Epidemiology of primary and secondary headaches in a Brazilian tertiary-care center

OBJECTIVE: To analyze the demographic features of the population sample, the time of headache complaint until first consultation and the diagnosis of primary and secondary headaches. METHOD: 3328 patients were analyzed retrospectively and divided according to gender, age, race, school instruction, onset of headache until first consultation and diagnosis(ICHD-II, 2004). RESULTS: Sex ratio (Female/Male) was 4:1, and the mean age was 40.7±15 years, without statistical differences between sexes. Approximately 65% of the patients were white and 55% had less than eight years of school instruction. Headache complaint until first consultation ranged from 1 to 5 years in 32.99% patients. The most prevalent diagnosis were migraine (37.98%), tension-type headache-TTH (22.65%) and cluster headache (2.73%). CONCLUSION: There are few data on epidemiological features of headache clinic populations, mainly in developing countries. According to the literature, migraine was more frequent than TTH. It is noteworthy the low school instruction of this sample and time patient spent to seek for specialized attention. Hypnic headache syndrome was seen with an unusual frequency.

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Population-Based Validation of a German-Language Self-Administered Headache Questionnaire

Cephalalgia ◽

10.1111/j.1468-2982.2008.01560.x ◽

2008 ◽

Vol 28 (6) ◽

pp. 605-608 ◽

Cited By ~ 35

Author(s):

M-S Yoon ◽

M Obermann ◽

G Fritsche ◽

M Slomke ◽

P Dommes ◽

...

Keyword(s):

General Population ◽

Population Sample ◽

Population Based ◽

Tension Type Headache ◽

German Language ◽

General Population Sample ◽

Trigeminal Autonomic Cephalalgia ◽

Screening Questionnaires ◽

Headache Clinic ◽

Type Headache

We validated a German-language self-administered headache questionnaire for migraine (M), tension-type headache (TTH) and trigeminal autonomic cephalalgia (TAC) in a general population sample of people with headache. Randomly selected subjects ( n = 240) diagnosed by the questionnaire as M ( n = 60), TTH ( n = 60), a combination of M and TTH (M+TTH, n = 60) and TAC ( n = 60) were invited for examination by headache specialists. One hundred and ninety-three subjects (80%) were studied. Sensitivity and specificity for M were 0.85 and 0.85, for TTH 0.6 and 0.88, for M+TTH 0.82 and 0.87, respectively. Cohen's κ was 0.6 (95% confidence interval 0.50, 0.71). Of 45 patients with TAC according to the questionnaire, physicians diagnosed cluster headache in two patients only. We conclude: (i) the questionnaire can be used to diagnose M, TTH and M+TTH, but not TAC; (ii) screening questionnaires for epidemiological research should be validated in a general population sample but not in a tertiary headache clinic.

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Assessment of inflammation with hematological parameters in patients with migraine and tension-type headache: a prospective study from a tertiary care center

Pain Management ◽

10.2217/pmt-2021-0036 ◽

2021 ◽

Author(s):

Halil Okay Albayrak ◽

Hande Gurbuz ◽

Sehnaz Basaran ◽

Serkan Yılmaz

Keyword(s):

Hematological Parameters ◽

Care Center ◽

Tertiary Care ◽

White Blood Cells ◽

Tension Type Headache ◽

Significant Rise ◽

Neutrophil To Lymphocyte Ratio ◽

Clinical Trial Registration ◽

Lymphocyte Ratio ◽

Type Headache

Aim: To investigate the role of inflammatory markers in patients with an acute headache attack. Materials & methods: This prospective controlled observational study comprised 150 subjects (migraine with aura [MA] n = 51, migraine without aura [MO] n = 51, tension-type headache n = 48, healthy controls n = 80). White blood cells (WBC), neutrophil, lymphocyte and platelet counts, mean platelet volume, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were documented. Results: MA and MO constituted 14.2% of the admissions to the emergency department due to headaches. In addition, MA and MO had higher WBC and MO showed higher neutrophil count during the attacks than healthy control (p < 0.05). Conclusion: Although inflammatory parameters, including WBC and neutrophil counts, were high in headache patients, neutrophil-to-lymphocyte ratio did not show a significant rise. Clinical trial registration: NCT04891848

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Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

BMC Surgery ◽

10.1186/s12893-021-01051-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmed Shabhay ◽

Pius Horumpende ◽

Zarina Shabhay ◽

Andrew Mganga ◽

Jeff Van Baal ◽

...

