Social determinants of health for moderate and severe periodontal disease in rural and urban populations.

OBJECTIVE: We assessed the prevalence of moderate and severe periodontitis and its association with social determinants of health in rural and urban population from the State of Chiapas, in Southern Mexico. MATERIAL AND METHODS: A cross-sectional population-based study was conducted in 2013 comprising people 20 years and older. The determinants were categorized as proximal (age, sex, indigenous origin, diabetes, smoking, diet), intermediate (level of schooling, occupation, medical and dental care), and structural (type of institution of health care provision, residence area). Periodontal status was assessed using the Periodontal Screening and Recording (PSR) Index. RESULTS: In total, 467 persons (72.4% women; mean age 43.0 years [s.d 14.7]) participated. Of them, 76.5% lived in rural areas and 56.7% were of indigenous origin. Participants with moderate and severe periodontitis had a significantly lower toothbrushing frequency (44.1% and 44.8%, respectively), and poorer oral hygiene (90% and 90.3%, respectively) compared with people without periodontitis (29.4% for toothbrushing frequency and 74.5% for oral hygiene). Moderate periodontitis was associated with poor oral hygiene (OR=2.63) and no schooling (OR=1.86). Severe periodontitis was associated with age (OR=1.05), poor oral hygiene (OR=3.99), no schooling (OR=2.08), and the interaction term of rural area and indigenous origin (RM=5.23). CONCLUSIONS: Social determinants of health play an important role in the development of periodontitis. Preventive oral health programs should thus focus on the specific social, economic, and geographical context of the population.

Evolving concepts and management of endoleaks after endovascular aneurysm repair: where do we stand in 2019?

In recent years, there has been tremendous progress in endovascular aneurysm repair (EVAR) techniques and devices. This process has seen a change in incidence, risk factors, and treatment of endoleaks as well as in follow-up protocols after EVAR. In particular, recent literature has highlighted new concepts in the evaluation and prevention/treatment of type I and II endoleak after standard EVAR. There is also recent evidence regarding new imaging protocols for follow-up after EVAR, which include magnetic resonance imaging and contrast-enhanced ultrasound. This comprehensive review aims to outline the most recent concepts on imaging follow-up, pathophysiology/risk factors, and management of endoleaks.

Diabetes or hypertension as risk indicators for missing teeth experience: An exploratory study in a sample of Mexican adults.

BACKGROUND: To determine an exploratory estimation of the strength of type 2 diabetes mellitus (T2DM) and hypertension diagnoses as risk indicators for missing teeth in a sample of Mexican adults. MATERIALS AND METHODS: A comparative cross-sectional study of sixty adult patients in a health center in Mexico included as dependent variable, the number of missing teeth (and having a functional dentition) and as independent variables, diagnoses for diabetes or hypertension, age, sex, maximum level of schooling, and tobacco use. Of the 60 participants, 20 were diagnosed with T2DM, 13 with hypertension, and 27 were otherwise diagnosed as healthy in their most recent medical checkup. A negative binomial regression (NBR) model was generated. RESULTS: Mean age was 50.7 ± 16.2 and 50.0% were women. Mean number of missing teeth was 4.98 ± 4.17. In the multivariate NBR model, we observed that individuals with T2DM had higher risk of more missing teeth (incidence rate ratios [IRRs] = 3.13; 95% confidence interval [CI] = 2.09-4.69), followed by those with hypertension (IRRs = 2.63; 95% CI = 1.77-3.90). In addition, participants with current tobacco use were significantly more likely to have suffered tooth loss (P < 0.05) than those who were never smokers or former smokers, just like older participants (P < 0.05). CONCLUSIONS: T2DM and hypertension are independently associated with higher experience of missing teeth in an open adult population in Mexico. Future studies with a more sophisticated epidemiological design and encompassing a more detailed landscape of chronic diseases, type and length of use of long-term medications, and patterns of dental care use are needed to better delineate these associations.

Availability of zinc from infant formula by in vitro methods (solubility and dialyzability) and size-exclusion chromatography coupled to inductively coupled plasma-mass spectrometry.

