ABSTRACT
Background: Headache is the most common symptom encountered in neurology outpatient department (OPD). One-fifth of patients in neurology clinics present with headache. Headache was long been found to be associated with epilepsy, especially migraine both chronic neurologic disorders share possible clinical interrelationships. Studying their association is necessary as identification of clinical subgroups vulnerable to develop to both disorders can be made possible in the future. Aims and Objectives: The objective of the study was to analyze the characteristic features of various types of headaches in epilepsy patients and their causal association. Materials and Methods: A total of 100 epilepsy patients with headache were recruited from the OPD of the neurology department in a tertiary care center and interviewed regarding the characteristic features of headache through a questionnaire. Results: Out of our study population, female outweighs the male (53, 47). Out of all, interictal was more prevalent (57%), followed by post-ictal (48%), pre-ictal (22%), and intra-ictal (0%) among epilepsy patients. Migraine was found to be the most common type of headache in all subgroups of headaches in epilepsy patients (pre-ictal – 77% of migraine, postictal – 81% of migraine, and interictal – 61% of migraine). Associated characters of headaches such as photophobia (42%) and their prevalence are also studied. Conclusions: Stronger association between migraine and headache is validated, and the strongest associated with migraine in postictal headache is highlighted (81%). This can strengthen the theories proposed so far such as the frequent triggering of headache by a seizure. Further research on common etiologic or pathophysiological processes to these associations can lead to a common therapeutic strategy and prevention of morbidity in patients.
ABSTRACT
Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, involving joints and extra-articular manifestations. About 50% mortality in RA is due to cardiovascular disease. Cardiovascular events occur approximately a decade earlier in RA like that in diabetes mellitus. Aim: The aim of the study was to correlate and compare the association between disease severity and various clinical and cardiovascular manifestations in RA patients. Materials and Methods: This prospective cross-sectional study is carried out in known RA patients fulfilling the American College of Rheumatology criteria 2010 attending General Medicine and Rheumatology outpatient clinic of Tirunelveli Medical College Hospital between April 2017 and April 2018. They have been subjected to detail clinical and laboratory investigations and their cardiovascular manifestations are compared with their clinical profile and disease activity score. Results: In this study, 50 patients were included, with a mean age of 47.76 years and 72% of female patients. The mean clinical disease activity index (CDAI) score among them is 25.16 ± 10.4. The disease severity was high among our study group with 60% of cases occupying high CDAI score with no patients under remission. The most common electrocardiogram abnormality found in the study group was left axis deviation (30%) followed by nonspecific ST-T changes (24%). Mean carotid intima-media thickness (CIMT) was found to be increased in 68% of patients. Asymptomatic carotid plaque was present in 8% of patients. The most common echocardiographic abnormality is left ventricular (LV) diastolic dysfunction, which contributes 44% in our study group. Conclusion: Cardiovascular abnormalities such as LV diastolic and systolic dysfunction, premature atherosclerosis occur commonly in RA patients and positively correlate with CDAI score, disease duration, and treatment duration. All RA patients should be screened for chorionic villus sampling abnormalities through echocardiography and CIMT periodically
ABSTRACT
Background: Bronchial Asthma is one of the worldwide health problems associated with increased morbidity and also mortality. Bronchial Asthma is a disease of airways that is characterized by increased responsiveness of the trachea-bronchial tree. Anti asthmatic drugs are associated with adverse effects which can affect the compliance and course of treatment. Monitoring adverse drug reactions in asthma will play a vital role in alerting physicians about the possibility and circumstances of such events, thereby protecting the user population from avoidable harm.Methods: The study was conducted in 500 bronchial asthma patients (250 patients in Beta 2 agonist group (Salbutamol) and 250 patients in Methylxanthine group (Deriphyllin) who fulfilled the study criteria and were observed for three months at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. Their prescriptions were collected and analysed. Adverse drug reactions(ADRs) in each group were collected and evaluated. The causality assessment was done by WHO-UMC assessment scale and severity by using Modified Hartwig-Seigel severity assessment scale.Results: Total 38% of patients taking anti-asthma drugs were encountered adverse drug reactions and were more common in elderly females (61 to 70 years). Adverse Drug Reactions were more common in Methylxanthine group (48%) compared to Beta 2 agonist group (28%). Headache (38%) was the commonest ADR in Methylxanthine group and Tremors (31%) in Beta 2 agonist group. Most of ADRs were mild (95 %), manageable and comes under possible (60 %) category of WHO causality assessment scale.Conclusions: Treatment of Bronchial Asthma is mainly based on Beta 2 agonist and Methylxanthine group. So, occurrence of ADR is much common. Our study offers a representative idea of the ADR profile of anti asthmatic drugs. Constant vigil in detecting ADRs and subsequent dose adjustments can make therapy with anti asthmatic drugs safer and more effective. This, in turn, will improve compliance.