Types of Secondary Headache and Comorbid conditions

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Management of secondary chronic headache in the general population: the Akershus study of chronic headache

Management of secondary chronic headache in the general population: the Akershus study of chronic headache

The present study is based on recruitment from the gen- eral population. The large sample and high response rate should ensure representativity. The secondary chronic headaches CPTH, CEH and HACRS are frequent enough to ensure accurate descriptive statistics, while other types of secondary chronic headache are too infre- quent for statistical analyses. The age range, though it may exclude some secondary headache types, was chosen explicitly to focus on a population without too much co-morbidity of non-headache disorders. Data from the Norwegian prescription registry indicate a high increase in drug prescriptions among people above 50 years [25]. This includes medication used for high blood pressure and pain killers for non-headache pain which both are is likely to influence the headache spectrum, a bias that we tried to avoid. Headache diag- noses are a challenge in people with chronic headache. To ensure precise diagnostic, two neurological residents experienced in headache diagnostics conducted all inter- views. Complicated headache histories were discussed among the authors before classification. The different headache diagnoses were equally frequently by the two interviewers, suggesting that inter-observer variation was low. Whether the participants had been interviewed in person or by phone made no difference to the various
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Management of secondary chronic headache in the general population: the Akershus study of chronic headache

Management of secondary chronic headache in the general population: the Akershus study of chronic headache

Methodological considerations The present study is based on recruitment from the gen- eral population. The large sample and high response rate should ensure representativity. The secondary chronic headaches CPTH, CEH and HACRS are frequent enough to ensure accurate descriptive statistics, while other types of secondary chronic headache are too infre- quent for statistical analyses. The age range, though it may exclude some secondary headache types, was chosen explicitly to focus on a population without too much co-morbidity of non-headache disorders. Data from the Norwegian prescription registry indicate a high increase in drug prescriptions among people above 50 years [25]. This includes medication used for high blood pressure and pain killers for non-headache pain which both are is likely to influence the headache spectrum, a bias that we tried to avoid. Headache diag- noses are a challenge in people with chronic headache. To ensure precise diagnostic, two neurological residents experienced in headache diagnostics conducted all inter- views. Complicated headache histories were discussed among the authors before classification. The different headache diagnoses were equally frequently by the two interviewers, suggesting that inter-observer variation was low. Whether the participants had been interviewed in person or by phone made no difference to the various
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The value of outdoor behavioral healthcare for adolescent substance users with comorbid conditions

The value of outdoor behavioral healthcare for adolescent substance users with comorbid conditions

The preceding comparison of the completion rates, relative costs, effectiveness, and benefits of OBH and TAU demonstrates the potential benefit of insurance coverage of all types of post- acute SUD treatment, especially OBH. However, further inquiry is needed to substantiate and elaborate upon these initial findings. Future directions in the movement toward insurance coverage of post-acute SUD treatment should further address additional eco- nomic evaluation of OBH and TAU, implications of insurance coverage for OBH and TAU, the significance of the Affordable Care Act and growing payment of services by the public sector, and thoughts on more direct involvement in SAMHSA’s special- ized mental health treatment approaches programs.
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Patient priorities in osteoarthritis and comorbid conditions: a secondary analysis of qualitative data.

Patient priorities in osteoarthritis and comorbid conditions: a secondary analysis of qualitative data.

For two of the participants (IDs 12 and 20) the unpredictable nature and potential adverse effects of one of their co-morbid conditions led to this being prioritised over their OA. Whilst, OA can also be unpredictable and produce fluctuating symptoms, e.g. pain, these participants did not perceive the severity of their OA symptoms as detrimental to their health when compared to their other condition. For example, Participant 12, despite being recruited to the primary study on the basis of having moderate to severe pain, said that he could ‘grin and bear’ his pain. In comparison, he described the serious consequences that could arise from his epilepsy and a need to be constantly vigilant due to the possibility of a sudden epileptic episode:
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Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population

Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population

The present study demonstrated an inverse dose– response relationship between headaches and alcohol consumption in both men and women. Previous data for the association have been less clear [4, 9–11, 14, 15], but a large population-based cross-sectional study in Norway showed a tendency for the prevalence of headache to decrease with increasing alcohol consumption [16], and another large population-based cross-sectional study in the Netherlands showed that migraine sufferers were less likely to consume alcohol [17]. A recent prospective analysis of migraine sufferers in Austria showed that consumption of beer reduced the risk of headache and migraine, as well as the risk of headache persistence [12]. Our findings are consistent with the results of these studies. In the Norwe- gian study only 3% of the subjects reported drinking [ 14 standard units of alcohol per 2 weeks, whereas in our study 48% of the men and 12% of the women reported drinking C22 g ethanol per day. The drinking behavior of the Japanese is strongly governed by the Asian genetic poly- morphism of ALDH2. ALDH2 genotyping among a subgroup of the present study population showed a much higher frequency of ALDH2-deficient individuals among the non/rare drinkers than the drinkers (75 vs. 33% of the men and 57 vs. 20% of the women). ALDH2-deficient individuals are more sensitive to alcohol flushing responses [18] and hangover [5, 6], in both of which headache is a major symptom. Intake of alcoholic beverages has been reported to be an aggravating factor of headache [4], especially migraine [19] and cluster headache [20]. Indi- viduals with migraine have a higher risk of delayed alcohol-induced headache than those without it [21]. Pos- sible mechanisms by which alcohol induces headache [22, 23] include a vasodilatory effect on the intracranial vasculature, altered cytokine pathways [24], endocrine and immune system disturbance, toxic effects of congeners, and acetaldehyde-mediated changes [5, 6, 18]. Japanese headache sufferers with inactive ALDH2 may be more vulnerable to severe alcohol-induced or hangover head- ache, than those without inactive ALDH2, and must avoid alcohol drinking. Another possible explanation of the inverse association between headache and alcohol drinking is related to the development of tolerance for headache in drinkers. Habitual drinking leads to the development of tolerance for alcohol-induced headache [6], which may affect the mechanisms by which common headaches occur. Third, non-drinking may influence other lifestyle factors associated with headache, since alcoholic beverages serve as a stress reliever or sleep aid in some persons. Further in- depth study of the association between headache classifi- cation and drinking habit is needed.
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Types of Headache and How to Treat Them

Types of Headache and How to Treat Them

B. Distinct and clearly remembered onset, with pain becoming continuous and unremitting within 24 hours C. Present for >3 months D. Not better accounted for by another ICHD-3 diagnosis New daily persistent headache is a relatively rare disorder, and evidence is limited to case series. 3)-5) This headache has also been reported in Japanese, but the number of cases is relatively small. 4)6) In summary, the male to female ratio is slightly higher in female. The mean age of onset is in the thirties. The day of headache onset is usually clearly remembered by the patient. While the headache often has features resembling those of tension-type headache, it may also manifest characteristics of migraine such as nausea, photophobia and phonophobia. The headache may remit, or recur and remit repeatedly, or persist, but many patients follow a chronic course. Robbin et al. 5) divided new daily persistent headache according to headache properties into two groups: a group with migraine-like headache that has a female preponderance and frequently a history of anxiety or depressive disorder, and a group with features of tension-type headache in which patients recall accurately the day of headache onset. Their report emphasizes that new daily persistent headache may manifest migraine-like headache. In a Norwegian population-based study of a sample aged 30 to 40 years, the 1-year prevalence was 0.03%. 7) Among children and adolescents who are less likely to overuse medications than adults, onset of new daily persistent headache is typically secondary to infection and trauma. 8)9)
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When Is a Headache More Than Just a Headache? : The Secondary Headaches

