Frequency Of Attacks Research Articles

Intensive cognitive behavioral group therapy for the treatment of panic disorder

Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety. Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients. Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted. Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy. Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

The HortONS study. Treatment of chronic cluster headache with transcutaneous electrical nerve stimulation and occipital nerve stimulation: study protocol for a prospective, investigator-initiated, double-blinded, randomized, placebo-controlled trial

BackgroundChronic cluster headache (CCH) is a debilitating primary headache disorder. Occipital nerve stimulation (ONS) has shown the potential to reduce attack frequency, but the occipital paresthesia evoked by conventional (tonic) stimulation challenges a blinded comparison of active stimulation and placebo. Burst ONS offers paresthesia-free stimulation, enabling a blinded, placebo-controlled study.Identification of a feasible preoperative test would help select the best candidates for implantation.This study aims to explore ONS as a preventive treatment for CCH, comparing burst stimulation to tonic stimulation and placebo, and possibly identifying a potential preoperative predictor.MethodsAn investigator-initiated, double-blinded, randomized, placebo-controlled trial is conducted, including 40 patients with CCH. Eligible patients complete a trial with the following elements: I) four weeks of baseline observation, II) 12 weeks of transcutaneous electrical nerve stimulation (TENS) of the occipital nerves, III) implantation of a full ONS system followed by 2 week grace period, IV) 12 weeks of blinded trial with 1:1 randomization to either placebo (deactivated ONS system) or burst (paresthesia-free) stimulation, and V) 12 weeks of tonic stimulation.The primary outcomes are the reduction in headache attack frequency with TENS and ONS and treatment safety. Secondary outcomes are treatment efficacy of burst versus tonic ONS, the feasibility of TENS as a predictor for ONS outcome, reduction in headache pain intensity (numeric rating scale), reduction in background headache, the patient’s impression of change (PGIC), health-related quality of life (EuroQoL-5D), self-reported sleep quality, and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale, HADS).Data on headache attack characteristics are registered weekly. Data on patient-reported outcomes are assessed after each trial phase.DiscussionThe study design allows a comparison between burst ONS and placebo in refractory CCH and enables a comparison of the efficacy of burst and tonic ONS. It will provide information about the effect of burst ONS and explore whether the addition of this stimulation paradigm may improve stimulation protocols.TENS is evaluated as a feasible preoperative screening tool for ONS outcomes by comparing the effect of attack prevention of TENS and tonic ONS.Trial registrationThe study is registered at Clinicaltrials.gov (trial registration number NCT05023460, registration date 07–27-2023).

The volume of the thalamus and hippocampus in a right-handed female episodic migraine group

Background/aimMigraine is a disabling headache with clinical and radiological complications. The aim of this study was to investigate the volume of the thalamus and hippocampus in migraineurs, the role of white matter lesions (WMLs), and the migraine characteristics in volume changes.MethodsBrain MRIs of 161 right-handed female episodic migraine patients and 40 right-handed, age-related, healthy women were performed. Left and right thalamus segmentation was performed on the 3D MPRAGE images using the Freesurfer 5.3 image analysis suite. Hippocampal subfield segmentation was based on a novel statistical atlas built primarily upon ultra-high-resolution ex vivo MRI data.ResultsThe left hippocampus had a smaller and the left thalamus had a larger total volume than the right one in both the control (p &amp;lt; 0.001) and migraine groups (p &amp;lt;0.001). Patients with white matter lesions (L+) showed smaller right thalamus and right hippocampal tail volumes than patients without lesions (L–) (p = 0.002 and p = 0.015, respectively) and controls (p = 0.039 and p = 0.025, respectively). For the right hippocampal body, we found significantly smaller volume in L+ patients when compared to L– patients (p = 0.018) and a similar trend when compared to the control group (p = 0.064). Patients without aura (A–) showed a larger right hippocampus (p = 0.029), right hippocampal body (p = 0.012), and tail volumes (p = 0.011) than patients with aura (A+). Inverse correlations were found between attack frequency and the volumes of the left and right hippocampal tails (p = 0.018 and p = 0.008, respectively).ConclusionThese findings indicate that WMLs may influence the volume of the right thalamus and hippocampus, while migraine aura and attack frequency may lead to volume changes in different parts of the hippocampi in migraine patients. These data support the necessity of effective migraine management to limit subcortical volume loss in migraineurs.

