Frequency Of Attacks Research Articles

Investigation of the correlation of C1 esterase inhibitor levels and functions with attack severity and frequency in hereditary angioedema

Investigation of the correlation of C1 esterase inhibitor levels and functions with attack severity and frequency in hereditary angioedema

Comparison of Vitamin D, B12, and Folic Acid Levels According to Attack Frequency in Familial Mediterranean Fever Cases.

Familial Mediterranean fever (FMF) is an autoinflammatory disease more commonly observed in the Eastern Mediterranean region. Studies have shown that inflammatory processes may decrease vitamin D, vitamin B12 and folate levels, but there is no clear data on the effect of attack frequency on these levels. Our study aimed to evaluate the effect of FMF attack frequency on vitamin levels. FMF patients aged between 4-18 years were considered as the study group, while healthy children who had vitamin levels during the same period were considered as the control group. The study group was further subgrouped according to the number of attacks. Those experiencing 2 or fewer attacks per year are classified as the attack group, while those experiencing 6 or more attacks per year are classified as the frequent attack group. A total of 494 subjects were included. The study group was composed of 333 FMF patients, 108 of them in the attack group and 225 in the frequent attack group. Control group included 161 children. The median and interquartile range (IQR: P25-75) in the frequent attack, attack, and control groups for 25(OH)D levels were 14.3 (9.57-18.9), 14.85 (10.12-21.77), and 14.95 (9.92-20.12) ng/ml, for B12 levels were 320 (238-415), 328 (250.25-439.25), and 373 (273.75-519.25) pg/ml, and for folate levels were 6 (5.13-8.12), 6.8 (5.36-8.9), and 7 (5.3-9.9) ng/ml, respectively. There is no significant difference between groups for 25(OH)D and folate (p=0.436 and p=0.25, respectively). Vitamin B12 levels are significantly lower in study group (p=0.001) but there is no difference according to attack frequency (p=0.92). There is no effect of attack frequency on 25(OH)D, vitamin B12 and folate levels. The fact that vitamin B12 levels are within normal limits in patients with FMF may be explained by the adequate dietary habits of these patients.

EVALUATING THE EFFICACY OF BRIHAT DASHAMOOLA TAILA NASYA AND RASNA DASHAMOOLA KASHAYA WITH VARUNAADI KSHEERA GHRITA NASYA AND MUNDITAKA KASHAYA IN THE MANAGEMENT OF ARDHAVABHEDAKA VIS-A-VIS MIGRAINE

Introduction: Ardhavabedhaka is a condition characterized by severe pain in half of the head, such as bheda, toda, bhrama, shula appearing in interval of either 15 or 10 days or spontaneously without any cause1. This disease shows close resemblance to migraine. Migraine is a neural condition characterized by severe recurrent headache usually on one side of the head often accompanied by nausea, vomiting and photophobia2. Migraine affects globally 12% of the population. In India 14.12%-25.2% population and it is a disease predominantly seen in females, with male to female ratio of 1.7:2.6 and among those from urban than rural areas 1.3:1.83. Currently, migraines are managed by usage of analgesics and triptans. Chronic usage of these drugs may cause renal and hepatotoxicity. Therefore, it is necessary to explore ayurvedic approaches that can combat the disease. In Ayurevda this disease is managed by usage of uttama matra of chatuhsneha, shirokaya virechana, nadi sweda, niruha basti, anuvasana basti and shamanaoushadi. As Nasya karma is the prime treatment modality for the management of urdhwa jatrugata vikaras, it is considered appropriate for management of Ardhavabedhaka4. Materials and Methods: The study was conducted using Brihat dashamoola taila as nasya for 8 days and Rasna dashamooladi Kashaya as shamanoushadhi for 23 days post nasya in group 1 and Varunadi ksheera ghrita nasya for 8 days and Munditaka Kashaya as shamanoushadhi for 23 days post nasya in group 2. The assessments were done on the domains of intensity of pain, frequency of attacks and duration of pain, along with the Headache impact score, on the 0th, 8th and 31st days, before and after the treatment. Result: It showed that there was significant decrease in intensity, frequency, duration of pain and Hit score, post nasya karma in both group 1 and 2, also the reduction in pain was significant in both group 1 and 2 post shamanoushadhi. With the overall treatment, it was seen that the reduction in Hit score was highly significant with a p value of 0.000. On comparing the results obtained in both groups, it was observed that group 1 had significant results compared to group 2. Conclusion: Nasya karma works as a treatment of choice in Ardhavabhedaka, due to its ability to eliminate the accumulated doshas from the shiras. The present study showed that Brihat dashamoola taila nasya along with Rasna dashamoola kashaya gives better results in vatakapha pradhana Ardhavabhedaka, and Varunadi ksheera ghrita nasya along with Munditaka Kashaya works better in vatapitta pradhana Ardhavabhedaka.

