New precipitating factors for migraine during Covid-19 pandemic lockdown

Background: Lock down caused sudden lifestyle changes and represented a massive impact on human health. We aimed to report new migraine headache precipitating factors due to lifestyle changes during coronavirus disease 2019 (COVID-19) Pandemic lockdown. Methods: This cross-sectional survey included patients diagnosed with migraine based on The International Classification of Headache Disorders, 3rd edition (ICDH-3). During the lockdown, we submitted an online self-reported web-based questionnaire to patients already diagnosed with migraine and attending headache clinic at Ibn Sian Hospital in Kuwait. Questions explored different new precipitating factors of migraine headache attacks during COVID-19 pandemic lockdown compared to precipitating factors before lockdown. Results: A total of 340 migraine patients responded to online questionnaire. The mean age of them is 34.65 years. Females were predominant 79.1%. Majority of the cohort 85 % has more than one trigger of migraine headache attack. During pandemic, the common precipitating factors were smell of strong odors in 214 (62.9%), followed by certain food  in 175 (51.8%), sleep disturbance in 120 (35.3%), emotional or mental stress  in 80 (23.6%), caffeine in 80 (23.6%), flickers of light in 78 (22.9%), weather changes in 68(20%), smoking in 65 (19.12%), noise in 56 (16.5%),  sun light exposure in 41 (12.1%), fasting/ hypoglycemia in 40 (11.7%), hormonal changes in 37 (10.6%), physical excretion/fatigue in 24 (7.1%), screen exposure in 20 (5.9%), and dehydration in 14 (4.1%) patients. Before pandemic, noises 200 (58.8%), flicker of light 180 (52.9%), weather changes 175 (51.5%), sun light 170 (50%), food 160 (48.5%) and 130 (38.2%) sleep deprivation were the most common precipitating factors of migraine. 40% did not report precipitating factors for migraine before lockdown. Conclusions: Change of habits during lock down exposed migraine patients to different precipitating factors. Strong odors, food, sleep disturbance and stress were the most common migraine headache precipitating factors during COVID-19 lockdown

Efficacy of onabotulinumtoxinA treatment in episodic migraine

BackgroundOnabotulinumtoxinA (BoNT-A) is approved as a prophylactic treatment of chronic migraine (CM) only. We aimed to assess the efficacy and safety of BoNT-A in the treatment of episodic migraine (EM).MethodsThis is a prospective study included migraine patients, aged 18–65 years, and completed 1 year treatment with BoNT-A. Patients received 4 courses of BoNT-A treatment. Patient’s headache was assessed by headache diary at baseline, and before every injection. Migraine Specific Quality of Life Questionnaire (MSQ) and work productivity were collected at baseline and in their last visit. Adverse events (AEs) were reported.ResultsThe study recruited 210 patients. Between baseline and the final visit, there were a significant reduction in migraine days, analgesic consumption days, and headache severity (9.54 ± 1.70 versus 4.58 ± 2.77, p < 0.001), (8.47 ± 1.49 versus 2.98 ± 0.21, p < 0.001), (8.37 ± 0.72 versus 2.54 ± 0.18, p < 0.001), respectively. BoNT-A treatment reduced the mean number of missed hours from work and daily activities over a 7-day period (4.63 ± 2.39 versus 6.26 ± 2.04, p < 0.001); (2.24 ± 3.30 versus 3.94 ± 3. 45; p < 0.001). Treatment with BoNT-A significantly improved the MSQ scores at last visit versus baseline visit, MSQ Role Function-Restrictive (51.55 ± 29.12 vs. 26.89 ± 17.42; p < 0.001), MSQ Role Function-Preventive (56.07 ± 24.73 vs. 30.64 ± 15.25; p < 0.001), and for MSQ Emotional Function (76.47 ± 115.29 vs. 35.12 ± 20.83; p < 0.001). Fifty-four patients (14.4%) experienced mild and short-lasting AEs.ConclusionBoNT-A is an effective and well tolerated therapy in the prophylaxis of EM. It improved MSQ and WPAI

Migraine among medical students in Kuwait University

Abstract Background Medical students routinely have triggers, notably stress and irregular sleep, which are typically associated with migraine. We hypothesized that they may be at higher risk to manifest migraine. We aimed to determine the prevalence of migraine among medical students in Kuwait University. Methods This is cross-sectional, questionnaire-based study. Participants who had two or more headaches in the last 3 months were subjected to two preliminary questions and participants with at least one positive response were asked to perform the validated Identification of Migraine (ID Migraine™) test. Frequency of headache per month and its severity were also reported. Results Migraine headache was suggested in 27.9% subjects based on ID-Migraine™. Migraine prevalence (35.5% and 44%, versus 31.1%, 25%, 21.1%, 14.8%, 26.5%, p &lt; 0.000), frequency (5.55 + 1.34 and 7.23 + 1.27, versus 3.77 ± 0.99, 2.88 ± 0.85, 3.07 ± 0.96, 2.75 ± 0.75, 4.06 ± 1.66, p &lt; 0.000); and severity of headache (59.1% and 68.2%, versus 28.3%,8.3%, 6.7%,16.7%, p &lt; 0.000; were significantly increased among students in the last 2 years compared to first five years of their study. Stress 43 (24.9%), irregular sleep 36 (20.8%), and substantial reading tasks 32 (18.5%), were the most common triggering factors cited by the students. Conclusion The prevalence of migraine is higher among medical students in Kuwait University compared to other published studies. The migraine prevalence, frequency and headache severity, all increased in the final two years of education. </jats:sec

