Helicobacter pylori infection in migraine headache: a true association or an innocent bystander?

Much concern was directed towards the relationship between migraine and Helicobacter pylori (H. pylori) infection. Some researchers reported a strong association. Meanwhile, others have indicated totally negative results. The aim of this work was to clarify the association between migraine headaches and both H. pylori infection and Gastrointestinal (GIT) symptoms and to study their impact on the frequency and severity of migraine headache attacks.This is a case control study conducted on 77 migraine patients and 77 healthy controls. History was taken from the included patients regarding the frequency of migraine headache attacks/month and GIT symptoms including dyspepsia, flatulence, weight loss, and epigastric pain. Migraine Disability Assessment Test (MIDAS) and Visual Analogue Scale (VAS) were used for assessment of migraine severity. Helicobacter pylori was detected in the stool of the included patients and controls.There was a significantly higher prevalence of infection with H. pylori in migraine patients [77.9% (n = 60)] than control group [50.6% (n = 39)] (P-value˂ 0.001, Odds ratio= 3.439, 95% CI =1.708 - 6.923). The prevalence of dyspepsia, flatulence, and epigastric pain. was significantly higher in migraine patients in comparison to control group (P-value= 0.003, 0.017, 0.006 respectively). There was no effect of infection with H. pylori or presence of GIT symptoms on frequency of migraine attacks, MIDAS or VAS scores.GIT symptoms and H. pylori infection are more prevalent in patients with migraine compared to controls, however, they might not have an impact on the frequency or severity of migraine headache attacks.

MicroRNA-22 Level in Patients with Multiple Sclerosis and Its Relationship with Vitamin D and Vitamin D Receptor Levels.

INTRODUCTION: Multiple sclerosis (MS) is known to be a multifactorial disorder. Numerous observational studies have suggested the implication of multiple genetic and environmental factors in the pathogenesis of MS. The aim of this work was to evaluate expression of the microRNA-22 (miRNA-22) level, in relation to vitamin D (VD) and VD receptor (VDR) levels in patients with MS during remission state. METHODS: This case-control study was conducted in 50 patients with clinically definite MS and 50 age- and sex-matched healthy controls. miRNA-22 expression was assessed in both MS patients and controls using quantitative RT-PCR. The serum level of VD and VDR was assessed in both MS patients and controls using ELISA techniques. RESULTS: The miRNA-22 level was significantly downregulated in MS patients in comparison to controls (p value <0.001). MS patients had also significantly lower VD and VDR levels in comparison to controls (p value <0.001 and <0.001, respectively). Patients with secondary progressive MS (SPMS) have a significantly higher miRNA-22 level than patients with relapsing remitting MS (RRMS) (p value = 0.042). There was a statistically significant positive correlation between the miRNA-22 level and EDSS (p value = 0.033). There was also a statistically significant positive correlation between the miRNA-22 level and VDR level (p value = 0.002). CONCLUSION: The miRNA-22 level was significantly downregulated in MS patients, but it had a positive correlation with disability status. Patients with SPMS have a significantly higher miRNA-22 level than patients with RRMS. VD and VDR levels were significantly lower in MS patients than controls. The miRNA-22 level was positively correlated with the VDR level.

Zinc deficiency correlates with severity of diabetic polyneuropathy.

OBJECTIVES: There are controversies about the role of zinc in the development of both types 1 and 2 diabetes. The aim of this study was to assess serum zinc level in diabetic patients with and without peripheral neuropathy in comparison to healthy controls and to explore the possible relationship between serum zinc level and severity of peripheral neuropathy. METHODS: This case control study was conducted on 120 subjects: 40 patients fulfilled the criteria for diagnosis of probable diabetic polyneuropathy (DPN), 40 diabetic patients without polyneuropathy (N-DPN) and 40 healthy controls. DPN patients were submitted to clinical assessment of diabetic neuropathy using neuropathy symptom and change (NSC) scale, Michigan Neuropathy Screening Instrument Physical Assessment (MNSI) scale and electrophysiological assessment using nerve conduction study. Zinc serum level was measured in all subjects included in this study using direct colorimetric test method. RESULTS: Diabetic patients with and without neuropathy were found to have significantly lower mean values of serum zinc than healthy controls (p = .025,  .03 respectively). There is a statistically significant negative correlation between zinc serum level and hemoglobin A1C (HA1C) (p ˂ .001), NSC score (p = .001) and MNSI score (p = .003) in DPN group. There were also statistically significant correlations between zinc serum level and nerve conduction study values. CONCLUSION: Zinc deficiency significantly correlates with the severity of DPN and glycemic control.

Multidisciplinary headache clinic-impact of a new model for headache care in Dubai.