The effectiveness of garlic extract against Spodoptera litura on Chili

Spodoptera litura is a polyphagous pest and attack many families of cultivated plants, such as chili plants. Application of synthetic pesticides is still the mainstay for controlling this pest in the field. To support eco-friendly plant protection management, it is important to explore potential natural materials such as garlic extract. This research aims to determine the potential of garlic extract in controlling S. litura on chili plants, and to see its indirect effect on chili yield. The research was carried out in two sites, in the laboratory and the field. The experiment used a completely randomized design with 6 treatments and 4 replications. The concentrations of garlic extract, i.e., control (0%), 24%, 26%, 28%, 30%, and 32%. The results showed the application of garlic extract had a significant effect on the mortality of S. litura, the frequency of attacks, and the intensity of pest attacks in the field, and had an effect on the variable number of fruit and fruit weight of chili plants. The LC50 and LC90 values reached 19.66% and 29.97% in the laboratory, and 28.30% and 34.3%% in the field, respectively. The LT50 and LT90 values from the 32% garlic extract in the laboratory were respectively 3.37 and 7.23 days. The application of garlic extraction affected growth and yield, i.e. healthy leaves, number of fruits, and weight of fruits in chili. The garlic extract is potentially used as an organic pesticide to suppress the S.litura attacks while keeping the plant's growth and yield.

Recent Clinical Research on Acupuncture Therapy for Cluster Headache

Objectives: This study presents evidence by analyzing the research trends in acupuncture treatment for cluster headache in the last 10 years.Methods: Randomized controlled trials (RCTs) about acupuncture for cluster headache were searched from the China National Knowledge Infrastructure, PubMed, Cochrane Library, Oriental Medicine Advanced Searching Integrated System, ScienceON, Korean Studies Information Service System, and Research Information Sharing Service. The search terms were the combinations of “cluster headache”, “acupuncture”, and “needle therapy”, and the articles were restricted to those published between 2013 and 2023. Only RCTs were selected. The risk of bias (RoB) was assessed according to the revised Cochrane RoB2 criteria.Results: Six RCTs were selected and analyzed in this review. All selected studies were conducted in China. All RCTs comprised 628 participants. Manual acupuncture was used in all studies. Acupuncture targeting the sphenopalatine ganglion was performed in two papers published after 2020. ST8, Ex-HIN3, and GB14 were the most frequently used acupoints in acupuncture treatment. The most commonly used indicators for evaluation were headache attack frequency, clinical efficacy, and the visual analog scale. In each study, adding acupuncture treatment to conventional therapy had significant effects in relieving the symptoms of cluster headaches.Conclusion: The results suggest that acupuncture is an effective treatment for cluster headache. To ensure objective evidence for the effectiveness of acupuncture treatment in cluster headache, it is important to continue large-scale case reports and RCTs.

Lanadelumab demonstrates high efficacy in reducing the frequency of angioedema attacks in patients with severe HAE in real-life settings

Introduction and objective: Evaluation of lanadelumab efficacy in preventing angioedema attacks in patients with severe hereditary angioedema due to C1-inhibitor deficiency in Poland and descriptive analysis of this group of patients. Materials and methods: Retrospective analysis of patients treated with lanadelumab in Poland. Data were acquired from the electronic database of the National Health Fund, compiled from 15 hereditary angioedema centres. Only patients with severe hereditary angioedema course (at least 12 severe – abdominal, pharyngeal or laryngeal – hereditary angioedema attacks per six months, requiring on-demand medications) initiated treatment. The patients received lanadelumab 300 mg every two weeks. The efficacy of the therapy was assessed after six months. Results: Lanadelumab was initiated in a total of 43 patients (group B). Twenty of them achieved the follow-up point after six months (group A). The mean age of the patients was 44 years. The majority (76.7%) were female and 79% had a family history of hereditary angioedema. Most patients (95.3%) had HAE-1 (absolute deficiency of C1-inhibitor). On average, within six months before treatment, group A patients experienced 19.7 (95% confidence interval, CI: 16.06–23.33) severe hereditary angioedema attacks. In the six months following treatment initiation, the number of attacks decreased to an average of 0.5 (95% CI: 0–1.0), with significant reductions in all types of hereditary angioedema attacks – abdominal (p < 0.0001), pharyngeal (p < 0.005), and laryngeal (p < 0.05). Utilisation of on-demand medications dropped from an average of 23.5 (95% CI: 16.7–30.3) to 0.5 standard therapeutic dose (95% CI: 0–1.1). Conclusions: The study highlights the therapeutic potential of lanadelumab in managing hereditary angioedema, usually offering patients a complete resolution of severe hereditary angioedema attacks and release from dependence on rescue medication. Our results support the current paradigm shift in hereditary angioedema treatment.

