Cluster headache is an excruciatingly painful primary headache syndrome, with attacks of unilateral pain and cranial autonomic symptoms. The current licensed treatment for acute attacks is ...subcutaneous sumatriptan.
To ascertain whether high-flow inhaled oxygen was superior to placebo in the acute treatment of cluster headache.
A double-blind, randomized, placebo-controlled crossover trial of 109 adults (aged 18-70 years) with cluster headache as defined by the International Headache Society. Patients treated 4 headache episodes with high-flow inhaled oxygen or placebo, alternately. Patients were randomized to the order in which they received the active treatment or placebo. Patients were recruited and followed up between 2002 and 2007 at the National Hospital for Neurology and Neurosurgery, London, England.
Inhaled oxygen at 100%, 12 L/min, delivered by face mask, for 15 minutes at the start of an attack of cluster headache or high-flow air placebo delivered alternately for 4 attacks.
The primary end point was to render the patient pain free, or in the absence of a diary to have adequate relief, at 15 minutes. Secondary end points included rendering the patient pain free at 30 minutes, reduction in pain up to 60 minutes, need for rescue medication 15 minutes after treatment, overall response to the treatment and overall functional disability, and effect on associated symptoms.
Fifty-seven patients with episodic cluster headache and 19 with chronic cluster headache were available for the analysis. For the primary end point the difference between oxygen, 78% (95% confidence interval, 71%-85% for 150 attacks) and air, 20% (95% confidence interval, 14%-26%; for 148 attacks) was significant (Wald test, chi(5)(2) = 66.7, P < .001). There were no important adverse events.
Treatment of patients with cluster headache at symptom onset using inhaled high-flow oxygen compared with placebo was more likely to result in being pain-free at 15 minutes.
isrctn.org Identifier: ISRCTN94092997.
Background and Aims
Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB) persons contribute a substantially larger ...number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study.
Approach and Results
We performed systematic searches for articles published in 2009–2019 reporting HBsAg seroprevalence in emigrants and in‐country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta‐analyses (total 2,800 surveys involving 112 million subjects). Combining country‐specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21‐1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in‐country rates.
Conclusions
Including FB and U.S.‐born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
Background
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic ...symptoms (SUNA) are two rare headache syndromes classified broadly as Trigeminal Autonomic Cephalalgias (TACs).
Methods
Here, 65 SUNCT (37 males) and 37 SUNA (18 males) patients were studied to describe their clinical manifestations and responses to treatment.
Results
Pain was almost always unilateral and side-locked. There were three types of attack: Single stabs, stab groups, and a saw-tooth pattern, with some patients experiencing a mixture of two types. As to cranial autonomic symptoms, SUNA patients mainly had lacrimation (41%) and ptosis (40%). Most cases of the two syndromes had attack triggers, and the most common triggers were touching, chewing, or eating for SUNCT, and chewing/eating and touching for SUNA. More than half of each group had a personal or family history of migraine that resulted in more likely photophobia, phonophobia and persistent pain between attacks. For short-term prevention, both syndromes were highly responsive to intravenous lidocaine by infusion; for long-term prevention, lamotrigine and topiramate were effective for SUNCT, and lamotrigine and gabapentin were efficacious in preventing SUNA attacks. A randomized placebo-controlled cross-over trial of topiramate in SUNCT using an N-of-1 design demonstrated it to be an effective treatment in line with clinical experience.
Conclusions
SUNCT and SUNA are rare primary headache disorders that are distinct and very often tractable to medical therapy.
In 2020, almost half a million individuals developed rifampicin-resistant tuberculosis (RR-TB). We estimated the global burden of RR-TB over the lifetime of affected individuals. We synthesized data ...on incidence, case detection, and treatment outcomes in 192 countries (99.99% of global tuberculosis). Using a mathematical model, we projected disability-adjusted life years (DALYs) over the lifetime for individuals developing tuberculosis in 2020 stratified by country, age, sex, HIV, and rifampicin resistance. Here we show that incident RR-TB in 2020 was responsible for an estimated 6.9 (95% uncertainty interval: 5.5, 8.5) million DALYs, 44% (31, 54) of which accrued among TB survivors. We estimated an average of 17 (14, 21) DALYs per person developing RR-TB, 34% (12, 56) greater than for rifampicin-susceptible tuberculosis. RR-TB burden per 100,000 was highest in former Soviet Union countries and southern African countries. While RR-TB causes substantial short-term morbidity and mortality, nearly half of the overall disease burden of RR-TB accrues among tuberculosis survivors. The substantial long-term health impacts among those surviving RR-TB disease suggest the need for improved post-treatment care and further justify increased health expenditures to prevent RR-TB transmission.
The 2020 Nobel Prize in Medicine or Physiology was awarded to Drs. Harvey Alter, Michael Houghton, and Charles Rice for their contributions to the discovery and characterization of the hepatitis C ...virus (HCV). Their achievements represent a remarkable triumph of biomedical science which allowed the development of curative therapy for HCV, that will save countless lives. This tribute provides a historical perspective of the laureates' seminal work leading to the discovery of the HCV and a synopsis of a forum hosted by the American Association for the Study of Liver Diseases to honor the laureates in which they offered their perspectives, advice for young investigators and what's left to accomplish in the field. Finally, others in the research community who have worked closely with one or more of the laureates, share some of their personal reflections and anecdotes.
