Series of patients with SARS-CoV-2 infection report headache in 6%-15% of cases, although some data suggest that the actual frequency is higher, and that headache is not associated with fever. No ...study published to date has analyzed the characteristics of headache in these patients.
To analyze the characteristics of COVID-19 related headaches.
We conducted a survey of Spaniard healthcare professionals who have been infected by SARS-CoV-2 and presented headache during the course of the disease. The survey addressed respondents' medical history and headache characteristics, and we analyzed the association between both.
We analyzed the responses of a sample of 112 healthcare professionals. History of migraine was reported by 20/112 (17.9%) of respondents, history of tension-type headache by 8/112 (7.1%), and history of cluster headache was reported by a single respondent; 82/112(73.2%) of respondents had no history of headache. Headache presented independently of fever, around the third day after symptom onset. The previous history of migraine was associated with a higher frequency of pulsating headache (20% in patients with previous migraine vs 4.3% in those with no history of migraine, P = .013).
Headache is often holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Because the characteristics of the headache and the associated symptoms are heterogeneous in our survey, we suggest that several patterns with specific pathophysiological mechanisms may underlie the headache associated with COVID-19.
Background and purpose
Several variables have been reported to be associated with anti‐calcitonin gene‐related peptide (CGRP) receptor or ligand antibody response, but with differing results. Our ...objective was to determine whether machine‐learning (ML)‐based models can predict 6‐, 9‐ and 12‐month responses to anti‐CGRP receptor or ligand therapies among migraine patients.
Methods
We performed a multicenter analysis of prospectively collected data from patients with migraine receiving anti‐CGRP therapies. Demographic and clinical variables were collected. Response rates in the 30% to 50% range, or at least 30%, in the 50% to 75% range, or at least 50%, and response rate of at least 75% regarding the reduction in the number of headache days per month at 6, 9 and 12 months were calculated. A sequential forward feature selector was used for variable selection and ML‐based predictive models for the response to anti‐CGRP therapies at 6, 9 and 12 months, with model accuracy not less than 70%, were generated.
Results
A total of 712 patients were included, 93% were women, and the mean (SD) age was 48 (11.6) years. Eighty‐four percent of patients had chronic migraine. ML‐based models using headache days/month, migraine days/month and the Headache Impact Test (HIT‐6) yielded predictions with an F1 score range of 0.70–0.97 and an area under the receiver‐operating curve score range of 0.87–0.98. SHAP (SHapley Additive exPlanations) summary plots and dependence plots were generated to evaluate the relevance of the factors associated with the prediction of the above‐mentioned response rates.
Conclusions
Our results show that ML models can predict anti‐CGRP response at 6, 9 and 12 months. This study provides a predictive tool that can be used in a real‐world setting.
In this study, the ability of machine‐learning (ML) algorithms to predict response to anti‐calcitonin gene‐related peptide (CGRP) receptor or ligand‐antibody therapies in a large cohort of patients with migraine was evaluated. The main finding was that ML can generate predictive models for response to anti‐CGRP receptor at 6, 9 and 12 months with high accuracy, using clinically relevant headache variables and scales. A calculator tool for the prediction of response rate was also generated. This study shows that ML may have an important role to play in improving prediction of anti‐CGRP treatment responses in a real‐world setting and could serve as a decision support system aid.
Neutrophil extracellular traps (NETs) induce a procoagulant response linking inflammation and thrombosis. Low levels of miR-146a, a brake of inflammatory response, are involved in higher risk for ...cardiovascular events, but the mechanisms explaining how miR-146a exerts its function remain largely undefined. The aim of this study was to explore the impact of miR-146a deficiency in NETosis both, in sterile and non-sterile models in vivo, and to inquire into the underlying mechanism. Two models of inflammation were performed: 1) Ldlr-/- mice transplanted with bone marrow from miR-146a-/- or wild type (WT) were fed high-fat diet, generating an atherosclerosis model; and 2) an acute inflammation model was generated by injecting lipopolysaccharide (LPS) (1 mg/Kg) into miR-146a-/- and WT mice. miR-146a deficiency increased NETosis in both models. Accordingly, miR-146a-/- mice showed significant reduced carotid occlusion time and elevated levels of NETs in thrombi following FeCl3-induced thrombosis. Infusion of DNAse I abolished arterial thrombosis in WT and miR-146a-/- mice. Interestingly, miR-146a deficient mice have aged, hyperreactive and pro-inflammatory neutrophils in circulation that are more prone to form NETs independently of the stimulus. Furthermore, we demonstrated that community acquired pneumonia (CAP) patients with reduced miR-146a levels associated with the T variant of the functional rs2431697, presented an increased risk for cardiovascular events due in part to an increased generation of NETs.