THE RESPONSE OF SOME ROSE VARIETIES TO THE ATTACK OF THE PATHOGEN DIPLOCARPON ROSAE WOLF IN THE CLIMATIC CONDITIONS OF 2023

The research was carried out on 10 varieties of roses grown in the "Alexandru Buia" Botanical Garden. During the growing season, field ratings were made on the frequency (F%) and intensity (I) of attack in order to calculate the degree of attack (GA%). The determinations were made at three different times, namely in June, September and October.Depending on the average values of the degree of attack at the three determinations, it was found that two varieties behaved as sensitive with attack degree values of 8.06% and (Ajsa) and 10% (Terracotta), respectively, and eight varieties as very sensitive with values between 15.83% (Velvet Fragance) and 35% (Melina).The quantification of the effect of the attack of the pathogen Diplocarpon rosae Wolf on the monitored rose varieties revealed changes in some biological characteristics related to the ratio of foliole length and width to the same parameters in the case of unattacked organs. The most severe loss was due to their response to attack by the pathogen Diplocarpon rosae Wolf

Assessment of Quality of Life in Young Adults with Migraine

Migraine is a primary headache disorder with recurring headaches, nausea, vomiting, photophobia, and phonophobia. Migraine is believed to impact more than 10% of the world's population, is most prevalent between the ages of 20 and 50, and is about three times more prevalent in women than in males. Patients with Migraine may have significant medical comorbidity load associated with pain, disability, and activity limitation which in turn affects their Health-related quality of life (HRQOL). Hence, there is a growing need to research the impact of Migraine on patients HRQOL in order to improve the productivity and QOL of patient The goal of the study was to assess the quality of life in young adults with Migraine. The study also aimed to determine the Migraine triggers in individuals. The severity, duration, and frequency of Migraine attacks were also studied. A total of 84 subjects were enrolled in the study out of which 29.76% (n=25) were Male and 70.24% (n=59) were Female. Stress (42.85%) was found to be the more prevalent trigger. The severity of subjects was assessed, 35.71% are having severe migraine which is more prevalent. y. Almost half (47%) of the patients had migraine episodes 1-2 weeks back followed by 1 month back. . Most of the subjects (44%) had migraine attacks for 4-6 hours. The study concluded that migraine was more prevalent in women. The most common symptoms seen in this study population were pain followed by nausea & vomiting. Out of this study, population stress was the common trigger followed by travel and noise. The results of the current study indicate the quality of life of migraine patients was significantly low almost half and the most affected domain in the majority of the patient was role function restrictive.

PECULIARITIES OF CARBOHYDRATE METABOLISM INDICATORS, THE FUNCTIONAL STATE OF THE THYROID GLAND IN THE COURSE TREATMENT WITH TELMISARTAN AS PART OF THE COMPLEX THERAPY OF PATIENTS WITH CORONARY ARTERY DISEASE, TYPE 2 DIABETES MELLITUS ON THE BASIS OF METAB

