8% were women (n = 34) and 29 2% were men (n = 14) with an averag

8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range 20–78 years) and an average age of onset of 48.6 years (range 22–74 years). Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 27 (56.2%), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty one percent (n = 10) complained of disruption of their physical and social activity. No association was found between FI and type

of IBD. Significant associations were found between FI and age (p = 0.005), gender (p < 0.001), colo-rectal surgery (p = < 0.001). QOL was significantly affected by FI (p < 0.001). Conclusion: In our study population, nearly a quarter of patients reported FI. There was a significant correlation between FI and BGB324 cost QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in IBD patients. Key Word(s): 1. IBD; 2. Faecal incontinence; 3. Ulcerative colitis;

4. Quality of lIfe; Presenting Author: DUMINDA SUBASINGHE Additional Authors: NAVARATHNA MUDIYANSELAGEMETHTHANANDA NAVARATHNA, DHARMABANDUNANDADEVA SAMARASEKERA Corresponding Author: DUMINDA SUBASINGHE Affiliations: Department of Surgery, The National Hospital of Sri Lanka; Medical Gastroenterology Unit, The National Hospital of Sri Lanka Objective: Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory conditions selleck compound related to the gastrointestinal tract. Faecal incontinence (FI) impairs quality of life (QOL), causing embarrassment and limiting daily activities. FI can have a negative impact on the QOL of patients with inflammatory bowel disease (IBD). There is limited published data on FI amongst people with IBD in South Asia. This study looks at the frequency

and severity of FI, and its effect on the QOL in IBD patients who presented to very a tertiary care center. Methods: Patients with an established diagnosis of IBD were identified and demographics, disease characteristics, FI (Vaizey score), quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 15. Results: A total of 184 patients (women = 101, 54.9%; UC = 153, 83.2%) were included. Female preponderance was observed for UC (male/female ratio = 1 : 1.5) and male for CD (male/female = 2 : 1). Forty eight (26%) reported symptoms of FI. Among the patients who reported FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range 20–78 years) and an average age of onset of 48.6 years (range 22–74 years). Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 27 (56.2%), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty one percent (n = 10) complained of disruption of their physical and social activity. No association was found between FI and type of IBD.

23 These preliminary data indicated that persistent virus replica

23 These preliminary data indicated that persistent virus replication such as HBV and HCV, at least in part, may be a contributing factor to Th17 expansion

in these patients. In addition, a fraction of Th17 cells coexpressing IFN-γ, IL-4, and FoxP3 was increased in CHB patients as compared to healthy controls. Although few data define the role of these double-positive cells at present, it is likely that they represent a subset of interim cells differentiating from Th1, Th2, or Tregs. Indeed, recent studies have confirmed that Th1, Th2, and Treg cells have the potential to differentiate into Th17 cells under certain conditions.36 In CHB patients, the increased Th17-related cytokines such as IL-1β and IL-6 as well as IL-23 may facilitate Th17 differentiation and expansion. It will be of interest to elucidate the factors that selectively facilitate Th17 differentiation selleck screening library and expansion in CHB patients in the future. In summary, our findings demonstrate, for the first time, that peripheral and intrahepatic

XL765 Th17 cells are preferentially increased in CHB patients, which might activate mDCs and monocytes to release inflammatory cytokines during chronic HBV infection. Thus, Th17 cells may participate in the immunopathogenesis of chronic HBV infection. We thank all HBV-infected individuals and healthy participants in this study. Additional Supporting Information may be found in the online version of this article. “
“The apical sodium-dependent bile acid transporter (ASBT, SLC10A2) mediates intestinal, renal, and cholangiocyte bile acid reclamation. Transcriptional regulation of ASBT is well described, whereas information on posttranscriptional regulation is limited. Prior studies suggested that ontogeny of

ASBT is controlled in part by changes in messenger RNA (mRNA) stability. We studied the role that Hu antigen R (HuR) and tristetraprolin (TTP) play in regulating the expression of mRNA that contains the 3′ untranslated region (UTR) of rat ASBT. The 3′UTR was incorporated into an SV-40 driven luciferase Unoprostone reporter (rASBT3-luciferase) for rapid screening of regulatory effects. Silencing HuR reduced luciferase reporter activity, whereas silencing TTP enhanced luciferase activity. Conversely, overexpression of HuR enhanced rASBT3-luciferase reporter activity. The same 3′UTR fragments of rat ASBT were incorporated into a beta-globin coding mRNA construct for analysis of mRNA stability (rASBT3-βglobin). mRNA half-life was progressively shortened by the incorporation of increasing sized fragments of the 3′UTR. Silencing HuR shortened the half-life of rASBT3-βglobin containing 0.3 kb of the rat ASBT 3′UTR. Gel shift assays revealed binding of HuR and TTP to rat ASBT 3′UTR.