The role of disease‐modifying therapies in patients with autoimmune disorders during severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection is controversial. Immunocompromised patients ...could have a more severe coronavirus disease‐2019 (COVID‐19) due to the absence of an adequate immune response against the SARS‐CoV‐2. However, therapies that act on immune response could play a protective role by dampening the cytokine‐release syndrome. Fingolimod is a drug used for immune therapy in patients with multiple sclerosis (MS) through the sequestration of activated lymphocytes in the lymph nodes. We report the case of a 57‐year‐old man with relapsing‐remitting MS treated with fingolimod that showed a reactivation of COVID‐19 with signs of hyperinflammation syndrome after fingolimod withdrawal. Our case suggests that discontinuation of fingolimod during COVID‐19 could imply a worsening of SARS‐CoV2 infection.
Highlights
We report a patient with Multiple Sclerosis presenting COVID‐19 when treated with fingolimod.
Hyperinflammation syndrome was observed after fingolimod withdrawal.
Discontinuation of fingolimod during COVID‐19 could imply a worsening of SARS‐CoV‐2 infection.
Aim and objectives
The aim of this study is to identify preoperative indicators and/or predictors of complications or inefficiencies in the surgical process that can be modified within nursing ...practice.
Background
Due to rapid sociodemographic and technological change, the global demand for surgical attention is rising exponentially, requiring new strategies for optimisation and sustainability in perioperative care.
Design
We conduced the scoping review using the methodology recommended by the Joanna Briggs Institute supported with The PAGER framework and guided by the PRISMA‐ScR Checklist.
Methods
Four databases (CINAHL, MEDLINE, SCOPUS and PUBMED) were examined to extract relevant published results for elective surgery on adult patients during the period 2011–2021. This process identified 609 records. Exclusion criteria were applied, and the sample was then evaluated with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD), after which 15 studies remained.
Results
The following preoperative indicators and/or predictors were considered: (1) Anxiety; (2) Pain; (3) Health education, knowledge and training; (4) Satisfaction; (5) Management/organisation (including costs, resources used/available, organisational issues, hospital stay (preoperative), standardisation and protocolisation.
Conclusion
The identification of five indicators and/or predictors of complications or inefficiencies in the surgical process, which can be modified by nursing, allows the effective application of interventions in the preoperative phase, optimising care and improving health outcomes.
Relevance to clinical practice
The development and implementation of specific nursing skills in the preoperative phase are essential to optimise the surgical process.
Anti-calcitonin gene-related peptide (CGRP) therapies are recent preventive therapies approved for both episodic and chronic migraine. One of the measures of effectiveness is the withdrawal of other ...preventive treatments. The objective of this study is to quantify the impact of anti-CGRP drugs in concomitant preventive treatment in patients with migraine.
This was an observational, retrospective, multicenter cohort study with patients from nine national headache units. Patients with migraine undergoing treatment for at least 6 months with anti-CGRP antibodies, who were initially associated with some preventive treatment (oral and/or onabotulinumtoxinA) were included. Demographic and clinical variables were collected, as well as variables related to headache. Differences according to withdrawal or nonwithdrawal were evaluated.