Aim. Is to study the characteristics of carbohydrate metabolism indicators, the functional state of the thyroid gland in the course treatment with Telmisartan as a part of the complex therapy of patients with Coronary Artery Disease, type 2 Diabetes Mellitus on the basis of Metabolic Syndrome.
 Materials and Methods. Research design. The first stage - formation of groups (the experimental group and the comparison group). The experimental group consisting of 27 patients (13 men and 14 women), taking Telmisartan 80 mg/day as a part of complex therapy (Metformin, Amlodipine, Rosuvastatin, Acetylsalicylic acid, and Nitroglycerin as needed). The comparison group consisting of 24 patients (12 men and 12 women) taking Ramipril, 5 mg/day in addition to the standard therapy, mentioned above. At the second stage, the patients were examined for carbohydrate metabolism and Thyroid-stimulating hormone and free Thyroxine. At the third stage, patients were prescribed the treatment for 1 month. The dose of metformin did not change during the study. Re-examination of hormones and carbohydrate metabolism parameters one month after the start of therapy was carried out at the fourth stage. The control group consisted of 40 practically healthy people (17 men and 23 women). The work involved researching the carbohydrate spectrum parameters as well as the followings hormones: free Thyroxine and Thyroid-stimulating hormone, control of blood pressure parameters. The Patients were examined twice, on the day of admission to inpatient treatment and after 1 month. According to the results of the obtained data, the studied groups were compared with each other, as well as with a group of healthy individuals.
 Results and Discussion. The study compared the dynamics of blood pressure parameters, indicators of carbohydrate metabolism, Thyroid-stimulating hormone and Free thyroxine in patients with Coronary Artery Disease and compensated type 2 Diabetes Mellitus on the basis of Metabolic Syndrome, depending on their intake of Telmisartan or Ramipril against the background of standard therapy, which included: Metformin, Amlodipine, Acetylsalicylic acid. In the group taking Telmisartan as part of complex treatment, a decrease in clinical manifestations of syntropic pathology was found, and the presence of positive dynamics of diastolic blood pressure indicators was noted even after 1 month of treatment. Patients experienced a decrease in the frequency of angina attacks, reduced shortness of breath, palpitations during exercise, headaches, dizziness, anxiety, improved attention and memory. The results of our study show taking Telmisartan as a part of complex therapy contributed to changes in the parameters of carbohydrate metabolism such as fasting blood glucose, insulin level, HOMA-IR index decreased significantly, which can be explained by a decrease in insulin resistance at addition Telmisartan to the complex treatment. In contrast to the mentioned above parameters, indicators of glycosylated hemoglobin after 1 month treatment did not change significantly, which can be explained by the insufficient duration of treatment. In the patients of the experimental group, it was found that the level of Thyroid-stimulating hormone significantly decreased during treatment with Telmisartan as part of complex therapy, in contrast to the comparison group, taking Ramipril at the same time. The level of free Thyroxine in patients with experimental group increased a month after start of therapy, while it remained unchanged in patients with comparison group.
 Conclusions. The effectiveness of correction of diastolic blood pressure parameters, the presence of peculiarities of changes in carbohydrate metabolism and thyroid functional state when Telmisartan is used as part of the complex therapy of patients with Coronary Artery Disease and compensated type 2 Diabetes Mellitus on the basis of Metabolic Syndrome. The use of Telmisartan as part of complex treatment reduces insulin resistance; helps to reduce the level of fasting blood glucose, values of the HOMA-IR index, as well as the amount of insulin in the blood. The use of Telmisartan in patients with Coronary Artery Disease and type 2 Diabetes Mellitus on the basis of Metabolic Syndrome aids in reducing the level of Thyroid-stimulating hormone and increase in free Thyroxine (within the reference values), confirming participation in the correction of metabolic changes.

Treatment Adherence Effect on the Visual Acuity of Behçet’s Uveitis Patients

ABSTRACT Purpose This study aimed to explore the relationship between treatment adherence, visual acuity, quality of life (QoL), depression, and anxiety levels in individuals with Behçet’s uveitis (BU). Methods A total of 55 BU patients and 55 healthy controls completed sociodemographic questionnaires, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF), Self-reported Questionnaire About Treatment Compliance, and the Morisky Medication Adherence Scale (MMAS). The scores obtained from these scales were analyzed to assess the relationship between treatment adherence, visual acuity, QoL, depression, and anxiety levels. Results The results revealed that 36 (65.4%) of the 55 BU patients exhibited depressive symptoms, while 45 (81.8%) of them experienced symptoms of anxiety. Patients with BU demonstrated significantly higher BAI and BDI scores compared to the healthy control group (p < 0.001). Furthermore, the patient group reported lower mean scores across multiple domains of the WHOQOL-BREF questionnaire, including general health, psychological health, social relationships, and environment (p < 0.05). Moreover, a significant association was observed between low treatment adherence and lower values of best-corrected visual acuity (BCVA) (p < 0.05), as well as a higher frequency of uveitis attacks (p = 0.005). Conclusion Poor treatment adherence in BU patients has a negative effect on final visual acuity outcomes. Moreover, BU patients experience lower QoL and higher rates of depression and anxiety compared to the healthy control group. These findings highlight the importance of addressing treatment adherence and psychological well-being in the management of BU.

