Underdiagnosis and the impact of headache-related disability on the quality of life patients

To determine the extent of under-diagnosis of migraine and the impact of headache-related disability on the quality of life of patients. Prospective, Observational. This study was conducted at the Department of Neurology, Medical Unit II, PUHMS, Nawashah from 1.1.2009 to 31.12.2009. The demographic and clinical data was collected in a proforma. Migraine was diagnosed according to the International Headache Society Classification. Neurological examination and routine laboratory tests were done in all cases. CT Scan of brain was performed whenever deemed necessary. A clinically reliable Migraine Disability Assessment Scale [MIDAS] was administered to the patients with migraine headache. The disability was rated as Grade I [little or no disability] to Grade IV [severe disability] based on the information provided by the patients. Sixty-eight cases were documented. Male=31, Female = 37. Age ranged from 10-59 years. The majority were in the age group of 10-39 years. Fifty-seven [83.8%] had migraine without aura [common migraine] while 11/68 [16.2%] had migraine with aura [classic migraine]. In 36/68 [52.9%] nausea was the most frequent associated symptom. Photophobia [17.6%] was more common than phonophobia [5.8%]. Visual changes [flashing lights] was the most common associated symptom in migraine with aura. Stress was the most frequent triggering factor in majority in 29.4%. Only 8/68 [11.7] were previously diagnosed as they were taking some anti-migraine therapy whereas majority 60/68 [88.3%] were newly diagnosed at the time of our assessment. The usual frequency of headache was once/week in 30/68 [44.2%], once/2 weeks in 22/68 [32.3%] and once/month in 16/68 [23.5%]. Disability was Grade I in 8/68 [11.7%], Grade II in 12/68 [17.6%], Grade III in 30/68 [44.2%] and Grade IV in 18/68 [26.5%]. Most of our cases were unaware of their illness nor they were provided relevant information by their physician regarding migraine and its associated aspects. This study indicates that migraine is under diagnosed in a greater proportion of cases in our region. The headache-related disability caused by migraine adversely affects the quality of life of patients. Unawareness about the disease appears to be the main reason for under diagnosis and increasing disability in our patients

Young-onset stroke in the rural areas of Sindh

to determine the risk factors and clinical features in the young-onset stroke belonging to the rural areas. Retrospective, Observational. This study was conducted at the Department of Neurology, Medical Unit II, Peoples Medical College Hospital, Nawabshah from 1.1.2006 to 31.12.2006. Hospital records of acute stroke cases aged 20-45 years were reviewed. Stroke was defined according to the WHO criteria. Demographic and clinical data including the risk factors were scrutinized. Laboratory investigations and the CT Scan of brain were evaluated in all cases. Twenty-cases were documented. Male= 12 [60%], Female= 8[40%]. Age ranged from 20-45 years. Majority were uneducated and they were residents of small rural communities. Hypertension was the most frequent risk factor in 13 [65%] of cases [Table 1]. Only 2 [10%] were previously taking antihypertensive treatment while 18 [90%] were not receiving any treatment prior to stroke. Heart disease was present in 2 [10%]. Three [15%] were smokers. One [5%] had Diabetes mellitus, 3 [15%] had previous stroke and 1 [5%] had a family history of stroke. Three [15%] had none of the above risk factors. Hemiplegia was the most common presentation where 8 [40%] had right while 7[35%] had left hemiplegia and in 5 [25%] sidedness could not be ascertained because of deep coma [Table 2]. Glasgow Coma Scale [GCS] ranged from 5-12 out of 15. Cerebral infarction was more common 12 [60%] than cerebral haemorrhage 6 [30%] while in 2 [10%] CT findings were unremarkable [Table 3]. Of the 20 cases 3 [15%] expired and 17 [85%] survived [Table4]. Fatal cases had GCS of below 8 out of 15. This study indicates that hypertension is the major risk factor for stroke in young adults belonging to the rural areas. Hemiplegia was the most common presenting feature. Cerebral infarction accounts for 60% of the cases and the survival rate was 85%. Unawareness and poor control of hypertension appears to be the main reasons behind the young-onset stroke in our region

Acute and late complications of organophosphate poisoning

To describe the acute and late complications of organophosphate [OP] poisoning. Case series. Medicine Department at Peoples Medical College Hospital, Nawabshah, from June 2008 to December 2009. A total of 300 patients with organophosphate poisoning admitted to the Medical ICU were included. Baseline investigations included blood complete picture, urea, creatinine, arterial blood gas values, and serum cholinesterase levels. Data was retrieved from the files on a structured proforma. Studied variables included gender, mode of exposure, acute [occurring within 4 weeks] and delayed [occurring after 4 weeks onwards] complications. There were 50 [16.66%] males and 250 [83.33%] females with ratio of 1:5. Two hundred and forty eight [82.6%] had ingested while 18 [6%] had inhaled the poison. Acute complications included fits in 50 [16.66] bradycardia in 30 [10%] and hyperglycemia in 15 [5%] patients. Delayed complications [after 4 weeks and later] included monoplegia and mild sensory loss of lower limbs in 4 [2.66] and paraplegia and weakness of upper limbs in 2 [0.66%] patients each. A total of 50 patients died due to different complications in acute period making a mortality rate of 16.66%. Frequency of acute organophosphate [OP] poisoning complications is much higher and related with high mortality and morbidity and where as late complications are less frequent and less life threatening