A total of 408 patients were included, 86.52% women, 48.79 (SD = 1.46) years old. Preventive treatment was withdrawn in 43.87% (179/408), 20.83% partially and 23.04% totally. In 27.45% (112/408), it was maintained exclusively due to comorbidity and in 28.6% (117/408) due to partial efficacy. The most frequent time of withdrawal was between 3 and 5 months after the start of treatment. The baseline characteristics associated with nonwithdrawal were comorbidities: insomnia, hypertension and obesity, chronic migraine, and medication overuse. In the multivariate analysis, the absence of high blood pressure, a greater number of preventive treatments at the start, and a lower number of migraine days/month after anti-CGRP treatment were independently associated with withdrawal of the treatment (p < 0.05).
Anti-CGRP antibodies allow the withdrawal of associated preventive treatment in a significant percentage of patients, which supports its effectiveness in real-life conditions.
Nonfluorinated hydrophobic surfaces are of interest for reduced cost, toxicity, and environmental problems. Searching for such surfaces together with versatile processing, A200 silica nanoparticles ...are modified with an oligodimethylsiloxane and used by themselves or with a polymer matrix. The goal of the surface modification is controlled aggregate size and stable suspensions. Characterization is done by NMR, microanalysis, nitrogen adsorption, and dynamic light scattering. The feasibility of the concept is then demonstrated. The silica aggregates are sprayed in a scalable process to form ultrahydrophobic and imperceptible coatings with surface topographies of controlled nanoscale roughness onto different supports, including nanofibrillated cellulose. To improve adhesion and wear properties, the organosilica was mixed with polymers. The resulting composite coatings are characterized by FE-SEM, AFM, and contact angle measurements. Depending on the nature of the polymer, different functionalities can be developed. Poly(methyl methacrylate) leads to almost superhydrophobic and highly transparent coatings. Composites based on commercial acrylic car paint show “pearl-bouncing” droplet behavior. A light-emitting polyfluorene is synthesized to prepare luminescent and water repellent coatings on different supports. The interactions between polymers and the organosilica influence coating roughness and are critical for wetting behavior. In summary, the feasibility of a facile, rapid, and fluorine-free hydrophobization concept was successfully demonstrated in multipurpose antiwetting applications.
Background
Headache is a frequent symptoms of coronavirus disease 2019 (COVID-19). Its long-term evolution remains unknown. We aim to evaluate the long-term duration of headache in patients that ...presented headache during the acute phase of COVID-19.
Methods
This is a post-hoc multicenter ambisective study including patients from six different third-level hospitals between 1 March and 27 April 2020. Patients completed 9 months of neurological follow-up.
Results
We included 905 patients. Their median age was 51 (IQR 45–65), 66.5% were female, and 52.7% had a prior history of primary headache. The median duration of headache was 14 (6–39) days; however, the headache persisted after 3 months in 19.0% (95% CI: 16.5–21.8%) and after 9 months in 16.0% (95% confidence interval: 13.7–18.7%). Headache intensity during the acute phase was associated with a more prolonged duration of headache (Hazard ratio 0.655; 95% confidence interval: 0.582–0.737).
Conclusion
The median duration of headache was 2 weeks, but in approximately a fifth of patients it became persistent and followed a chronic daily pattern.
Summary
In recent years, there has been an increase in studies on the implications of gut microbiota (GM) on the behaviour of children with autism spectrum disorders (ASD) due to a dysbiosis in GM ...that can trigger onset, development or progression of ASD through the microbiota–gut–brain axis. The aim of this study is to carry out a systematic review of articles from the last 6 years that analyse GM in children with ASD compared to GM in control groups. Children with ASD showed a higher abundance of Roseburia and Candida genera, and lower abundance of Dialister, Bilophila, Veillonella, Streptococcus, Coprococcus and Prevotella genera. Those differences can be attributed to factors such as different nationalities, nature of control groups, place where the sample was taken, gastrointestinal (GI) problems or bacterial detection methods. It is still too early to define a specific GM profile of children with ASD, and future studies should focus on homogenizing the characteristics of samples and control groups. Furthermore, new multicentre studies should also focus on the impact of GM on GI physiology, neurophysiology and behaviour of children with ASD, and on performing psychometric analyses of the correlation between the severity of ASD behavioural symptoms and GM profiles.
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