Potential Triggering Factors Research Articles

Changing behaviours: interventions that count.

Many individuals affected by tension-type headache (TTH) choose the self-care route without seeking medical advice from their primary care doctor. As a result, community pharmacies play an important role in identifying patients with TTH, providing education and counselling on potential lifestyle trigger factors and recommending appropriate analgesics.

Successful Treatment of the Different Urticaria Subtypes

Whereas acute spontaneous urticaria is self-limiting and easy to treat, the management of chronic urticaria subtypes is often problematic. In principle, every urticaria should be treated until it is gone paralleled by a maximization of quality of life, vigilance, work, or school ability and a minimization of drug-related side effects. Complete remission can be achieved by treating or eradicating potential triggering factors, e.g., persistent infections. In daily practice, it is very useful to follow the current treatment algorithm that has been proposed by the international urticaria guidelines published in 2014. According to the first step of this algorithm, second-generation H1 antihistamines in standard dose are recommended. If this does not result in complete symptom control at step two, the dose is increased up to fourfold considering possible side effects. If this step is not sufficient, add-on treatment with either omalizumab, cyclosporine A, or montelukast is indicated. After the guideline consensus in many countries, omalizumab has received approval for the treatment of chronic spontaneous urticaria that is refractory to H1-antihistamines. The risk-benefit profile of each treatment approach should be carefully considered, and at least every 3–6 months, the need for ongoing treatment should be controlled.

A comparative perspective on epigenetics

Ever since Watson and Crick signed off their 1953 Nature paper with the closing line, ‘It has not escaped our notice that the specific pairing we have postulated immediately suggests a possible copying mechanism for the genetic material’, we have lived in an age of genes and genomes. And before

Mechanisms of Heightened Airway Sensitivity and Responses to Inhaled SO2 in Asthmatics.

Sulfur dioxide (SO2) is a problematic inhalable air pollutant in areas of widespread industrialization, not only in the United States but also in countries undergoing rapid industrialization, such as China, and it can be a potential trigger factor for asthma exacerbations. It is known that asthmatics are sensitive to the effects of SO2; however, the basis of this enhanced sensitivity remains incompletely understood. A PubMed search was performed over the course of 2014, encompassing the following terms: asthma, airway inflammation, sulfur dioxide, IL-10, mouse studies, and human studies. This search indicated that biomarkers of SO2 exposure, SO2 effects on airway epithelial cell function, and animal model data are useful in our understanding of the body’s response to SO2, as are SO2-associated amplification of allergic inflammation, and potential promotion of neurogenic inflammation due to chemical irritant properties. While definitive answers are still being sought, these areas comprise important foci of consideration regarding asthmatic responses to inhaled SO2. Furthermore, IL-10 deficiency associated with asthma may be another important factor associated with an inability to resolve inflammation and mitigate oxidative stress resulting from SO2 inhalation, supporting the idea that asthmatics are predisposed to SO2 sensitivity, leading to asthma exacerbations and airway dysfunction.

Clinical and demographic characteristics of Guillain-Barre syndrome

Objective: We aimed to assess the epidemiological, clinical, laboratory, electrophysiological findings in patients with Guillain-Barrea syndrome Methods: We performed a retrospective analysis of 33 patients with GBS admitted to Dicle University Medical Faculty Hospital neurology clinic from January 2011 to March 2014. Were reviewed. Epidemiological, clinical, therapeutical and evolutionary data were collected. Results: Thirty-six patients with the diagnosis of GBS included 22 males and 14 females. The average age at diagnosis was 41.3p21.38years with a wide age range (11n82) and a peak between 36 and 55 years. Based on clinical and electrophysiological features, 61.1% of the patients had acute inflammatory demyelinating polyneuropathy (AIDP), 22.2% acute motor and sensory axonal neuropathy 11.1% had acute motor axonal neuropathy, and 5.6% had Miller Fisher Syndrome. In 28 of 36 patients (77.0%), potential trigger factors could be identified. Respiratory tract infection was the most common infection (36.1%), followed by gastrointestinal infection (27.8%), after surgery (11.1%), vaccination (2.8%) Conclusion: Our study showed that surgery may be triggered GBS and suggesting a geographical and environmental factor involved in GBS etiopathogenesis.