Keyword(s):

Blood Glucose ◽

Diabetic Foot ◽

Care Center ◽

Tertiary Care ◽

Limb Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Random Blood Glucose ◽

North Eastern ◽

The Mean

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

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History of Headache Research in Denmark

Cephalalgia ◽

10.1177/033310240102100702 ◽

2001 ◽

Vol 21 (7) ◽

pp. 748-752 ◽

Cited By ~ 1

Author(s):

P Tfelt-Hansen

Keyword(s):

Migraine With Aura ◽

Tension Type Headache ◽

Regional Cerebral Blood ◽

Danish Population ◽

Genetic Studies ◽

History Of ◽

Headache Clinic ◽

Type Headache ◽

Acute Headache ◽

First Time

Headache research in Denmark started with the description in 1949 by Dalsgaard-Nielsen of the percutaneous nitroglycerin test. In 1976 Jes Olesen started The Copenhagen Acute Headache Clinic and from that time modern headache research began in Denmark. Specific changes in regional cerebral blood flow during attacks of migraine with aura, spreading oligaemia, were described for the first time in 1980. The first headache classification with operational diagnostic criteria was published in 1988 and used in a Danish population study from 1989. The lifetime prevalence of migraine was 8% in men and 25% in women. An intravenous nitroglycerin test was introduced in 1989 and has been developed as an experimental headache model. In 1993 it was suggested by Jes Olesen et al. that NO supersensitivity could be a possible molecular mechanism of migraine pain. Recent genetic studies have supported the distinction between migraine with aura and migraine without aura. From the middle of the 1980s the pathophysiology of tension-type headache has been investigated and recent results indicate central sensitization in patients with chronic tension-type headache.

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Daily Quality Control in CD3+and CD4+T Cell Estimation by the FACSCount System at a Tertiary Care Center in South India

Clinical and Vaccine Immunology ◽

10.1128/cvi.00246-12 ◽

2012 ◽

Vol 19 (10) ◽

pp. 1693-1696 ◽

Cited By ~ 3

Author(s):

Veena V. Ramalingam ◽

Monika Mani ◽

Vijayanand C. Sundaresan ◽

Ramesh J. Karunaiya ◽

Jaiprasath Sachithanandham ◽

...

Keyword(s):

Quality Control ◽

T Cell ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Cd4 T Cell ◽

Internal Quality ◽

Cell Counts ◽

Resource Poor ◽

The Mean

ABSTRACTCD4+T cell count estimations are subject to high variations; hence, in this study, the previous day's tested samples were included routinely as the internal quality controls. The percentages of variation of the 2-day values were analyzed for 280 observations and the mean variation for CD4+and CD3+T cell counts ranged from 5.21% to 9.66%. This method is a good internal quality control (IQC) procedure for the estimation of CD3+and CD4+T cell counts in resource-poor settings.

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A study of peripartum cardiomyopathy in a tertiary care center in India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170374 ◽

2017 ◽

Vol 6 (2) ◽

pp. 523 ◽

Cited By ~ 1

Author(s):

Aditi V. Joshi ◽

Michelle N. Fonseca ◽

Deepali S. Kharat-Kapote

Keyword(s):

Care Center ◽

Tertiary Care ◽

Fetal Outcome ◽

Peripartum Cardiomyopathy ◽

Early Interventions ◽

Tertiary Care Center ◽

Common Risk Factor ◽

The Mean ◽

Time Of Presentation ◽

Underlying Pathogenesis

Background: Peripartum cardiomyopathy is an idiopathic and reversible form of dilated cardiomyopathy. The aim of the study was to study the mean age of presentation of peripartum cardiomyopathy in pregnant patients over a period of 1 year in a tertiary health care and study the maternal and fetal outcome of patients with peripartum cardiomyopathy.Methods: A retrospective observational study with total of 22 patients with peripartum cardiomyopathy was diagnosed in a total of 10,279 deliveries conducted at LTMMC, Sion hospital between September 2014 to February 2016.Results: Our study revealed that most of the affected patients were young with the mean age at presentation being 26.8±4.29 years. Most of the patients were diagnosed in the postpartum period (63.6%). the most common risk factor was pre-eclampsia (22.7%) followed by anemia (18.2%). The mean Ejection fraction at the time of presentation was 25.3±9.8%. There were 2 (9.1%) intrauterine fetal deaths and 1 neonatal death.Conclusions: There is a need for more multi-centric studies in order to understand the underlying pathogenesis and to determine the possible early interventions to help provide better pregnancy outcome.

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Thyroid status and Treatment Response of Hypothyroid Infertile Women in Tertiary Care Center of Bangladesh

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v31i2.34216 ◽

2017 ◽

Vol 31 (2) ◽

pp. 86-89

Author(s):

Farzana Deeba ◽

Parveen Fatima ◽

Jesmine Banu ◽

Shakeela Ishrat ◽

Nurjahan Begum ◽

...