Next we examined whether the enhanced inflammatory responses asso

Next we examined whether the enhanced inflammatory responses associated with chronic ethanol exposure were associated with increased histone acetylation. Immunofluorescence microscopy

for total acetylated lysine residues, acetyl-histone H3, and acetyl-histone H4 revealed a time-dependent increase in acetylation over 6 see more days culture in 86 mM ethanol (Fig. 2A). Coculture with the inhibitor of ethanol metabolism 4-methylpyrazole in the ethanol-containing medium reduced the acetylation staining to baseline, suggesting that ethanol metabolism rather than simply ethanol exposure was responsible for the acetylation changes. Global increases in acetyl-histone H3 and H4 after 7 days ethanol culture were also demonstrated by western blotting. This effect was not abrogated by inhibition of the MEK and JNK stress-activated protein kinases previously demonstrated to increase histone H3 acetylation in the presence of ethanol,27 suggesting that a separate mechanism is responsible for the increased acetylation in this setting (Supporting online Figs. 1, 2). These observations demonstrate that ethanol metabolism by mononuclear cells is associated Belnacasan with increased histone acetylation, with a time course similar to the cytokine

enhancement, and which is dependent on the metabolism of ethanol but not on Fluorometholone Acetate MEK and JNK kinase signaling. The immunofluorescence

microscopy revealed global increases in histone acetylation. To determine whether this specifically included increased acetylation of the crucial promoter regions of proinflammatory cytokine genes we performed chromatin immunoprecipitation on cells cultured in ethanol and control cells cultured in normal medium. The immunoprecipitates produced by anti-acetyl-histone H3 and anti-acetyl-histone H4 antibodies from the monococcal nuclease-digested chromatin of ethanol-exposed cells were enriched for DNA from the promoter regions of the IL6 and TNF-α genes relative to immunoprecipitates from unexposed cells (Fig. 2B). This confirmed that increased histone H3 and H4 acetylation was present at these proinflammatory cytokine gene promoters after 7 days culture in 86 mM ethanol, providing a mechanism for increased cytokine transcription in response to LPS stimulation. A potential mechanism for the effect of ethanol exposure on histone acetylation status would be through increased exposure to acetate (the principal hepatic metabolite of ethanol). In order to address this mechanism we explored the extent to which coculture with acetate could replicate the ethanol effect on histone acetylation.

Cardiorespiratory complications of ERCP in older patients, Gastro

Cardiorespiratory complications of ERCP in older patients, Gastrointest Endosc. 2006, 63(7):948–955. O ZARGHOM, SB FANNING, BL MITCHELL, RL WILSON, J WETTENHALL, M VELDHUIS Department of Gastroenterology, Launceston General Hospital, Launceston, Tasmania, Australia Background and aims: The novel over-the-scope-clip (OTSC; Ovesco Endoscopy GmbH,

Tübingen, Germany) has been reported as an effective method for management SAHA HDAC of upper gastrointestinal bleeding and luminal perforation or fistula. Several recent international publications examined short and long term efficacy of OTSC. This retrospective case series aims to assess the early results after introduction of OTSC in a regional Australian Hospital. selleck compound Methods: Launceston General Hospital is

a major 308 bed regional hospital servicing Northern Tasmania. We interrogated a prospectively maintained endoscopic database of all patients who underwent Gastroscopy(OGD) from March 2012, and identified those cases where an OTSC was used. Medical charts were reviewed, and where appropriate patients were contacted. We assessed primary haemostasis, complications, mortality, and blood count at week 1 and 4 following the application of OTSC. Results: A total of 1444 OGDs were performed during the study period. Of these, 48 were performed for the indication of acute gastrointestinal bleeding and 4 for the management of perforations or fistulas. The OTSC was utilized in five oxyclozanide cases (age 59–92 years, mean age: 77.4, mean admission Haemoglobin of 64 g/L) by two interventional endoscopists. Four patients had haemodynamically unstable upper gastrointestinal bleeding ( Including a Gastric Dieulafoy, Duodenal ulcer, perforated Duodenal ulcer, and Mallory-Weiss