Zinc bioaccessibility from infant formula was estimated by in vitro methods (solubility and dialyzability) and size-exclusion chromatography (SEC) coupled to inductively coupled plasma-mass spectrometry (ICP-MS). Infant formula samples were first characterized in terms of Zn bound to lipids and proteins and Zn distribution in the aqueous soluble protein fraction. We found that Zn is not incorporated into the lipid fraction of the samples, being mainly associated with the protein fraction (around 100%). Fractionation of Zn-containing proteins in the soluble protein fraction was achieved by SEC-ICP-MS after performing protein extraction with a solution of 100mM (pH 6.8) Tris-HCl. The percentages of zinc in the soluble protein fraction in the soy-based and lactose-free infant formula were very low, around 7 and 24%, respectively, whereas the content of Zn in the soluble protein fraction of milk-based formula was around 90%. By SEC-ICP-MS, we found that Zn is associated with low-molecular weight compounds (around 10kDa) in all the infant formulas tested. The percentages of Zn estimated in the in vitro gastrointestinal digests of the infant formula ranged from 30 to 70% and from 1 to 10% for solubility and dialyzability assays, respectively. The dialyzability test resulted in lower than expected scores, as SEC-ICP-MS analysis of the gastrointestinal extracts revealed that Zn is bound to biomolecules with a molecular weight ranging from 1 to 7kDa, which suggests that dialysis data should be interpreted with caution. Speciation studies are a valuable tool for establishing availability of nutrients and for validating data from dialyzable in vitro methods.

Transcriptome comparison between inactivated and activated ovaries of the honey bee Apis mellifera L.

Ovarian activity not only influences fertility, but is also involved with the regulation of division of labour between reproductive and behavioural castes of female honey bees. In order to identify candidate genes associated with ovarian activity, we compared the gene expression patterns between inactivated and activated ovaries of queens and workers by means of high-throughput RNA-sequencing technology. A total of 1615 differentially expressed genes (DEGs) was detected between ovaries of virgin and mated queens, and more than 5300 DEGs were detected between inactivated and activated worker ovaries. Intersection analysis of DEGs amongst five libraries revealed that a similar set of genes (824) participated in the ovary activation of both queens and workers. A large number of these DEGs were predominantly related to cellular, cell and cell part, binding, biological regulation and metabolic processes. In addition, over 1000 DEGs were linked to more than 230 components of Kyoto Encyclopedia of Genes and Genomes pathways, including 25 signalling pathways. The reliability of the RNA-sequencing results was confirmed by means of quantitative real-time PCR. Our results provide new insights into the molecular mechanisms involved in ovary activation and reproductive division of labour.

Biogeochemical indicators of elevated nitrogen deposition in semiarid Mediterranean ecosystems.

Nitrogen (N) deposition has doubled the natural N inputs received by ecosystems through biological N fixation and is currently a global problem that is affecting the Mediterranean regions. We evaluated the existing relationships between increased atmospheric N deposition and biogeochemical indicators related to soil chemical factors and cryptogam species across semiarid central, southern, and eastern Spain. The cryptogam species studied were the biocrust-forming species Pleurochaete squarrosa (moss) and Cladonia foliacea (lichen). Sampling sites were chosen in Quercus coccifera (kermes oak) shrublands and Pinus halepensis (Aleppo pine) forests to cover a range of inorganic N deposition representative of the levels found in the Iberian Peninsula (between 4.4 and 8.1 kg N ha(-1) year(-1)). We extended the ambient N deposition gradient by including experimental plots to which N had been added for 3 years at rates of 10, 20, and 50 kg N ha(-1) year(-1). Overall, N deposition (extant plus simulated) increased soil inorganic N availability and caused soil acidification. Nitrogen deposition increased phosphomonoesterase (PME) enzyme activity and PME/nitrate reductase (NR) ratio in both species, whereas the NR activity was reduced only in the moss. Responses of PME and NR activities were attributed to an induced N to phosphorus imbalance and to N saturation, respectively. When only considering the ambient N deposition, soil organic C and N contents were positively related to N deposition, a response driven by pine forests. The PME/NR ratios of the moss were better predictors of N deposition rates than PME or NR activities alone in shrublands, whereas no correlation between N deposition and the lichen physiology was observed. We conclude that integrative physiological measurements, such as PME/NR ratios, measured on sensitive species such as P. squarrosa, can provide useful data for national-scale biomonitoring programs, whereas soil acidification and soil C and N storage could be useful as additional corroborating ecosystem indicators of chronic N pollution.

