ABSTRACT
Introduction: Migraine is a syndrome of recurrent headaches which commonly affects the most productive age group. The clinical presentation of a migraine varies is from the patient. The drug treatment needs to be selected by grouping into different categories based on the clinical profile. In this study, an attempt has been made to study the clinical spectrum EEG changes and therapeutic response in patients with a migraine. Aim of the study: To study the clinical spectrum of a migraine, to study the EEG changes in migraine patient, to assess the therapeutic response in patients treated with prophylactic drugs. Materials and methods: In this study, patient with age between 12 years and 60 years who attended the headache clinic and satisfied the international headache society criteria for a migraine included the patients were evaluated in the following way: Detailed History taking, Physical examinations, laboratory investigations. Results: In the present study, most of the patients were in the age group of 30 to 35 years in both migraine with aura (MA) and migraine without aura (MO) (MA 48% and MO 52%). The minimum age in this study was 14 years maximum age was 54 and the mean age was 33.2. Prevalence of a migraine varies with age peaking between age of 30 to 45 years. Overall prevalence was highest from 25 to 55 years of being productive age. The family history of a migraine was present in 32% of the total patients (MA 62% to 32%) seen predominantly in first degree relatives. The present rating factors were found in 76% of patients in the study group. Stress was commonest precipitating factor for migraine (MA 33%, MO 50%). Other precipitating factors were menses (MA 17%, MO 20%) hunger (MA 17%, MO 15%), sleep deprivation (MA17%, MO15%), food (MA 5%), head trauma (MA11%). In this study group, 61 patients had followed up for more than 3 months. Among them, 26 patients 42.6% were treated with three propranolol 33 patients 54% were treated which combination J. A. Vasanthakumar, K. Ganesamoorthi. A study on migraine in tertiary care centre at Dharmapuri IAIM, 2018; 5(3): 8-14. Page 9 of Beta blocker and amitriptyline and 2 patients 3.2%were treated with sodium valproate. At the end of 3 months, response to therapy was assessed by MIDAS score. Conclusion: Prodrome symptoms were present in 38% of patients and postdrome symptoms were present 50% of the patients. Visual Aura was the commonest aura. A headache was predominantly unilateral 72% pulsatile 95% moderate-to-severe intensity of pain 83% with the main duration of 16.5 hours. Nausea and vomiting were commonest associated symptoms. Stress was a commonest precipitating factor.
ABSTRACT
Background: The most common adverse event that is associated with GDM is that it has led to higher incidence of maternal diabetes mellitus later in life and the major morbidities among the infants born to the diabetic mothers include respiratory distress, macrosomia, polycythaemia, hypoglycaemia, hypocalcaemia, hypomagnesemia, and congenital malformations. As most of the oral hypoglycaemic agents is prone to cause teratogenic effects the most preferred was the insulin therapy and the subcutaneous insulin therapy has been considered as the standard therapy in the management of GDM. Aim: To assess the factors associated in the incidence of diabetes among the gestational diabetes mothers and to assess the effect of insulin on them in terms of maternal and foetal outcome. Methodology: A prospective study was undertaken among the gestational mothers with diabetes for a period of one year during Jan 2015 – Dec 2015 at the Government Medical College Hospital, Salem. A total of 150 maternal mothers with more than 24 weeks of gestation were included in the study and who had been diagnosed as gestational diabetes mellitus. The insulin used for majority of the patients was novo rapid and it was used four times a day. The outcome parameters which were used for antenatal mothers were their weight gain and the type of complications at the time of delivery whereas for the neonates their birth weight and the necessity for NICU admission were considered as the outcome parameters. Results: the risk factors found to be associated with the gestational diabetes among the study population were age more than 30 years, BMI of more than 25, family history both father and mother being diabetic, having a bad obstetric history, primigravida and the mothers who had gained more than 7 kgs in the first two trimesters. majority of the mothers delivered macrosomia babies (29.3%), hypoglycaemia and hypothyroidism was found only in 6% and 5.3% of the new-born babies and 4 were still births and 15 babies were got admitted to NICU for respiratory distress. The pearson’s correlation had shown a strong positive correlation between the dose of the insulin given to the antenatal mother and their increase in the weight (r=0.819) and a strong negative correlation with the weight of the neonate (r= -0.532). Conclusions: Gestational diabetes mellitus being associated with maternal and neonatal adverse outcomes, so maintaining adequate blood glucose levels in GDM helps in reducing the morbidity for both the mother and baby. Insulin would be a right choice for treating GDM and when initiated early it prevents most of the complications due to GDM both in the mother and the neonate.