When Is a Headache More Than Just a Headache? : The Secondary Headaches

pain begins abruptly and is severe in intensity right from the onset; a typical patient description is “I felt like my head was hit by a baseball bat.” While crash migraine may be the most common cause of thunderclap headache, a host of other conditions and diseases may produce this remarkable wallop of head pain (Table 2.I). Some of these, as with migraine, are “primary” in origin and do not reflect significant un- derlying neurologic or general physical disease. Two common examples are benign exertional headache and be- nign sexual headache/“explosive” type. The following two cases highlight the features of these personally alarming but fundamentally benign headache disorders.
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Mortality in epilepsy and the influence of comorbid conditions and antiepileptic drugs

Mortality in epilepsy and the influence of comorbid conditions and antiepileptic drugs

5.2 Is there a causal relationship between the use of lamotrigine and a higher occurrence of SUDEP in female patients? Only months after the identification of LTG use as a potential risk factor for SUDEP in IGE (Hesdorffer et al. 2011), the same authors stated that they had provided a consistent message that it is the number of GTCSs that increases SUDEP risk, and not AEDs (Hesdorffer et al. 2012). This conclusion was reached after a new analysis showed that when the frequency of primary or secondary generalized tonic-clonic seizures had been controlled for then LTG was not associated with a significantly increased risk of SUDEP. Interestingly, however, and in concordance with our own findings, a similar gender difference was detected, although it was not statistically significant, with an odds ratio for SUDEP in females on LTG of 6.6 compared with 0.4 in males. The lack of statistical significance after controlling for the frequency of GTCSs implies that a causal relationship could not be detected in a mixed epilepsy population with primary and secondary generalized tonic-clonic seizures. However, IGE was not analysed separately, and, given the possibility that the risk is only increased in IGE and not in localization related epilepsy, the definite conclusion that there is a lack of association between LTG use and SUDEP may have been reached too hastily.
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Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients

Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients

Perhaps those individuals with asthma have lesser risk of developing glioma, but are prone to more aggres- sive tumors or a worse clinical course when the tumor does emerge, which is plausible given the results of this study. It could also be that individuals with atopic diseases are less likely to develop secondary GBM arising from low-grade glioma, due to the previously-reported decreased susceptibility to lower-grade gliomas in these patients. Since primary GBM has a worse prognosis than secondary GBM this could explain the poorer survival seen in this sample. The relationship between atopy and GBM is actively being researched, and the relationship between asthma and overall survival in particular needs additional evidence.
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Towards the Discrimination of Primary and Secondary Headache: An Intelligent Systems Approach

Towards the Discrimination of Primary and Secondary Headache: An Intelligent Systems Approach

In this work we have considered the enduring medical problem of diagnostic differentiation between primary and secondary forms of headache, the misdiagnosis of which may result in immediate and irreversible consequences for the patient. Both primary and secondary headache terms are seen not to comprise a single entity, but in fact encompass a highly complex, heterogeneous space of conditions, within which symptoms relating to causes of markedly differing origins may exhibit significant overlap. Costly specialist procedures such as CT and MRI neuroimaging, while providing rich internal views of the human biological system, do not represent a sustainable, scalable means of diagnosis, since they can be applied only in cases where a priori indication of a problem exists. We therefore presented a strategy grounded in the hypothesis that data intensive biosignals analysis, originating from increasingly available sensor technologies, may be en- abled through an intelligent systems methodology, giving rise to a deepened scope of analysis with the necessary operational features for use over arbitrary diagnostic junctures. Moreover, we recognise that the complexity inherent in bio-domain analysis in fact necessitates the extrication of low level human input, since considerable complexity must be handled within a restrictive time frame. The use of intelligent systems therefore permits a level of utility normally provided through the work of multidisciplinary teams, to be combined into a single unit of operation, driven by a marginal resource footprint. To demonstrate the potential of our proposed strategy, we reported a preliminary experiment, in which the Epilepsies, a group of paroxysmal neurological disorders, known to result in headaches, were considered within the framework of a classi-
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Retention in care and survival rates in comorbid conditions in persons living with HIV