The Effect of Anti-Inflammatory Drugs on MEFV, PSTPIP1, Siva, and ASC Gene Expression Levels

Aim: Familial Mediterranean Fever (FMF) is the one of the most common autoinflammatory diseases. FMF is characterized by fever attacks and inflammation and colchicine treatment reduces the frequency and severity of FMF attacks. The FMF gene, MEditerranean FeVer (MEFV), encodes a protein called Pyrin, which regulates inflammation through its interactions with several proteins. These proteins are; Apoptosis-associated speck like protein with a CARD (ASC), Proline serine threonine phosphatase interacting protein 1 (PSTPIP1), 14.3.3 proteins and Siva proteins. In this study, we aimed to study the effect of anti-inflammatory drugs with different mechanisms of action on MEFV, PSTPIP1, Siva, and ASC gene expression levels. &#x0D; Material and Methods: We used differentiated monocytic cell line called THP-1 cells. Cells treated with colchicine, naproxen, prednol-L, acetylsalicylic acid, or azathioprine w and w/o lipopolysaccharide (LPS). After incubation, quantitative RT-PCR (qRT-PCR) was performed to measure MEFV, PSTPIP1, Siva, and ASC gene expression levels. &#x0D; Results: MEFV gene expression level was down regulated in colchicine, naproxen, and azathioprine treated cells whereas PSTPIP1 gene expression level was down regulated in naproxen and azathioprine treated cells with LPS. Siva gene expression level was up regulated in all treatments although ASC gene expression level was up regulated in only prednol-L treated cells with LPS.&#x0D; Conclusion: These anti-inflammatory drugs are known to have different mechanisms of action however they are all used to treat pain or inflammation. Since Pyrin, PSTPIP1, Siva, and ASC have pro and anti-inflammatory roles, the results showing an alteration in gene expression levels with specific drugs may indicate the possible mechanisms of therapeutic action.

Investigating the T regulatory cells and Sirtuin-I serum level in immunotherapy treated house dust mite allergic asthma patients

Objectives House dust mite aeroallergens are predominant triggers of frequent asthma attacks among adults and children. The intensity of asthma and immune reaction necessitates treatment alternatives based on adjusting chosen immunity biomarkers to control the exacerbation of symptoms and establish long-term immune tolerance. In this study, we selected CD4+CD25+Foxp3+ regulatory T cells (Tregs), FOXP3, and Sirtuin-1 as they are known to have a potential role in the immune reaction in different allergic diseases. We investigated their interplay during HDM allergic asthma and its respective immunotherapy. Methods Eighty-four subjects were divided into 3 groups; healthy controls (CT), HDM asthma patients without immunotherapy (WOIT), and HDM asthma patients treated with subcutaneous immunotherapy for 6 months before recruitment (WIT). They were enrolled according to the pulmonary function, skin prick tests, and HDM-specific IgE. CD4+ CD25+ and CD4+ CD25+ FOXP3+hi T cells Cell percentages, FOXP3 gene expression, and Sirtuin-1 (Sirt1) serum level were analyzed. Results We found that there is a significant difference between WOIT and WIT groups in the CD4+ CD25+ and CD4+ CD25+ FOXP3+hi T cell percentages. While there is no statistically significant difference between WOIT and WIT groups in FOXP3 level. On the controversy, the SIRT1 level in the CT group (4.53 ± 3.880) significantly decreased in the WOIT and WIT groups. Conclusion This study revealed that both CD4 CD25 and CD4 CD25 high FOXP3 cell percentages increased in the WIT group and declined in the WOIT group. While, FOXP3 gene expression increased in both groups. In addition, the Sirt1 serum level showed some improvement in WIT group after a serious drop in the WOIT group comparing with the CT group. The modulation of these biomarkers for the remission and control of allergic asthma can be a prognostic outcome of immunotherapy which needs to be confirmed by larger scale studies.

A systematic review on physiological role of yoga and pranayama in management of orthostatic hypotension and vasovagal syncope

OH and VVS are increasingly recognized as important causes of impairment of quality of life and potentially of poor prognosis. Existing management therapies have modest effect. Recently few studies have emerged and have demonstrated the efficacy of yoga and pranayama in disorders having autonomic imbalance, suggesting its possible efficacy in OH and VVS.This review aims to determine the effectiveness of yogic practices in patients with orthostatic hypotension (OH) and recurrent vasovagal syncope (VVS). A Medline search was done in Google chrome to review relevant articles in English literature considering the eligibility criteria that the article should focus on yoga and pranayama and its physiological effects on OH and VVS. The main outcome expected was attenuation of OH and frequency of attacks of syncope and presyncope.: Out of the total 86 articles searched, 7 articles (3 RCTs, 3 observational/interventional, 1 review) full filled the eligibility criteria and depicted that yogic practices can have positive impact in attenuation of orthostatic hypotension and reduce the frequency of attacks of syncope and presyncope, among patients with recurrent VVS. However, we recommend higher-quality RCTs in future to confirm our results.

