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Introduction: Intermittent fever has been occasionally related to migraine, either as a migraine equivalent or as a migraine accompaniment. We present a case of recurrent increase in body temperature consistently associated with migraine headaches., Methods: A 15-year-old girl reported a 3-year lasting history of migraine without aura, with a feeling of warmth occurring in each episode. Ancillary tests did not show any evidence of secondary headaches or any systemic disease. A 2-month headache diary was obtained, with daily records of headache intensity (0, no headache; 1, mild pain; 2, moderate pain; 3, severe pain) and simultaneous measurements of axillary temperature. Both parameters were registered in the evening, at 6:00 pm every day. The distribution of headache intensity and body temperature as well as the relationship between both variables over time were analyzed with nonparametric tests., Results: The number of days without pain was 28 (45.2%); a mild headache was present on 13 days (21%), a moderate headache on 15 days (24.2%), and a severe headache on 6 days (9.7%). Headache days were associated with higher body temperature than headache-free days (median values: 37.3°C vs 36.6°C; Mann-Whitney U-test, P < 0.001). Moreover, a positive correlation was found between headache intensity and body temperature (Spearman's rho coefficient: 0.83, P < 0.001)., Conclusions: Recurrent increase in body temperature may be another manifestation of the complex clinical spectrum of migraine. This symptom is probably related to hypothalamic involvement., (Wiley Periodicals, Inc.)

Background: Data about the immigrant population living in Spain, their lifestyle habits, and risk factors for gestational diabetes mellitus (GDM) are limited. Thus, the aim of the present study was to describe risk factors for the onset of GDM, the evolution of gestation and delivery, and newborns of Hispanic women living in Spain compared with those of Spanish women., Methods: A semiquantitative questionnaire regarding lifestyle habits was administered to 459 pregnant women (115 Hispanic) with a positive O'Sullivan test (24-28 weeks gestation) between 1 April 2007 and 31 March 2008. Information was collected regarding gestation, delivery, and the newborn., Results: The prevalence of GDM increased with mother's age, pregestational overweight/obesity, and multiparity. In addition, GDM was associated with lower pregestational fiber and a lower intake of low glycaemic index foods in Hispanic women. The odds ratios (OR) for the total population were 2.53 (95% confidence interval [CI] 1.28-5.01) for overweight, 3.68 (95% CI 1.72-7.90) for obesity, 3.83 (95% 2.03-7.23) for age ≥35 years, and 1.64 (95% CI 1.02-3.01) for multiparity. Newborns from the Hispanic population were significantly heavier than newborns from Spanish women and the rate of Caesarean delivery was significantly higher in the Hispanic population with GDM compared with those without GDM., Conclusions: The immigrant Hispanic population living in Spain trends to acquire the same risk factors associated with lifestyle to the indigenous population. Preventive strategies must stress increased physical activity and fiber intake, decreased intake of sweetened beverages, and an effective reduction in body weight before pregnancy., (© 2012 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

Background: Infection is a major complication of cerebrospinal fluid shunting procedures. The present report assesses the efficacy of such catheters in both shunts and external ventricular drains (EVDs) against infection and particularly against Staphylococcus spp. infection., Methods: All shunt and EVD procedures performed by means of antibiotic-impregnated catheters (AICs) and non-AICs during the period of study were registered. In cases of shunt procedures, a minimal follow-up of 90 days was considered, as well as de novo insertion and catheter revisions. Single valve revisions were not included. In cases of EVD procedures, those catheters removed before the fifth post-insertion day were not included. A total of 119 cerebrospinal fluid shunting procedures performed with AICs were studied in comparison with 112 procedures performed by means of non-AICs., Results: Antibiotic-impregnated catheters were associated with a significant decrease in both overall and staphylococcal infection (p = 0.030 and p = 0.045, respectively). The number needed to treat for AICs was 8 to prevent one infection and 14 to prevent one staphylococcal infection. When comparing with shunts, the use of EVDs was associated with a 37-fold increased likelihood of infection., Conclusions: Antibiotic-impregnated catheters are a safe and helpful tool to reduce CSF shunting device-related infections.

Objective: To evaluate the usefulness of the Clinical Risk Index for Babies (CRIB) in predicting hospital mortality and severe intraventricular hemorrhage (IVH) in very low birth weight infants stratified by weight groups, in the Spanish neonatal network SEN 1500., Patients and Methods: A prospective cohort study was made. Morbidity-mortality data and CRIB were collected in newborns weighing below 1500 g and admitted to 68 neonatal intensive care units between January 2002 and December 2006. Data were analyzed globally and stratified by weight groups (< 501 g, 500-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g). Multivariate models were generated and ROC curves were plotted for estimating predictive values., Results: A total of 10,608 patients were analyzed. The mean weight was 1116 g (SD 267), and gestational age 29.5 weeks (SD 2.9). Low birth weight for gestational age was 34.3% and the multiple birth rate 36%. Prenatal corticoids were given in 78.2%. Severe intraventricular hemorrhage was diagnosed in 8.5%. Gender, prenatal corticoids, birth weight, gestational age and CRIB proved significant for the outcomes. CRIB showed the highest predictive accuracy in all strata (P < 0.001) except in the 501-750 g group, where it was similar to gestational age. Body weight showed the lowest AUC in all groups, except in the 1251-1500 g group, where it was no different to gestational age. Gestational age and CRIB yielded greater AUC values than weight (P < 0.001) in all groups. No significant differences were found between CRIB and gestational age, except in the 751-1000 g group, where gestational age was greater (P = 0.029)., Conclusions: The CRIB is the best predictor among newborns below 1500 g, except in the 501-750 g group, where CRIB is similar to gestational age. Body weight is the worst predictor, except in the group 1251-1500 g, where it is similar to gestational age. The accuracies of CRIB and gestational age in the prediction of IVH are similar, and both superior to body weight. This similarity persists in all the groups, except in the 751-1000 g interval, where gestational age is a better predictor.

Introduction and Objectives: The admission plasma glucose (APG) level is a recognized prognostic factor in patients with acute coronary syndrome (ACS). However, little is known about the prognostic value of the first fasting plasma glucose (FPG) measurement. The aim of this study was to determine the prognostic value of the first FPG measurement relative to that of the APG level in patients with ACS., Methods: The study involved 547 consecutive patients who were admitted to our center with a diagnosis of ACS in 2006. Patients were divided into three groups according to their first FPG or APG level (i.e., <126 mg/dL, 126-200 mg/dL, or >200 mg/dL). The primary endpoint was the combined outcome of death or reinfarction during hospitalization., Results: The primary endpoint was observed in 46 patients, 25 of whom died. Patients in this group were older, were more often diabetics or smokers, more often had had a prior myocardial infarction, were in a higher admission Killip class, showed more than one vessel disease on catheterization, had a lower left ventricular ejection fraction, and had higher admission creatinine, APG, and first FPG levels. Multivariate analysis, adjusted for previously identified factors, revealed that the first FPG level was an independent risk factor for death or reinfarction (126-200 mg/dL, odds ratio [OR]=5.26; 95% confidence interval [CI], 1.09-25.45; >200 mg/dL, OR=6.66; 95% CI, 2.05-21.63), but that the APG level was not (126-200 mg/dL, OR=0.84; 95% CI, 0.63-1.05; >200 mg/dL, OR=1.14; 95% CI, 0.29-4.51)., Conclusions: The first FPG level was found to be a better predictor of an adverse outcome (i.e., death or reinfarction) during hospitalization in ACS patients than the APG level.