Relationship of Plasma Pituitary Adenylate Cyclase-Activating Polypeptide-38 (PACAP-38) Levels with Cerebrovascular Vasomotor Reactivity in Chronic Migraine Sufferers

Introduction: Migraine is a complex health problem and causes disability, especially in women. The current pathophysiology of migraine is a combination of vascular, neurogenic, and neuroinflammatory theories. PACAP-38 is a vasoactive neuropeptide that increases during migraine attacks. Endothelial dysfunction results in impaired vasomotor reactivity. Analysis of vasomotor reactivity is determined by measuring the breath-holding index (BHI) and migraine vascular index (MVI), where there is a decrease in vasomotor reactivity values ??in migraine sufferers. This study aims to determine PACAP-38 levels in chronic migraine sufferers and their relationship to cerebrovascular vasomotor reactivity.&#x0D; Methods: This research is a comparative study (cross-sectional) that is carried out in hospitals and health centers spread across the city of Padang from May 2022 to June 2023. The research sample consisted of 30 chronic migraine sufferers and 30 healthy controls. Vasomotor reactivity was assessed by determining BHI and MVI values ??using transcranial Doppler. Plasma PACAP-38 levels were measured using the ELISA method. Data analysis was carried out using SPSS.&#x0D; Results: The mean value of vasomotor reactivity in chronic migraine sufferers is 0.355. There is a negative correlation between the frequency and duration of migraine attacks and vasomotor reactivity (frequency p=0.032; duration p=0.022). The mean value of PACAP-38 levels in chronic migraine sufferers was 6.15 pg/ml, and in healthy controls, 4.85 pg/ml; there was a significant difference between plasma PACAP-38 levels in chronic migraine sufferers compared to healthy controls. However, there was no significant difference between plasma PACAP-38 levels and vasomotor reactivity in chronic migraine sufferers.&#x0D; Conclusion: There is an increase in plasma PACAP-38 levels in chronic migraine sufferers, but there is no significant relationship between plasma PACAP-38 levels and vasomotor reactivity values.

Medium- and Long-Term Outcomes of Autologous Fat Grafting to Hands and Feet for Patients With Raynaud Phenomenon.

Autologous fat grafting (AFG) has emerged as a promising treatment option for Raynaud phenomenon. However, existing studies are limited by short follow-up, and there is little evidence regarding predictive factors for successful outcomes. A retrospective chart review and standardized phone interviews were performed for all patients (n = 17, 65% response rate) treated with AFG to the hands or feet at our institution for primary or secondary Raynaud from 2010 to 2021. Each occurrence of AFG was defined as a separate surgery (n = 23), with an average follow-up of 3.7 years. At follow-up, patients reported a 31% reduction in cold attack frequency, a 45% reduction in the intensity of individual attacks, a 29% reduction in the duration of attacks, and a 40% improvement in overall Raynaud Condition Score (P < 0.01). Although initial AFG to an extremity significantly improved symptoms, subsequent attempts were not shown to statistically improve outcomes. Digital ulcers were present in 65% of cases, and AFG resulted in ulcer healing in 87% of those cases. Median duration of maximum symptom relief was 1 year postoperatively, with 74% of patients reporting diminishing symptom relief by 4 years postoperatively. Those with a BMI ≥25, with primary Raynaud phenomenon or without preoperative ulcers experienced significantly longer symptom relief (P < 0.05). Average patient satisfaction was 7.7 of 10, and 91% would recommend the procedure to others. Autologous fat grafting is an effective, albeit sometimes temporary, treatment for Raynaud and digital ulcers. Certain patients may be more likely to experience lasting symptom relief beyond 1 year.