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features ...(SUNA) are described, although SUNA is rarely reported. The phenotype of SUNCT and SUNA was characterized from a large series of patients (43 SUNCT, 9 SUNA). Three attack types were identified: stabs, groups of stabs and saw-tooth attacks. The mean duration of stabs was 58 s (1–600 s); stab groups, 396 s (10–1200 s); and saw-tooth, 1160 s (5–12 000s). The attack frequency was a mean of 59 attacks/day (2–600), and this depended largely on the type of attack. The pain was orbital, supraorbital or temporal in 38 (88%) SUNCT and 7 (78%) SUNA, and also occurred in the retro-orbital region, side, top, back of head, second and third trigeminal divisions, teeth, neck and ear. All SUNCT patients had conjunctival injection and tearing. Two SUNA patients had conjunctival injection, four had tearing, but none had both. Other cranial autonomic symptoms included nasal blockage, rhinorrhoea, eyelid oedema, facial sweating/flushing and ear flushing. Cutaneous stimuli triggered attacks in 74% of SUNCT but only in 22% of SUNA patients. The majority (95% SUNCT and 89% SUNA) had no refractory period between attacks. For SUNCT 58% and for SUNA 56% of patients were agitated with the attacks. We propose a new set of diagnostic criteria for these syndromes to better encompass the clinical presentations and which include a wider range of attack length, wider trigeminal pain distribution, cutaneous triggering and lack of refractory period.
It is a conundrum of the 21st Century that there is much left to discover and yet never before has our cultural and ecological patrimony been so threatened. This is especially true in tropical ...regions where heavy vegetation, inaccessibility, and rugged topography hamper investigation. Here we present two case studies that add to a growing body of literature demonstrating the utility of airborne mapping LiDAR (a.k.a. Airborne Laser Scanning) for rapid archaeological assessments in poorly documented regions. The first outlines a program of LiDAR scanning to better understand the urban center of Angamuco in the Mexican State of Michoacán. This work shows that (1) large urban centers with complex spatial organization were present centuries prior to the formation of the Purépecha Empire; (2) the settlement incorporates gardens and other landscape features within and around the settlement demonstrating a high degree of human environmental modification; and (3) current models for the evolution of social complexity in the region cannot account for the presence of Angamuco. The second presents the results of a LiDAR survey of a remote valley in the Mosquitia tropical wilderness of Honduras which has seen little archaeological research. Here we demonstrate that (1) though today the valley is a wilderness it was densely inhabited in the past; (2) this population was organized into a three-tiered system composed of 19 settlements dominated by a city; and (3) this occupation was embedded within a human engineered landscape. For both, LiDAR data fundamentally changed the understanding of coupled human/natural systems in these areas while providing critical baseline data for conservation and management.
As a response to Hurricane Mitch and the resulting widespread loss of life and destruction of Honduran infrastructure in 1998, the United States Geological Survey (USGS) conducted the first wide-area ...airborne lidar topographic mapping project in Central America. The survey was executed by the Bureau of Economic Geology at the University of Texas at Austin (BEG) in 2000, and it was intended to cover 240 square kilometers distributed among 15 flood-prone communities throughout Honduras. The original data processing produced basic digital elevation models at 1.5-meter grid spacing which were used as inputs for hydrological modeling. The USGS published the results in a series of technical reports in 2002. The authors became interested in this dataset in 2013 while searching for geospatial data that would provide additional context and comparative references for an archaeological lidar project conducted in 2012 in the Honduran Mosquitia. After multiple requests to representatives from the USGS and BEG, we found various types of processed data in personal and institutional archives, culminating in the identification of 8-mm magnetic tapes that contained the original point clouds. Point clouds for the 15 communities plus a test area centered on the Maya site of Copán were recovered from the tapes (16 areas totaling 700 km2). These point clouds have been reprocessed by the authors using contemporary software and methods into higher resolution and fidelity products. Within these new products, we have identified and mapped multiple archaeological sites in proximity to modern cities, many of which are not part of the official Honduran site registry. Besides improving our understanding of ancient Honduras, our experiences dealing with issues of data management and access, ethics, and international collaboration have been informative. This paper summarizes our experiences in the hope that they will contribute to the discussion and development of best practices for handling geospatial datasets of archaeological value.
Background & Aims Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are potent antiviral agents that might have additive or synergistic antiviral activity in treatment of patients with chronic ...hepatitis B (CHB). We compared the efficacy and safety of ETV monotherapy with those of a combination of ETV and TDF. Methods We performed a randomized, open-label, multicenter, superiority study of 379 nucleos(t)ide-naïve patients with hepatitis B e antigen (HBeAg)-positive (n = 264) or HBeAg-negative (n = 115) CHB. Subjects were given ETV 0.5 mg (n = 182) or a combination of ETV 0.5 mg and TDF 300 mg (n = 197) for 100 weeks. Results At week 96, comparable proportions of patients in each study arm achieved the primary end point of a level of hepatitis B virus (HBV) DNA <50 IU/mL (83.2% vs 76.4%; P = .088). Among HBeAg-positive patients, a greater proportion given combination therapy achieved levels of HBV DNA <50 IU/mL than those given ETV alone (80.4% vs 69.8%; P = .046). However, this difference was observed only in patients with baseline levels of HBV DNA ≥108 IU/mL (79% vs 62%) and not in those with baseline levels of HBV DNA <108 IU/mL (83% in both arms). Rates of HBeAg loss and HBeAg seroconversion were comparable between groups, whereas the rate of alanine aminotransferase normalization was greater in the ETV monotherapy group. No HBV variants associated with ETV or TDF resistance were detected. Safety profiles were consistent with previous reports of ETV or TDF monotherapy. Conclusions The antiviral efficacy of ETV monotherapy is comparable to that of ETV plus TDF in a mixed population of nucleos(t)ide-naïve patients with CHB (70% HBeAg positive). The combination therapy could provide an incremental benefit to HBeAg-positive patients with baseline levels of HBV DNA ≥108 IU/mL. Clinical trial information: ETV-110, the BE-LOW study; NCT00410072.
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