tear) with a mean transfusion requirement of 5 units per patient. All patients failed conventional haemostatic measures with Adrenaline, Gold probe, and Endoscopic clips. Primary haemostasis was achieved with OTSC in 100% of cases. Bleeding recurred in one patient with a giant 20 mm perforated duodenal ulcer on day 1. Unfortunately this patient died due to complications of premorbid anuric acute kidney injury and multi-organ failure after surgical intervention. Repeat haemoglobin levels at weeks 1 and 4 were stable in the other cases of major bleeding successfully treated with OTSC. One OTSC was also used unsuccessfully in an attempt to close a large gastric perforation following surgical hiatus hernia repair and fundoplication. Conclusion: In our retrospective case series, the OTSC appears to be an effective therapeutic modality for acute upper gastrointestinal bleeding in patients when conventional endoscopic haemostatic measures fail. We find it to be a particularly valuable tool in our regional centre. It might also be particularly useful in patients with significant medical comorbidities deemed inappropriate for surgery. OTSC use in patients with gastrointestinal perforation warrants further study.

In some instances, saliva substitutes may be prescribed or recomm

In some instances, saliva substitutes may be prescribed or recommended. Patients often consume many exogenous dietary acids, which will exacerbate any

tooth erosion associated with acid regurgitation. Patients with xerostomia may eat acidic fruits, chew or suck acidic sour-tasting candies and gums, use citric acid candy sprays, and rinse their mouths with acidic cola-type beverages to stimulate saliva production and to remove the remnants and taste of regurgitated stomach contents. Patients should be advised to avoid such acidic foods PD0325901 concentration and beverages and instead rinse their mouths either with water, milk, sodium bicarbonate solutions or sodium fluoride mouth rinses. Tooth brushing and chewing hard foods and sugar-free gums should be avoided for approximately 2 h after a regurgitation episode to allow for the re-establishment of salivary pellicle and subsequent tooth surface remineralization. Recurrent acid regurgitation and partial remineralization of exposed root surfaces of maxillary posterior teeth, particularly in older persons, may result in dark, softened, sensitive dentin that is susceptible to abrasion. Tooth brushing should be done carefully, using a soft multitufted tooth brush and a low-abrasive high sodium fluoride-containing dentifrice. Patients with GERD should be referred for dental consultations for the collaborative management

of any associated oral manifestations. GSK-3 inhibitor Erosive tooth wear may be accelerated by parafunctional habits and abrasive diets, and wear rates should be monitored periodically to evaluate tooth wear progression. Prevention of further tooth wear is a priority involving local preventive, restorative and maintenance phases.74 Preventive measures may involve the stimulation or substitution of salivary secretions (after assessing their quantity and quality), neutralizing the effects of endogenous and exogenous acids, reducing tooth sensitivity, providing dietary advice (regarding dental

erosion, dental caries and oral mucosal sensitivity), enhancing tooth surface integrity (using acidulated phosphate fluoride, metallic ions), and placing adhesive physical barriers on susceptible tooth surfaces.58 Oral discomfort and malodor caused by xerostomia should be alleviated both by home and professional dental care. The importance of adequate fluid intake should be reinforced in GERD sufferers, especially in the elderly living in hot and dry conditions. ALOX15 As saliva flow decreases during sleep, a humidifier may be required to relieve symptoms of sleep-related xerostomia.58 According to many research publications, the association of tooth erosion and GERD is stronger than generally perceived by physicians. Tooth erosion usually progresses slowly, and its signs are often subtle and not readily observed during a cursory oral examination under less-than-ideal conditions. Failure to diagnose early signs of erosive tooth wear can result in significant damage to the dentition and the masticatory system before treatment is sought.