Dietary patterns according to headache and migraine status: a cross-sectional study.

Several potential dietary trigger factors for migraine have been proposed. However, few studies have examined the intake pattern of these dietary items compared to adequate control populations and whether intake levels may vary by migraine aura status or attack frequency. We conducted a cross-sectional study among participants in the Women's Health Study. We used logistic regression to evaluate the association between migraine and headache status and low intake of foods commonly reported to affect migraine. A total of 25,755 women reported no history of migraine or headache, 5573 reported non-migraine headache and 7042 reported any migraine. Those with non-migraine headache or any migraine were more likely to have low intake of total alcohol (OR = 1.22, 95% CI:1.14-1.29 and OR = 1.17, 95% CI:1.11-1.24, respectively). Migraineurs with aura were more likely to have low intake of chocolate, ice cream, hot dogs, and processed meats. Those who experience migraine at least once per week were more likely to have low intake of skim/low-fat milk and white and red wine. Intake of most suggested migraine dietary triggers differs by migraine aura status and attack frequency, a pattern not found for non-migraine headache.

Associated occurrence of p75 neurotrophin receptor expressing aldynoglia and microglia/macrophages in long term organotypic murine brain slice cultures

Growth-promoting aldynoglia, characterized by the expression of the prototype immature Schwann cell marker p75 neurotrophin receptor (NTR) have been shown to occur in some demyelinating diseases. However, the mechanisms determining the emergence and fate of such cells are largely unknown. This study aimed at the identification of such cells and potential triggering factors using an in vitro slice culture approach. Organotypic cerebrum and brain stem slices of adult mice were cultivated for up to 18 days in vitro. Immunohistochemistry for the detection of p75NTR, CD107b, periaxin, growth associated protein (GAP)-43, and glial fibrillary acidic protein (GFAP) was performed. The results for p75NTR were substantiated by the use of in situ hybridization. Cultivation was associated with a progressively increasing spontaneous occurrence of bi- to multipolar p75NTR-positive, but periaxin-negative glia, indicative of aldynoglial Schwann cell like cells. Similar cells stained intensely positive for GAP-43, a marker for non-myelinating Schwann cells. The number of p75NTR positive glia did not correlate with GFAP expression, but showed a strong correlation with a remarkable spontaneous response of CD107b positive phagocytic microglia/macrophages. Moreover, aldynoglial p75NTR immunoreactivity negatively correlated to neuronal p75NTR expression, which was lost during culturing. The present results demonstrate that the cultivation of organotypic murine brain slices is accompanied by a spontaneous response of both microglia/macrophages and p75NTR positive cells, suggestive of Schwann cell like aldynoglia. The findings highlights the role of microglia/macrophages, which seem to be an important triggering factor, facilitating the occurrence of this unique type of macroglia.

Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports.

To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority.

Sudden unexpected fatal encephalopathy in adults with OTC gene mutations-Clues for early diagnosis and timely treatment.

BackgroundX-linked Ornithine Transcarbamylase deficiency (OTCD) is often unrecognized in adults, as clinical manifestations are non-specific, often episodic and unmasked by precipitants, and laboratory findings can be normal outside the acute phase. It may thus be associated with significant mortality if not promptly recognized and treated. The aim of this study was to provide clues for recognition of OTCD in adults and analyze the environmental factors that, interacting with OTC gene mutations, might have triggered acute clinical manifestations.MethodsWe carried out a clinical, biochemical and molecular study on five unrelated adult patients (one female and four males) with late onset OTCD, who presented to the Emergency Department (ED) with initial fatal encephalopathy. The molecular study consisted of OTC gene sequencing in the probands and family members and in silico characterization of the newly detected mutations.ResultsWe identified two new, c.119G>T (p.Arg40Leu) and c.314G>A (p.Gly105Glu), and three known OTC mutations. Both new mutations were predicted to cause a structural destabilization, correlating with late onset OTCD. We also identified, among the family members, 8 heterozygous females and 2 hemizygous asymptomatic males. Patients' histories revealed potential environmental triggering factors, including steroid treatment, chemotherapy, diet changes and hormone therapy for in vitro fertilization.ConclusionsThis report raises awareness of the ED medical staff in considering OTCD in the differential diagnosis of sudden neurological and behavioural disorders associated with hyperammonemia at any age and in both genders. It also widens the knowledge about combined effect of genetic and environmental factors in determining the phenotypic expression of OTCD.