Volumetric alteration of brainstem in female migraineurs with and without aura

Background and AimBrainstem descending modulatory circuits have been postulated to be involved in migraine. Differences in brainstem volume between migraineurs and healthy controls have been demonstrated in previous research, nevertheless, the effect of migraine aura on brainstem volume is still uncertain. The aim of this study was to investigate the brainstem volume in migraineurs and examine the effect of migraine aura on brainstem volume. MethodsOur study included 90 female migraine patients without white matter lesions. (29 migraine patients with aura (MwA) and 61 migraine patients without aura (MwoA) and 32 age-matched female healthy controls (HC). Using the FreeSurfer image analysis suite, the volumes of the entire brainstem and its subfields (medulla, pons, and midbrain) were measured and compared between migraine subgroups (MwA vs. MwoA) and the healthy control group. The possible effects of migraine characteristics (i.e., disease duration and migraine attack frequency) on brainstem volume were also investigated. ResultsMigraineurs had greater medulla volume (MwoA 3552 ± 459 mm3, MwA 3424 ± 448 mm3) than healthy controls (3236 ± 411 mm3). Statistically, MwA vs. HC p = 0.040, MwoA vs. HC p = 0.002, MwA vs. MwoA p = 0.555. A significant positive correlation was found between disease duration and the volume of medulla in the whole migraine group (r = 0.334, p = 0.001). Neither the whole brainstem nor its subfields were significantly different in volume between migraine subgroups. ConclusionBrainstem volume changes in migraine are mainly localized to the medulla and not specific to the presence of aura.

Baseline demographics and disease characteristics of patients with episodic or chronic cluster headache: data from two phase 3 randomized clinical trials in Europe and North America.

Two phase 3 galcanezumab trials were conducted in Europe and North America to analyze the reduction of weekly cluster headache (CH) attack frequency in populations with episodic and chronic CH. The current study aims to illustrate prospectively recorded baseline clinical data from these trials and to identify possible predictors of response. Patients (aged 18-65 years) met The International Classification of Headache Disorders 3rd edition-beta criteria for CH. Attacks were evaluated using an electronic headache diary for 7-day (episodic) or 14-day (chronic) eligibility assessments before patients were randomized 1:1 to monthly subcutaneous galcanezumab 300 mg or placebo. Data were collected from 106 patients with episodic and 237 with chronic CH. Overall, the mean age [standard deviation] was 45.4 [11.0] years; patients were predominantly White (84.5%), male (75.8%), and European (77.6%). Patients with episodic CH reported 17.5 [10.0] attacks/week; patients with chronic CH reported 18.8 [10.2] attacks/week. The average pain severity score (range 0-4) was 2.5 [0.7] for episodic CH and 2.7 [0.7] for chronic CH. Higher attack frequency was a possible predictor of response to galcanezumab; potential negative predictors of response were greater attack severity and duration. This large dataset of patients with CH provides reliable systematically and prospectively collected information on disease characteristics. The analysis in episodic CH underscores potential predictors of response worth considering for future CH trial design. ClinicalTrials.gov, identifiers: NCT02397473 and NCT02438826.

Patient outcomes associated with subcutaneous C1INH prophylaxis for hereditary angioedema: a retrospective analysis

BackgroundReal-world data on subcutaneous C1INH (C1INH[SC]) usage and patient-level impacts on hereditary angioedema (HAE)-related outcomes and quality of life (QoL) are both lacking and challenging to generate using conventional study methodologies. Using a hybrid study design involving patient interviews supplemented by retrospective medical chart data review, we conducted a real-world assessment of the impact of C1INH(SC) prophylaxis on HAE attack patterns, QoL, and on-demand medication use.MethodsThe study was conducted at seven US sites and included 36 adults with HAE who had been treated with C1INH(SC) long-term prophylaxis following ≥ 12 months of on-demand management only. Patients underwent 30-min interviews, facilitated and analyzed by a trained qualitative research specialist. Medical records were reviewed for 12 months before (pre-index) and after (post-index) initiation of C1INH(SC). Using interview data with descriptive terms converted to numerical values, we compared pre- versus post-index attack frequency, severity, and rescue medication usage.ResultsMean (SD) annualized attack frequency per patient decreased 82.0%, from 38.8 (38.8) attacks/year pre-index to 7.0 (15.3) attacks/year (P < 0.001); the median number of attacks decreased by 97.0% (30 pre-index to 1 post-index). For 20 patients, the annualized attack rate after starting C1INH(SC) prophylaxis was ≤ 1 attack/year; 12 of these patients reported 0 attacks. Mean (SD) attack severity (scale: 0 = none/mild to 4 = very severe) decreased from 2.3 (0.7) pre-index to 0.9 (0.9) post-index (P < 0.001). Mean/median rescue medication use decreased by 77.2%/96.3%. Improved QoL was narratively described for many domains.ConclusionsThese real-world findings indicate that long-term prophylaxis with C1INH(SC) markedly improves important factors that contribute to the goal of achieving total disease control and normalization of patients’ lives, including fewer and less severe attacks, less rescue medication usage, and improved QoL.

Does the provision of live black soldier fly and yellow mealworm larvae improve Muscovy duck welfare?

