Difference In Frequency Of Attacks Research Articles

The US Hereditary Angioedema Association Scientific Registry: hereditary angioedema demographics, disease severity, and comorbidities

BackgroundHereditary angioedema (HAE) and idiopathic nonhistaminergic angioedema (INHA) are ultra-rare diseases whose natural histories and comorbidities are incompletely understood. ObjectiveTo develop a national patient-centric registry to address these deficiencies in our knowledge and improve our ability to assess the real-world impact of therapeutic interventions. MethodsData from members of the US HAE Association were collected into an online registry between 2009 and April 7, 2021. Cohorts were categorized by reported physician diagnosis. Patient reported data were collected using a series of questionnaires. Demographic, natural history, and family history outcomes of the HAE due to C1 inhibitor deficiency (HAE-C1INH) participants were compared with those of the combined HAE with normal C1 inhibitor (HAE-nl-C1INH) plus INHA group. The prevalence of comorbid conditions in the HAE-C1INH group was compared with the general US population. ResultsA total of 485 HAE-C1INH, 26 HAE-nl-C1INH, and 70 INHA participants were included in the analysis. Delay to diagnosis was shorter in HAE-C1INH (5 vs 11 years), but both had decreasing delays over time. Differences in attack frequency and location were found between the groups. Morbidity surrogates including emergency department visits, hospitalizations, unnecessary abdominal surgeries, and intubations were strikingly high as was mortality with 36.9% of HAE-C1INH and 15.4% of HAE-nl-C1INH participants reporting family members who died from a HAE attack. Females with HAE-C1INH had a significant increase in the prevalence of depression, sleep disorders, kidney disease, anemia, and hepatitis. Cardiovascular comorbidities were significantly reduced in the HAE-C1INH group. ConclusionThe US HAEA Scientific Registry provides a mechanism to enhance our knowledge of HAE and INHA.

Colour, location and movement: what do models tell us about predation on colour morphs of a poison frog from eastern Amazonia?

Abstract Many dendrobatid frogs are known to be aposematic: brightly coloured and unpalatable to predators. To deceive predators, frog models used to test for predatory colour bias must be similar in size, colour, shape, and movement to frogs. We carried out an experiment with moving models of the species Adelphobates galactonotus, in two localities. A. galactonotus is a polytypic frog and each population of the species has a distinct colour. Birds and mammals were the vertebrates responsible for the marks on the models, but there was no difference in frequency of attacks on local-, non-local- and cryptic-colour models. Only invertebrates avoided cryptic models. Different populations of the species seem to be under different predation pressure, but colour differentiation in this species is probably related to other mechanisms, such as sexual selection.

Vasodilators for primary Raynaud's phenomenon.

Vasodilators for primary Raynaud's phenomenon.

High attack frequency in patients with angioedema due to C1-inhibitor deficiency is a major determinant in switching to home therapy: a real-life observational study.

BackgroundHereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) is characterized by recurrent attacks of swelling that affect various body sites. Such attacks are a frequent cause of visits to the emergency department and are often treated in the hospital. In recent years, self-administration of C1-inhibitor (C1-INH) concentrates at home has become an increasingly used option, with a positive impact on patient outcomes and quality of life.MethodsThis was an observational study of 6 months’ duration in 56 patients with C1-INH-HAE referred to a HAE center in southern Italy. The patients received three types of treatment for their swelling attacks: C1-INH concentrates administered at home (n = 25); icatibant administered at home (n = 12); and C1-INH concentrates administered in the hospital (n = 19). The objectives of this observational study were to compare therapy compliance (defined as the proportion of treated attacks) and quality of life in home- and hospital-treated patients, and to identify factors associated with the decision to use home therapy.ResultsOverall, 918 attacks were reported over 6 months, of which 544 (59.2 %) were treated. Total number of reported attacks and the mean (±SD) number of attacks per patient, respectively, in the three groups were: 611 and 24.4 (±26.1) for home-based C1-INH; 191 and 15.9 (±12.0) for home-based icatibant; 166 and 6.1 (±6.5) for hospital-based C1-INH. Differences in attack frequency between home- and hospital-based treatments were statistically significant (p = 0.002), while patient demographic characteristics and the disease severity score did not correlate with the use of home therapy. Compliance with therapy was significantly better with home-based therapy (71.2 % of treated attacks with C1-INH and 44.0 % with icatibant) than with hospital-based therapy (21.6 %, p = 0.003). Quality of life showed an opposite trend, with patients on hospital-based treatment reporting the highest quality of life.ConclusionsHome-based therapy was associated with better compliance compared with hospital-based therapy. The choice to adopt home-based therapy appeared to correlate with a high attack frequency. Home-based therapy is a valid treatment option for patients with C1-INH-HAE and should be offered to all such patients, and especially to those with high attack frequency.