Epidemiology of shivering (shivers) in horses.

Investigating the epidemiology of shivering in horses. The purpose of this study was to characterise the signalment, clinical signs and management factors associated with shivering (also known as shivers), a relatively rare, poorly defined movement disorder in horses. Web-based case series survey and case-control study. A Web-based survey was used to obtain information from owners, worldwide, who suspected that their horse had shivering. Survey respondents were asked to answer standardised questions and to provide a video of the horse. Authors reviewed the surveys and videos, and horses were diagnosed with shivering if they displayed normal forward walking, with difficulty during manual lifting of the hoof and backward walking due to hyperflexion or hyperextension of the pelvic limbs. Cases confirmed by video were designated 'confirmed shivering', while those with compatible clinical signs but lacking video confirmation were designated 'suspected shivering'. Owners of confirmed shivering horses were asked to provide information on 2 horses without signs of shivering (control group). Three hundred and five surveys and 70 videos were received; 27 horses were confirmed shivering (50 controls), 67 were suspected shivering and the rest had a variety of other movement disorders. Suspected shivering horses resembled confirmed shivering cases, except that the suspected shivering group contained fewer draught breeds and fewer horses with exercise intolerance. Confirmed shivering signs often began at <5 years of age and progressed in 74% of cases. Owner-reported additional clinical signs in confirmed cases included muscle twitching (85%), muscle atrophy (44%), reduced strength (33%) and exercise intolerance (33%). Shivering horses were significantly taller (confirmed shivering, mean ∼173 cm; control horses, ∼163 cm) with a higher male:female ratio (confirmed shivering, 3.2:1 vs. control, 1.7:1). No potential triggering factors or effective treatments were reported. Shivering is a chronic, often gradually progressive movement disorder that usually begins before 7 years of age and has a higher prevalence in tall male horses.

The influence of trigger factors on hereditary angioedema due to C1-inhibitor deficiency

BackgroundHereditary angioedema (HAE) resulting from C1-inhibitor deficiency is characterized by attacks of subcutaneous and submucosal edema. Many factors have been presumed to induce edema. Our study analyzed these factors in a fairly large patient population.MethodsIn the first stage of our study, we analyzed the data recorded by 92 subjects in their patient diaries over seven years. The second phase included 27 HAE patients, who had been completing the diary entry ‘Trigger factors’ every day for seven months whether or not they had experienced an attack.ResultsDuring the initial stage, 91% of the subjects described some factor possibly related to the onset of an attack. They could identify a trigger factor – most commonly (21%) mental stress – in 30% of the 3176 attacks. We found a significant (p < 0.001) difference in the distribution of the trigger factors of the edematous attacks of different locations. The 27 participants of the second phase identified 882 potential trigger factors and recorded 365 attacks. Of these, 246 (67%) occurred on days when the patients identified a potential trigger factor. The likelihood of edema-formation associated with the latter was as follows: menstruation – 63%, infection – 38%, mental stress – 26%, physical exertion – 25%, meteorological changes – 21%, fatigue – 17%.ConclusionThis analysis of the trigger factors explored, for the first time, their potential role in inducing HAE attacks. Our findings might open new perspectives in extending the indications for edema-prophylaxis, and could contribute to a better understanding of the pathomechanism of HAE attacks.

Cannabis use: signal of increasing risk of serious cardiovascular disorders.

BackgroundCannabis is known to be associated with neuropsychiatric problems, but less is known about complications affecting other specified body systems. We report and analyze 35 recent remarkable cardiovascular complications following cannabis use.Methods and ResultsIn France, serious cases of abuse and dependence in response to the use of psychoactive substances must be reported to the national system of the French Addictovigilance Network. We identified all spontaneous reports of cardiovascular complications related to cannabis use collected by the French Addictovigilance Network from 2006 to 2010. We described the clinical characteristics of these cases and their evolution: 1.8% of all cannabis‐related reports (35/1979) were cardiovascular complications, with patients being mostly men (85.7%) and of an average age of 34.3 years. There were 22 cardiac complications (20 acute coronary syndromes), 10 peripheral complications (lower limb or juvenile arteriopathies and Buerger‐like diseases), and 3 cerebral complications (acute cerebral angiopathy, transient cortical blindness, and spasm of cerebral artery). In 9 cases, the event led to patient death.ConclusionsIncreased reporting of cardiovascular complications related to cannabis and their extreme seriousness (with a death rate of 25.6%) indicate cannabis as a possible risk factor for cardiovascular disease in young adults, in line with previous findings. Given that cannabis is perceived to be harmless by the general public and that legalization of its use is debated, data concerning its danger must be widely disseminated. Practitioners should be aware that cannabis may be a potential triggering factor for cardiovascular complications in young people.

