Correlation Between Life Events and Quality of Life in Patients with Medication-Overuse Headache

Introduction: The present study aimed to determine (a) the correlation between type and number of stressful life events and quality of life in patients with medication-overuse headache (MOH) and (b) whether stressful life events could be attributed to medication overuse and the conversion of headache to a chronic type. Methods: The present study included 114 patients aged between 15 and 65 years who met the criteria for headache classification of International Headache Society (IHS). The patients were divided into three groups according to the revised 2004 IHS classification; MOH (n= 64), chronic migraine (n=25) and episodic migraine (n=25). Detailed data on clinical and sociodemographic characteristics were recorded. Neurological and physical examinations were performed for differential diagnosis. The patients underwent structured clinical interviews for DSM-IV Inventory (SCID-I), Beck Anxiety Inventory, Beck Depression Inventory, Short Form-36 (SF-36) and Life Events List. Scores of these inventories were statistically compared. Results: Comparing MOH group with episodic migraine group via SF36, statistically significant decreases were observed in the subscales of physical role limitation (p=.024), pain (p=.0001), general health (p=.043) and social functioning (p=.004). There was a statistically significant correlation between the number of life events and the time the disease became chronic in the patient group with non-MOH chronic migraine (p=.027). Moreover, a statistically significant correlation was observed between stressful family life events and the body pain subscale of quality of life scale (p=.038). Conclusion: The present study demonstrates that stressful life events impair quality of life in patients with MOH. It was also found that number of stressful life events could be attributed to the conversion of headache to a chronic type

Evaluation of Relationship Between Childhood Maltreatment and Medication Overuse Headache

Introduction: We aimed to evaluate the prevalence and relationship between childhood maltreatment (CMT) among patients with medication overuse headache (MOH) and to investigate whether CMT is associated with medication overuse in patients having headaches or with headaches that become chronic. Epidemiological studies report a relationship between childhood abuse and headache. There is growing knowledge about the evidence that childhood maltreatment leads to neurobiological sequel. Medication overuse is the most important problem for migraine to become chronic. But in the literature, there was no information about the role of childhood abuse in MOH and for migraine to become chronic. Methods: A total of 116 patients with headache, aged from 15 to 65 years, were included in the study. Patients having chronic migraine (CM), MOH and episodic migraine (EM) were selected out of patients presented to the headache outpatient clinic. Types of headache were determined according to the revised International Headache Society (IHS) criteria published in 2004. The Childhood Trauma Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory were performed. Presence of psychiatric co-morbidities was evaluated by a clinician using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, the Fourth Edition. Results: A total of 116 patients with headache were included in the study. Of patients, 64 had MOH, 25 had CM and 27 had EM. The prevalence of CMT, particularly emotional neglect (62%), physical neglect (44%) and emotional abuse (36.2%), was determined higher in all headache groups. There was no statistically significant difference in prevalence of childhood maltreatment between MOH, CM and EM groups. No statistically significant difference was detected between educational status, psychiatric co-morbidities and childhood trauma, except for physical neglect. Conclusion: Childhood maltreatment was observed in MOH as in other forms of migraine and headache. However, no significant difference was observed between the three groups of patients with headache

Association between platelet indices and febrile seizures in children

Purpose: Febrile seizures (FS) are the most common type of seizures in children. The aim of this study was to evaluate the relationship between platelet indices and FS in children. Materials and Methods: This prospective study included 40 children who presented with FS and 30 controls who presented with febrile illnesses without seizures. Complete blood counts, including platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW) from both groups within 1 hour of FS and 1 month later were obtained. Results: We found that the MPV and PDW within 1 hour of seizure in children with complex FS group was higher than simple FS group while there was no significant difference in MPV and PDW between patients in the simple and complex FS groups at 1 month. The mean PC was not significantly different between simple and complex FS groups; but, we found that the mean PC in the complex FS group was slightly lower than simple FS group. There was a moderate significant positive correlation between MPV and PDW in children with FS while there was a moderate significant negative correlation between PC and MPV, PDW for FS. Conclusion: Our findings suggest that the increasing platelet turnover in complex FS group causes a slightly decrease in the PC, an significantly increase of MPV and PDW values indicating that these parameters may play an important role in predicting the severity of FS in children at diagnosis

Assessment of prenatal and perinatal characteristics of pregnants with gestationel diabetes mellitus who have postnatal glucose abnormalities

Purpose: To examine the difference in terms of prenatal and perinatal characteristics between gestational diabetic (GDM) cases diagnosed with impaired fasting glucose (IFG)and impaired glucose tolerance (IGT) during early postpartum period. Material and Methods: Cases who had no history of any glucose metabolism disorder and diagnosed as GDM due to American Diabetes Association (ADA) criteria were included. Subjects were inquired for pregestational characteristics(glucose abnormality in previous pregnancies, birth of macrosomic baby and history of diabetes in a first-degree relative), prenatal characteristics (age, body mass index BMI), features at diagnosis (BMI,weight-gain ,blood pressure and HbA1C), and perinatal characteristics (birth week and baby birth weight) were recorded. Oral glucose tolerance test (OGTT) was reperformed in the 6th postpartum week. Effects of pregestational, prenatal and perinatal features on postpartum glucose abnormalities were analysed. Results: Out of 80 cases who completed the study 58.7%(n=47) had normal glucose metabolism, 13.7%( n=11) had IFG and 27.5%(n=22) had IGT. No difference was found between pregestational, prenatal , perinatal characteristics, features at the time of diagnosis and postpartum OGTT results. Incidence of IFG in postpartum OGTT for those who had diabetes in a first degree relative was elevated when compared with other cases(p=0,042). The difference was preserved after adjustment for other characteristic features with multivariate analysis (p=0,037). Conclusion: Presence of diabetes in a first degree relative may be a risk factor for postnatal early IFG. In our study other pregestational, prenatal, perinatal factors and features at diagnosis didn’t affect early postpartum glucose metabolism. [Cukurova Med J 2013; 38(4.000): 617-626

