Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña / Peripheral stimulation of the trigeminal nerve by nasopharyngeal swabbing as a possible trigger of migraine attacks

Introducción: La implicación del sistema nervioso central y periférico en la generación de la migraña no se conoce bien. Nuestro objetivo fue determinar si estímulos periféricos sobre el nervio trigémino, como el frotis nasofaríngeo, podrían desencadenar ataques de migraña.Sujetos y métodos: Se envió una encuesta a 658 médicos, enfermeras y estudiantes de medicina, preguntando por la presencia de cefalea sugestiva de migraña tras la realización de un frotis para la determinación del SARS-CoV-2, su historia previa de migraña, y sobre características demográficas y relacionadas con la cefalea. Los que tenían resultado positivo o que asociaban sintomatología de COVID fueron excluidos.Resultados: Se reclutó a 377 personas y se incluyó a 309. Cuarenta y siete (15,2%) refirieron cefalea sugestiva de migraña tras la realización del frotis, de las cuales 42 (89,4%) tenían historia previa de migraña. El riesgo de desarrollarla fue mayor en el subgrupo de pacientes con cefalea sugestiva de migraña previa –razón de probabilidad: 22,6 (intervalo de confianza al 95%: 8,597-59,397); p < 0,001–. No hubo diferencias entre las características principales de los ataques sugestivos de migraña previos y los desencadenados tras la prueba, excepto un porcentaje menor de aura asociada tras el frotis (42,8% frente a 26,1%; p = 0,016). Los individuos con ataques sugestivos de migraña previos con frecuencia superior a dos episodios mensuales presentaron mayor riesgo de desarrollar una cefalea sugestiva de migraña tras el test –razón de probabilidad = 2,353 (intervalo de confianza al 95%: 1,077-5,145); p = 0,03–.Conclusiones: El frotis nasofaríngeo podría desencadenar ataques de migraña, más probablemente en individuos con mayor frecuencia de migrañas previas. Esto confirmaría que estímulos periféricos sobre el nervio trigémino pueden desencadenar ataques de migraña en individuos con migraña, de acuerdo con su grado de sensibilización trigeminovascular.(AU)

Introduction: The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks.Subjets and methods: survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded.Results: total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine – odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test – odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03.Conclusions: Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.(AU)

[Peripheral stimulation of the trigeminal nerve by nasopharyngeal swabbing as a possible trigger of migraine attacks]. / Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.

INTRODUCTION: The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks. SUBJECTS AND METHODS: A survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded. RESULTS: A total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine - odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test - odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03. CONCLUSIONS: Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.

TITLE: Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.Introducción. La implicación del sistema nervioso central y periférico en la generación de la migraña no se conoce bien. Nuestro objetivo fue determinar si estímulos periféricos sobre el nervio trigémino, como el frotis nasofaríngeo, podrían desencadenar ataques de migraña. Sujetos y métodos. Se envió una encuesta a 658 médicos, enfermeras y estudiantes de medicina, preguntando por la presencia de cefalea sugestiva de migraña tras la realización de un frotis para la determinación del SARS-CoV-2, su historia previa de migraña, y sobre características demográficas y relacionadas con la cefalea. Los que tenían resultado positivo o que asociaban sintomatología de COVID fueron excluidos. Resultados. Se reclutó a 377 personas y se incluyó a 309. Cuarenta y siete (15,2%) refirieron cefalea sugestiva de migraña tras la realización del frotis, de las cuales 42 (89,4%) tenían historia previa de migraña. El riesgo de desarrollarla fue mayor en el subgrupo de pacientes con cefalea sugestiva de migraña previa ­razón de probabilidad: 22,6 (intervalo de confianza al 95%: 8,597-59,397); p < 0,001­. No hubo diferencias entre las características principales de los ataques sugestivos de migraña previos y los desencadenados tras la prueba, excepto un porcentaje menor de aura asociada tras el frotis (42,8% frente a 26,1%; p = 0,016). Los individuos con ataques sugestivos de migraña previos con frecuencia superior a dos episodios mensuales presentaron mayor riesgo de desarrollar una cefalea sugestiva de migraña tras el test ­razón de probabilidad = 2,353 (intervalo de confianza al 95%: 1,077-5,145); p = 0,03­. Conclusiones. El frotis nasofaríngeo podría desencadenar ataques de migraña, más probablemente en individuos con mayor frecuencia de migrañas previas. Esto confirmaría que estímulos periféricos sobre el nervio trigémino pueden desencadenar ataques de migraña en individuos con migraña, de acuerdo con su grado de sensibilización trigeminovascular.