Numerical stability analysis of submerged slopes subject to rapid sedimentation processes

In this paper, the stability of infinitely long submerged slopes subject to rapid sedimentation processes is theoretically/numerically investigated. In particular, rapid deposition is considered as a potential triggering factor for static liquefaction in inclined loose sand layers. The corresponding initial boundary value problem is numerically analysed by employing a one-dimensional finite difference scheme in conjunction with two distinct versions of the same constitutive model—elasto-plastic and elasto-viscoplastic (EV). The EV approach is shown to be the most suitable for describing the onset of liquefaction phenomena, since its mathematical well-posedness and numerical stability are never lost. The results of parametric analyses for both homogeneous and inhomogeneous strata are critically discussed in the light of some case history data concerning natural and anthropic sedimentation processes.

Can stress trigger Parkinson's disease?

In this manuscript we summarize the role of chronic stress as a potential trigger factor for Parkinson's disease. Underlying mechanisms and stress-induced changes to the neuronal networks have been highlighted....

Different strains of Propionibacterium acnes modulate differently the cutaneous innate immunity

Acne is a chronic inflammatory illness of the pilosebaceous follicle where innate immunity plays a central role. In acne, the density of Propionibacterium acnes is increased in the pilosebaceous unit. We hypothesized that the severity of acne is not only dependent on the proliferation of P.acnes but also dependent on the pro-inflammatory potential of P.acnes strains and consequently constitutes potential triggering factor for acne scarring. We investigated pro-inflammatory potential of five different strains of P.acnes and P.avidum in skin explants and the preventive effect of zinc gluconate. The expression of immune markers was studied by immunohistochemistry, RT-qPCR and ELISA. P.acnes strains modulate differently the expression of immune markers both at gene and at protein levels. P.acnes type III had the highest pro-inflammatory potential by up-regulating the expression of PAR-2, TNF-alpha, MMP-13 and TIMP-2, whereas P.avidum had the weakest by up-regulating only MMP-13 and TIMP-2. Preincubation of zinc gluconate, which is a modulator of innate immunity, down-regulates the expression of most immune markers induced by P.acnes, PAR-2, TIMP-2, up-regulates MMP-1, TIMP-1. Our results demonstrate that different P.acnes strains have different inflammatory potential targeting markers of cutaneous innate immunity, and that inflammatory potential can be down-regulated by zinc gluconate. As such, the inflammatory potential of P.acnes strains on acne skin may influence the severity of inflammatory acne lesions and scars.

Land Management Versus Natural Factors in Land Instability: Some Examples in Northern Spain

The objective of this work is to test a hypothesis formulated on the basis of former results which considers that there might be a ‘‘global geomorphic change,’’ due to activities related to land management and not determined by climate change, which could be causing an acceleration of geomorphic processes. Possible relationships between some geomorphic processes related to land instability (landslides or sediment generation) and potential triggering factors are analyzed in study areas in northern Spain. The analysis is based on landslide inventories covering different periods, as well as the determination of sedimentation rates. Temporal landslide and sedimentation rate trends are compared with different indicators of human activities (land-use change, logging, forest fires) and with potential natural triggers (rainfall, seismicity). The possible influence of the road network in the distribution of landslides is also analyzed. Results obtained show that there is a general increase of both landslide and sedimentation rates with time that cannot be explained satisfactorily by observed rainfall trends and even less by seismicity. Land use change appears to be by far the main factor leading to land instability, with some changes producing up to a 12-fold increase of landslide rate. A relationship between road network and the spatial distribution of landslides has also been observed. These results do confirm the existence of an acceleration of geomorphic processes in the region, and also suggest that climate-related factors play a limited role in the changes observed.