Effectiveness of Community-Based Nursing Intervention for Asthmatic Children: A Systematic Review and Meta-Analysis.

Preventive care can support and direct the nurse's efforts to deliver an asthma intervention for children as part of nursing interventions. Despite the significance, there have been few meta studies demonstrating the effectiveness of nursing interventions for the treatment of childhood asthma that includes only randomised controlled trials (RCTs). Therefore, this meta study was conducted to comprehensively evaluate the efficacy of nursing care interventions for the management of childhood asthma. STATA 14.2 (StataCorp, College Station, TX, USA) was used to conduct the meta-analysis. From 1964 to July 2022, we searched Medline, the Cochrane library, EMBASE, Scopus Science Direct, and Google Scholar. Depending on the type of outcome, a meta-analysis was performed using a random-effects model, pooled weight mean difference (WMD), standardised mean difference (SMD), and/or risk ratio (RR) with stated 95 percent confidence intervals (CIs). PRISMA guidelines were followed for conducing this study. Nine studies were analysed in total. The pooled RR for emergency visits was 0.49 (95%CI: 0.32 to 0.77), for hospitalizations was 0.64 (95%CI: 0.21 to 1.89). The pooled SMD for frequency of asthma attacks was -2.88 (95%CI: -3.22 to -2.54), quality of life was 0.49 (95%CI: 0.22 to 0.75) and asthma control was 1.25 (95%CI: -0.77 to 3.28). Paediatric asthma patients who received nursing interventions reported an improved quality of life and a decrease in emergencies and acute attacks due to asthma. Future RCTs should focus on uncovering the short- and long-term effects of these nursing interventions to provide optimal management and care.

Comparison between the effectiveness of three prophylactic drugs for vestibular migraine; cinnarizine, propranolol, and topiramate: prospective study

BackgroundVestibular migraine (VM) is considered one of the most common causes of episodic vertigo. Acute attacks may interfere or hinder daily activities, and hence decrease the quality of life. Accordingly, this study was designed to evaluate and compare the effectiveness of Cinnarizine, Propranolol, and Topiramate as prophylactic treatment for vestibular migraine, in order to decrease the occurrence of acute attacks. Several medications have been proposed as a prophylactic treatment, but their benefit is still a vast field of study.MethodsForty-five subjects were diagnosed with vestibular migraine. They were divided into 3 groups; each group either received Cinnarzine, Propranolol, or Topiramate. All patients were submitted to thorough history taking for headache and vertiginous attacks, Dizziness Handicap Inventory questionnaire (DHI) -Arabic version, visual analog scale, videonystagmography, and computerized dynamic posturography (CDP) before and after receiving the treatment by 3 months.ResultsTopiramate was significantly superior in reducing the frequency and severity of headache attacks. The three drugs showed improvement but with no significant difference as regards duration and frequency of vertiginous attacks, DHI scores, and CDP. Only 5 patients had non-serious temporary side effects.ConclusionsThe three drugs were effective for ameliorating vertiginous attacks in vestibular migraine patients, but Topiramate was better in the 25 mg twice daily dose.

Tongxinluo capsule in combination with conventional therapies for stable angina pectoris: A meta-analysis and systematic review.