A rare case of a secondary pituitary abscess arising in a craniopharyngioma with atypical presentation and clinical course / Un caso raro de absceso hipofisario secundario derivado de un craneofaringioma con presentación y evolución clínica atípicas

Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma. A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass. Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely (AU)

Los abscesos hipofisarios son infrecuentes. Se pueden dividir en primarios o secundarios, si se producen sobre una lesión previa. Presentamos el octavo caso de un absceso asentado sobre un craneofaringioma. Una mujer de 59 años consultó por fiebre y cefalea de tres semanas de evolución. La exploración física era anodina. Una resonancia magnética (RMN) evidenció una lesión hipofisaria sugestiva de un proceso inflamatorio crónico. Finalmente, se diagnosticó de una meningitis linfocítica e hipofisitis y se trató con corticoides. Dos meses después reconsultó por los mismos síntomas. En la RMN se evidenció crecimiento de la lesión, por lo que se biopsia endoscópicamente. Durante el procedimiento salió pus. En el examen histológico se evidenció un craneofaringioma y una inflamación meníngea. Se iniciaron antibióticos empíricamente. En el seguimiento a tres meses, la RMN evidenciaba un dudoso resto. Los abscesos hipofisarios secundarios son raros y hay que tener un alto índice de sospecha para diagnosticarlos. El tratamiento se basa en antibioterapia y evacuación transesfenoidal. Aunque los síntomas se suelen resolver, las endocrinopatías no (AU)

Current concepts on the pathophysiology of idiopathic chronic adult hydrocephalus: Are we facing another neurodegenerative disease? / Actualización en la fisiopatología de la hidrocefalia crónica del adulto idiopática: ¿nos enfrentamos a otra enfermedad neurodegenerativa?

INTRODUCTION: Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. DEVELOPMENT: Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. CONCLUSIONS: iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus.

Flavonoids in onion cultivars (Allium cepa L.).

Total phenol and flavonoid contents were analyzed by HPLC coupled with a diode array detector in 5 traditional onion cultivars from Tenerife (Guayonje, San Juan de la Rambla, Carrizal Alto, Carrizal Bajo, and Masca) and a commercial cultivar (Texas Early Grano 502). Five quercetin chemical species (isoquercetin, quercetin diglucoside, quercetin monoglucoside 1, quercetin monoglucoside 2, and free quercetin) and kaempferol were identified and quantified in the onion samples. Quercetin monoglucoside 1 and quercetin diglucoside were the major flavonoids accounting for 80% of the total quercetin content. The mean quercetin monoglucoside 1: quercetin diglucoside ratio (QMG/QDG) was 1: 2.2. There were differences between the onion cultivars in the cases of total phenol, quercetin diglucoside, isoquercetin, QMG/QDG ratio, and kaempferol. The Texas cultivar had a higher QMG/QDG ratio and a higher kaempferol content than the traditional cultivars. The correlation study showed significant correlations between the analyzed phenolic components.

Manganese, nickel, selenium and cadmium in molluscs from the Magellan Strait, Chile.

The concentrations of manganese, selenium, nickel and cadmium were determined in 112 samples of molluscs belonging to mussels (Mytilus chilensis, n = 47) and limpets (Nacella deaurata, n = 65), which were collected from the coastline of the Magellan Strait, Chile. Four (6.2%) samples of limpets exceeded the maximum limits for cadmium established in Europe. Limpets showed higher mean manganese, nickel and cadmium concentrations than mussels, whilst the mean selenium concentration in mussels was higher. The consumption of one serving (100 g) of molluscs represents a considerable contribution to the dietary daily intake of selenium, and limpets make a significant contribution to the manganese and cadmium intakes. The sampling zone influenced the trace element concentrations, and different uptakes were observed between the mollusc species.

Application of linear discriminant analysis to the biochemical and haematological differentiation of opiate addicts from healthy subjects: a case-control study.

