Validity and reliability of the Malay version of the Structured Migraine Interview (SMI) Questionnaire.

BACKGROUND: The Structured Migraine Interview (SMI) is a valid and reliable instrument for migraine diagnosis. However, a Malay version of the SMI is not available to be applied to the local Malaysian population. This study was designed to access the validity and reliability of a new Malay version of the SMI questionnaire. METHODS: Patients with headache attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, were screened against the inclusion/exclusion criteria before recruitment. A standard translation procedure was used to translate and adapt the questionnaire into the Malay language. The translated version was tested for face, content and construct validities. Subsequently, validity and reliability studies were conducted (1(st) compilation), followed by retesting seven days later (2(nd) compilation). RESULTS: A total of 157 patients between 15 and 60 years of age were enrolled in this study. The kappa value was 0.70 (p < 0.001) with high sensitivity (0.97) and specificity (0.63). The misclassification rate was 0.15, with a positive predictive value of 0.82 and a negative predictive value of 0.92. The positive likelihood ratio was 2.62, while the negative likelihood ratio was 0.05. The Cronbach's alpha was 0.93 (1(st) compilation) and 0.90 (2(nd) compilation), respectively. The Spearman's correlation coefficient ranged from 0.86 (Question 4) to 0.95 (Question 1). The overall concordance for item 1 was very high (97%), followed by item 4 (83%), item 2 (71%) and finally item 3 (64%). CONCLUSION: The Malay version of the SMI questionnaire is comparable to the English version in terms of validity and reliability. It was highly reliable with good internal consistency and can be used for the diagnosis of migraine in clinical settings in Malaysia.

Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine.

Migraine is the most common form of headache disorder globally. The etiology of migraine is multifactorial, with genetic components and environmental interactions considered to be the main causal factors. Some researchers postulate that deficits in mitochondrial energy reserves can cause migraine or an increase in homocysteine levels can lead to migraine attacks; therefore, vitamins could play a vital role in migraine prevention. For instance, riboflavin influences mitochondrial dysfunction and prevents migraine. Genes such as flavoenzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma levels of homocysteine and migraine with aura. Homocysteine catalyzation requires the presence of vitamins B6, B12, and folic acid, which can decrease the severity of migraine with aura, making these vitamins potentially useful prophylactic agents for treating migraine with aura. Menstrual migraine, on the other hand, is associated with increased prostaglandin (PG) levels in the endometrium, indicating a role for vitamin E, which is an anti-PG. Vitamin C can also be used as a scavenger of reactive oxygen species for treating neurogenic inflammation in migraine patients. This paper reviews possible therapies based on vitamin supplementation for migraine prophylaxis, focusing on migraine with aura and menstrual migraine.

Quality of life and migraine disability among female migraine patients in a tertiary hospital in Malaysia.

BACKGROUND: Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL) among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls. METHODS: Female diagnosed migraine patients (n= 100) and healthy controls (n=100) completed the Malay version of the World Health Organization QOL Brief (WHOQOL-BREF) questionnaire. Only migraine patients completed the Malay version of the Migraine Disability Assessment questionnaire. RESULTS: Females with migraines had significantly lower total WHOQOL-BREF scores (84.3) than did healthy controls (91.9, P<0.001). Similarly, physical health (23.4 versus 27.7, P<0.001) and psychological health scores (21.7 versus 23.2, P< 0.001) were significantly lower than those for healthy controls. Seventy-three percent of patients experienced severe disability, with significantly higher number of days with headaches (13.8 days/3 months, P< 0.001) and pain scores (7.4, P< 0.013). Furthermore, migraine patients with lower total QOL scores had 1.2 times higher odds of having disability than patients with higher total QOL scores. CONCLUSIONS: The present study showed that migraine sufferers experienced significantly lower QOL than the control group from a similar population. Disability was severe and frequent and was associated with lower QOL among the migraine patients.

Apical sealing ability of resilon/epiphany system.

BACKGROUND: Endodontic leakage research focus mainly on the quality of the apical seal of the root canal system and the newly introduced resilon/epiphany system claim to be superior to Gutta-percha in respect to obturation procedure. The aim of this study is to evaluate the root canal obturation completed by resilon/epiphany system. MATERIALS AND METHODS: A total of 42 teeth were selected and were divided into four groups. Two experimental groups consisted of 15 teeth each and positive control group consisted of eight teeth and negative control group consisted of four teeth. In the experimental groups, Group 1 was obturated with resilon/epiphany system and Group 2 was obturated with Gutta-percha and endofil sealer by lateral condensation technique. The teeth were then immersed in Methelene blue solution and were split longitudinally to access the amount of dye penetrated in the canal. The specimens were viewed under scanning electron microscope to evaluate the adhesion of the obturating material to the root canal walls. Data was subjected to statistical analysis by Analysis of Variance and Bonferroni multiple comparison test at 1% level of significance. RESULTS: The resilon/epiphany system showed better adaptation to the root canal walls, but the difference in dye penetration was not statistically significant when compared to specimens obturated with Gutta-percha and endofil sealer. CONCLUSION: Although, there was no statistically significant difference between the groups, but resilon/epiphany system showed better adaptation to the root canal walls.