Synergistic effects between microplastics and glyphosate on honey bee larvae.

Microplastic (MPs) pollution has emerged as a global ecological concern, however, the impact of MPs exposure, particularly in conjunction with other pollutants such as glyphosate (GLY) on honey bee remains unknown. This study investigated the effects of exposure to different concentrations of MPs and their combination with GLY on honey bee larvae development, or during the larvae period, regulation of major detoxification, antioxidant and immune genes, and oxidative stress biomarkers. Results revealed that combined exposure to MPs and GLY decreased larvae survivorship and weight, while exposure to MPs alone showed no significant differences. Both MPs and GLY alone downregulated the defensin-1 gene, but only combined exposure with GLY downregulated the hymenoptaecin gene and increased catalase enzyme activity. The data suggest a synergistic effect of MPs and GLY, leading to immunosuppression and reduced larvae survival and weight. These findings highlight potential risks of two prevalent environmental pollutants on honey bee health.

7T mMR in the assessment of acute arterial mesenteric ischemia in a rat model.

To validate a rat model of acute arterial mesenteric ischemia correlating MRI patterns with macro and microscopic changes in the small bowel. Thirty Sprague-Dawley rats were assigned to two experimental groups (Group I and Group II) of fifteen rats each. Group I underwent surgical procedure of superior mesenteric artery (SMA) ligation, followed by macroscopic observation. In Group II, a loop was tied loosely around the SMA without occluding the vessel. Three days after surgery, the loop was tied by external tips to completely occlude the artery. 7T microMR (7Tesla microMR) was performed before and 8 hours after SMA occlusion. At predetermined time-points the histopathological examinations were performed in both of groups. Macroscopic monitoring revealed thinning of mesenteric vessels, hypotonic reflex ileus and chromatic change of some loops. 7T microMR sequences evidenced loop dilation with gas-fluid mixed stasis, intraperitoneal free fluid and bowel wall hyperintensity. There were no significant differences in the histological analysis between the two groups. The gap of three days from surgery, adopted in the Group 2, allowed to avoid signs of peritoneal and mesenteric irritation which could bias imaging patterns. MR succeeded to identify the signs of arterial mesenteric ischemia.

Isolation, characterization and mode of antimicrobial action against Vibrio cholerae of methyl gallate isolated from Acacia farnesiana.

AIMS: The antimicrobial activity of Acacia farnesiana against Vibrio cholerae has been demonstrated; however, no information regarding its active compound or its mechanism of action has been documented. METHODS AND RESULTS: The active compound was isolated from A. farnesiana by bioassay-guided fractionation and identified as methyl gallate by nuclear magnetic resonance (NMR) techniques ((1) H NMR and (13) C NMR). The minimum bactericidal concentration (MBC) of methyl gallate and its effect on membrane integrity, cytoplasmic pH, membrane potential, ATP synthesis and gene expression of cholera toxin (ctx) from V. cholerae were determined. The MBC of methyl gallate ranged from 30 ± 1 to 50 ± 1 µg ml(-1) . Methyl gallate affected cell membrane integrity, causing a decrease in cytoplasmic pH (pHin , from 7·3 to <3·0), and membrane hyperpolarization, and ATP was no longer produced by the treated cells. However, methyl gallate did not affect ctx gene expression. CONCLUSIONS: Methyl gallate is a major antimicrobial compound from A. farnesiana that disturbs the membrane activity of V. cholerae. SIGNIFICANCE AND IMPACT OF THE STUDY: The effects of methyl gallate validate several traditional antimicrobial uses of A. farnesiana, and it is an attractive alternative to control V. cholerae.

Dysgnathia complex sine holoprosencephaly nor synotia: a case report and discussion of its nosology.

