Objective: The aim of the study was to examine the prophylactic role of repetitive transcranial magnetic stimulation (rTMS) on the frequency, and severity of migraine attacks in episodic migraineurs who failed medical treatment. Methods: A randomized double-blinded placebo-controlled study was designed to assess the effect of 5 Hz rTMS applied over the left dorsolateral prefrontal cortex (LDLPFC ) in 33 migraineurs. Patients were followed up for 1 month before receiving rTMS, and for another month after the sessions by a headache diary. The primary outcome measure was the achievement of 50% reduction in the number of migraine attacks. Secondary outcome measures included migraine days, assessment of migraine attack severity, disability by HIT-6, and side-effects to the procedure.Results: The study revealed that 69.2% of the active treatment group achieved 50% or more reduction in the number of migraine attacks versus 25% of cases in the control group (p = 0.02). The absolute number of migraine attacks was reduced by 3.1 vs 1.5 in the active and control group, respectively. The number of cases with severe HIT-6 scores was reduced by 46.2% in active treatment group versus a 7.1% reduction in the control group (p = 0.02). Conclusion: High-frequency rTMS applied to LDLPFC can reduce the number of migraine attacks by 50% or more in almost 70% of a sample of episodic migraineurs with a concomitant decrease in functional disability.

Background Even though stroke is rare in children, it is associated with serious or life-threatening consequences. Despite its rarity, the occurrence of stroke in children has age-related differences in risk factors, etiopathogenesis, and clinical presentations. Unlike adults, who have arteriosclerosis as the major cause of stroke, risk factors for pediatric strokes are multiple, including cardiac disorders, infection, prothrombotic disorders, moyamoya disease, moyamoya syndrome, and others. The goal of the current study was to compare the characteristics, clinical features, etiology, subtypes, and workup of pediatric and adult strokes. Methods This was a hospital-based observational study conducted on 222 participants. All patients underwent a full clinical and neurological examination, full laboratory study, cardiac evaluation, and neuroimaging; CT scan, MRI, MRA, MRV, carotid duplex, and transcranial Doppler (TCD). Ischemic stroke (IS) etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, the "proposed classification for subtypes of arterial ischemic stroke in children," and the Oxfordshire Community Stroke Project (OCSP). Stroke severity was determined by the National Institutes of Health Stroke Scale (NIHSS) and PedNIHSS on admission. Results The proportion of pediatric ischemic strokes in the current study was 63.4 percent, while hemorrhagic strokes were 36.5%. The majority of the adult patients had ischemic strokes (84.1%), while hemorrhagic strokes were noted in 15.8% of the patients. According to the original TOAST classification, in the current study, the etiology of pediatric IS was other determined causes in 63.6%, undetermined etiology in 27.2%, and cardioembolic in 9.0%. For the adult group, the major stroke subtypes were large artery disease, small vessel disease, cardioembolic, other determined causes, and undetermined etiology at 49.6%, 28.6%, 6.9%, 0.6%, and 12.5%, respectively. Conclusions There is a greater etiological role for non-atherosclerotic arteriopathies, coagulopathies, and hematological disorders in pediatric stroke, while adults have more atherothrombotic causes. The co-existence of multiple risk factors in pediatric ischemic stroke is noticed. Thrombophilia evaluation is helpful in every case of childhood stroke. Children who have had a stroke should undergo vascular imaging as soon as possible. Imaging modalities include TCD and Doppler ultrasound, CT, MRI, MRA, and MRV, and cerebral angiography.

Sepsis is widely diagnosed In ICU patients. The sepsis markers are numerous with variable sensitivity and specificity. Adiponectin is a protein hormone that is secreted from adipose tissue into the bloodstream. It is a key substance in metabolic syndrome and has an anti-inflammatory property. The relationship between adiponectin and sepsis is unclear. In the current study, we aim to demonstrate that low plasma adiponectin level could be an early predictor for morbidity and mortality of sepsis by its comparison with c-reactive protein, serum lactate and procalcitonine. Thirty patients admitted to the intensive care unit with picture clinically suggesting sepsis were enrolled in the study. Predisposition, insult/infection, response, and organ dysfunction (PIRO) score was used to follow the course of the septic process. Plasma adiponectin level, serum lactate level, procalcitonin level(PCT), c-reactive protein(CRP) were checked on day1 then day 4 then day 7 and so on until ICU discharge or demise for a total of 28 days . PIRO score was able to expect sepsis prognosis with high statistical significance. Procalcitonin, serum lactate and adiponectin were valuable in follow up the sepsis prognosis with P value (0, 0.01 & 0 respectively) on the contrary CRP had poor prognostic value in sepsis follow up (P value 0.16).We conclude that PIRO score is an effective model for staging of sepsis and predict mortality. Measuring serial procalcitonin levels may be the most useful in order to understand the trend, identify the peak, and be able to identify resolution of sepsis. Early high lactate level is a predictor for poor prognosis of sepsis. Adiponectin is similar to procalcitinin in early detection of sepsis & can be used as a prognostic indicator with considering that adiponectin level could be affected by other metabolic disorders.

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