scholarly journals Are some patient-perceived migraine triggers simply early manifestations of the attack?

2021 ◽  
Author(s):  
Nazia Karsan ◽  
Pyari Bose ◽  
Jayde Newman ◽  
Peter J. Goadsby
Keyword(s):  
Percentage Agreement ◽  
Trigger Factors ◽  
Food Cravings ◽  
Study Investigator ◽  
Patient Reported ◽  
Kappa Value ◽  
Migraine Triggers ◽  
Symptom Phenotype ◽  
Premonitory Symptoms ◽  
Good Agreement

Abstract Objective To study the agreement between self-reported trigger factors and early premonitory symptoms amongst a group of migraineurs in both spontaneous and pharmacologically provoked attacks. Methods Fifty-three subjects with migraine with and without aura, with ≤ 22 headache days/month, with spontaneous premonitory symptoms associated with migraine attacks were recruited nationally. A detailed history was taken by a study investigator to confirm diagnosis and extended phenotyping was performed to identify patient-reported triggers for migraine attacks, premonitory symptom phenotype and headache characteristics, using a standardised physician-administered questionnaire. The same subjects were exposed to a 0.5 mcg/kg/min nitroglycerin infusion over 20 min, to determine if similar migraine symptoms could be triggered. The triggered attacks were phenotyped in the same way as spontaneous ones. Percentage agreement and Cohen’s kappa measure of agreement were used to identify concordance between patient-reported triggers and the corresponding spontaneous and triggered premonitory symptoms. Percentage agreement of > 60% and/or a kappa value > 0.3 with P < 0.05 were considered significant. Results There was statistically significant agreement between perception of light as a migraine trigger and spontaneous premonitory photophobia; perception of sound as a trigger and triggered premonitory phonophobia; skipping meals as a trigger and spontaneous premonitory food cravings; and food triggers and spontaneous premonitory food cravings. There was good agreement between stress and premonitory triggered mood change. Conclusions At least some patient-reported triggers, such as light, sound, foods and skipping meals, may represent early brain manifestations of the premonitory phase of the migraine attack.

scholarly journals Comparative Results of QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold Plus Assays for Detection of Tuberculosis Infection in Clinical Samples

2020 ◽  
Vol 58 (4) ◽  
Author(s):  
Dongju Won ◽  
Jung Yong Park ◽  
Hyon-Suk Kim ◽  
Younhee Park
Keyword(s):  
T Cells ◽  
Latent Tuberculosis ◽  
Clinical Samples ◽  
Negative Results ◽  
Kappa Value ◽  
A Cell ◽  
Ifn Γ ◽  
Comparative Results ◽  
Clinical Departments ◽  
Good Agreement

ABSTRACT The QuantiFERON-TB Gold plus (QFT-Plus) assay, an interferon gamma (IFN-γ) release assay (IGRA), was recently introduced as the next version of the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay for diagnosing latent tuberculosis (TB). Whereas the QFT-GIT assay uses only one TB tube that induces a cell-mediated immune (CMI) response of CD4+ T cells, the QFT-Plus has an additional TB antigen 2 tube (TB2) for the CMI response of CD8+ T and CD4+ T cells, in addition to a TB antigen 1 (TB1) tube for the CMI response of CD4+ T cells only. We compared the results of the QFT-Plus and QFT-GIT assays as routine clinical tests for diagnosing TB. Samples from 220 patients referred for routine IGRA in various clinical departments were used. Correlations between IFN-γ levels in the QFT-GIT and QFT-Plus assays were strong and showed good agreement (kappa value = 0.69). Seven cases with positive QFT-GIT assay results and negative QFT-Plus assay results showed IFN-γ values near the cutoff value. However, 10 cases with active TB, recent TB, or immune problems showed discordance with the positive results only in the TB2 tube in QFT-Plus, unlike the negative results in TB1 and TB tubes. In these cases, IFN-γ levels in the TB2 tube were significantly higher than those in other tubes. This is the first study to compare these assays as routine IGRAs in the clinical setting. The QFT-Plus assay showed good agreement with the QFT-GIT assay and is presumably advantageous for patients with active TB, recent TB, and specific immune conditions involving CD8+ T-cell responses.