A severe mandibular hypoplasia and microstomy with intraoral anomalies including hypoglossia, fused gums, persistence of buccopharyngeal membrane, and laryngeal hypoplasia were noted in a female newborn with the dysgnathia complex (DC). Additionally, our proposita also presented natal teeth as a probably new finding. These clinical manifestations overlapped with those of the fourth report of hypomandibular faciocranial syndrome (HFS) (31), and given that both lack for craniosynostosis (pathognomonic of HFS), we considered that both represent a subtype of DC proposed as DC sine holoprosencephaly nor synotia (DCSHS). Differential characteristics between the DCSHS, the HFS, and the DC with holoprosencephaly sine synotia are reviewed and additionally, we discussed some aspects about the nosology of the DC.

Frequency of tooth brushing and associated factors in Mexican schoolchildren six to nine years of age.

OBJECTIVE: To determine the prevalence of daily tooth brushing and evaluate some variables associated. SUBJECTS AND METHODS: A cross-sectional study was carried out in 320 schoolchildren six to nine years old in Campeche, Mexico. Information on sociodemographic and socio-economic variables, oral hygiene practices and attitudes were collected through a questionnaire. The frequency of tooth brushing was categorized as "0" = fewer than seven times/week, "1" = at least once a day. In the analysis, nonparametric tests were used. RESULTS: Mean age was 6.99 +/- 1.00 years, 52.5% were boys. The prevalence of daily tooth brushing was 81.6%. In bivariate analysis, the prevalence of tooth brushing was higher (p < 0.05) among the children of mothers with higher schooling (9.80 years vs 8.47 years, p < 0.05), and in younger children (84.6% in 6-7-year olds vs 71.2% in 8-9-year olds, p < 0.05). A slight, non-significant association (p < 0.10) was noted between the current frequency of tooth brushing and an earlier age when the child first started brushing with toothpaste. There were no statistically significant differences (p > 0.05) in the frequency of tooth brushing by gender or by the mother's attitude toward the oral health of her child. CONCLUSIONS: The prevalence of daily tooth brushing was high compared to other studies. Mother's maximum level of schooling (as an indicator of socio-economic position) was associated with higher frequency of tooth brushing. Maternal characteristics are associated with the oral health behaviour of their children.

Antibacterial and antimycobacterial lignans and flavonoids from Larrea tridentata.

Three lignans and four flavonoids were isolated and characterized from Larrea tridentata and compounds were tested against 16 bacterial species/strains. Results showed that: dihydroguaiaretic acid (1) had activity towards methicillin resistant (MR) Staphylococcus aureus (minimum inhibitory concentration (MIC) 50 µg/mL) and multidrug-resistant (MDR) strains of Mycobacterium tuberculosis (MIC 12.5-50 µg/mL); 4-epi-larreatricin (2) was active against Enterobacter cloacae (MIC 12.5 µg/mL), as well as sensitive (MIC 50 µg/mL) and MDR strains of M. tuberculosis (MIC 25 µg/mL). 3'-Demethoxy-6-O-demethylisoguaiacin (3) displayed activity against sensitive and resistant S. aureus (MIC 25 µg/mL), Enterococcus faecalis (MIC 12.5 µg/mL), Escherichia coli (MIC 50 µg/mL), E. cloacae (MIC 12.5 µg/mL) and MDR strains of M. tuberculosis (MIC 12.5 µg/mL). 5,4'-Dihydroxy-3,7,8,3'-tetramethoxyflavone (4) and 5,4'-dihydroxy-3,7,8-trimethoxyflavone (5) were active against M. tuberculosis MDR strains having MIC values of 25 and 25-50 µg/mL, respectively, while 5,4'-dihydroxy-7-methoxyflavone (6) was active against S. aureus (MIC 50 µg/mL) and E. faecalis (MIC 50 µg/mL). We concluded that lignan 3 is the main compound responsible for the antibacterial activity of L. tridentata. Lignans 1 and 2 as well as flavonoid 6 contribute with some degree of antibacterial activity. On the other hand, compounds 1, 2, 3, 4 and 5 contributed to the antimycobacterial activity found in L. tridentata.

Immunomodulatory activity of diethylcarbamazine on humoral, cellular cytokine response and respiratory burst in BALB/c mice.