Trigeminal Autonomic Cephalalgias.

This article reviews the clinical features of and treatment options for the trigeminal autonomic cephalalgias (TACs). The TACs are a group of primary headache disorders characterized by short-lasting episodes of severe unilateral headaches that are associated with ipsilateral cranial autonomic symptoms. The best known and most commonly seen TAC in clinical practice is cluster headache. The other syndromes within this group include paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks. Although these disorders share a similar phenotype, they are distinguished by differences in attack frequency and duration. Recognition of these clinical differences is paramount because treatment options vary; paroxysmal hemicrania and hemicrania continua demonstrate an absolute response to treatment with indomethacin, while the other syndromes respond to other agents. Although much less common than other headache disorders seen in clinical practice, recognition of the TACs is especially important as they are among the most severe and disabling syndromes in headache medicine.

Stress at work in migraine patients: Differences in attack frequency

IntroductionMigraine is a common and prevalent disease that contributes to health expenditure and interferes with quality of life. Our goal was to analyse the level of stress at work in a sample of migraine and its possible association with the chronicity of the process. Materials and methodsWe applied the Maslach Burnout Inventory (MBI), consisting of 22 items grouped into blocks that assess emotional exhaustion (EE), personal accomplishment (PA), depersonalisation at work (DP) and positive influence (PI), to 94 consecutive subjects recruited in the outpatient clinic. Differences were compared between clinical groups (chronic migraine [CM]: >15days/month with headache over a 3-month period vs episodic migraine [EM]: <15days/month with headache) using the general linear model adjusted for age and MIDAS score. ResultsThe mean age was higher in the CM group. Mean MIDAS scores were 51±4.1 in CM, and 17.7±15 in EM (P=0.001). Adjusted means for EE were 24.6±2.6 in CM patients, 16.2±2.6 in EM patients, and 13.4±2.3 (P=0.03) in the healthy group. MIDAS scale scores were inversely correlated to PA (P<0.05). DiscussionOur results suggest that the level of EE at work is higher in EM than in CM patients, while PA levels decrease as impact on the MIDAS scale increases. The Maslach scale is a potentially useful tool for studying migraine impact. Surprisingly, EE is higher in patients with fewer episodes; this tendency could be related to stress adaptation mechanisms present in patients with chronic illness.

Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report

Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment. We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software. Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P < .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P < .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P < .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients. This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.

Prostaglandin Analog Mechanisms Are Not Effective in Refractory Chronic Cluster Headache

Prostaglandin E analogs have been shown to be effective in the treatment of refractory trigeminal neuralgia in patients with multiple sclerosis. Prostaglandin E inhibits the functions of T lymphocytes which are involved in the pathophysiology of cluster headache. Therefore, a double-blind, placebo-controlled, crossover study on the efficacy of misoprostol in chronic refractory cluster headache was performed. Eight patients were treated with 600 micrograms misoprostol and with placebo for a 2-week period. No differences in attack frequency, intensity, global impression, and side effects could be detected, suggesting that prostaglandin E analogs are not effective in the treatment of chronic cluster headache.

Prevention of acute adenolymphangitis in brugian filariasis: comparison of the efficacy of ivermectin and diethylcarbamazine, each combined with local treatment of the affected limb

Acute attacks of adenolymphangitis (ADL) not only force patients with lymphatic filariasis to seek medical attention but also hasten the progression of filarial oedema. Patients with filariasis-associated ADL are currently treated with repeated courses of the antifilarial drug diethylcarbamazine (DEC), with or without antibiotics and anti-inflammatory agents. In this double-blind, placebo-controlled study, the efficacy of local treatment of the affected limb combined with repeated doses of ivermectin or DEC, in preventing the occurrence of ADL in Brugia malayi lymphatic filariasis, was examined. Overall, 120 patients who had each had at least two ADL attacks in the previous year were each admitted to the study at the time of an ongoing episode of ADL. The patients were randomly allocated to receive 12, monthly treatments of ivermectin (400 µg/kg), DEC (10 mg/kg) or placebo, in addition to local care of the affected limbs.There was a significant reduction in the frequency of ADL attacks in each of the three groups during the 2-year study period (P<0.001 for each comparison). Most importantly, there were no significant differences in frequency of attacks between the three groups, either at the end of the treatment phase or at the end of the post-treatment phase (P < 0.15 for each comparison), suggesting that foot care combined with appropriate use of local antibiotics or antifungals is adequate to reduce the number of ADL attacks. The implications of these observations for planning morbidity control in lymphatic filariasis are discussed.