This study aimed to assess the efficacy and safety of Tongxinluo capsule (TXLC) in combination with conventional therapies for treating stable angina pectoris (SAP) through a comprehensive meta-analysis and systematic review. We conducted a systematic search of the China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Embase, and CENTRAL databases for randomized controlled trials investigating the use of TXLC as adjuvant therapy for SAP published up to June 2023. The Cochrane Handbook was used to evaluate the risk of bias. Meta-analysis was performed using Review Manager 5.4.1, and publication bias was assessed using Begg test and Egger test in the Stata SE 12.0 software. GRADEpro was used to assess the quality of the evidence. This meta-analysis included 26 randomized controlled trials with a total of 2352 patients. TXLC co-administration demonstrated significant reduction in angina attack frequency (mean difference (MD) -0.91, 95% confidence interval (CI) -0.97 to -0.84, P < .00001) and duration (MD -1.71, 95% CI -2.24 to -1.19, P < .00001), decreased use of nitroglycerin tablets (MD -6.28, 95% CI -7.16 to -5.41, P < .00001), lowered C-reactive protein (MD -1.19, 95% CI -1.35 to -1.03, P < .00001) and low-density lipoprotein cholesterol levels (MD -0.68, 95% CI -0.86 to -0.51, P < .00001). TXLC co-administration did not increase gastrointestinal reactions (RR 1.17, 95% CI 0.38 to 3.57, P = .78). The Begg test and Egger test results indicated no publication bias. The evidence quality was rated as very low for frequency of angina attack, duration of angina attack, and nitroglycerin usage, and low for C-reactive protein, low-density lipoprotein cholesterol levels, and gastrointestinal reaction events. This meta-analysis supports TXLC as a beneficial adjunct treatment for SAP.

Evolution of Guidelines for the Management of Hereditary Angioedema due to C1 Inhibitor Deficiency.

Hereditary angioedema (HAE) is a severe and disabling condition characterized by recurrent episodes of subcutaneous or mucosal swelling in the skin and respiratory and gastrointestinal tracts. HAE due to C1-esterase inhibitor deficiency (C1-INH-HAE) is the most prevalent subtype. The present Iberian study compared C1-INH-HAE treatment guidelines published between 2010 and 2022 to identify the main differences in therapeutic approaches for on-demand treatment and short- and long-term prophylaxis (LTP). HAE guidelines evolved with the availability of new treatments and with a change in the management paradigm towards an individualized, patient-centered approach, where quality of life (QOL) is central. A parallel trend was observed towards increasingly frequent home-based treatment, which potentially facilitates timely interventions, provides greater flexibility and convenience, and is associated with increased QOL, enabling patients to lead more normal lives. Most innovations over the years were made for LTP, together with the advent of new therapies and awareness of patients' needs. Several prophylactic therapies with a high level of evidence became available, although formal head-to-head comparisons are lacking. The treatment goals became more ambitious, ranging from a reduction in the frequency, severity, and duration of attacks to achieving total disease control and normalization of patients' lives. The document also addresses relevant items such as changes in terminology (eg, the introduction of designations as "first-line") and the introduction of patient-reported outcome measures to assess patients' perceptions of their self-experienced QOL and well-being. Unmet needs in the management of C1-INH-HAE are identified.

A Novel Simulation Approach for Fault Injection Mechanism Assessing Dependability of Cybersecurity Attacks

Clock attacks and power attacks are used as common means to inject faults in embedded devices. Critical analysis of the properties and the components engaged with these fault injection methods is of high importance to assess the related dangers and furthermore to enhance the process of designing suitable counter-measures. This paper provides critical analysis of induced faults on combinational and sequential circuits and study effects of various attacks (over-clock, under clock, power attack). While doing analysis, it was revealed that clock attacks i.e., under and over clock attacks have similarity index of (80–90%). Also it was found that power attacks have results similar (60–70%) to clock attacks but they cause propagation delay in circuits affecting the output. Cadence virtuoso 45 nm technology node, Keil and Multi-sim software’s were used to generate various attacks. The comparative analysis reveals that the attack timing and frequency of the glitch is the key while inducing fault injection attacks. While performing this work, it is observed the sequential circuits get less impacted by attacks comparing to combinational circuits. This research is conducted from an attacker’s perspective instead of mitigation perspective.