Diethylcarbamazine (DEC) is an anthelmintic piperazine derivative drug with putative immunomodulating properties, including increased platelet and granulocyte adhesion to parasites and enhanced production of cytokines. To further analyse these properties in a well-established animal model, we evaluated the effect of DEC on antibody, cellular cytokine response and respiratory burst in BALB/c mice. Animals were challenged with a thymus-dependent (tetanus toxoid, (TT)) and with a thymus-independent (lipopolysaccharide, (LPS)) antigen and treated with DEC for seven days with two different doses (50 mg/day and 500 mg/day). Serum was assessed for antibody production at 0, 4, 7, 14, 21 and 28 days after stimulation and at 0, 24 and 48 h for IL-2, IFN-γ, IL-10 and IL-12 release. Respiratory burst of neutrophils and monocytes from peripheral blood was measured by flow cytometry. We found low-dose treatment with DEC enhanced cytokine production vs. TT and antibody production vs. LPS, whereas a higher dose enhanced significantly the respiratory burst of both polymorphonuclear leukocytes and monocytes, with a significant higher effect on the former. Our results suggest a stimulating, dose-dependent immunomodulatory effect of DEC with a higher effect on the phagocytic cells.

Maternal characteristics and treatment needs as predictors of dental health services utilisation among Mexican school children.

AIM: To determine whether maternal characteristics and treatment needs are associated with dental health services utilization (DHSU) in school children. MATERIALS AND METHODS: A cross-sectional study in 1373 school children aged 6- 12 years in elementary schools in Campeche, Mexico collected family and sociodemographic characteristics; an oral examination was conducted. The dependent variable was DHSU in the year preceding the study. RESULTS: DHSU prevalence was 65.5%. The variables associated (p<0.05) with DHSU in the final multivariate model were age (OR=1.27), maternal schooling (OR=1.07), mother's attitude toward oral health (OR=1.39), frequency of tooth brushing (OR=1.83), enamel defects (OR=1.55), and unmet oral health needs (moderate: OR=1.42 and high: OR=2.30). CONCLUSION: Specific sociodemographic and maternal variables were associated with DHSU. Strategies are needed to increase appropriate and timely use of services to improve health status.

Use of Violence as a Strategy of Early Adolescents for Rejecting Drug Offers in Mexican Cities.

Drug use and violence are two interconnected problems in violent urban contexts, leading to coercive drug offers. In this study, relationships between drug use, use of violence as a strategy for rejecting drug offers, and exposure to neighborhood violence were analyzed in Mexican students. Data were obtained through a self-report survey and focus groups with lower secondary students in three Mexican metropolitan areas. Both quantitative and qualitative results indicated that students who had used or would use violence as a strategy for rejecting drug offers presented a more problematic psychosocial profile, with exposure to neighborhood violence as the main predictor. These results suggest that Mexican students in violent cities may resort to violence as a strategy for rejecting drug offers.

El consumo de drogas y la violencia son dos problemas interconectados en contextos urbanos violentos y generan ofrecimientos de drogas coercitivos. En este estudio se analizaron las relaciones entre el consumo de drogas, el uso de violencia como una estrategia para resistir ofrecimientos de drogas y la exposición a violencia en el barrio entre estudiantes mexicanos. Se obtuvieron los datos mediante una encuesta de autoinforme y grupos de discusión centrada con estudiantes de educación secundaria en tres áreas metropolitanas de México. Tanto los resultados cuantitativos como los cualitativos indicaron que aquellos estudiantes que habían usado o usarían violencia como una estrategia para resistir ofrecimientos de drogas presentaban un perfil psicosocial más problemático, con la exposición a violencia en el barrio como el principal predictor. Estos resultados sugieren que los estudiantes mexicanos en ciudades violentas pueden recurrir a la violencia como una estrategia para resistir ofrecimientos de drogas.

Gelatin-Coated Magnetic Nanowires for High-Sensitivity Optical Labels.

The encapsulation of magnetic nickel nanowires (NiNWs) with gelatin is proposed as an alternative for optical label detection. Magnetic nanowires can be detected at very low concentrations using light-scattering methods. This detection capacity could be helpful in applications such as transducers for molecular and biomolecular sensors; however, potential applications require the attachment of specific binding molecules to the nanowire structure. In the present study, a method is presented which is helpful in coating magnetic nanowires with gelatin, a material with the potential to handle specific decoration and functionalization of the nanowires; in the first case, silver nanoparticles (AgNPs) are efficiently used to decorate the nanowires. Furthermore, it is shown that the synthesized gelatin-coated particles have excellent detectability to the level of 140 pg/mL; this level of detection outperforms more complex techniques such as ICP-OES (~3 ng/mL for Ni) and magnetoresistance sensing (~10 ng/mL for magnetic nanoparticles).

