Cold stimulation of the oral cavity redistributes blood towards the brain in healthy volunteers

BACKGROUND

The aim of this study was to analyze cold stimulation-induced changes in cerebral and cardiac hemodynamics.

METHODS

Upon ingestion of an ice cube, the changes in resistance index, mean flow velocity and flow index of the middle cerebral arteries (MCA) were assessed using transcranial Doppler sonography. Extracranial duplex sonography was used to measure the mean flow velocity and resistance index of the right internal carotid artery (ICA). The change in mean arterial pressure, heart rate, root mean square of successive differences (RMSSD) and end-tidal carbon dioxide pressure were analyzed additionally. These changes were compared to sham stimulation.

RESULTS

Compared with sham stimulation, cooling of the oral cavity resulted in significant changes in cerebral and cardiac hemodynamics. The cold stimulation decreased the resistance index in the MCA (-4.5% ± 5.4%, p < 0.0001) and right ICA (-6.3% ± 15.6%, p = 0.001). This was accompanied by an increase in mean flow velocity (4.1% ± 8.0%, p < 0.0001) and flow index (10.1% ± 43.6%, p = 0.008) in the MCA. The cardiac effects caused an increase in mean arterial pressure (1.8% ± 11.2%, p = 0.017) and RMSSD (55% ± 112%, p = 0.048), while simultaneously decreasing the heart rate (-4.3% ± 9.6%, p = 0.0001).

CONCLUSION

Cooling of the oral cavity resulted in substantial changes in cerebral and cardiac hemodynamics resulting in a blood flow diversion to the brain.

Vertebrobasilar artery elongation in migraine-a retrospective cross-sectional study

BACKGROUND

Numerous but inconclusive findings have sparked an ongoing debate about whether the arteries of migraine patients undergo vascular alterations. The outlet angle of the superior cerebellar artery (SUCA) and the lateral displacement of basilar arteries are good surrogate parameters for determining elongation of the vertebrobasilar arteries.

METHODS

We retrospectively determined the SUCA outlet angle and the lateral displacement of the basilar artery in 63 patients with migraine (30.6 ± 8.9 years, 84% women, 16% chronic migraine, 60% migraine with aura) and compared these with 126 age- and sex-matched control subjects.

RESULTS

In patients with migraine, the SUCA outlet angle was lower (159 ± 26° vs. 169 ± 29°, p = 0.020) and the lateral displacement of the basilar artery was greater (3.7 ± 2.7 mm vs. 2.8 ± 2.4 mm, p = 0.020) than in the control subjects. Age, gender, migraine characteristics and presence of any cardiovascular risk factors did not affect the SUCA outlet angle or lateral displacement of the basilar artery.

CONCLUSION

Migraine patients exhibited a lower SUCA outlet angle and greater lateral displacement of the basilar arteries. Both may be attributable to the elongation of the vertebrobasilar arteries, which is an indication of arterial wall pathology in migraine.

On-farm detection of claw lesions in dairy cows based on acoustic analyses and machine learning

Claw lesions are a serious problem on dairy farms, affecting both the health and welfare of the cow. Automated detection of lameness with a practical, on-farm application would support the early detection and treatment of lame cows, potentially reducing the number and severity of claw lesions. Therefore, in this study, a method was proposed for the detection of claw lesions based on the acoustic analysis of a cow's gait. A panel was constructed to measure the impact sound of animals walking over it. The recorded impact sound was edited, and 640 sound files from 64 cows were analyzed. The classification of animal-lameness status was performed using a machine-learning process with a random forest algorithm. The gold standard was a 2-point scale of hoof-trimming results (healthy vs. affected), and 38 properties of the recorded sound files were used as influencing factors. A prediction model for classifying the cow lameness was built using a random forest algorithm. This was validated by comparing the reference output from hoof-trimming with the model output concerning the impact sound. Altering the likelihood settings and changing the cutoff value to predict lame animals improved the prediction model. At a cutoff at 0.4, a decreased false-negative rate was generated, and the false-positive rate only increased slightly. This model obtained a sensitivity of 0.81 and a specificity of 0.97. With this procedure, Cohen's Kappa value of 0.80 showed good agreement between model classification and diagnoses from hoof-trimming. In summary, the prediction model enabled the detection of cows with claw lesions. This study shows that lameness can be detected by machine learning from the impact sound of hoofs in dairy cows.

Exploring the potentials of underutilized grain amaranth (Amaranthus spp.) along the value chain for food and nutrition security: A review

The burden of malnutrition in Africa calls for deeper exploration of underutilized species which are rich in nutrients and have the potential to reduce food and nutrition insecurity. The common staple crops are not able to meet daily requirements for both macro- and micro-nutrients. In order to lessen this burden; protein, calorie and micronutrient deficiencies must be properly addressed for optimal growth and development to be attained. African indigenous underutilized vegetables can play a significant role in the food security of vulnerable groups like under-five children and women in both urban and rural settings. The potential of grain amaranth in meeting the nutrition needs of humans has remained a subject of interest in scientific research. Amaranth is considered one of the most commonly produced and consumed indigenous vegetables on the African continent with high nutritional potentials but yet to be fully exploited. This review therefore aims at discussing the current knowledge of the inherent potentials of grain amaranths, its current application in the food industry and proposes a framework for actions and partnerships required to scale up and improve amaranth value chain.

Feeding practices of pre-school children and associated factors in Kathmandu, Nepal

BACKGROUND

In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding practices of pre-school children and their associated factors.

METHODS

A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured questionnaire was administered to 145 mothers. Descriptive analyses were conducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers' perception of their current feeding practices.

RESULTS

We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01-0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices.

CONCLUSIONS

Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-economic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures.

Increased Blood Flow Velocity in Middle Cerebral Artery and Headache Upon Ingestion of Ice Water

Introduction: “Headache attributed to ingestion or inhalation of a cold stimulus” (HICS) is one of the most common primary headache disorders. Little is known about the pathophysiology of HICS and other headache disorders. The aim of this study was to analyze mean flow velocity (MFV) and cerebrovascular resistance (RI) in both middle cerebral arteries (MCA) upon ingestion of ice water.

Methods: The MFV and RI in both MCAs was continuously measured by transcranial sonography. HICS was induced by drinking 200 ml of ice water.

Results: In all volunteers, the ingestion of ice water led to a decrease in RI, which was accompanied by an increase in MFV. In volunteers with induced HICS, MFV were significantly higher compared to volunteers that did not experience HICS. In volunteers with HICS, MFV increased even more significantly when lacrimation occurred compared to volunteers in which it did not. In volunteers without induced HICS, MFV was higher in those volunteers with a positive history of HICS than in those with a negative HICS history.

Conclusion: This study revealed a raised MFV upon ingestion of ice water. Volunteers with a provoked case of HICS had a higher MFV than volunteers without HICS. The increase in MFV was even higher when the headache was accompanied by lacrimation. This may indicate an involvement of the trigeminal-parasympathetic vasodilator reflex.

White matter lesions in treated late onset Pompe disease are not different to matched controls

INTRODUCTION

Genetic deficiency of α-1,4-glucosidase leads to multi-systemic glycogen storage and causes muscular disorder known as classic infantile Pompe disease (CIOPD) and late onset Pompe disease (LOPD). Treatment with recombinant human alglucosidase alfa is available as enzyme replacement therapy (ERT). Recently progressive white matter lesions (WML) have been observed as a new phenotype in CIOPD patients on treatment with ERT.

OBJECTIVE

To investigate the impact of disease and ERT for the development of WML in LOPD.

METHODS

WML were analysed in 19 treated LOPD patients and compared with findings of 38 matched controls.

RESULTS

Patients median age was 54.4 years (range 19 to 82 years) with median disease duration of 7 years (range 2 to 40 years). Median ERT duration was 63 months (range 9 to 135 months). Grading of WML by Fazekas Score was not different in LOPD patients and controls: Mean of total Fazekas score in LOPD was 2.42 ± 2.40 and in controls 1.60 ± 2.64; p = 0.68. Also volume of WML was similar in patients and controls (mean 5.27 ml ± 5.88 and 7.89 ml ± 11.40 respectively, p = 0.35). Total Fazekas grade correlated directly with the age in LOPD patients (r = 0.60; p = 0.007) and in controls (r = 0.32; p = 0.04). There was a negative correlation of ERT duration and total Fazekas grade (r = -0.41; p = 0.04).