Prevention of acute adenolymphangitis in brugian filariasis: comparison of the efficacy of ivermectin and diethylcarbamazine, each combined with local treatment of the affected limb

Acute attacks of adenolymphangitis (ADL) not only force patients with lymphatic filariasis to seek medical attention but also hasten the progression of filarial oedema. Patients with filariasis-associated ADL are currently treated with repeated courses of the antifilarial drug diethylcarbamazine (DEC), with or without antibiotics and anti-inflammatory agents. In this double-blind, placebo-controlled study, the efficacy of local treatment of the affected limb combined with repeated doses of ivermectin or DEC, in preventing the occurrence of ADL in Brugia malayi lymphatic filariasis, was examined. Overall, 120 patients who had each had at least two ADL attacks in the previous year were each admitted to the study at the time of an ongoing episode of ADL. The patients were randomly allocated to receive 12, monthly treatments of ivermectin (400 micrograms/kg), DEC (10 mg/kg) or placebo, in addition to local care of the affected limbs. There was a significant reduction in the frequency of ADL attacks in each of the three groups during the 2-year study period (P < 0.001 for each comparison). Most importantly, there were no significant differences in frequency of attacks between the three groups, either at the end of the treatment phase or at the end of the post-treatment phase (P > 0.15 for each comparison), suggesting that foot care combined with appropriate use of local antibiotics or antifungals is adequate to reduce the number of ADL attacks. The implications of these observations for planning morbidity control in lymphatic filariasis are discussed.

Female Aggression in Albino ICR Mice: Development, Social Experience, and the Effects of Selective Breeding

Social experience has been shown to mask or eliminate heritable effects on aggressive behavior in male mice. This work assesses the impact of social experience in females from lines of mice selectively bred for differential male aggressiveness. These results confirm the earlier report of cross-sex similarity in aggressive behavior after selection directed only at male behaviors ( Hood &amp; Cairns, 1 988 ). Repeated test experience increased aggressive behavior of S6 females. In addition, a genetic-developmental interaction was found, with enhanced aggressiveness in mature vs. young high-aggressive line females. Repeated test experience in 4 daily trials with mature S15 females obscured the clear line differences in attack frequency obtained on the first trial. In particular, a few highly aggressive individuals emerged among the group-reared low-aggressive line females. Isolation housing did not alter female aggressiveness. These findings are discussed in regard to conceptions of genetic-experiential-developmental interactions, and the role of female social behavior in microevolutionary processes.

Hyperparasites of the Gypsy Moth (Lepidoptera: Lymantriidae): Field Attack Patterns on Cotesia melanoscela (Hymenoptera: Braconidae) at Different Host Densities and on Different-sized Host Clumps

Laboratory-reared cocooned larvae of Cotesia melanoscela (Ratzeburg) were exposed in the field in two ways. First, 50 cocoons in five clumps of 10 per clump were placed on trees at nine sites in different areas of Connecticut to relate hyperparasite attack frequency to natural population levels of C. melanoscela. Second, clumps of cocoons having 1, 5, and 10 individuals per clump were exposed at one site to see if differences in attack frequency occurred on different-sized clumps. Hyperparasites from six hymenopteran families were recovered. Results suggest that populations of the two most abundant groups of hyperparasites sampled, Dimmockia sp. (Hymenoptera: Eulophidae) and Gelis spp. (Hymenoptera: Ichneumonidae), were not noticably influenced by C. melanoscela abundance, probably because these hyperparasites have many alternate hosts. These same hyperparasites tended to attack several cocoons per clump of those found, and at east Gelis spp. attacked more clumps with 10 cocoons per clump than those with 1 cocoon per clump. However, for both hyperparasites, average parasitization of individual cocoons was not significantly different for different-sized clumps. Evidently the hyperparasites have low reproductive potentials or long handling times that may limit their ability to fully exploit aggregated hosts.