Visual outcome of intravitreal ranibizumab for exudative age-related macular degeneration: timing and prognosis

Purpose: To describe 1-year clinical results of intravitreal ranibizumab treatment in patients with choroidal neovascularization secondary to exudative age-related macular degeneration (AMD) and to evaluate whether early treatment is a predictive value for prognosis of the disease. Materials and methods: Clinical records were retrospectively reviewed of 104 eyes that underwent intravitreal ranibizumab therapy for exudative AMD. Patients were divided into two groups according to their symptom duration: group 1,,1 month; and group 2, 1-3 months. After three monthly injections, patients were examined monthly, and subsequent injections were performed as needed. Results: There were 43 female (48.9%) and 45 males (51.1%). The follow-up time was 13.7 +/- 1.9 (12-19) months. The mean logarithm of minimum angle of resolution best-corrected visual acuity (BCVA) improved significantly, from 0.45 +/- 0.639 at baseline to 0.08 +/- 0.267 at 12 months in group 1, and from 1.06 +/- 0.687 at baseline to 0.75 +/- 0.563 at 12 months in group 2. The increase in BCVA was statistically significant in group 1 (P=0.009). The mean central retinal thickness (CRT) decreased significantly, from 355.13 +/- 119.93 mu m at baseline to 250.85 +/- 45.48 mu m at 12 months in group 1, and from 371.88 +/- 91.047 mu m at baseline to 268.61 +/- 53.51 mu m at 12 months in group 2. The decrease in CRT was statistically significant in group 1 (P=0.001). Conclusion: Intravitreal ranibizumab therapy was effective in significantly increasing mean BVCA and reducing CRT. Shorter duration of AMD, as measured by the subjective duration of visual symptoms, is associated with better visual outcome after treatment

Can We Differentiate Pyelonephritis and Cystitis without 99mTc-Dimercaptosuccinic Acid Scan in Children?

Purpose: Urinary tract infection is one of the most common infections in childhood. Because of the long term sequelae, differentiation of pyelonephritis from cystitis is important. The aim of this study is to determine the value of biomarkers such as C-reactive protein and procalcitonin and whether preferred to predict pyelonephritis in children without 99mTc-Dimercaptosuccinic Acid scan. Material and Methods: Fifty children aged 3 months to 16 years with a first urinary tract infection were included in this retrospective observational study. The medians, sensitivity, specificity, and cut-off values of serum C - reactive protein and procalcitonin to predict pyelonephritis were determined. Results: Thirty-two (64%) patients were diagnosed with pyelonephritis and 18 (36%) were diagnosed with cystitis. The cut-off value for C - reactive protein was 34 mg/L to predict pyelonephritis, with 69% sensitivity and 61% specificity. The cut-off value for procalcitonin was 0.23 ng/mL to predict pyehlonephritis, with 69% sensitivity and 66% specificity. In combination, these biomarkers were 63% sensitive and 78% specific to predict pyelonephritis. Conclusion: Using a combination of procalcitonin and C-Reactive Protein is preferred to predict pyelonephritis in children, instead of the 99mTc-Dimercaptosuccinic Acid scan. Because of its disadvantages, the 99mTc-Dimercaptosuccinic Acid scan should be avoided in children

Effectiveness of Visual Methods in Information Procedures for Stem Cell Recipients and Donors

Objective: Obtaining informed consent from hematopoietic stem cell recipients and donors is a critical step in the transplantation process. Anxiety may affect their understanding of the provided information. However, use of audiovisual methods may facilitate understanding. In this prospective randomized study, we investigated the effectiveness of using an audiovisual method of providing information to patients and donors in combination with the standard model. Materials and Methods: A 10-min informational animation was prepared for this purpose. In total, 82 participants were randomly assigned to two groups: group 1 received the additional audiovisual information and group 2 received standard information. A 20-item questionnaire was administered to participants at the end of the informational session. Results: A reliability test and factor analysis showed that the questionnaire was reliable and valid. For all participants, the mean overall satisfaction score was 184.8 +/- 19.8 (maximum possible score of 200). However, for satisfaction with information about written informed consent, group 1 scored significantly higher than group 2 (p=0.039). Satisfaction level was not affected by age, education level, or differences between the physicians conducting the informative session. Conclusion: This study shows that using audiovisual tools may contribute to a better understanding of the informed consent procedure and potential risks of stem cell transplantation

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction <= 40%)