Risk of seizure recurrence in children with new-onset afebrile seizure

BACKGROUND A seizure is a brief change in the normal neuronal electrical activity of the brain that causes changes in consciousness, perception, behavior, or movement. This study aimed to evaluate clinical findings, initial electroencephalography (EEG), and brain imaging findings as predictors of seizure recurrence after the first nonfebrile seizure.&#x0D; METHODS This prospective follow-up study was conducted at Azadi Teaching Hospital, Kirkuk from July 2019 to January 2022 and enrolled 150 patients, ranging from 1 month to 15 years of age, who presented with their first afebrile seizure. The seizure types were classified based on the International League Against Epilepsy in 2017. A brain imaging with EEG was performed within 72 hours after admission.&#x0D; RESULTS The median age of the patients was 5 years. A higher risk of seizure recurrence occurred in patients with focal seizure (relative risk [RR] = 6.604) (95% confidence interval [CI] 3.975–10.971), seizure occurrence at sleep (RR = 3.815) (95% CI 2.410–6.039), an abnormal neurological presentation such as Todd’s paralysis (RR = 1.739) (95% CI 1.252–2.415), a positive family history of seizures (RR = 2.333) (95% CI 1.598–3.408), abnormal EEG (RR = 0.171) (95% CI 0.092–0.318), and abnormal brain image findings (RR = 0.681) (95% CI 0.492–0.941) within 72 hours. Seizure recurrence was not correlated with sex.&#x0D; CONCLUSIONS Early and late childhood new-onset afebrile seizures with a positive family history, focal epilepsy, seizure during sleep, prolonged attack duration with frequent attacks within 24 hours, and abnormal initial EEG and brain image had a high risk of seizure recurrence.

Efficacy of Jade Wind-Barrier Powder in adjuvant treatment for children with asthma, and its influence on IFN-γ, immunoglobulin and mucin

Purpose: To study the effects of Jade Wind-Barrier Powder on peripheral blood interferon-γ (INF-γ), immunoglobulin and sputum mucin in children with asthma.Methods: Sixty-six children with asthma in remission stage were randomly separated into study and control groups. The control group was treated with budesonide formoterol powder inhaler, while the study group was orally administered Jade Wind-Barrier Powder. The therapeutic effects, and INF-γ, immunoglobulin and mucin levels in sputum, as well as pulmonary function parameters in both groups were determined. The number of acute relapses of asthma and duration of wheezing were counted in the patients. The relative effectiveness of Jade Wind-Barrier Powder in the treatment of asthma in the children was also assessed.Results: The overall response rate (ORR) in the study group was 93.94 %, which was higher than in the control group (75.76 %, p &lt; 0.05). Over the 6-month period of follow-up, the frequency of acute attacks of asthma in the study group was significantly lower while the duration of wheezing during attack was also shorter than in the control group. After treatment, pulmonary function indices in the study group were higher, whereas mucin 5AC (MUC5AC), mucin 5B (MUC5B) and mucin 1 (MUC1) levels in sputum were lower than in the control group (p &lt; 0.05).Conclusion: Jade Wind-Barrier Powder exerts therapeutic effect in children with asthma. However, further clinical trials across multi-centers are required to validate it its use in clinical practice.

Machine Learning-Based Intrusion Detection System for Cyber Attacks in Private and Public Organizations

Cyber-attacks have proven to be a force for hacking groups and state-sponsored organizations seeking to level the playing field with competitors. The hacker threat paired with the enormously hazardous and costly danger of fraud or intellectual property theft by insiders has created a volatile situation in private and public organizations. While a majority of internal breaches are due to employee negligence or human error, attacks by malicious insiders with access to sensitive company information have increased dramatically in recent years. Threats of financial loss, theft of sensitive information, and destruction to critical sectors have made cybersecurity a top security priority around the globe. Whereas the increase in frequency and complexity of attacks on the industry has increased the danger of being unprepared, it also has influenced the cost of preventing and recovering from cyber-attacks. To construct a machine learning bases instruction detection system is capable of detecting Cyber-attacks in the private and public sectors in Nigeria and the whole world. The results show that Random Forest and Random Tree algorithms outperform the other algorithms in their level of precision and F-measure as they are above 99% and 98% respectively, while the Random Forest outperforms the others by its detection rate. However, the Random Forest and Random Tree algorithms are more efficient in performing classification exercise on the Test datasets

Did Martin Luther suffer from vestibular migraine?

Martin Luther (1483-1546) reported attacks of headache and of vertigo in his letters and in his lectures. The symptomatology of his headache attacks fulfilled, at least in part, the diagnostic semiological criteria of migraine. However, because we cannot be sure about the time pattern and the exclusion of other disorders that might explain the headache, the diagnosis of migraine is not final. The vertigo attacks sometimes fulfilled the criteria of Ménière's disease. Vertigo also occurred together with headache attacks fulfilling the International Classification of Headache Disorders, 3rd edition criteria for vestibular migraine; however, we do not know exactly the pattern of attack frequency and duration. In summary, it is possible that Martin Luther suffered from attacks of vestibular migraine and had in addition a comorbidity of migraine and Ménière's disease.

Research on the intelligent internet nursing model based on the child respiratory and asthma control test scale for asthma management of preschool children.