Clinical phenotypes and constipation severity in Parkinson’s disease: Relation to Prevotella species

Background:&nbsp;The gut microbiome is speculated to play a crucial role in its pathogenesis of Parkinson’s disease as a triggering factor. Recent hypotheses suggested that&nbsp;Prevotella species&nbsp;regulate gut permeability, exert a neuroprotective effect, and interestingly, has been suspected to be deficient in PD patients, and so may play a role in this disease.&nbsp;Aim:&nbsp;This study was designed to compare between PD patients and their healthy controls as regards relative&nbsp;Prevotella&nbsp;abundance, prevalence of&nbsp;Prevotella-dominant Enterotype, and constipation severity. Also, to correlate&nbsp;Prevotella&nbsp;changes with the clinical phenotypes and &nbsp;severity of motor and non-motor symptoms of PD.&nbsp;Methods:&nbsp;Twenty-five PD cases were enrolled in this study and cross-matched to 25 healthy subjects representing the control group. Overall NMS severity was assessed using the Non-Motor Symptoms Scale (NMSS). Quantitative SYBR green Real Time PCR was performed for the identification and quantitation of&nbsp;Prevotella&nbsp;in stool.&nbsp;Results:&nbsp;Prevotella&nbsp;relative abundance was 4-fold decreased in cases when compared to controls with PIGD phenotype showing the lowest abundance, however the difference was not statistically significance.&nbsp;Prevotella-dominant Enterotype was less presented in cases compared to controls, the result was statistically significant. Severe and very severe constipation grades presented 64% of cases group Vs 12% of control group. There was statistically significant positive correlation between total constipation score and UPDRS total score and motor symptoms phenotypes.&nbsp;Conclusion:&nbsp;Relative low&nbsp;Prevotella abundance&nbsp;in PD patients appears to be related to severe phenotypes of the disease; PIGD and mixed phenotypes. Severe constipation was more presented in PD cases which may be considered &nbsp;as a preclinical biomarker for PD

Cobalt Oxide Nanoparticles/Graphene/Ionic Liquid CrystalModified Carbon Paste Electrochemical Sensor for Ultra-sensitiveDetermination of a Narcotic Drug

Purpose: Drug-abuse, namely morphine (MO) affects the metabolism of neurotransmitterssuch as dopamine (DA). Therefore, it is crucial to devise a sensitive sensing technique tosimultaneously determine both compounds in real samples.Methods: The fabrication of the sensor is based on in situ modification of a carbon paste (CP)electrode with cobalt oxide nanoparticles, graphene, and ionic liquid crystal in presence ofsodium dodecyl sulfate; CoGILCCP-SDS. The modified sensor is characterized using scanningelectron microscopy, electrochemical impedance spectroscopy and voltammetry measurements.Results: Electron transfer kinetics and analytical performance of the proposed sensor wereenhanced due to the synergistic role of all the modifiers. The simultaneous determination of MOand DA achieved low detection limits of 0.54 nmol L−1 and 0.25 nmol L−1, respectively. Besides,a carbon-based electrochemical sensor is fabricated for the nano-molar determination of MOin real samples and formulations. The sensor showed fouling resistance and anti-interferenceability in presence of other species in human fluids. The real sample analysis of MO wassuccessfully achieved with good recovery results in urine samples and pharmaceutical tablets.Linear dynamic range, sensitivity, detection limit and quantification limit of MO in urine were5 nmol L−1 to 0.6 μmol L−1, 6.19 μA/μmol L-1, 0.484 nmol L−1 and 1.61 nmol L−1, respectively.Conclusion: This sensor has great ability to be extended for electrochemical applications inassaying of many drugs

Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region

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Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Use of Telemedicine for Postdischarge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review With Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardized assessment tools are needed. // Background: Surgical site infection (SSI) is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. // Methods: The primary outcome of this study was SSI reported up to 30 days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analyzed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30 days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). // Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval: 0.63–0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In 9 eligible nonrandomized studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47–0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. // Conclusions: Use of telemedicine to assess the surgical wound postdischarge is feasible, but risks underreporting of SSI. Standardized tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally