Association of hypothyroidism in patients with migraine and tension-type headache disorders in Kashmir, North India

Objective: This case control study was undertaken to ascertain the frequency of subclinical and overt hypothyroidism in patients with various types of primary headache disorders in Kashmir, North India. Methods: The study was conducted in a tertiary care (university of Kashmir) hospital of North India. The study subjects consisted of 250 patients with primary headache disorders. This was compared with an age-sex matched control of 500 subjects. Thyroid function tests were performed by new automated immunochemiluminometric assay. Results: Among patients with primary headache disorders, subclinical hypothyroidism was present in 22% and overt hypothyroidism in 7.2%. On the other hand, subclinical hypothyroidism was observed in 11.2% and overt hypothyroidism in 1.2% of cases in the control group, the differences between primary headache and control group was statistically significant (p 0.05). Conclusion: Hypothyroidism is found to be a co-morbidity or predisposes to the development of chronic headache (tension-type headache and migraine) in this North Indian study.

Emergency showstopper- factors behind delays in final disposition

Introduction: Clinical management outcome of emergency patients with delays are directly related to blocked access to the next level of care from emergency department. It predicts delay to the definitive procedure plan to manage the patient and is also a marker of hospital functional flaws

Objective: To study the frequency and associated factor of delays behind final disposition of patients presenting to the Emergency Department of a tertiary care hospital in Pakistan

Methods: This is comparative cross sectional study, conducted at Aga Khan University Hospital. Both adult and pediatric patients were included. Comparison was done between delayed and non-delayed emergency department patients. Six hour was taken as cut-off. SPSS version 19 and MS excel 2010 were used for analysis

Results: Out of 365 cases, 133 [36%] were pediatric and 232 [64%] were adults patients. There were 184 [50%] males. More than six hour delay was noted in 94 patients [27%]. Adult patients were delayed more than pediatric patients [p<0.001]. Laboratorial, radiological test and generated consults were all found highly significant difference for the delays [p<0.001]. 297 [81%] were discharged home, while 17 [5%] of them were admitted

Discussion: Overcrowding is common in Emergency Department [ED] and hence the chances of delay in disposition of patients from ED are very high which will ultimately compromise the patient care. Reducing the number of comparatively stable patients with effective triaging, ED clinics and diverting available resources towards more critical patients can reduce congestion, input and throughput. Reducing consults and unnecessary investigations with the provision of more experienced physicians and nurses is an important factor to reduce delays

Conclusion: Extended length of stay in ED may exceed the potential capability to deliver quality care within appropriate time frame; this may lead to drastic decrease in patient and family satisfaction, leading to compromised clinical care

Qualitative adaptation of child behaviour problem instruments in a developing-country setting

A key barrier to epidemiological research on child behaviour problems in developing countries is the lack of culturally relevant, internationally recognized psychometric instruments. This paper proposes a model for the qualitative adaptation of psychometric instruments in developing-country settings and presents a case study of the adaptation of 3 internationally recognized instruments in Pakistan: the Child Behavior Checklist, the Youth Self-Report and the Teacher's Report Form. This model encompassed a systematic procedure with 6 distinct phases to minimize bias and ensure equivalence with the original instruments: selection, deliberation, alteration, feasibility, testing and formal approval. The process was conducted in collaboration with the instruments' developer. A multidisciplinary working group of experts identified equivalence issues and suggested modifications. Focus group discussions with informants highlighted comprehension issues. Subsequently modified instruments were thoroughly tested. Finally, the instruments' developer approval further validated the qualitative adaptation. The study proposes a rigorous and systematic model to effectively achieve cultural adaptation of psychometric instruments.

Dental caries. A meta analysis on a Saudi population

To determine the prevalence of caries in the primary and permanent teeth in a Saudi population. This study was conducted at the College of Dentistry, University of Dammam, Dammam, Kingdom of Saudi Arabia. In June 2010, a literature search was started and found all studies conducted in Saudi Arabia on dental caries from 1999 to 2008. Sixty articles were found on PubMed, which had been published during the considered time period. Sixteen studies were passed through inclusion criteria and included in analysis. A 2 to 12-year-old Saudi population was included to determine the prevalence of caries in primary teeth, and for permanent teeth, the age range was 6-18 years. The prevalence of caries in primary and permanent teeth were analyzed separately. Forest plot and Chi-square test revealed considerable heterogeneity. A random effect model was used to find caries prevalence in primary and permanent teeth. The mean decayed, missing and filled teeth [dmft] was 5.38 [95% CI: 4.314 - 6.436], and in the permanent teeth the DMFT was 3.34 [95% CI: 1.97 - 4.75]. Publication bias diagnostics suggested possible overestimation of caries prevalence in permanent teeth but not in primary teeth. The results in this study present a high decayed, missing, and filled teeth score in the adult and young population of Saudi Arabia, however, more published data is required as the results obtained from this meta analysis may not give a true picture, and reality may be worse

Herpes zoster oticus masquerading as lateral pontomedullary syndrome

Ramsay Hunt syndrome, also known as herpes zoster oticus is usually caused by reactivation of preexisting varicella zoster virus in the geniculate ganglion. Here we report a case of herpes zoster oticus masquerading as lateral pontomedullary syndrome occurring during the pre-eruptive phase of chicken pox. The case is being reported for its rare and unusual clinical presentation.

Nahargarh Wildlife Sanctuary [NWS] A Place for Extraordinary Medicinal Plant Diversity

Nahargarh Wildlife Sanctuary is a potentially rich source of medicinal plants and exhibits a great diversity of plant species. There are about two hundred plant species which are used for medicinal purpose to treat various ailments by villagers in the vicinity of the sanctuary. This article describes 146 plants and their different parts [root, stem, bark, corm, bulb, leaf, fruit and seed] or the whole plant/herb is used for medicinal purpose. These plants contain several phytochemicals which can prevent ailments or can be used in the treatment of many diseases. The herbs mainly belong to families such as Fabaceae, Poaceae, Asteraceae, Cucurbitaceae, Euphorbiaceae, Amaranthaceae, Asclepiadaceae, Apocynaceae, Moraceae, Polygonaceae, etc.

Urgent laparoscopic surgery for cholecystitis and appendicitis during pregnancy

To study the safety and outcome of laparoscopic surgery in pregnancy in non obstetrical abdominal emergencies in a tertiary referral teaching hospital in Rawalpindi, Pakistan. Prospective observational study. This study was carried out at Fauji Foundation Hospital, Rawalpindi, Pakistan from March 2004 till Feb 2010. All the pregnant females presenting with acute abdominal pain requiring surgical intervention underwent laparoscopic surgery by experienced laparoscopic surgeons. Total of twelve laparoscopic procedures were performed in pregnancy for nonobstetrical emergencies at variable gestational ages representing all the three trimesters. Outcome of the procedures, complications, hospital stay and follow up was recorded and compared with the relevant literature on open and laparoscopic surgery in similar situations. All the patients had successful laparoscopic procedures with no complications to pregnancy. One patient developed laparoscopic port site infection and another patient had a brief episode of pulmonary edema. All the patients were followed till the end of their pregnancies and delivered healthy babies. For pregnant females presenting with acute abdominal conditions laparoscopic surgery is safe, feasible and the preferred option provided adequate laparoscopic facilities and expertise exists

Therapeutic evaluation of a unani formulation in the management of seborrhoeic dermatitis

Apart from advancement in diagnosis and management of skin diseases, several problems are still having no radical cure in dermatology and seborrhoeic dermatitis is one of them. In Unani medicine, management of several diseases are described in accordance with its fundamental principle of Mijaz and Akhlat, and have very promising effect on such diseases. Musaffiyat are in fact the key tools for almost every skin disorder. Several Unani formulations are being used since ancient times without any known side effects. As our study is based on modern approach of diagnosis and management, the result may be considered as more promising

Clinical evaluation of Unani formulation in myocardial ischaemia

Coronary Artery Disease [CAD] plays a major role in mortality worldwide. Thus there is a great challenge before clinicians to find out safe and effective therapy. There are some Unani drugs like Badranjaboya, Balchar, Jadwar and Arjun whose efficacy is mentioned in Unani literature without any known side effect. A clinical trial of these drugs on 60 patients of ischaemia was carried out which were selected on the ground of clinical presentation, ECG findings and ventricular dyskinesia in 2D, M-mode echocardiography. Drugs were given in the powder form orally [10 gm powder in two divided doses], study duration was set for two months and efficacy of the formulation was evaluated following modern parameters

Therapeutic evaluation of a combination of Bambusa arundinacea, Calotropis gigantea, piper nigrum, Zingiber officinole, Colchicum autoummale, Asphalt and Calcined iron in gout

Gout [Niqras: derived from Anqaroos meaning greater toe] is not a single disease. The term is used to describe a number of disorders in which crystals of monosodium urate deposit on joints give rise to acute gouty arthritis of metatarso-phalangeal joint of a greater toe in 70% of patients. Several Unani single and polypharmaceutical combinations are reported in literature as being highly beneficial in gout. In this study an attempt has been made to evaluate the efficacy of a combination of drugs in gout [Niqras]. The observations and results were analysed statistically and test of significance was done by applying paired 't' test

Hypertension in Saudi Arabia

To determine the prevalence of hypertension among Saudis of both gender, between the ages of 30-70 years in rural as well as urban communities. This work is part of a major national study on Coronary Artery Disease in Saudis Study [CADISS]. This is a community-based study conducted by examining subjects in the age group of 30-70 years of selected households during a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history using a validated questionnaire, and examination including measurement of blood pressure. The data were analyzed to provide prevalence of hypertension. Logistic regression was used to develop a risk assessment model for prevalence of hypertension. The total number of subjects included in the study was 17,230. The prevalence of hypertension was 26.1% in crude terms. For males, the prevalence of hypertension was 28.6%, while for females; the prevalence was significantly lower at 23.9% [p<0.001]. The urban population showed significantly higher prevalence of hypertension of 27.9%, compared to rural population's prevalence of 22.4% [p<0.001]. The prevalence of CAD among hypertensive patients was 8.2%, and 4.5% among normotensive subjects [p<0.001]. Increasing weight showed significant increase in prevalence of hypertension in a linear relationship. Hypertension is increasing in prevalence in KSA affecting more than one fourth of the adult Saudi population. We recommend aggressive management of hypertension as well as screening of adults for hypertension early to prevent its damaging consequences if left untreated. Public health awareness of simple measures, such as low salt diet, exercise, and avoiding obesity, to maintain normal arterial blood pressure need to be implemented by health care providers

Eruption time of permanent first molars and incisors among a sample of Saudi male schoolchildren

The objectives of the present study were to determine the mean eruption time of permanent first molars, central and lateral incisors and to compare the relationship of eruption time with Body Mass Index [BMI] in Saudi male preschool and primary schoolchildren of grade 1 to grade 3 [G1 to G3]. The study population comprised 716 randomly selected male preschool and primary school children from G1 to G3. The eruption time of permanent first molars, central and lateral incisors with age, height and weight were recorded. The mean age of children was 81.5 +/- 10.9 months ranging from 61 months to 111 months. The results show that, maxillary right first molar had the lowest mean eruption time of 70.2 +/- 5.3 months and the right upper lateral incisor was the last tooth to erupt with mean eruption time of 94.1 +/- 8.3 months. Furthermore, the mandibular incisors erupted significantly earlier than maxillary incisors. By the age of 88.4 months, 97% of the boys had all their first permanent molars erupted. There was no significant correlation observed between eruption times with BMI, except for tooth # 32. Nevertheless, it seems that an inverse relationship may exist between the eruption time and BMI. When comparing with the reported results of other national studies, the Saudi male children showed later eruption time than some of African countries and earlier eruption than Iranian and Australian children of permanent first molars, central and lateral incisors