CONCLUSION

The study suggests that WML in LOPD mainly result from concomitant cerebrovascular risk factors rather than from the Pompe disease itself.

Experimental provocation of ‘ice-cream headache’ by ice cubes and ice water

Background

There are various studies on experimentally provoked ‘ice-cream headache’ or ‘headache attributed to ingestion or inhalation of a cold stimulus’ (HICS) using different provocation protocols. The aim of this study was to compare two provocation protocols.

Methods

Ice cubes pressed to the palate and fast ingestion of ice water were used to provoke HICS and clinical features were compared.

Results

The ice-water stimulus provoked HICS significantly more often than the ice-cube stimulus (9/77 vs. 39/77). Ice-water-provoked HICS had a significantly shorter latency (median 15 s, range 4–97 s vs. median 68 s, range 27–96 s). There was no difference in pain localisation. Character after ice-cube stimulation was predominantly described as pressing and after ice-water stimulation as stabbing. A second HICS followed in 10/39 (26%) of the headaches provoked by ice water. Lacrimation occurred significantly more often in volunteers with than in those without HICS.

Discussion

HICS provoked by ice water was more frequent, had a shorter latency, different pain character and higher pain intensity than HICS provoked by ice cubes. The finding of two subsequent HICS attacks in the same volunteers supports the notion that two types of HICS exist. Lacrimation during HICS indicates involvement of the trigeminal-autonomic reflex.

[Nail polish allergy. An important differential diagnosis in contact dermatitis]

HISTORY AND CLINICAL FINDINGS

Case 1. A 34-year-old woman presented with a recurrent, itching and erythematous plaque on her right cheek. Case 2. A 27-year-old woman reported itching erythema on her fingertips from time to time recently. Inspection revealed dyshidrosiform blisters. Both patients had been using nail varnish and varnish remover. Case 3. A 49-year-old woman had, for about 5 years, repeatedly experienced itching erythema at the perionychium of several fingers on which she had placed artificial nails. Marked oedema and erythema was noted.

INVESTIGATION

Extensive epicutaneous tests were performed on these patients. They showed sensitisation against important allergens in nail varnish (toluolsulphonamide-formaldehyde resin), nail varnish remover (benzophenone-2) and artificial nails (ethylacrylate), respectively. The three patients also showed type IV sensitisation against other substances.

DIAGNOSIS, TREATMENT AND COURSE

Epicutaneous tests documented type IV allergies to important constituents of nail varnish, nail varnish remover and artificial nails. Symptoms and skin changes disappeared when these three items were no longer used.

CONCLUSION

Allergies against nail varnish and its remover and against artificial nails should be included in the differential diagnosis of skin allergies, even when patients have additional type IV sensitizations against common allergens. As the causative allergen can be easily avoided, knowledge of the particular problems associated with these allergies is of a great practical significance.

[Sensitization to nickel sulfate in patients with ileitis terminalis (Crohn disease)]

The history of inpatients with Crohn's disease revealed several occurrences of contact dermatitis due to metal ions. Therefore, we considered the question as to whether allergic reactions to amalgam fillings or mercury, delivered in small amounts, could be a factor in the activity of regional enteritis. 23 patients with Crohn's disease (15 females, 8 males), aged from 20 to 44 years were screened by an extended standard patch test (following the rules of the ICDRG). Surprisingly, no case of hypersensitivity to amalgam and/or mercury was found. However, nickelsulfate yielded positive reactions in 39.1% of all tested patients (9/23). In comparison to the normal population this prevalence of nickelsulfate hypersensitivity is distinctly increased. It may be an epiphenomenon of Crohn's disease (sensitization via an enhanced permeability of the irritated mucous membranes for nutritive nickelsulfate) or an etiopathogenetic co-factor. In the latter case regional enteritis might be regarded as an allergic-irritative disease of the bowel.

[Contact allergy to dicyclohexylcarbodiimide and N-hydroxyphthalimide]

We report a case of a female laboratory worker in the chemical industry who acquired contact allergy to dicyclohexylcarbodiimide and N-hydroxyphthalimide. Both substances are used in the chemical synthesis of peptides. So far there have only been a few reports concerning contact allergy to these substances.

Intravenous Injections of Nicotine and their effects upon the Aorta of Rabbits

Images