An electronic, unsupervised patient-reported Expanded Disability Status Scale for multiple sclerosis

2020 ◽  
pp. 135245852096881
Author(s):  
Andrew R Romeo ◽  
William M Rowles ◽  
Erica S Schleimer ◽  
Patrick Barba ◽  
Wan-Yu Hsu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Care ◽  
Expanded Disability Status Scale ◽  
Clinical Assessments ◽  
Patient Reported ◽  
Disability Status ◽  
Two Measures ◽  
Highly Correlated ◽  
Participation In Research ◽  
Good Agreement

Background: In persons with multiple sclerosis (MS), the Expanded Disability Status Scale (EDSS) is the criterion standard for assessing disability, but its in-person nature constrains patient participation in research and clinical assessments. Objective: The aim of this study was to develop and validate a scalable, electronic, unsupervised patient-reported EDSS (ePR-EDSS) that would capture MS-related disability across the spectrum of severity. Methods: We enrolled 136 adult MS patients, split into a preliminary testing Cohort 1 ( n = 50), and a validation Cohort 2 ( n = 86), which was evenly distributed across EDSS groups. Each patient completed an ePR-EDSS either immediately before or after a MS clinician’s Neurostatus EDSS evaluation. Results: In Cohort 2, mean age was 50.6 years (range = 26–80) and median EDSS was 3.5 (interquartile range (IQR) = [1.5, 5.5]). The ePR-EDSS and EDSS agreed within 1-point for 86% of examinations; kappa for agreement within 1-point was 0.85 ( p < 0.001). The correlation coefficient between the two measures was 0.91 (<0.001). Discussion: The ePR-EDSS was highly correlated with EDSS, with good agreement even at lower EDSS levels. For clinical care, the ePR-EDSS could enable the longitudinal monitoring of a patient’s disability. For research, it provides a valid and rapid measure across the entire spectrum of disability and permits broader participation with fewer in-person assessments.

The Icatibant Outcome Survey: Trigger Factors and Premonitory Symptoms of Angioedema Attacks in Patients with Hereditary Angioedema

2015 ◽  
Vol 135 (2) ◽  
pp. AB278
Author(s):  
Teresa Caballero ◽  
Marcus Maurer ◽  
Hilary Longhurst ◽  
Werner Aberer ◽  
Laurence Bouillet ◽  
...  
Keyword(s):  
Hereditary Angioedema ◽  
Trigger Factors ◽  
Icatibant Outcome Survey ◽  
Premonitory Symptoms

Cortico-NRM Influences on Trigeminal Neuronal Sensation

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 640-652 ◽  
Author(s):  
GA Lambert ◽  
KL Hoskin ◽  
AS Zagami
Keyword(s):  
Dura Mater ◽  
Mechanical Stimulation ◽  
Light Flash ◽  
Inhibitory Effect ◽  
Cortical Activation ◽  
Trigger Factors ◽  
Trigeminal Neurons ◽  
Raphe Magnus ◽  
Migraine Triggers ◽  
Stimulation Of

We tested the idea that migraine triggers cause cortical activation, which disinhibits craniovascular sensation through the nucleus raphe magnus (NRM) and thus produces the headache of migraine. Stimulation of the dura mater and facial skin activated neurons in the NRM and the trigeminal nucleus. Stimulation of the NRM caused suppression of responses of trigeminal neurons to electrical and mechanical stimulation of the dura mater, but not of the skin. This suppression was antagonized by the iontophoretic application of the 5-HT1B/1D receptor antagonist GR127935 to trigeminal neurons. Migraine trigger factors were simulated by cortical spreading depression (CSD) and light flash. Activity of neurons in the NRM was inhibited by these stimuli. Multiple waves of CSD antagonized the inhibitory effect of NRM stimulation on responses of trigeminal neurons to dural mechanical stimulation but not to skin mechanical stimulation. The cortico-NRM-trigeminal neuraxis might provide a target for a more universally effective migraine prophylactic treatment.

scholarly journals Indirect Enzyme Linked Immunosorbent Assay Sebagai Metode untuk Melacak Bruselosis pada Sapi Perah (INDIRECT ENZYME IMMUNOSORBENT ASSAY (I-ELISA) AS METHOD FOR DETECT BRUCELLOSIS IN DAIRY COW)

2019 ◽  
Vol 20 (1) ◽  
pp. 30
Author(s):  
Rinaldi Ghurafa ◽  
Denny Widaya Lukman ◽  
Hadri Latif
Keyword(s):  
Sensitivity And Specificity ◽  
Immunosorbent Assay ◽  
Elisa Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Test Results ◽  
Kappa Value ◽  
Alternative Test ◽  
The Rose ◽  
Higher Sensitivity ◽  
Good Agreement