Keyword(s):

Subclinical Hypothyroidism ◽

Early Stage ◽

Care Center ◽

Tertiary Care ◽

Target Population ◽

Fertility Treatment ◽

Tertiary Care Centre ◽

Infertile Women ◽

The Mean ◽

Tsh Levels

Objective(s): Aim of this study was to find out the prevalence of hypothyroidism in infertile women as well as to assess their response to treatment.Materials and methods: This descriptive study was conducted in Infertility unit of Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, a tertiary care centre from January 2014 to December 2014. Four hundred women who visited infertility clinic of the department for fertility treatment were the target population for this study. Routine investigations such as CBC, Blood sugar 2 hours postparandial or GTT, TSH and Prolactin was done. Subclinical hypothyroidism was diagnosed when there was increased TSH and normal FT4. Hypothyroid patients were given Levothyroxin depending upon TSH levels and continued until end of the study. Patients were followed up for six months even if pregnancy was attained.Results: Out of 400 women 55% were primary and 45% were secondary subfertility. Mean duration of infertility was 4.5 ± 1.2 years. Ninety two (23%) patients were hypothyroid. Among them 66 (16.5%) were subclinical hypothyroid and 26 (6.5%) were frank hypothyroid. The mean TSH levels were 7.34 ± 2.13 ìIU/ml, and the mean PRL levels were 52.46 ± 11.17 ng/ml. Out of 92 infertile women diagnosed as hypothyroidism 75 (81.52%) women conceived after treatment with drugs for hypothyroidism (dose depending upon severity of hypothyroidism, i.e. TSH levels). More than 90% women had regular ovulation for consecutive three cycles after initiation of treatment.Conclusion: The normal TSH levels are the pre-requisite for fertilization. The decision to initiate thyroid replacement therapy in both clinical and subclinical hypothyroidism at early stage is justified in infertile women.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 86-89

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Comparison of Thrombocyte Count Between Pediatric Patients With Migraine or Tension-Type Headache: A Retrospective Cohort Study

Journal of Child Neurology ◽

10.1177/0883073819862738 ◽

2019 ◽

Vol 34 (13) ◽

pp. 824-829 ◽

Cited By ~ 1

Author(s):

Aviv Benedick ◽

Avraham Zeharia ◽

Tal Eidlitz Markus

Keyword(s):

Negative Correlation ◽

Pediatric Patients ◽

Tension Type Headache ◽

Thrombocyte Count ◽

Laboratory Parameters ◽

Pediatric Headache ◽

Increased Risk ◽

Migraine Group ◽

Headache Clinic ◽

Type Headache

Hypercoagulability may explain the increased risk of thromboembolic cerebrovascular events in patients with migraine. Thrombocytes play a crucial part in the coagulation process, and some studies have demonstrated hyperaggregation of thrombocytes in adult migraineurs. We aimed to compare thrombocyte count between pediatric patients with migraine or tension-type headache and to evaluate the correlation of thrombocyte count with headache parameters. The electronic database of a tertiary pediatric headache clinic was retrospectively searched for all children and adolescents diagnosed with migraine or tension-type headache in 2016-2018. Data on thrombocyte counts were collected from the medical files and compared between the groups by parametric and nonparametric statistical tests. The cohort included 299 patients, 176 girls (59.0%) and 123 (412.0%) boys, of mean age 12.2 ± 3.4 years; 198 had migraine and 101 had tension-type headache. Among the laboratory parameters evaluated, a significantly lower mean thrombocyte number was found in the migraine group than in the tension-type headache group (282 ± 60 vs 304±71 ×103/μL, P = .004). Within the migraine group, there was a significant negative correlation between the thrombocyte count and the duration of headache attacks in hours ( P < .05). No significant between- or within-group differences were found in other laboratory parameters. The low relative thrombocyte count in pediatric headache clinic patients with migraine and its negative correlation with duration of migraine suggest that migraine may be associated with a different underlying pathogenesis from tension-type headache.

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Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study

Journal of Clinical Imaging Science ◽

10.25259/jcis_168_2020 ◽

2020 ◽

Vol 10 ◽

pp. 74

Author(s):

Prashant Nagpal ◽

Sarv Priya ◽

Ali Eskandari ◽

Aidan Mullan ◽

Tanya Aggarwal ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Radiation Dose ◽

Care Center ◽

Tertiary Care ◽

Multivariate Logistic Regression Analysis ◽

Factors Affecting ◽

Model Based ◽

Pulmonary Angiogram ◽

The Mean

Objectives: Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods: This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy−1•cm−1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results: There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2–104.4 years) and BMI of 31.3 kg/m2 (range 12–91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median – 4.27 mSv; range 0.1–43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose (P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion: Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.

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Usefulness of the Non-Contact Tonometry in Out-Patient Screening

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v15i2.232 ◽

2016 ◽

Vol 15 (2) ◽

Author(s):

Satheesh Solomon T Selvin ◽

Chris Elsa Samson Jacob ◽

Thomas Kuriakose

Keyword(s):

Central Corneal Thickness ◽

Care Center ◽

Corneal Thickness ◽

Tertiary Care ◽

Cross Sectional Study ◽

Applanation Tonometry ◽

Cross Sectional ◽

Significant Difference ◽

Iop Measurement ◽

The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg. The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram.

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