Retention in care and survival rates in comorbid conditions in persons living with HIV

L IMITATIONS AND F UTURE RESEARCH Although this study has a large sample size, some limitations exists. First, each group population is different, especially with PLWH+DM+CKD. PLWH+DM+CKD had a small portion population as compared to the other two groups (PLWH, PLWH+DM). Thus, this circumstance might have bias in our study. However, the mortality rate was highest in this group as compared to the other two groups. Therefore, despite this study having some bias, it remains important. In future studies, researchers will need a larger sample of PLWH+DM+CKD to be more accurate. In addition, this study is a secondary database analysis, so it might have missing data and/or incorrect data entered from the initial data. Also, we do not know the initial date of patients’ HIV diagnosis date, so, it might be biased to predict the survival rates. But this study used age at initial clinic visit, which in turn related in early retention in care. This study will thus contribute to retention to the literature in care and survival rates in PLWH with comorbid conditions. As a result, there could be unintentional bias to our study. Despite this, if we have or do not have missing or incorrect data entered in the initial data set, we have enough population portions to complete an analysis in our study, which could make the study come across as generalizing. Finally, during our study period, 2006 through 2015, most data have a large censored data, so there might be bias on calculating on the survival rate on our study, but the SPSS captured the censored data on each disease group.
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Psychological distress, neuroticism and disability associated with secondary chronic headache in the general population – the Akershus study of chronic headache

Psychological distress, neuroticism and disability associated with secondary chronic headache in the general population – the Akershus study of chronic headache

We have previously shown that secondary chronic head- aches have varying courses, depending on the subtype, with HACRS having a better long-term prognosis than CEH [26]. However, why some people develop persistent symptoms in the first place and what predicts poor prognosis in whiplash-associated traumas, mild to mod- erate head injuries and neck disorders is disputed partly due to inconsistent findings [12, 13, 16, 42, 45]. The lack of correspondence between severity of the traumas (whip- lash and post-traumatic headache) and neck conditions (CEH) and the chronicity of symptoms has led to the as- sumption that psychological factors may play a crucial role in the cause and maintenance of these disorders. However, psychological factors account for only a portion of the variance in most of these studies, thereby highlighting the possible and complex bio-behavioural pathophysiology which may partly explain these conditions [42]. It has been hypothesised that a certain set of personality traits or distress makes these patients more vulnerable, with poorer adjustment to their medical condition than other people without these personality traits [10]. Our results indicate that only a high headache frequency, severe headache dis- ability and type of secondary headache seem to influence the outcome after 3 years. However, based on the study design, it is not possible to say if personality traits or psy- chological distress are linked to the development of the secondary chronic headache.
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Patterns of secondary forest recovery in two soil types

Patterns of secondary forest recovery in two soil types

Chapter 6 General conclusion This doctoral thesis investigated patterns of secondary forest recovery in two contrasting soil types in the Wet Tropics of Australia. Differences in substrates and their relationships with soil organic carbon and the structure and composition of woody plant communities and the communities of arbuscular mycorrhizal fungi were documented in detail in the previous data chapters. These investigations were a response to knowledge gaps identified in the literature review, where I found that there is surprisingly limited data on the effects of soil type and soil abiotic and biotic conditions on secondary forest regeneration despite its frequent mention of importance in the literature. Therefore, this thesis has contributed to the understanding of secondary forest succession, not only for Australian rainforests but for the field of forest ecology as a whole. In this final chapter, I revisit some of the key findings to provide a general conclusion and some future research directions.
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Prevalence of Comorbid Conditions in Relation to Severity of Asthma

Prevalence of Comorbid Conditions in Relation to Severity of Asthma

After excluding these correctable issues, it becomes important to identify the concurrent co – morbid conditions associated with recurrent exacerbations of asthma. Recent studies report that co – morbid conditions like allergic rhinitis, sinusitis, gastro esophageal reflux disease do play a significant role in determining the severity and morbidity of asthma 9 -14 . Rhinitis, sinusitis and gastroesophageal reflex commonly accompany asthma and can worsen disease severity.