OBJECTIVE: Biochemical and haematological parameters of nutritional interest were determined in the serum of opiate addicts in order to compare them with those obtained in healthy subjects. Linear discriminant analysis was applied for the differentiation of the opiate addicts. SUBJECTS: Sera of 106 opiate addicts in detoxification treatment (n=19) or in Methadone Maintenance Treatment Program (MMTP) (n=87) were studied. DESIGN: : The determination of classical biochemical and haematological parameters in blood samples was carried out using standardized methods. Determination of retinol and alpha-tocopherol was carried out by high-performance liquid chromatography with diode-array detector. Folic acid and vitamin B(12) were determined using competitive binding techniques. Minerals were determined by flame emission spectrometry (Na and K) and atomic absorption spectrometry with air-acetylene flame (Ca, Mg, Fe, Cu and Zn) or with hydride generation (Se). Phosphorous was determined using a colorimetric method with ammonium molibdate. All statistical analyses were performed by means of the SPSS version 10.0 software for Windows. RESULTS: Stepwise linear discriminant analysis simplified the system to the following variables: Na, K, Mg, number of leucocytes, triglycerides, GPT, glucose, albumin, retinol and folic acid; and 90.1% (86.4% after crossvalidation) of correct classification was obtained. Representing the first and second discriminant functions, the control groups were well separated from opiate addicts. CONCLUSIONS: Applying linear discriminant analysis on several biochemical and haematological parameters, the opiate addicts could clearly be differentiated from the control individuals, and a tendency to differentiate the opiate addicts in MMTP and in detoxification treatment was observed.

[Haematologic parameters in opiate addicts]. / Parámetros hematológicos en pacientes opiaceodependientes.

Levels of haemoglobin, haematocrit, number of red cells and leukocytes, haematological index (MCV, MCH, MCHC, DEI, MPV), sedimentation rate, iron, parameter related to accumulation and transport of iron (transferrin, ferritin, iron binding capability, transferring saturation index) and platelets were determined in blood samples of opiate addicts and they were compared with these results obtained in a control group. For both sexes, the levels of haemoglobin, haematocrit, iron and platelets were similar in the control groups and opiate addicts. Opiate addicts females presented a number of red cells and platelets higher and lower respectively than the correspond values of the control group. The haematological index in opiate addicts were higher than the values in the control groups for overall and considering males and females independently. The levels of ferritin in opiate addicts males were higher than these levels found in control groups, occurring the contrary in the females. Opiate addicts males and females included in the methadone maintenance treatment program (MMTP) presented similar values of haemoglobin, haematocrit, number of red cells and leukocytes than the corresponding opiate addicts non-included in MMTP, except opiate addicts males, who showed lower haematocrit values.

Estudio de correlación y análisis factorial aplicado a la excreción urinaria de selenio / Study of correlation and factor analysis applied to the excretion urinary of selenium

Objetivo. En este trabajo se ha evaluado la influencia del sexo, edad, peso y talla sobre distintas formas de expresión de la excreción urinaria de selenio (Se) correspondientes a un grupo de personas sanas. Diseño experimental. Se analizaron 97 muestras de orina de 24 h (46 hombres y 51 mujeres) pertenecientes a la población sana de la isla de Tenerife. La determinación de los niveles de Se se realizó por un método espectrof luorimétrico, y la creatinina (CT) por el método modificado de Jaffé. Los análisis estadísticos han sido realizados usando el programa SPSS versión 10.0 para Windows. Resultados. Se obtuvieron numerosas correlaciones significativas entre las variables analizadas, destacando la existente entre la concentración urinaria de Se y de creatinina. En cuanto al análisis factorial, se seleccionaron cuatro factores, los cuales presentaron autovalores mayores que 1. Estos factores explicaron el 83 por ciento de la varianza total del sistema. Se constata que el primer factor estaba relacionado con parámetros antropométricos; el segundo y el tercer factor estaban influenciados principalmente por parámetros relacionados con la excreción de Se y de creatinina; respectivamente; en el cuarto factor las variables más influyentes fueron las concentraciones de Se y de creatinina. Conclusiones. El estudio de correlación puso de manifiesto la relación existente entre la concentración urinaria de Se y de creatinina. Además, se comprobó que la concentración de Se expresada como microg Se/g CT representa mejor la excreción urinaria de Se que la concentración expresada como microg Se/l (AU)

Concentraciones de calcio, magnesio, sodio y potasio en leche materna y fórmulas de inicio / Concentrations of calcium, magnesium, sodium and potassium in human milk and infant formulas

Concentrations of calcium, magnesium, sodium and potassium were determined in 55 samples of mature human milk from Canary women and 5 samples of powdered infant formula. According to the literature our data fell within the normal intervals described for each kind of milk. The mean concentration of Ca, Mg, Na y K of powdered infant formula was higher than those concentrations found in the human milks. Significant differences among the concentrations of Ca, Mg and Na for the milks of the considered mothers were observed. Only the Ca intakes for infants fed with human milk were lower than those requirements recommended by the Food and Nutrition Board (1989). However, the infants fed with powdered infant formula had an adequate intake of all the studied metals. A progressive decrease of the Na, K and Ca concentrations with the lactation stage was observed. Maternal age, parity and sex of the newborns did not affect the metal concentrations significantly.

