processing pipeline included the automatic segmentation of the images, the extraction of 1,479 imaging features (both morphological and intensity-based), harmonization, feature selection and training inside a 10-fold cross-validation scheme. Separate models based only on morphological and intensity features were also trained, and all the Brain Age models were later applied to a discovery cohort composed of 247 subjects, divided into healthy controls (HC, n=82), episodic migraine (EM, n=91), and chronic migraine patients (CM, n=74). Results: CM patients showed an increased Brain Age Gap compared to HC (4.16 vs -0.56 years, P=0.01). A smaller Brain Age Gap was found for EM patients, not reaching statistical significance (1.21 vs -0.56 years, P=0.19). No associations were found between the Brain Age Gap and headache or migraine frequency, or duration of the disease. Brain imaging features that have previously been associated with migraine were among the main drivers of the differences in the predicted age. Also, the separate analysis using only morphological or intensity-based features revealed different patterns in the Brain Age biomarker in patients with migraine. Conclusion: The brain-predicted age has shown to be a sensitive biomarker of CM patients and can help reveal distinct aging patterns in migraine

Viability of AMURA biomarkers from single-shell diffusion MRI in clinical studies

Diffusion Tensor Imaging (DTI) is the most employed method to assess white matter properties using quantitative parameters derived from diffusion MRI, but it presents known limitations that restrict the evaluation of complex structures. The objective of this study was to validate the reliability and robustness of complementary diffusion measures extracted with a novel approach, Apparent Measures Using Reduced Acquisitions (AMURA), with a typical diffusion MRI acquisition from a clinical context in comparison with DTI with application to clinical studies. Fifty healthy controls, 51 episodic migraine and 56 chronic migraine patients underwent single-shell diffusion MRI. Four DTI-based and eight AMURA-based parameters were compared between groups with tract-based spatial statistics to establish reference results. On the other hand, following a region-based analysis, the measures were assessed for multiple subsamples with diverse reduced sample sizes and their stability was evaluated with the coefficient of quartile variation. To assess the discrimination power of the diffusion measures, we repeated the statistical comparisons with a region-based analysis employing reduced sample sizes with diverse subsets, decreasing 10 subjects per group for consecutive reductions, and using 5,001 different random subsamples. For each sample size, the stability of the diffusion descriptors was evaluated with the coefficient of quartile variation. AMURA measures showed a greater number of statistically significant differences in the reference comparisons between episodic migraine patients and controls compared to DTI. In contrast, a higher number of differences was found with DTI parameters compared to AMURA in the comparisons between both migraine groups. Regarding the assessments reducing the sample size, the AMURA parameters showed a more stable behavior than DTI, showing a lower decrease for each reduced sample size or a higher number of regions with significant differences. However, most AMURA parameters showed lower stability in relation to higher coefficient of quartile variation values than the DTI descriptors, although two AMURA measures showed similar values to DTI. For the synthetic signals, there were AMURA measures with similar quantification to DTI, while other showed similar behavior. These findings suggest that AMURA presents favorable characteristics to identify differences of specific microstructural properties between clinical groups in regions with complex fiber architecture and lower dependency on the sample size or assessing technique than DTI

Dynamic Intracellular Metabolic Cell Signaling Profiles During Ag-Dependent B-Cell Differentiation

© 2021 Díez, Pérez-Andrés, Bøgsted, Azkargorta, García-Valiente, Dégano, Blanco, Mateos-Gomez, Bárcena, Santa Cruz, Góngora, Elortza, Landeira-Viñuela, Juanes-Velasco, Segura, Manzano-Román, Almeida, Dybkaer, Orfao and Fuentes.Human B-cell differentiation has been extensively investigated on genomic and transcriptomic grounds; however, no studies have accomplished so far detailed analysis of antigen-dependent maturation-associated human B-cell populations from a proteomic perspective. Here, we investigate for the first time the quantitative proteomic profiles of B-cells undergoing antigen-dependent maturation using a label-free LC-MS/MS approach applied on 5 purified B-cell subpopulations (naive, centroblasts, centrocytes, memory and plasma B-cells) from human tonsils (data are available via ProteomeXchange with identifier PXD006191). Our results revealed that the actual differences among these B-cell subpopulations are a combination of expression of a few maturation stage-specific proteins within each B-cell subset and maturation-associated changes in relative protein expression levels, which are related with metabolic regulation. The considerable overlap of the proteome of the 5 studied B-cell subsets strengthens the key role of the regulation of the stoichiometry of molecules associated with metabolic regulation and programming, among other signaling cascades (such as antigen recognition and presentation and cell survival) crucial for the transition between each B-cell maturation stage.We gratefully acknowledge financial support from the Spanish Health Institute Carlos III (ISCIII) for the grants: FIS PI14/01538, FIS PI17/01930 and CB16/12/00400. We also acknowledge Fondos FEDER (EU) and Junta Castilla-León (COVID19 grant COV20EDU/00187). Fundación Solórzano FS/38-2017.The Proteomics Unit belongs to ProteoRed, PRB3-ISCIII, supported by grant PT17/0019/0023, of the PE I + D + I 2017-2020, funded by ISCIII and FEDER. AL-V is supported by VIII Centenario-USAL PhD Program. PJ-V is supported by JCYL PhD Program and scholarship JCYL-EDU/601/2020. PD and EB are supported by a JCYL-EDU/346/2013 Ph.D. scholarship

The Determination of alpha_s from Tau Decays Revisited

We revisit the determination of alpha_s(m_tau) using a fit to inclusive tau hadronic spectral moments in light of (1) the recent calculation of the fourth-order perturbative coefficient K_4 in the expansion of the Adler function, (2) new precision measurements from BABAR of e+e- annihilation cross sections, which decrease the uncertainty in the separation of vector and axial-vector spectral functions, and (3) improved results from BABAR and Belle on tau branching fractions involving kaons. We estimate that the fourth-order perturbative prediction reduces the theoretical uncertainty, introduced by the truncation of the series, by 20% with respect to earlier determinations. We discuss to some detail the perturbative prediction and show that the effect of the incomplete knowledge of the series is reduced by using the so-called contour-improved calculation, as opposed to fixed-order perturbation theory which manifests convergence problems. The corresponding theoretical uncertainties are studied at the tau and Z mass scales. Nonperturbative contributions extracted from the most inclusive fit are small, in agreement with earlier determinations. Systematic effects from quark-hadron duality violation are estimated with simple models and found to be within the quoted systematic errors. The fit gives alpha_s(m_tau) = 0.344 +- 0.005 +- 0.007, where the first error is experimental and the second theoretical. After evolution to M_Z we obtain alpha_s(M_Z) = 0.1212 +- 0.0005 +- 0.0008 +- 0.0005, where the errors are respectively experimental, theoretical and due to the evolution. The result is in agreement with the corresponding NNNLO value derived from essentially the Z width in the global electroweak fit. The alpha_s(M_Z) determination from tau decays is the most precise one to date.Comment: 22 pages, 7 figure