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Incidence and impact of pain conditions and comorbid illnesses

Incidence and impact of pain conditions and comorbid illnesses

There are some limitations to using claims data, includ- ing difficulty generalizing to a noninsured population, miscoding due to administrative causes such as making a diagnosis fit a billing requirement or sometimes choosing the code that obtains the greater payment. 22 Although many pain conditions are chronic, ICD-9 codes do not include the chronicity of the illness in the diagnosis. This study limited the scope of comorbidities to other pain, mental health, and sleep-related diagnoses. Other studies have found that other physical comorbidities, such as hypertension or heart disease, are commonly reported by patients with pain. If this had been examined, an even greater burden would be present, but this has been shown by previous literature. The patients were also put into categories somewhat arbitrarily if they had other pain comorbidities, as mentioned in the study sample and cohorts section. Further, there were so many comorbid patients that we could not determine whether costs/prescrip- tion medication use is driven by the primary diagnosis or one of the other diagnoses.
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Tinnitus Patients with Comorbid Headaches: The Influence of Headache Type and Laterality on Tinnitus Characteristics

Tinnitus Patients with Comorbid Headaches: The Influence of Headache Type and Laterality on Tinnitus Characteristics

In addition to headache type also headache laterality had an impact on patients’ characteristics. Comorbid left-sided and bilateral headache had a particular impact on tinnitus severity, on quality of life, and on comorbid disorders such as vertigo, pain, depressive symptoms, and on the frequency of psychiatric treatment. Likewise for headache type, this pattern mainly reflects that patients with comorbid bilateral or left-sided headache are more severely impaired and more frequently suffer also from other somatic, somatoform, and psychiatric symptoms. An earlier analysis of the same sample revealed that left-sided headaches are also frequently associated with left-sided tinnitus and bilateral headaches more frequently with bilateral tinnitus ( 16 ). The finding of higher impairment of patients with left-sided symptoms is in line with the literature that shows a slight left-sided preponderance (55–60%) in somatoform disorders ( 38 ) and in somatoform pain ( 39 ). With respect to headaches, a relatively small study suggests that left-sided migraine is more frequently associated with psychiatric symptoms than right-sided migraine ( 40 ). Thus, among tinnitus patients with left-sided headaches, there might be a higher proportion of patients with a somatoform disorder, which can explain the higher impairment in this group. The same explanation may hold true for patients with bilateral headaches, as this group includes also all patients with a rather unspecific description of their headaches, and among patients with rather unspecific description of their headache syndrome a higher proportion of comorbid somatoform disorders is expected as well.
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Headache Types. Behavioral Treatments of. Tension Headache. Migraine Headache. Mixed Headaches. TMJ Disorder. Tension Migraine.

Headache Types. Behavioral Treatments of. Tension Headache. Migraine Headache. Mixed Headaches. TMJ Disorder. Tension Migraine.

• EMG measures surface tension to train EMG measures surface tension to train muscle relaxation, reducing tension • Thermal teaches to increase hand. temperature, increasing blood flow [r]

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Individually tailored internet-based treatment for depression and comorbid conditions

Individually tailored internet-based treatment for depression and comorbid conditions

(0.08-0.40) at follow-up. There were no significant differences between TAIL and PE at any time point. 96 3.1.2.3 Other treatment effects in REGASSA (previous studies) Some other analyses of treatment effects in REGASSA not included in this thesis are also worth mentioning. There were no significant differences in effects on clinician-rated depression between the three exercise intensity levels in PE, strengthening the decision to analyze PE as one intervention. 97 In an analysis of the earlier mentioned IVR-data, both TAIL and PE improved psychological functioning and sleep better than TAU up to three months after treatment. 98 In the analysis of effects on sick-leave and employment, all three groups were associated with reductions in long-term sick leave but there were no differences between the participants' employment or sick-leave status in the TAIL or PE group compared to TAU. 99 3.1.2.4 Preliminary effects of TAIL on symptoms of comorbid conditions (new data) Since the self-report measures that participants in the TAIL condition completed included scales of symptoms comorbid to depression, we can describe the TAIL participants’ comorbid symptoms more clearly than participants in PE and TAU. The proportion of participants in TAIL, before and after treatment, with a score above the pre-defined cut-off indicating at least mild symptoms can be found in Table 5.
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The relationship of individual comorbid chronic conditions to diabetes care quality.