Brucellosis has become a zoonotic disease that received attention in efforts to prevent and eradicate strategic infectious animal diseases in Indonesia. Brucellosis can be detected early by the rose bengal test (RBT), followed by complement fixation test (CFT) and by enzyme linked immunosorbent assay (ELISA). The aims of this research was to study the indirect enzyme linked immunosorbent assay test (I-ELISA) as an alternative test for detecting brucellosis in dairy cattle. The method was used by conducting tests of RBT, CFT, I-ELISA and commercial I-ELISA to test brucellosis. The test results were calculated sensitivity and specificity, as well as analyzed by calculating the kappa value. The method was used by conducting tests of RBT, CFT, I-ELISA and commercial I-ELISA to test brucellosis. The test results were calculated for sensitivity and specificity, as well as analyzed by calculating the Kappa statistical value. The results of the sensitivity and specificity calculation showed that the indirect enzyme linked immunosorbent assay (I-ELISA) test developed a higher sensitivity (100%) compared to RBT test (93.75%) and commercial I-ELISA (93.75%). The developed I-ELISA specificity (74.68%) was still lower than RBT (89.87%), but higher than commercial I-ELISA (70.52%). The calculation of the statistical value of kappa RBT with CFT showed the kappa value 0.7120 which meaned it had a good agreement, commercial I-ELISA with CFT showed kappa value 0.6165 which meaned it had good suitability, whereas I-ELISA developed with CFT showed kappa value 0.4984 which meaned having a moderate agreement.In conclusion, the indirect enzyme linked immunosorbent assay (I-ELISA) which had been developed had low specificity, but the sensitivity was the highest compared to the commercial I-ELISA test and RBT, so this test was appropriate to be used as a screening test, especially in dairy cows movement into brucellosis-free areas or regions.

PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia

2020 ◽  
Vol 48 (2) ◽  
pp. 385-394 ◽  
Author(s):  
Deborah J. Li ◽  
John C. Clohisy ◽  
Maria T. Schwabe ◽  
Elizabeth L. Yanik ◽  
Cecilia Pascual-Garrido
Keyword(s):  
Outcome Measures ◽  
Acetabular Dysplasia ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Ceiling Effects ◽  
The Mean ◽  
Symptomatic Acetabular Dysplasia ◽  
Good Agreement

Background: No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). Purpose: To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. Results: The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain ( r = −0.66; P < .0001) and mHHS ( r = −0.60; P < .0001) preoperatively and the HOOS pain ( r = −0.64; P < .0001) and mHHS ( r = −0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL ( r = 0.51; P < .0001) and mHHS ( r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL ( r = 0.56; P < .0001) and mHHS ( r = 0.56; P < .0001). Conclusion: We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.

Evaluation of KRAS, NRAS and BRAF mutational status and microsatellite instability in early colorectal carcinomas invading the submucosa (pT1): towards an in-house molecular prognostication for pathologists?

2020 ◽  
Vol 73 (11) ◽  
pp. 741-747 ◽  
Author(s):  
Amélie Bourhis ◽  
Caterina De Luca ◽  
Mélanie Cariou ◽  
Elena Vigliar ◽  
Fanny Barel ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Molecular Testing ◽  
Mutational Status ◽  
Kappa Value ◽  
Next Generation Sequencing Ngs ◽  
Generation Sequencing ◽  
Control Study ◽  
Mmr Proteins ◽  
Good Agreement

AimWe aimed to study the prognostic value of KRAS, NRAS, BRAF mutations and microsatellite stable (MSS)/instable (MSI) in the field of colorectal cancer invading the submucosa (ie, pT1 colorectal cancer (CRC)).MethodsWe led a case-control study in tumour samples from 60 patients with pT1 CRC with (20 cases) and without (40 cases) metastatic evolution (5 years of follow-up) which were analysed for KRAS, NRAS, BRAF mutations (Idylla testing and next generation sequencing, NGS) and MSS/MSI status (Idylla testing and expression of mismatch repair (MMR) proteins using immunohistochemistry).ResultsKRAS mutations were encountered in 11/20 (55%) cases and 21/40 (52.5%) controls (OR=1.11 (0.38 to 3.25), p=0.8548), NRAS mutations in 1/20 (5%) cases and 3/40 (7.5%) controls (OR=3.08 (0.62 to 15.39), p=0.1698) and BRAF mutations in 3/20 (15%) cases and 6/40 (15%) controls (OR=1.00 (0.22 to 4.5), p=1.00). A MSI status was diagnosed in 3/20 (15%) cases and 5/40 (12.5%) controls (OR=1.2353 (0.26 to 5.79), p=0.7885). Beyond the absence of significant association between the metastatic evolution and any of the studied molecular parameters, we observed a very good agreement between methods analysing KRAS, NRAS and BRAF mutations (Kappa value of 0.849 (0.748 to 0.95) between Idylla and NGS) and MSS/MSI (Idylla)—proficient MMR/deficient MMR (immunohistochemistry) status (Kappa value of 1.00).ConclusionAlthough being feasible using the fully automated Idylla method as well as NGS, the molecular testing of KRAS, NRAS, BRAF and MSS/MSI status does not seem useful for prognostic purpose in the field of pT1 CRC.

