OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study

BACKGROUND AND PURPOSE

OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome.

METHODS

We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months.

RESULTS

A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045).

CONCLUSIONS

This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.

Thin Glomerular Basement Membrane in a Kidney Transplant of an Alport's Syndrome Patient: A Case Report

Alport syndrome (AS) and thin basement membrane lesions are caused by various mutations in type IV collagen genes. Although AS is considered a rare disease, thin basement membrane is a frequent pattern, especially in families with a history of persistent hematuria. We report a patient with a diagnosis of AS who developed end-stage kidney disease (ESKD) and received a kidney transplant from a living unrelated donor. The graft biopsy specimen surprisingly showed a pattern of thin basement membranes.

Responsiveness of pituitary to galanin throughout the reproductive cycle of male European sea bass (Dicentrarchus labrax)

The neuropeptide galanin (Gal) is a putative factor regulating puberty onset and reproduction through its actions on the pituitary. The present study investigated the pituitary responsiveness to galanin and the patterns of galanin receptors (Galrs) expression throughout the reproductive cycle of two years old male European sea bass (Dicentrarchus labrax), an important aquaculture species. Quantitative analysis of pituitary and hypothalamus transcript expression of four galr subtypes revealed differential regulation according to the testicular developmental stage, with an overall decrease in expression from the immature stage to the mid-recrudescence stage. Incubation of pituitary cells with mammalian 1-29Gal peptide induced significant changes in cAMP concentration, with sensitivities that varied according to the testicular development stages. Furthermore 1-29Gal was able to stimulate both follicle stimulating hormone (Fsh) and luteinizing hormone (Lh) release from pituitary cell suspensions. The magnitude of the effects and effective concentrations varied according to reproductive stage, with generalized induction of Fsh and Lh release in animals sampled in January (full spermiation). The differential expression of galrs in pituitary and hypothalamus across the reproductive season, together with the differential effects of Gal on gonadotropins release in vitro strongly suggests the involvement of the galaninergic system in the regulation the hypothalamus-pituitary-gonad axis of male sea bass. This is to our knowledge the first clear evidence for the involvement of galanin in the regulation of reproduction in non-mammalian vertebrates.

[Multimodal imaging in primary intraocular lymphoma]

INTRODUCTION

Vitreoretinal lymphoma is a serious disease with highly varied clinical presentations. The goal of this work is to identify the various presentations (clinical, imaging) in order to improve screening for this disease.

MATERIALS AND METHOD

We collected data of patients followed on our service for vitreoretinal lymphoma. The fundus exam, autofluorescence and angiography data were classified in order to identify signs, which might lead to earlier diagnosis of lymphoma.

RESULTS

The diagnosis of vitreoretinal lymphoma was confirmed by vitrectomy or cerebral biopsy for 12 patients (8 women and 4 men). Three clinical presentations were identified: no retinal involvement (2 patients), retinal infiltrate (4 patients) or acute retinal necrosis (3 patients). One patient had no imaging (deceased before it could be obtained), and two patients had uninterpretable imaging.

CONCLUSION

Vitreoretinal lymphoma remains a rare and under-diagnosed disease. The prognosis is related to early diagnosis. Multimodal imaging can help to diagnose early vitreoretinal lymphoma in some cases.

Life course path analysis of total and central adiposity throughout adolescence on adult blood pressure and insulin resistance

BACKGROUND AND AIM

We aimed to study whether the effect of adolescent adiposity on adult blood pressure and insulin resistance was mediated by adult adiposity.

METHODS AND RESULTS

Data from the EPITeen cohort at 13, 17 and 21 years was used (n = 2211). Sex- and age-specific body mass index z-scores (BMIz) and waist-to-hip ratio (WHR) were used as indicators of total and central adiposity, respectively. Systolic blood pressure (SBP), glucose and insulin were assessed at 21 years and the homeostasis model assessment (HOMA-IR) was used as a marker of insulin resistance. Path analysis was applied to evaluate direct and indirect effects of adiposity (13, 17 and 21y) on adult SBP and HOMA-IR, separately for total and central adiposity and for each outcome. Results are presented as standardized regression coefficients [β (95%CI)]. The total effect of BMIz at 13 years on SBP at 21 years was 0.211 (0.178; 0.244), totally mediated by adult BMIz. Total effect of BMIz 13y on HOMA-IR was 0.248 (0.196; 0.299). Although this effect was mostly mediated by BMIz 21y, an additional direct effect from BMIz 17y was found [β = -0.240 (-0.315; -0.164)]. Central adiposity was also positively associated with SBP and HOMA-IR at 21 years, and the effect of adolescent WHR was totally mediated by adult WHR for both outcomes.

CONCLUSIONS

The effect of adolescent adiposity on adult SBP and HOMA-IR was mostly mediated by adult adiposity. However, for HOMA-IR an additional direct effect from total adiposity at 17 years was found.