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[Concentrations of calcium, magnesium, sodium and potassium in human milk and infant formulas]. / Concentraciones de calcio, magnesio, sodio y potasio en leche materna y fórmulas de inicio.

Concentrations of calcium, magnesium, sodium and potassium were determined in 55 samples of mature human milk from Canary women and 5 samples of powdered infant formula. According to the literature our data fell within the normal intervals described for each kind of milk. The mean concentration of Ca, Mg, Na y K of powdered infant formula was higher than those concentrations found in the human milks. Significant differences among the concentrations of Ca, Mg and Na for the milks of the considered mothers were observed. Only the Ca intakes for infants fed with human milk were lower than those requirements recommended by the Food and Nutrition Board (1989). However, the infants fed with powdered infant formula had an adequate intake of all the studied metals. A progressive decrease of the Na, K and Ca concentrations with the lactation stage was observed. Maternal age, parity and sex of the newborns did not affect the metal concentrations significantly.

Concentrations of iron, copper and zinc in human milk and powdered infant formula.

Concentrations of iron, copper and zinc were determined in 56 samples of mature human milk from Canarian women and 5 samples of powdered infant formula. According to the literature our data fall within the normal limits in each kind of milk. The mean concentration of Fe, Cu and Zn of powdered infant formula was significantly higher than those concentrations found in the human milks. Significant differences among the concentrations of the studied metals for the milks of considered mothers were observed. The Fe, Cu and Zn intakes of infants fed with human milk are lower than the requirements recommended by the Food and Nutrition Board (1989). However, the infants fed with powdered infant formula had consumed an adequate intake of Fe and Cu. A progressive decrease of the metal concentrations with the lactation stage was observed. The human milk obtained in spring presented Fe and Zn concentrations lower than in autumn, which could be due to changes in nutritional habits of the mothers. Age of mother and number of previous children seem to influence the Zn and Cu concentrations of human milk.

Chemometric studies of several minerals in milks.

A statistical study of correlation, factorial, and discriminant analysis on the metal composition (Se, Fe, Cu, Zn, Na, K, Ca, Mg) of different types of milks (human, cow, goat, pasteurized, and powdered infant formula) was carried out to establish the relationships between the metal concentrations and, therefore, differentiate the samples according to the type of milk. A large number of significant intermetallic correlations were found in all samples, which could be due to biological relationships between the metals studied. After the factorial analysis, the dimension space was reduced from eight variables to two factors, accounting for approximately 71.4% of the total variance. After an orthogonal rotation, the first factor was positively correlated with Ca and the second factor with Fe. The representation of the scores makes it possible to separate not only human milk from powdered infant formula but also to separate both of these from the other milks. In the discriminant analysis, four discriminant functions were obtained, which are linear combinations of the quantitative variables that best explain the differences among the different milks analyzed. These functions make it possible to classify 98% of the samples analyzed within each type of milk correctly. Therefore, discriminant functions obtained here can be used to identify the origin of any milk sample.

Urinary selenium status of healthy people.

Urinary selenium (Se) concentrations (microgram/l of urine and microgram/g of creatinine) and urinary Se excretions (microgram/d and microgram/d.kg of body weight) have been determined in healthy Canarian people. Urinary Se status was relatively low and similar to those data published from European regions. Females excreted daily significantly (P = 0.005) higher amounts of Se per kg of body weight in urine than males. An increase of daily urinary Se excretion was observed up to 30 years of age. Children (< 10 years old) had daily urinary Se excretion per kg of body weight higher than persons with age > 10 years old. Both units of Se excretion, microgram/d and microgram/d.kg, increased or decreased respectively with weight and height of the individuals. Food habits such as consumption of rich protein or rich fibre food, and drinking alcohol or coffee as well as smoking do not seem to influence the urinary Se status. Depletion of daily urinary Se excretion was observed with the increase of physical exercise. Unit of concentration (microgram/g of creatinine) is a more adequate indicator of the urinary Se excretion than the unit microgram/l.

Urinary selenium concentrations in heroin abusers.

Urinary selenium (Se) concentrations (micrograms Se/l and microgram Se/g creatinine) have been determined in heroin abusers and in healthy controls. Heroin abusers showed significantly (P < 0.050) lower urinary Se concentrations (microgram Se/l and microgram Se/g creatinine) than healthy controls. The decrease of the urinary Se concentration (microgram Se/g creatinine) observed with the increase in age of heroin abusers may be due to the higher exposure to heroin with increased age. No significant differences (P > 0.100) of urinary Se concentrations (both as microgram Se/l and microgram Se/g creatinine) are observed between heroin abusers during methadone treatment and heroin abusers who have stopped taking the drug, with respect to healthy controls.