Childhood asthma is a common respiratory ailment that significantly affects preschool children. Effective asthma management in this population is particularly challenging due to limited communication skills in children and the necessity for consistent involvement of a caregiver. With the rise of digital healthcare and the need for innovative interventions, Internet-based models can potentially offer relatively more efficient and patient-tailored care, especially in children. To explore the impact of an intelligent Internet care model based on the child respiratory and asthma control test (TRACK) on asthma management in preschool children. The study group comprised preschoolers, aged 5 years or younger, that visited the hospital's pediatric outpatient and emergency departments between January 2021 and January 2022. Total of 200 children were evenly and randomly divided into the observation and control groups. The control group received standard treatment in accordance with the 2016 Guidelines for Pediatric Bronchial Asthma and the Global Initiative on Asthma. In addition to above treatment, the observation group was introduced to an intelligent internet nursing model, emphasizing the TRACK scale. Key measures monitored over a six-month period included the frequency of asthma attack, emergency visits, pulmonary function parameters (FEV1, FEV1/FVC, and PEF), monthly TRACK scores, and the SF-12 quality of life assessment. Post-intervention asthma control rates were assessed at six-month follow-up. The observation group had fewer asthma attacks and emergency room visits than the control group (P < 0.05). After six months of treatment, the children in both groups had higher FEV1, FEV1/FVC, and PEF (P < 0.05). Statistically significant differences were observed between the two groups (P < 0.05). For six months, children in the observation group had a higher monthly TRACK score than those in the control group (P < 0.05). The PCS and MCSSF-12 quality of life scores were relatively higher than those before the nursing period (P < 0.05). Furthermore, the groups showed statistically significant differences (P < 0.05). The asthma control rate was higher in the observation group than in the control group (P < 0.05). TRACK based Intelligent Internet nursing model may reduce asthma attacks and emergency visits in asthmatic children, improve lung function, quality of life, and the TRACK score and asthma control rate. The effect of nursing was significant, allowing for development of an asthma management model.

Ar yra ryšys tarp migrenos ir neramių kojų sindromo?

Migraine and restless legs syndrome are diseases that disturb the normal quality of human life. Moreover, comorbidity of these disorders determines even more difficult condition of the patients. Migraine is a headache that can cause severe throbbing pain, usually on one side of the head, and it is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine is one of the reasons that can cause unhealthy sleep, and if sleep is disturbed, this leads to the provocation of migraine attacks. Sleep disorders have various clinical manifestations, one of which is restless legs syndrome. It is a neurosensory impairment which is characterized by an unrelenting urge to move the legs that occurs or worsens at rest. For this reason, patients may complain of impaired sleep. Although the relationship between migraine and restless legs syndrome and their pathogenesis is not fully understood, current research suggests that these diseases may be related. People with restless legs syndrome are 1.23 to 2.65 times more likely to develop migraine attacks. It is believed that the occurrence of both diseases is determined by several pathophysiological factors, such as the activity of the dopamin- ergic system, iron deficiency, genetic predisposition, and changes in the gray matter of the brain. Although the association between restless legs syndrome and migraine is being investigated, the predominant pathophysiological link has not yet been established. Separate treatment of these diseases has been known for a long time. The principle of migraine treatment is to suppress pain and reduce the frequency of attacks. Treatment for restless legs syndrome is based on the relief of symptoms. Unfortunately, a common treatment for both diseases in relation to each other has not yet been approved. Because of the similar pathophysiology of these disorders, drugs that affect the dopaminergic system (e.g., pramipexole) are currently being investigated in order to relieve the symptoms of restless legs syndrome and migraine attacks.

FRI430 A Case Of Elevated Sex Hormone-binding Globulin Secondary To Variegate Porphyria In A Patient With Hypogonadotropic Hypogonadism