RAPID-COMMUNICATION Genetic diversity and differentiation in natural populations of Arapaima gigas from lower Amazon revealed by microsatellites

Genetic variability is one of the important criteria for species conservation decisions. This study aimed to analyze the genetic diversity and the population differentiation of two natural populations of Arapaima gigas, a species with a long history of being commercially exploited. We collected 87 samples of A. gigas from Grande Curuai Lake and Paru Lake, located in the Lower Amazon region of Amazônia, Brazil, and genotyped these samples using a multiplex panel of microsatellite markers. Our results showed that the populations of A. gigas analyzed had high levels of genetic variability, which were similar to those described in previous studies. These two populations had a significant population differentiation supported by the estimates of F_ST and R_ST (0.06), by Bayesian analysis (K = 2), and by population assignment tests, which revealed a moderate genetic distance.

The role of prenatal exposures on body fat patterns at 7 years: Intrauterine programming or birthweight effects?

BACKGROUND AND AIMS

It remains unknown whether the effects of prenatal exposures on child's adiposity reflect entirely intrauterine programming. We aimed to assess the effects of maternal gestational weight gain, diabetes and smoking on the child's body fat patterns, disentangling the direct (through intrauterine programming) and indirect (through birthweight) effects.

METHODS AND RESULTS

We included 4747 singleton 7-year-old children from the Generation XXI birth cohort (Porto, Portugal). At birth, maternal and newborn's characteristics were obtained. Anthropometrics were measured at age 7 years and body fat patterns were identified by principal component analysis. Path analysis was used to quantify direct, indirect and total effects of gestational weight gain, diabetes and smoking on body fat patterns. Pattern 1 was characterized by strong factor loadings with body mass index, fat mass index and waist-to-height ratio (fat quantity) and pattern 2 with waist-to-hip ratio, waist-to-thigh ratio, and waist-to-weight ratio (fat distribution). The positive total effect of maternal gestational weight gain and diabetes on the child's fat quantity was mainly through a direct pathway, responsible for 91.7% and 83.7% of total effects, respectively (β = 0.022; 95% Confidence Interval (CI): 0.017, 0.027; β = 0.041; 95% CI: -0.011, 0.093). No effects on fat distribution were found. Maternal prenatal smoking had a positive direct effect on patterns 1 and 2, explaining 94.9% and 76.1% of total effects, respectively.

CONCLUSION

The effects of maternal gestational weight gain, diabetes and smoking on a child's fat quantity seem to be mainly through intrauterine programming. Maternal smoking also showed a positive direct effect on child's fat distribution.

Genomic full-length sequence of two new HLA-C alleles, HLA-C*04:239 and HLA-C*05:137

Two novel HLA-C alleles, C*04:239 and C*05:137, were characterized in Spanish individuals.

A homozygous loss-of-function mutation in inositol monophosphatase 1 (IMPA1) causes severe intellectual disability

The genetic basis of intellectual disability (ID) is extremely heterogeneous and relatively little is known about the role of autosomal recessive traits. In a field study performed in a highly inbred area of Northeastern Brazil, we identified and investigated a large consanguineous family with nine adult members affected by severe ID associated with disruptive behavior. The Genome-Wide Human SNP Array 6.0 microarray was used to determine regions of homozygosity by descent from three affected and one normal family member. Whole-exome sequencing (WES) was performed in one affected patient using the Nextera Rapid-Capture Exome kit and Illumina HiSeq2500 system to identify the causative mutation. Potentially deleterious variants detected in regions of homozygosity by descent and not present in either 59 723 unrelated individuals from the Exome Aggregation Consortium (Browser) or 1484 Brazilians were subject to further scrutiny and segregation analysis by Sanger sequencing. Homozygosity-by-descent analysis disclosed a 20.7-Mb candidate region at 8q12.3-q21.2 (lod score: 3.11). WES identified a homozygous deleterious variant in inositol monophosphatase 1 (IMPA1) (NM_005536), consisting of a 5-bp duplication (c.489_493dupGGGCT; chr8: 82,583,247; GRCh37/hg19) leading to a frameshift and a premature stop codon (p.Ser165Trpfs*10) that cosegregated with the disease in 26 genotyped family members. The IMPA1 gene product is responsible for the final step of biotransformation of inositol triphosphate and diacylglycerol, two second messengers. Despite its many physiological functions, no clinical phenotype has been assigned to this gene dysfunction to date. Additionally, IMPA1 is the main target of lithium, a drug that is at the forefront of treatment for bipolar disorder.