05), Liver function’s changes have no significant difference betw

05), Liver function’s changes have no significant difference between tow groups. Compared the level in preoperative stage with after 1 month, the total effect rate of the group of all three indicators (APT, TSGF AFP) decreased was higher than the group of one or two Falling indicators, while the deterioration rate

was lower. Conclusion: APT, TSGF joint AFP in the serum of patients with PHC can be as TACE short-term efficacy evaluation. Key Word(s): 1. PHC; 2. TACE; 3. AFP; Presenting Author: XIA HONGMEI Additional Authors: SHENG JIANWEN Corresponding Author: XIA HONGMEI Affiliations: The People’s Hospital of YiChun city in JiangXi province; The People’s Hospital of YiChun city in JiangXi province Objective: To investigate the clinical effects of compound matrine injection on the treatment of liver carcinoma pain. Methods: 60 patients with advanced liver carcinoma

at The People’s click here Etoposide price Hospital of Yichun city in Jiangxi province were included randomly. All pain patients were treated with three stages each stage for 4 weeks. The first stage was oxycodone hydrochloride zyban by orally, the second stage plus compound matrine injection per day, the third stage only with oxycodone hydrochloride zyban by orally. During treatments, we adjust the dose of Oxycodone hydrochloride zyban according pain in order to relieve pain. Results: when combined with compound matrine, oxycodone hydrochloride zyban in dose was reduced significantly. The toxicity of thirst and constipation decreased obviously. Conclusion: Compound matrine injection could relieve liver carcinoma pain effectively and safely, which would be accepted easily. Key Word(s): 1. matrine; 2. Oxy ER; 3. Liver carcinoma; 4. Pain; Presenting Author: MAZINR ALJABIRI Additional Authors: LEA MEDIODA, EVELYN DAULAT, SOCORINA FERNANDES, MARESHAH BANAAG,

ADNAN ABUHAMMOUR, ASAD DAJANI Corresponding Author: MAZINR ALJABIRI Affiliations: Mediclinic Dubai Objective: Extensive controversy exists around the clinical implication of the diagnosis of focal active Meloxicam colitis (FAC). Focal crypt injury by neutrophils (cryptitis or focal active colitis (FAC), is a common isolated finding in endoscopic colorectal biopsies. Focal active colitis is often thought of as a feature of Patients Crohn’s disease or is it really an early finding of Ulcerative colitis. Also patients presenting with diarrhoeal illness, infection, excess use of non steroidal anti-inflammatory (NSAID), irritable bowel syndrome Or even bowel preparation and ischemia can all present as FAC on histological findings. AimTo assess if FAC is a new group or subtype of Inflammatory Bowel Disease and assess the response to 5-aminosalicylic acid (5 ASA). Methods: A Multi-centre study in 3 large medical centres responsible for local community and expats, Clinical, endoscopic, and pathological data were retrospectively reviewed between August 2011 and October 2012, 597 patients (between 7 and 69 years.

Conclusion: Anti-tTG antibodies are found in a small (3 0%) but s

Conclusion: Anti-tTG antibodies are found in a small (3.0%) but significant proportion of young subjects in our population. Confirmatory testing with EMA antibodies was positive in 5 subjects to date and further EMA testing is underway. There appears to be a racial predominance in Malays and Chinese races but these differences have to be confirmed in a larger

sample population to be recruited in this on-going study. Key Word(s): 1. Celiac; 2. Disease; 3. anti-tTG; 4. EMA; Table 1 showing the results of anti-tTG and EMA in the subject population together with symptoms Race Positive anti-tTG (%) Positive EMA (Data to date) Symptoms selleck chemical In EMA positive subjects Malay 6/203 (3.0%) 1 Bloating Chinese 6/162 (3.7%) 4 1 – Bloatng 1 – Fatigue 2 – Asymptomatic Presenting Author: JINYAN LEI Corresponding Author: JINYAN LEI Affiliations: Tianjin Second People’s Hospital Objective: To investigate the value of combined detection AFP, AFU and GP73 in the early diagnosis of liver cancer. Methods: Serum AFP, AFU and GP73 were detemined in patients with HCC, those with cirrhosis, and Chronic hepatitis B, and statistical analysis. Results: The levels of serum AFP, AFU and GP73 were significantly higher in liver cancer patients than in those with benign cirrhosis, and Chronic hepatitis KU-60019 B (both P < 0.05). The sensitivity, specificity and effectiveness of combined detection