Do folate, vitamins B6 and B12 play a role in the pathogenesis of migraine? The role of pharmacoepigenomics.

Migraine is a neurovascular disease that has classically been attributed to multifactorial aetiologies, with genetic components and environmental interactions considered the main influence. Genes such as flavoenzyme 5, 10- methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma homocysteine levels. This elevation in homocysteine results in an array of metabolic disorders and increased risk of complex diseases, including migraine. Catalysation of homocysteine requires the presence of vitamins B6, B12 and folate. Deficiencies in these cofactor vitamins result in hypomethylation, which triggers migraine. Because migraine predominantly affects females, it is hypothesised that fluctuating oestrogen levels, which are governed by oestrogen receptor 1 polymorphisms, are important. Another important factor is homocysteine, the production of which is dependent upon MTHFR and B vitamins. Gene expression is modulated through epigenetic mechanisms, which involve methionine. Additionally, folate plays a major role in DNA synthesis. We propose that vitamin B intake, coupled with MTHFR and oestrogen receptor 1 polymorphisms, causes differential DNA methylation and gene expression that may contribute to the occurrence of migraine.

Validity and reliability of the Bahasa Melayu version of the Migraine Disability Assessment questionnaire.

BACKGROUND: The study was designed to determine the validity and reliability of the Bahasa Melayu version (MIDAS-M) of the Migraine Disability Assessment (MIDAS) questionnaire. METHODS: Patients having migraine for more than six months attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, were recruited. Standard forward and back translation procedures were used to translate and adapt the MIDAS questionnaire to produce the Bahasa Melayu version. The translated Malay version was tested for face and content validity. Validity and reliability testing were further conducted with 100 migraine patients (1st administration) followed by a retesting session 21 days later (2nd administration). RESULTS: A total of 100 patients between 15 and 60 years of age were recruited. The majority of the patients were single (66%) and students (46%). Cronbach's alpha values were 0.84 (1st administration) and 0.80 (2nd administration). The test-retest reliability for the total MIDAS score was 0.73, indicating that the MIDAS-M questionnaire is stable; for the five disability questions, the test-retest values ranged from 0.77 to 0.87. CONCLUSION: The MIDAS-M questionnaire is comparable with the original English version in terms of validity and reliability and may be used for the assessment of migraine in clinical settings.

Rapid resolution liquid chromatography method development and validation for simultaneous determination of homocysteine, vitamins B(6), B(9), and B(12) in human serum.

AIM: Hyperhomocysteinemia and vitamins B(6), B(9), and B(12) deficiencies usually result in various neurological, vascular, ocular, renal, and pulmonary abnormalities. However, to date, there are no simultaneous detection methods available for determining homocysteine, vitamins B(6), B(9), and B(12) levels in various biological fluids. In this study, we aim to develop a new validated simultaneous detection method for all four compounds to save both cost and time of analysis. MATERIALS AND METHODS: The mobile phase consisted of a mixture of methanol and 1-heptanesulfonic acid sodium salt (33:67) with 0.05% triethylamine. The pH of the entire mixture was adjusted to 2.3 and the flow rate was 0.5 mL/min. Separation was achieved using a C-18 column (5 µm; 150 mm × 4.6 mm) maintained at 28°C in a column oven and the detection was conducted at 210 nm. RESULTS: The method was linear between 50 and 1600 ng/mL for all of the drugs. The limits of detection for homocysteine, vitamins B(6), B(9), and B(12) were 5, 5, 10, and 10 ng/mL, respectively, while the limits of quantification were 10, 10, 25, and 25 ng/L, respectively. The developed method achieved good precision and accuracy and complies with the Food and Drug Administration (FDA) requirements. CONCLUSION: The developed and validated method is suitable to be used for the routine analysis of homocysteine, vitamins B(6), B(9), and B(12) simultaneously in human serum.

Burden of stroke in Nepal.

Based on disability-adjusted life years, stroke is one of the major causes of death and is among the top five diseases in Nepal. Despite this fact, information on the prevalence, morbidity, and mortality of stroke in Nepal is limited to urban areas, with no official reports published on the epidemiology of stroke throughout the country. The mean age of stroke patients in Nepal is between 59 and 62 years, with males affected more frequently. Hypertension, cigarette smoking, alcohol consumption, and diabetes are the main predisposing factors for stroke, and ischemic stroke is more common (63%) than hemorrhagic stroke (37%). Because of a lack of facilities and specialists, most stroke patients, especially in the rural areas, seek traditional healers to treat their conditions. More governmental and non-governmental organizations should be involved in improving facilities and implementing prevention strategies.