BackgroundThe provision of environmental enrichments to Muscovy ducks could reduce the expression of the aggressive behaviors. The aim of the present study was to evaluate the effects of black soldier fly (BSF) and yellow mealworm (YM) live larva provision on Muscovy duck performance, excreta corticosterone metabolites (ECM), behavior, and blood parameters.MethodsA total of 126 3-day-old female Muscovy ducklings were allotted to 18 pens (6 replicates/treatment, 7 birds/pen) and assigned to 3 experimental treatments: a control group fed commercial feed, and two experimental treatments fed commercial feed plus the 5% (based on the expected daily feed intake, as fed basis) of BSF and YM live larvae (BSF and YM groups, respectively). A two-phase feeding program was applied: starter (from 3 to 31 days of age) and grower-finisher (from 32 to 55 days of age). The live weight, average daily gain, average daily feed intake, and feed conversion ratio were calculated. Larva consumption times were collected, and video recordings were performed during 3 periods (P) each day: the hour before (P1), during (P2), and after (P3) the larva administration. ECM were evaluated at 3, 31, and 55-day-old. Finally, the total red and white blood cell counts, serum proteins, lipids, and liver and renal function serum enzymes were evaluated on 12 birds/treatment.ResultsThe experimental treatment did not affect the growth performance of the birds (P > 0.05). Larva consumption times were always similar between the two insect species, except at 14–18 days of age, were BSF larvae were consumed faster than YM larvae (P < 0.001). The birds showed less walking activity during P2, and preening behavior increased in YM birds during P3. The C birds increased the attack behavior over the weeks (P < 0.05). During weeks 1–3 the YM group reduced the attack frequency (P1 > P3; P < 0.05). Finally, the provision of live BSF and YM larvae significantly reduced the ECM at 55 days of age and the heterophil to lymphocyte ratio (P < 0.05).ConclusionsLive BSF and YM larva supplementation in Muscovy duck improves duck welfare, without impairing birds’ growth performance.

ANTIOXIDANT POTENTIAL BY DPPH ASSAY OF FRESH BUTTERFLY PEA (Clitoria ternatea L) FLOWER OF BREWING AT VARIOUS TEMPERATURES

Stroke is a condition with rapidly progressive clinical symptoms, manifested by symptoms of focal and generalized neurological deficits, lasting 24 hours or more and for no apparent reason other than damage to blood vessels, and can cause death. Objective: To determine the effect of shaker training and the Delsohn maneuver on swallowing ability in stroke patients. Method: The type of research used is a quasi-experimental design with a pretest and posttest with control group design. The research sample consisted of 44 stroke patients who experienced mild to moderate swallowing disorders with RAPIDS scores of 50-100. The sampling technique is purposive sampling data collection using the RAPIDS test questionnaire sheet. Results: The average swallowing ability of respondents before being given shaker training and the Delsohn maneuver was 73.82, after being given the intervention the average swallowing ability increased to 91.55. Shows that there is an effect of shaker exercise and the Mendelsohn maneuver on swallowing ability with a p-value of 0.001&lt;0.05. With the characteristics of respondents based on age in the intervention group being 60 years and 59 years in the control group, the education of respondents in the intervention group was mostly high school and the control group was mostly elementary school, and the gender of the intervention group was mostly female and the control group was mostly male, while the type of intervention The strokes of respondents and their groups were non-hemorrhagic strokes and the frequency of attacks for all respondents was first attacks. Conclusion: Shaker exercise and the Mendelsohn maneuver are effective for improving swallowing ability in stroke patients.

Long-term management and treatment of acute intermittent porphyria with recurring attacks using pharmacological prophylaxis.

There is no definitive guidance on whether patients with acute intermittent porphyria (AIP) with recurrent attacks need pharmacological prophylactic treatment. The management strategies for patients with frequent (defined as ≥4 annualized attack rate (AAR) and less frequent attacks (<4 AAR), including treatment for acute attacks and duration of prophylaxis (weekly heme arginate 3mg/kg body weight and/or investigational drug, givosiran), were summarized. The AAR for the following periods were presented: the first 2 years after diagnosis, before/after prophylaxis, and the most recent 2 years. A total of 29 patients with AIP were included, 19 (34.5%) had <4 AAR and 10 (65.6%) had ≥4 AAR in the first 2 years after diagnosis. All patients experienced reduced attacks during the treatment course, 23 (79.3%) were attack-free during the most recent 2 years. Among the 9 patients who received prophylaxis (7 heme arginate; 1 givosiran, 1 heme arginate followed by givosiran), 5 (55.6%) were attack-free in the most recent 2-year period and prophylaxis was discontinued because there had been no attacks for >1 year. For patients without prophylaxis (n = 20), 18 (90.0%) were attack-free in the most recent 2-year period and 15 (75.0%) experienced attacks only in the first 2 years after diagnosis. Prophylaxis could be considered for patients with AIP with ≥4 biochemically confirmed attacks/year after routine treatment of 1-2 years, during which the severity and frequency of attacks should be closely monitored to determine the necessity of pharmacologic prophylaxis. More studies are needed to reach a consensus on the use of pharmacological prophylaxis and treatment of AIP.