of serum AFP, AFU and GP73 in the diagnosis of liver cancer were 93.02%, 94.02%, and 65.45%, respectively, significantly and effectiveness than those of detection of each of these markers alone (all P < 0.05). Conclusion: Combined detection of serum AFP, AFU and GP73 can markedly improve the diagnostic sensitivity

for liver cancer. Key Word(s): 1. HCC; 2. GP73; 3. early diagnosis; 4. tumor markers; Presenting AMP deaminase Author: XU-HE HAN Corresponding Author: XU-HE HAN Affiliations: Tianjin Second People’s Hospital Objective: To observe the inhibition effect and strength of ursolic acid on the human hepatoma SMMC-7721 tumor xenografts in nude mice and provide base date to further clinical application research. Methods: SMMC-7721 was injected subscaneously in nude mice to establish the xenograft tumor animal model. The 24 nude mice were equally divided into three groups by random: the negative control group, cyclophosphamide positive control group and ursolic acid groups. The mice of positive control group and ursolic acid group were intraperitoneal injected cyclophosphamide by 20 mg/kg and ursolic acid by 4.5 mg/kg daily for a 14-day continuous administration, respectively. Meanwhile, the mice of negative control group were intraperitoneal given the same amount of sterile water daily. During the administration, the weight of the mice and the size of the xenografts were measured regularly. All mice were killed after 14-day treatment, and subscaneous xenograft tumors were taken out to measure the weight and size and calculate the tumor inhibition rate.

[55, 56] There is no effective disease-specific treatment for CAD

[55, 56] There is no effective disease-specific treatment for CADASIL and current therapy addresses symptoms. For migraine with aura, conventional prophylactic medications are recommended if attack frequency warrants treatment. Acetazolamide has been anecdotally reported to be effective in the prophylaxis of migraine in CADASIL, but randomized, controlled trials are lacking.57-59 Acetazolamide has

also been suggested to improve overall cerebral hemodynamics selleck screening library in CADASIL, perhaps suggesting a protective effect, but this has also not been proven in controlled trials.[60, 61] For acute treatment of migraine attacks, triptans and ergot derivatives should generally be avoided due to the high risk of stroke in these patients, and simple analgesics and non-steroidal anti-inflammatory drugs are preferred.[22] For secondary stroke prevention, antiplatelet agents should be used over anticoagulants due to high

prevalence of cerebral microbleeds, which may suggest an increased risk of symptomatic intracerebral hemorrhage.[43, 62] Cerebrovascular risk factors should be tightly controlled, including appropriate use of antihypertensive agents and statins.[22] The efficacy of donepezil in the treatment of cognitive impairment in CADASIL patients was studied in a randomized, controlled trial of 168 patients. There was no significant difference between donepezil and placebo in the primary end-point, which was defined as a change from baseline in the score Selleckchem Ulixertinib on the vascular Alzheimer’s disease assessment scale cognitive subscale at 18 weeks. Improvement was noted, however, on several secondary end-points that were measures of executive function,

but its clinical significance remains unclear.[63] An important aspect of care in CADASIL patients is supportive and involves rehabilitation, physiotherapy, psychiatric and psychological support, and nursing care. Genetic counseling is also important for these patients and for their at risk asymptomatic family members.[22] Acute head pain in the postpartum period should raise concern, especially if “red flags” are HSP90 present, as Dr. Robbins points out. The differential diagnosis of sudden severe headache is long, and even when diagnostic testing is negative, a high suspicion level should persist before diagnosing sudden acute (“crash”) migraine or benign thunderclap headache. In this case, initial work-up might have yielded the diagnosis of CADASIL, but the patient was lost to follow-up and further evaluation was halted. It is peculiar that this genetic disease produces in most patients characteristic migraine auras and headaches.