Effect of active water movement on energy and nutrient acquisition in coral reef-associated benthic organisms

Most visitors of Indo-Pacific coral reefs observe underwater an unexpected phenomenon on the seafloor. Some colonies of the soft coral family Xeniidae open and close their polyps, some pulsing in synchronized, and others in unsynchronized, motion. This pulsation behavior represents a striking and fascinating feature because, sessile benthic (coral reef-associated) organisms do not usually show any active body movements. Surprisingly, to date, no study has resolved the potential reasons and triggering factors for such an unusual and apparently energy-costly behavior. Intensive literature research results in only two related studies from the 1950s. These early investigations indicate that water temperature and some inorganic ions may affect pulsation rates of xeniid soft corals (1, 2), unfortunately without providing further insights into the potential reasons and/or associated benefits of their pulsation. Now, however, in PNAS, Kremien et al. (3) have succeeded in bringing some light into the darkness. Our colleagues from Israel are able to show, using an interconnected series of in situ observations and laboratory experiments at the Northern Red Sea, that the pulsation movement of the coral reef-associated soft coral species Heteroxenia fuscescens leads to increased water flow and turbulence, thereby generating at least two great benefits: (i) enhancement of photosynthesis via fast removal of excess oxygen; and (ii) prevention of refiltration of surrounding water by neighboring polyps.

Stress as a Trigger for Relapses in IBD: A Case-Crossover Study.

BackgroundIt is important to identify factors that influence the risk of relapses in inflammatory bowel disease. Few studies have been conducted and with limited methodology. This prospective case-crossover study, aims to examine whether perceived stress has a short-term acute effect, namely whether it acts as a trigger, on the risk of relapse in inflammatory bowel disease.MethodsSixty patients with inflammatory bowel disease and in remission were included. The case-crossover design was employed, which is an epidemiological design developed to study triggers for acute events and diseases. To collect information regarding symptoms and potential trigger factors, such as perceived stress, a structured diary was constructed. The participants were instructed to fill in the diary daily during six months. Fifty patients completed the study.ResultsThe analysis showed an effect for high level of perceived stress. Being exposed to “quite a lot” of stress, yield an increase in risk for relapse during the forthcoming day (OR = 4.8, 95% CI 1.09 - 21.10). No statistically increased risk for lower levels of perceived stress was found, although elevated effect estimates were found for “some” stress.ConclusionThis study supports earlier findings regarding perceived stress as an important factor in triggering relapses in IBD. However, this is the first case-crossover study performed to explore the trigger risk of stress in this population. Further investigations with larger patient samples are needed to confirm the findings.

Triggering Risk Factors for Stroke: A Case Crossover Study from a Tertiary Care Hospital in Northwest India

Introduction: The role of traditional risk factors in the pathophysiology of stroke (IS) has been established and is well know. It has recently been shown that 10 risk factors are associated with 90% of the risk of stroke. Material and methods: A case-crossover study design was used for the purpose of study. 2-hour hazard period immediately before the onset of stroke was compared with the 2-hour control period at the same time on the day before the onset of stroke. Results: The study assessed the role of seven potential triggers for stroke. Forty four patients (73%) reported exposure to at least one potential triggering factor during the 2 hours hazard period before onset of stroke symptoms. Twenty nine patients (66%) reported exposure to at least one of three (Anger, sudden change in posture, negative emotions) potential triggers during the 2-hour hazard period. Discussion: The current study examined possible association between exposure to potential triggers during a defined hazard period and triggering of the acute onset of stroke. There have been previously reported observations on the potential effect of emotions as a trigger for MI. Conclusion: The period of study and the study sample may not be large enough for extrapolation but nevertheless does open up a new area for research in our setup.

Trigger factors in migraine patients

The objective of this study was to examine potential trigger factors in migraine patients. A total of 126 migraine patients were interviewed about possible trigger factors for migraine. The most common trigger factors were emotional stress (79%), sleep disturbance (64%) and dietary factors (44%). Sleep and stress were significant trigger factors in patients with migraine with aura, whereas environmental factors were important trigger factors in patients with migraine without aura. Stress, sleep and environmental factors were important trigger factors in women and differed significantly from men. Trigger factors are frequent in migraine patients, and avoidance of such factors may result in a better control of the disorder.