The relationship of individual comorbid chronic conditions to diabetes care quality.

any similar analysis, there were unmeasured patient characteristics for which we could not make adjustments. To establish actively managed comorbid conditions, we used ICD-9 codes billed at face-to-face visits in the base- line year, as has been performed previously. 20 21 There is a risk for underdiagnosis of certain conditions with this approach, such as obesity 34 and depression; 35 however, there is less risk of bias than with condition patient self- report. 21 There is also a potential for patients to receive some care and achieve diabetes care goals outside of their medical home health system, and this goal achieve- ment would not be recognized in our analysis. Our statis- tical approach included multiple variables, and many conditions were of low prevalence. We chose not to correct for multiple comparisons, such as with the Bonferroni method, to avoid increasing type 2 error in this first-step study. Instead, we used a p value <0.01 to determine signi ficant associations. We do note that the impact of some conditions on care goal achievement are small in magnitude while statistically signi ficant (ie, OR 1.1) and their clinical signi ficance therefore could be limited and should be tested in other populations in future work. There is also a potential for interaction effects among conditions, but these were not studied in the current analyses and the impact of combinations of conditions should be studied in future work. Finally, we used publicly reported testing and control care goals as markers of diabetes quality, as these are relevant to our population of patients with diabetes, consistently meas- urable, and there is agreement that achieving these goals leads to better long-term outcomes. 7 31 It is important to note that there are other aspects of care, other health outcomes and patient factors that were not tested in this study as the study was not designed to address them, including patient preference for care, patient contextual factors and provider and health system priorities for care. 5 11 13 32 We also recognize that some of our findings could be due to chance. Future work should assess broader, more patient-oriented long- term outcomes, such as health-related quality of life and mortality and include more patient sociodemographic and context measures.
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Chromosomal microarray analysis in developmental delay and intellectual disability with comorbid conditions

Chromosomal microarray analysis in developmental delay and intellectual disability with comorbid conditions

To assess the diagnostic yields in DD/ID patients with co-occurring conditions, the cohort were divided to sub- groups based on the presence of following conditions or their combination: pre/peri-natal problems, family his- tory, short stature, congenital heart defects and twenty other conditions (Table 1, also see Methods for details). The number of patients with pCNVs identified and the diagnostic rate of each group was listed in Table 1 part II/III. Odds ratio (OR) of yielding a pathogenic finding in the presence of select condition was calculated (Table 1.II) and plotted (Fig. 3) when the number of patients with select condition was above 50. Four condi- tions when co-occurring with DD/ID showed a statisti- cally higher chance of yielding pCNVs - congenital heart defects (55%, OR:5.52), facial dysmorphism (39%, OR:2.57), microcephaly (34%, OR:2.33), hypotonia (35%, OR:2.87) - markedly higher than the 28% overall diagnos- tic rate. In the presence of two comorbid conditions - short stature and facial dysmorphism, or congeital heart defects and facial dysmorphism, the yield was also mark- edly elevated (38%, OR:4.22; 62%, OR:10.81, respectively). Karyotypical abnormalities were known in 26 patients prior to CMA. Among these patients, 24 (92%) were iden- tified with pCNVs, including 11 cases with the genomic content of marker chromosomes revealed, 3 cases with gain or loss found in “ balanced rearrangement ” (based on karyotype), 9 cases with gain/loss confirmed and spanning clarified, and 1 case with pCNV identified in a region
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