Abstract Disclosure: J. Law: None. C. Yip: Research Investigator; Self; Eli Lilly &amp; Company. Background: Acute porphyria is a group of disorders characterized by enzymatic defects in the heme biosynthetic pathway. The liver is the source of both acute intermittent porphyria (AIP) and variegate porphyria. AIP is known to cause an elevation in sex hormone-binding globulin (SHBG) levels, likely secondary to impaired hepatic function and hepatocyte abnormalities1. We describe a case of elevated SHBG secondary to variegate porphyria, in a male with hypogonadotropic hypogonadism. Case Report: A 44-year-old male presented with an elevated SHBG and symptoms of hypogonadism with low libido, weakness, and fatigue. Fasting morning bloodwork revealed an elevated SHBG at 89 nmol/l (13.5- 71.0), a normal total testosterone level at 12.95 nmol/l (8-32), and a low bioavailable testosterone at 0.82 nmol/l (2.5-10), with confirmatory repeat blood work. His history was significant for longstanding variegate porphyria, manifesting as frequent attacks of abdominal pain. He was on opioids for greater then 10 years for his chronic pain, as well as metoclopramide. On assessment of causes for his elevated SHBG, his TSH was normal at 1.49 mIU/L (0.35-4.30). He did not have cirrhosis, hepatitis, hereditary hemochromatosis, and was not on anticonvulsants. No other cause was found, and his elevated SHBG was deemed secondary to his variegate porphyria. His normal total testosterone level was due to his elevated SHBG, but as mentioned, his bioavailable testosterone was low. His LH and FSH were both inappropriately normal, with his LH being 4.67 IU/L (0.6-12.0) and his FSH 4.7 IU/L (1.0-12.0), in keeping with hypogonadotropic hypogonadism. He went through normal pubertal development and had no anosmia. Workup revealed an elevated prolactin level of 73.8 ug/l (3.5-19.4). He had no galactorrhea or gynecomastia and an MRI sella revealed a normal pituitary gland. His elevated prolactin level was determined to be secondary to his opioid medication and/or metoclopramide use. His hypogonadotropic hypogonadism was deemed secondary to his opioid medications and/or hyperprolactinemia. Conclusion: This case demonstrated variegate porphyria as a likely cause of elevated SHBG, similar to AIP. In patients with variegate porphyria and symptoms of hypogonadism, the SHBG should be measured and if it is elevated, the bioavailable or free testosterone levels should be used in assess instead of relying on the total testosterone levels. As has been previously shown, this case also illustrated the use of opioid medications as a cause of hypogonadotropic hypogonadism.

Long-term effects of middle ear pressure therapy with the EFET01 device in patients with Ménière’s disease and delayed endolymphatic hydrops in Japan

Background Long-term efficacy of middle ear pressure therapy (MEPT) with the EFET01 device in patients in Japan with definitive Ménière’s disease (MD) and delayed endolymphatic hydrops (DEH) was evaluated. Objective To examine the effects of reducing vertigo attacks and improving hearing of MD and DEH patients by using MEPT with the EFET01 device for two years after treatment. Material and Methods A retrospective study was conducted of 32 MD patients and 2 DEH patients treated by MEPT with the EFET01 device from December 2018 to April 2021. According to Japan Society for Equilibrium Research (JSER) guidelines, patients were investigated for the frequency of vertigo attacks and change in hearing levels during a period of 6 months before to 18–24 months after start of treatment. Results The frequency of vertigo attacks significantly decreased in both MD and DEH patients, and hearing level has remained stable in the majority of our patients after treatment. Conclusion Our study clarified that MEPT with the EFET01 device was effective in controlling vertigo symptoms of MD and DEH. It should be considered a safe option for patients failing medical treatment. Significance The efficacy of MEPT with the EFET01 was shown over a 2-year follow-up period.

Secure Consensus of Multiagent Systems With DoS Attacks via Fully Distributed Dynamic Event-Triggered Control

This article investigates the secure consensus problem of general linear multiagent systems with denial-of-service (DoS) attacks. Owning to the existence of DoS attacks, it is challenging to investigate the event-triggered control of multiagent systems in a fully distributed manner. This article presents a novel dynamic event-triggered mechanism to alleviate the limited communication resources. Moreover, the designed mechanism is fully distributed and scalable owing to the introduction of some adaptive coupling weights. Since the DoS attacks have been considered in the event-triggered rule design, a novel adaptive parameter with an additional exponential term is adopted to deal with DoS attacks. The Lyapunov design also introduces such a term for the subsequent stability analysis. Sufficient conditions guaranteeing the asymptotic consensus of the studied system are developed in light of the controller’s parameters, duration, and frequency of the DoS attacks. Strict proof is provided to demonstrate that a secure consensus can be reached effectively under the proposed control mechanism. Furthermore, it is shown that the Zeno behavior can be excluded from the designed triggering mechanism. Finally, simulations on a multiagent system consisting of interconnected unmanned intelligent vehicles are conducted to verify the results.