Method of capture and population structure of Aegla georginae Santos and Jara, 2013 (Decapoda: Anomura: Aeglidae) in a tributary of the Ibicuí River in southern Brazil

In the current study, we investigated population aspects of Aegla georginae in the Ibicuí River Basin by considering different capture methods and the implication of these data in the analysis of population dynamics. We sampled 1774 individuals: 1259 males (21 and 97 juveniles and 1029 and 113 adults in trap and handnet, respectively), 512 females (05 and 140 juveniles, 184 and 64 adults, and 81 and 38 ovigerous in trap and handnet, respectively) and 03 unsexed individuals (02 and 01 in trap and handnet, respectively). The frequency distribution in size classes shows a bimodal model for both sexes. The carapace length (CL) in males and females varied from 3.11 to 26.00 and 3.73 to 22.36 mm, respectively. Males presented significantly larger sizes than females. The relative abundance between males and females was significantly different from 1:1 with more males than females in most sampling periods (p < 0.05) when considering the grouped data (handnet + trap) and trap captures, but followed the expected ratio in most months when considering individuals sampled only with handnet (p > 0.05). Juveniles were recorded in all seasons, and reproduction occurs throughout the year. The population structure is similar to the model known for aeglids, and the capture methods affected the analysis of A. georginae, where the grouped data and trap captures presented greater abundance of individuals than handnet and males predominate in the larger size classes, and females in the intermediary size classes. Therefore, an integrated view of the capture methods is the best model for studying the population dynamics of aeglids.

Comparing the quality of life of adults with and without intellectual disability

BACKGROUND

Quality of life (QOL) is an important issue for all citizens, comprising equity, equality, inclusion and participation of each person in society. The research purposes driving this investigation were (1) to compare QOL among people with and without intellectual disability (ID) and (2) to examine the predictors of QOL in both groups of participants.

METHODS

Data were collected from 1929 adults, including 1264 individuals with an ID and the remainder (n = 665) were participants without a disability. QOL was assessed by the Portuguese version of the Personal Outcomes Scale.

RESULTS

The findings supported significantly higher QOL for adults without ID. Furthermore, QOL is influenced by individual and environmental variables, stressing that the health status was the highest mutual predictor of QOL among those with and without ID.

CONCLUSION

The gaps among both groups of participants should be addressed in service provision and policies. Taking into account the research findings, the personalised supports should enable the full inclusion and participation of adults with ID in community-based settings.

Personality traits in patients with cluster headache: a comparison with migraine patients

Background

Cluster headache (CH) has been associated with certain personality traits and lifestyle features, but there are few studies assessing personality profiles in CH. We aimed to analyze personality traits in patients with CH, and to compare them with those found in migraine.

Methods

We included all consecutive patients with CH attending 5 outpatient offices between January and December 2013. Personality traits were evaluated using the Salamanca screening test, a validated inventory assessing 11 personality traits grouped in 3 clusters. We analyzed the test results in this population, and compared them with those of a migraine population previously assessed with the same test.

Results

Eighty patients with CH (75 men, 5 women; mean age, 43.2 ± 9.9 years) were recruited. The reference population consisted of 164 migraine patients (30 men, 134 women; mean age 36.4 ± 12.7 years). In CH patients, the most frequent personality traits were anancastic (52.5 %), anxious (47.5 %), histrionic (45 %), schizoid (42.5 %), impulsive (32.5 %) and paranoid (30 %). When compared to migraine patients, paranoid (p < 0.001; χ2 test), and schizoid traits (p = 0.007; χ2 test) were significantly more prevalent in CH patients. In logistic regression analysis the paranoid trait was significantly associated with CH (p = 0.001; OR: 3.27, 95 % CI [1.66–6.43]).

Conclusion

According to the Salamanca screening test, personality traits included in cluster A (odd or eccentric disorders) are more prevalent in CH patients than in a population of migraineurs. Larger studies are needed to determine whether certain personality traits are related to CH.

Perceived causes for changes in sleep pattern in postpartum women

Aim

To investigate the causes that postpartum women most mention for changes in sleep pattern and its associations with obstetric and sleep variables and depressive symptoms.

Methods

At three months postpartum 192 women fill in a booklet containing obstetric and sleep variables and the Postpartum Depression Screening Scale (PDSS; Pereira et al., 2010). If they experienced changes in their sleep pattern, they were asked about the perceived cause(s) (multiple choice). Chi-squared and Student t tests were applied as appropriate.

Results

A total of 64.6% women referred to some cause(s); the most mentioned were feeding/baby care and older children care (32.3%) and worries (baby and life problems related) (29.5%). Women who mentioned feeding/baby and older children care as a cause did not significantly differ in relation to type of delivery, feeding method proportions and in PDSS mean scores. Women who identified worries as a cause vs. women who did not – presented significant differences in proportions of vaginal (20.0%) vs. assisted delivery (52.2%) (OR 4.444), caesarean-section (22.2%) vs. assisted delivery (52.6%) (OR 3.827), in breast-feeding (36.0%) vs. bottle-feeding (12.9%) (OR .263) and in “having trouble sleeping even when the baby is asleep” (28.0% vs. 2.9%) (OR 12.833) (all P<.05). PDSS mean scores were also significantly higher in women who mentioned worries as a cause (50.20 ± 20.622 vs. 58.640 ± 15.766, P < 0.05).

Conclusion

It is important to distinguish the causes for changes in sleep pattern in postpartum women. Worries as a perceived cause have a higher impact and clinical significance than causes related to baby care demands.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Genomic sequence of HLA-B*41:43, a new HLA-B allele generated by an intralocus recombination mechanism

HLA-B*41:43 has been generated by an intralocus recombination comprising B*41:02:01 and a B*14, 38, or 67 allele.