Criticism could be raised for the absence of a control arm, but t

Criticism could be raised for the absence of a control arm, but this study set out not to compare fatigue severity across liver disease, but to precisely evaluate fatigue in PBC in the context of the whole patient. Therefore, a control group was not absolutely necessary or appropriate. Future studies this website will also need

to be particular in having uniform criteria in the definition and assessment of comorbidities and assessing for other causes of fatigue, The presence of fatigue in other liver disease supports our overarching findings. Future studies are required to validate and refine our findings, particularly in clinic populations from different parts of the world, and where possible with longitudinal evaluation of the significance of any observations to outcomes, because this remains a point of concern.8 Additionally the methods we applied to define comorbidities likely underreport such associations, because more formal involved evaluations of patients would be helpful. It was not possible

in this study, for example, to have an in-depth depression evaluation. This does not detract from our findings, because our definitions of comorbidities were conservative. Having objective numerical evaluations of fatigue is difficult, and as is clearly shown in our study, there is a disparity between physician-reported and objective assessment. The analysis, www.selleckchem.com/products/Vorinostat-saha.html however, is by its nature based on the numerical scores reported, and this represents a limitation in terms of clinical significance at an individual patient level. However, the purposes of such analyses are to guide future research studies and help define and refine the questions they set out to answer. In this way, future work can come closer than we have been able to, in specifying see more the factors that account for fatigue as a whole. In conclusion,

we confirm that fatigue is a prevalent concern for patients with PBC that is underreported to physicians routinely. We demonstrate that the symptom complex has a multifactorial cause and is not specific to the disease. Careful appraisal in clinic is therefore relevant when addressing this symptom. Furthermore, when evaluating the biological basis of this symptom, or developing novel interventions, studies must account for these demonstrated extrahepatic associations. We thank our patients for their ongoing support of our clinic, Jenny Heathcote for her guidance, and Tamara Arenovich for statistical input. “
“Aim:  Recent studies have revealed that primary biliary cirrhosis patients with anticentromere antibody (ACA) commonly develop portal hypertension. However, the clinical characteristics of autoimmune hepatitis (AIH) remain uncertain.

The majority of respondents of both sexes with migraine endorsed

The majority of respondents of both sexes with migraine endorsed “severe pain” associated with headache. Males with migraine were slightly more likely to endorse “extremely severe pain” whereas females were more likely to endorse “severe pain,” although absolute percentages varied by only 2%. Respondents with PM showed similar results. The majority of females with PM endorsed “moderately severe” pain and the Ensartinib chemical structure majority of males endorsed “severe pain” associated with headache. Males with PM were slightly more likely to endorse

“extremely severe pain” than females although absolute rates were only 2% different (12.8% males vs 10.8% females, female to male PR = 0.84, 95% CI = 0.74-0.95). Females with migraine were 1.34 times more likely than males (12.4% vs 9.3%, 95% CI = 1.21-1.48) to have the highest level of headache-related disability (MIDAS Grade 4) (Table 6). Females were more likely than males to have moderate (PR = 1.46, 95% CI = 1.31-1.63) or mild (PR = 1.46, 95% CI = 1.33-1.60) headache-related disability whereas males were significantly more likely to report no headache-related disability (PR = 0.84, 95% CI = 0.82-0.86). CT99021 in vivo Among those with PM, there was not a significant sex difference among those with severe headache-related disability; however, females with PM were significantly more likely to have moderate

(PR = 1.52, 95% CI = 1.24-1.87) or mild (PR = 1.47, 95% CI = 1.25-1.72) levels of headache-related disability PDK4 than males and were less likely to report no headache-related disability (PR = 0.93, 95% CI = 0.91-0.95). Examination of individual MIDAS items reveal that females with migraine and PM were significantly more

likely than males to report inability to do household work on at least 1 day due to headache, work or school productivity reduced by at least 50% on at least 1 day due to headache, and missed family or social activities on at least 1 day due to headache. When asked how they were usually affected by their “severe” headaches, females with both migraine and PM were significantly more likely than males to report requiring bed rest during an attack, whereas males with migraine and PM were more likely to report being able to work and function normally (Table 6). When asked how long after a headache attack they were unable to work or undertake normal activities, females with migraine were more likely than males to be impaired for 3-<6 days, whereas males with migraine were significantly more likely to report being impaired for 0 or <1 day. Females with PM were significantly more likely than males to be impaired 1-<3 days whereas males with PM were significantly more likely to report no impairment following attacks. Females who met ICHD-2 criteria for migraine at the time of the AMPP Study survey were significantly more likely than males who met these criteria to have been diagnosed with migraine by a HCP (69.8% vs 46.2%; PR = 1.