scholarly journals A Comparison of Anti-Nuclear Antibody Quantification Using Automated Enzyme Immunoassays and Immunofluorescence Assays

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Renata Baronaite ◽  
Merete Engelhart ◽  
Troels Mørk Hansen ◽  
Gorm Thamsborg ◽  
Hanne Slott Jensen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Screening Test ◽  
Cohen’S Kappa ◽  
Enzyme Immunoassays ◽  
Double Stranded Dna ◽  
Cohen's Kappa ◽  
Kappa Value ◽  
Fluorescence Assays ◽  
Good Agreement

Anti-nuclear antibodies (ANA) have traditionally been evaluated using indirect fluorescence assays (IFA) with HEp-2 cells. Quantitative immunoassays (EIA) have replaced the use of HEp-2 cells in some laboratories. Here, we evaluated ANA in 400 consecutive and unselected routinely referred patients using IFA and automated EIA techniques. The IFA results generated by two independent laboratories were compared with the EIA results from antibodies against double-stranded DNA (dsDNA), from ANA screening, and from tests of the seven included subantigens. The final IFA and EIA results for 386 unique patients were compared. The majority of the results were the same between the two methods (n=325, 84%); however, 8% (n=30) yielded equivocal results (equivocal-negative and equivocal-positive) and 8% (n=31) yielded divergent results (positive-negative). The results showed fairly good agreement, with Cohen’s kappa value of 0.30 (95% confidence interval (CI) = 0.14–0.46), which decreased to 0.23 (95% CI = 0.06–0.40) when the results for dsDNA were omitted. The EIA method was less reliable for assessing nuclear and speckled reactivity patterns, whereas the IFA method presented difficulties detecting dsDNA and Ro activity. The automated EIA method was performed in a similar way to the conventional IFA method using HEp-2 cells; thus, automated EIA may be used as a screening test.

scholarly journals Functional near-infrared spectroscopy is in moderate accordance with functional MRI in determining lateralisation of frontal language areas

2017 ◽  
Vol 31 (2) ◽  
pp. 133-141 ◽  
Author(s):  
KM Arun ◽  
KA Smitha ◽  
PG Rajesh ◽  
Chandrasekharan Kesavadas
Keyword(s):  
Infrared Spectroscopy ◽  
Optical Imaging ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Percentage Agreement ◽  
Functional Near Infrared Spectroscopy ◽  
Language Dominance ◽  
Statistical Measures ◽  
Kappa Value ◽  
Language Areas

Purpose Understanding language dominance is crucial in pre-surgical evaluation of patients with epilepsy and in patients having a tumour close to the language area. Functional magnetic resonance imaging (fMRI) studies are well established in evaluating language dominance. Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical imaging modality that offers a convenient and affordable technique to image language-related cortical areas. This study investigates the agreement between results from task-based fMRI and fNIRS in determining language lateralisation. Methods Language laterality indices LIs were calculated from both fMRI and fNIRS measurements of the same individual volunteers by using an identical paradigm. Statistical measures of percentage agreement and kappa value have been calculated for testing agreement and reliability. Results A correlation analysis of the LI values shows a good correlation with r = 0.677 at p < 0.05. Statistical comparison of both fMRI and fNIRS methods for language lateralisation yielded a percentage agreement of 90% and a moderate kappa value of κ = 0.621. Conclusion Our study suggests that fNIRS is in moderate accordance with fMRI in determining lateralisation of the frontal language areas. It implies that the optical imaging technique can provide additional information on functional lateralisation of frontal language areas.

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