Analysis of the ocular surface functional unit in episodic migraine

AimMigraine is a chronic neurovascular disease that affects the trigeminovascular system. The purpose of this study was to evaluate corneal subbasal nerve fibers, dendritic cells and to measure tear film parameters in migraine.Patients and methods87 eyes of 44 patients suffering from migraine with a mean age of 33.23 ± 11.41 years were included in our study. 25 age-matched controls (mean age of 30.16 ± 12.59 years; P = 0.162) were recruited. The corneal subbasal plexus and the dendritic cells (DC) were analyzed using in vivo confocal microscopy (Heidelberg Retina Tomograph II Rostock Cornea Module; Heidelberg Engineering GmbH), and the tear film was imaged using LacryDiag (Quantel Medical, France).ResultsRegarding the subbasal nerve fibers of the cornea, none of the examined parameters differed significantly in migraine patients from controls. We found a significant increase in the corneal DC density (P < 0.0001) and DC area (P < 0.0001) in migraine patients compared to healthy volunteers. DC density showed a positive correlation with the monthly attack frequency (r = 0.32, P = 0.041) and the DC area a negative correlation with corneal nerve branch density (r = -0.233, P = 0.039), nerve fiber length (r = -0.232, P = 0.04) and total branch density (r = -0.233, P = 0.039). Using LacryDiag a significant loss of Meibomian gland area could be detected on the superior eyelid (P = 0.005) in migraine.ConclusionsOur results suggest the presence of neuroinflammation in the cornea of migraine patients affecting the peripheral trigeminal system. Dendritic cells surrounding the subbasal plexus may be involved in the activation and modulation of pain in migraine.

Sleep disturbance associated with temporal lobe degeneration in frontotemporal dementia

AbstractBackgroundSleep abnormalities are increasingly recognized as markers and potential drivers of neurodegenerative proteinopathies. However, the sleep phenotype of less common dementias remains poorly characterised. In particular, clinical experience suggests that patients with focal temporal lobe degeneration in the frontotemporal dementia spectrum can experience sometimes striking sleep disruption. We recently had the opportunity to corroborate this clinical impression in a small series of representative patients participating in a larger cohort study.MethodsTo date, we have studied seven patients and three healthy age‐matched controls. The patients’ diagnoses comprise behavioural variant frontotemporal dementia associated with focal right temporal lobe atrophy (n = 3), semantic dementia associated with focal left temporal lobe atrophy (n = 2), young onset Alzheimer’s disease and logopenic aphasia (each n = 1). No participant had a past history of a clinical sleep disorder. Detailed data on sleep patterns, adapted standard sleep questionnaires (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale), overnight oximetry and neuropsychological test scores (covering domains of executive function, emotion processing, memory, and auditory perceptual learning) pre‐/post‐overnight sleep were collected with the assistance of patients’ caregivers.ResultsTwo patients with right temporal lobe atrophy and one with left temporal lobe atrophy had marked sleep fragmentation, in one right temporal case accompanied by frequent sleep attacks, with increased overall time in bed and/or attempting to sleep. Epworth and Pittsburgh indices in these patients indicated significant daytime sleepiness and reduced sleep quality; none had evidence of significant sleep apnoea on overnight oximetry. Comparatively mild clinical sleep disturbances were reported in patients with other dementia diagnoses. However, there was evidence for reduced auditory perceptual learning benefit from overnight sleep relative to healthy older controls, particularly in the patients with underlying Alzheimer pathology.ConclusionsThese preliminary findings suggest that focal temporal lobe degeneration may be associated with clinically relevant sleep disruption, as part of the more pervasive derangement of homeostasis in these syndromes. Further work is indicated to define the hypnic phenotype in detail, with sleep electrophysiology and correlative behavioural, neuroimaging and laboratory data in larger patient cohorts.