Seven-Tesla micro-MRI in early detection of acute arterial ischaemia: evolution of findings in an in vivo rat model.

PURPOSE: Acute mesenteric ischaemia (AMI) is a life-threatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution. METHODS: Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the first group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI. RESULTS: Macroscopically, a reflex spastic ileus followed by reflex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fluid levels, free intraperitoneal fluid and bowelwall oedema. Histological analysis confirmed ischaemia and earlier damage involving the central portion of the ileum. CONCLUSIONS: This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.

Simulated nitrogen deposition influences soil greenhouse gas fluxes in a Mediterranean dryland.

Soil nitrogen (N) availability is a key driver of soil-atmosphere greenhouse gas (GHG) exchange, yet we are far from understanding how increases in N deposition due to human activities will influence the net soil-atmosphere fluxes of the three most important GHGs: nitrous oxide (N2O), methane (CH4) and carbon dioxide (CO2). We simulated four levels of N deposition (10, 20 and 50 kg N ha-1 yr-1, plus unfertilised control) to evaluate their effects on N2O, CH4 and CO2 soil fluxes in a semiarid shrubland in central Spain. After 8 years of experimental fertilisation, increasing N availability led to a consistent increase in N2O emissions, likely due to simultaneous increases in soil microbial nitrification and/or denitrification processes. However, only intermediate levels of N fertilisation reduced CH4 uptake, while increasing N fertilisation had no effects on CO2 fluxes, suggesting complex interactions between N deposition loads and GHG fluxes. Our study provides novel insight into the responses of GHGs to N deposition in drylands, forecasting increases in N2O emissions, and decreases in CH4 uptake rates, with likely consequences to the on-going climate change.

Impact of nutritional stress on the honeybee colony health.

Honeybees Apis mellifera are important pollinators of wild plants and commercial crops. For more than a decade, high percentages of honeybee colony losses have been reported worldwide. Nutritional stress due to habitat depletion, infection by different pests and pathogens and pesticide exposure has been proposed as the major causes. In this study we analyzed how nutritional stress affects colony strength and health. Two groups of colonies were set in a Eucalyptus grandis plantation at the beginning of the flowering period (autumn), replicating a natural scenario with a nutritionally poor food source. While both groups of colonies had access to the pollen available in this plantation, one was supplemented with a polyfloral pollen patty during the entire flowering period. In the short-term, colonies under nutritional stress (which consumed mainly E. grandis pollen) showed higher infection level with Nosema spp. and lower brood and adult bee population, compared to supplemented colonies. On the other hand, these supplemented colonies showed higher infection level with RNA viruses although infection levels were low compared to countries were viral infections have negative impacts. Nutritional stress also had long-term colony effects, because bee population did not recover in spring, as in supplemented colonies did. In conclusion, nutritional stress and Nosema spp. infection had a severe impact on colony strength with consequences in both short and long-term.

Cognitive and psychiatric effects of topiramate monotherapy in migraine treatment: an open study.

Few data are available on cognitive and psychiatric effects of topiramate (TPM) monotherapy in migraine. Twenty patients affected by migraine were treated with TPM monotherapy. At the same time, twenty control subjects were selected. A comprehensive neuropsychological and behavioural battery of tests were performed at baseline (T0), at titration (T1) and in maintenance period (T2). Topiramate serum levels were also investigated at T1 and T2. On comparison with the control group, no cognitive and psychiatric differences were detected at baseline. A significant reduction of word fluency score (P < 0.05) was evident after TPM treatment, both at T1 and T2. No patient developed psychiatric adverse events. TPM induced an impairment of verbal fluency and no psychiatric adverse events, demonstrating selective negative cognitive profile in migraine therapy. Slow titration, low doses, lack of previous psychiatric disorders and/or familial history may explain our data.