INTRODUCTION: Primary headache disorders pose a huge burden to health systems around the world. A new model for headache care was introduced at two primary health centers (PHCs) in Dubai, UAE. Our objective is to describe the model, and the impact it had on increasing the number of patients receiving specialist care as well as on patient's response and satisfaction level. METHODS: The model consisted of a weekly multi-disciplinary headache clinic with a neurologist, a general physician, a psychologist and a nurse, at each of the two PHCs. Patients were referred from all PHCs in Dubai. Follow up visits were either with the general physician or through tele-headache with the neurologist. We used the HURT questionnaire to evaluate the headache for each patient at baseline and then again at follow up. Information on patient satisfaction was also collected. Data were analyzed using SPSS version 21. RESULTS: The model proved to be effective in terms of increase in the number of headache patients receiving specialist care. Using HURT questionnaire, improvement was seen in good control and in the sense of control over headache, and in risk of medication overuse between baseline and follow up visits. Patient satisfaction with various aspects of headache care was 80-90% after the first visit and improved further at follow up. CONCLUSION: Our multi-disciplinary headache model improved the access of patients to neurologists, and resulted in improved headache control and patient satisfaction levels. Other countries can adopt such models to improve headache care for their patients.

Physical and Mental Fatigue in Subjects Recovered from COVID-19 Infection: A Case-Control Study.

PURPOSE: Much effort has been directed toward studying COVID-19 symptoms; however, the post-COVID-19 phase remains mysterious. The aim of this work was to conduct a clinical and neurophysiological evaluation of physical and mental fatigue in COVID-19 long-haulers and to study whether markers of COVID-19 severity are able to predict the likelihood of developing postinfectious fatigue syndrome (PIFS) in such patients. PATIENTS AND METHODS: This case-control study was conducted on 46 COVID-19 long-haulers who met the criteria for PIFS and 46 recovered COVID-19 subjects without any residuals. Clinical assessment of fatigue was done using a fatigue questionnaire. Repetitive nerve stimulation and single-fiber electromyography were done after excluding neuropathy and myopathy. RESULTS: The median value for physical fatigue was 4 (IQR 2-7), while that for mental fatigue was 2 (IQR 0-3). Each day's increase in the period of COVID-19 illness increased the odds of PIFS in COVID-19 long-haulers 1.104-fold, and each unit increase in ferritin increased the odds of PIFS 1.006-fold. A significant decrement in at least one muscle was observed in 50% of patients. Patients with PIFS had significantly higher mean consecutive difference (MCD) in the extensor digitorum communis than the control group. There were statistically significant positive correlations between MCD values and physical, mental, and total fatigue scores. CONCLUSION: Higher ferritin levels and prolonged COVID-19 infection were independent predictors of PIFS in COVID-19 long-haulers. There was electrophysiological evidence of abnormalities in the peripheral portion of the motor unit in COVID-19 long-haulers with PIFS.

Cerebrospinal fluid confirmed COVID-19-associated encephalitis treated successfully.

The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19's classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.

Probiotics as a prophylaxis to prevent oral candidiasis in patients with Sjogren's syndrome: a double-blinded, placebo-controlled, randomized trial.

Patients with Sjögren's syndrome are at a higher risk to develop oral candidiasis than the general population. As antifungals have many side-effects, new approaches are needed to address this problem. This randomized controlled study aimed to evaluate the short-term efficacy of probiotics in the reduction of oral candidal growth in patients with SS. Thirty-two Sjogren's syndrome patients were randomly allocated in two groups receiving either Probiotics or placebo capsules twice a day for 5 weeks. The strains included in the probiotic capsule were Lactobacillus acidophilus, Lactobacillus bulgaricus, Streptococcus thermophilus and Bifidobacteriumbifidum. Oral rinse solution samples were collected and candidal levels were determined (CFU/mL) at baseline and after the 5-week experimental period. Pain, erythema and angular cheilitis were also assessed at baseline and after 2, 4 and 5-week. In the probiotic group, there was a statistically significant reduction of the candidal load from baseline to the 5th week respectively. However, the change in candidal load at the same time in the placebo group was not statistically significant. The tested probiotic product may represent an unconventional method to reduce candidal colonization, to prevent oral candidosis in patients with Sjogren's syndrome.Clinical trials registration ID NCT03840538 (https://clinicaltrials.gov/show/NCT03840538).

Evaluating optic nerve diameter as a possible biomarker for disability in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: The development of new biomarkers for multiple sclerosis (MS) is of paramount importance to improve our ability to predict disease progression and disability. The aim of this study was to evaluate the potential role of the optic nerve diameter (OND) measured by ultrasonography as a biomarker of early disability in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: Forty-nine RRMS patients, 23 with a history of optic neuritis (MS-ON) and 26 without a history of optic neuritis (MS N-ON), and 50 age- and sex-matched healthy control subjects were included in the study. The OND and optic nerve sheath diameter (ONSD) were measured by transorbital sonography (TOS), and the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses were measured by optical coherence tomography (OCT) using the Optovue RTVue™ system (Optovue, Inc., Fremont, CA, USA). RESULTS: There was no significant difference between the patient (whether ON or N-ON eyes) and control groups in either the OND (p=0.979) or the ONSD (p=0.911). However, patients with an expanded disability status scale (EDSS) score >2 had a significantly lower OND and RNFL thicknesses (p=0.014, p=0.010 respectively) than patients with an EDSS score ≤2. Statistical logistic regression revealed that OND was an independent predictor of EDSS>2 (p=0.044, OR =0.000, 95% CI=0.000-0.589). CONCLUSION: The OND, as measured by ultrasonography, could be potentially used as a biomarker for the detection of early disability in RRMS patients.