Metabolic syndrome in Saudi Arabia

Metabolic syndrome [MS] is a well-established risk factor for the development of coronary artery disease [CAD]. We designed this study to obtain the prevalence of MS and each of its components in Saudi Arabia. This study is part of Coronary Artery Disease in Saudi Study [CADISS]. We conducted this community-based national epidemiological health survey by examining Saudi subjects in the age group of 30-70 years of selected households over a 5-year period between 1995 and 2000 in Saudi Arabia. We interviewed all subjects, examined and took measurements of their blood pressure, weight, height, waist circumference, as well as fasting samples of plasma glucose, triglycerides, and high-density lipoprotein [HDL] cholesterol. We obtained the prevalence of MS based on the presence of at least 3 of the following: abdominal obesity [waist circumference >102 cm [40 inch] in male and >88 cm [35 inch] in female], triglycerides >=150 mg/dl [1.69 mmol/L], HDL cholesterol <40 mg/dl [1.03 mmol/L] in male and <50 mg/dl [1.29 mmol/L] in female, blood pressure >=130/85 mm Hg, fasting glucose >=110 mg/dl [6.1 mmol/L] as defined by the Adult Treatment Panel [ATP] III in 2001. We included 17,293 subjects in this survey during the study period. The overall age-adjusted prevalence of MS in Saudi Arabia obtained from this study is 39.3%. Age adjusted prevalence in males is 37.2% and crude prevalence is 40.9% [95% confidence interval [CI] 39.8-42], while females have a higher prevalence of 42% and crude prevalence of 41.9% [95% CI 40.9-42.9]. Saudi subjects from urban areas have significantly higher prevalence of 44.1% [95% CI 43.2-45] compared to those living in rural areas of 35.6% [95% CI 34.3-36.7] [p<0.0001]. Low HDL affects 81.8% of females and 74.8% of males with MS leading all other factors, and it continued to be consistent in all different age groups. Metabolic syndrome is a risk factor for CAD, as the prevalence of CAD was higher among patients with MS [6.7%] compared to subjects without MS [4.6%] [p<0.0001]. The prevalence of MS is high in Saudi Arabia. Low HDL cholesterol plays a major role in the contribution to the MS in Saudi Arabia. Therefore, we recommend routine assessment for the components of MS in patients with CAD, furthermore, we encourage aggressive management of the MS for primary prevention of CAD, particularly, measures to increase HDL cholesterol

Trends in dental caries and missing teeth in adult patients in Al-Ahsa, Saudi Arabia

The aim of the study was to determine dental caries prevalence and severity among adult patients attending Al-Ahsa Dental Center in Al-Ahsa Region of Saudi Arabia. A total of 544 adult patients, 42% males and 58% females with a mean age of 42.7 +/- 18.1 years, were examined for dental caries utilizing WHO criteria for diagnosis of dental caries. The caries prevalence among the sample was 89.2% with a mean DMFT score of 13.24 +/- 11.53. The mean DMFT scores of the patients from urban areas [14.03 +/- 12.11] were significantly higher than patients from rural areas [11.39 +/- 9.84] [P<0.01]. Missing teeth was the major component of the total DMFT score. About 17% of the patients were edentulous. However, more than half [56.8%] of the patients above 61 years were edentulous. In conclusion, the caries prevalence and severity were very high among the subjects studied

Anticoagulant effect ofsome herbal drugs used inunani system of medicine

Atherosclerosis is the degenerative processaffecting all the sections of population of either sex, ageand socio-economic status. If the plaque is complicatedby blood clotting, it causes ischaemia and infarction ofthe tissues or organs, most vulnerable are heart andbrain. In the present [in vitro]study, twelve cardiotonicdrugs were selected which have been used by therenowned Unani physicians. The drugs were purchasedfrom Dawakhana Ajmal Khan Tibbiya College, AligarhMuslim University, Aligarh and properly identified.All the drugs were powdered separately and theiraqueous solutions were prepared. Fresh human venousblood was mixed with them. Eight drugs prevented theclotting of blood in different concentrations so theywere identified as having anticoagulant effect. Neitherthe morphology of centrifuged blood cells was altered or hemolysis took place. The details are given in fulllength paper. Out of eight, details of four drugs arebeing given here

Diabetes mellitus in Saudi Arabia

Diabetes mellitus [DM] is a major public health problem worldwide, and it is a known risk factor for coronary artery disease [CAD]. New recommendations for the diagnosis of diabetes have changed the epidemiology of DM. Therefore, we designed this study with the objective to determine the prevalence of DM among Saudis of both sexes, between the ages of 30-70-years in rural as well as urban communities. This work is part of a major national project: Coronary Artery Disease in Saudis study [CADISS] that is designed to look at CAD and its risk factors in Saudi population. This study is a community-based national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70-years of selected households over a 5-year period between 1995 and 2000. Data were obtained from history, fasting plasma glucose levels, and body mass index. The data were analyzed to classify individuals as diabetic, impaired fasting glucose and normal, using 1997 American Diabetes Association [ADA] criteria, which was adopted by the World Health Organization [WHO] in 1998, to provide prevalence of DM in the Kingdom of Saudi Arabia [KSA]. A total of 17232 Saudi subjects were selected in the study, and 16917 participated [98.2% response rate]. Four thousand and four subjects [23.7%], out of 16917 were diagnosed to have DM. Thus, the overall prevalence of DM obtained from this study is 23.7% in KSA. The prevalence in males and females were 26.2% and 21.5% [p<0.00001]. The calculated age-adjusted prevalence for Saudi population for the year 2000 is 21.9%. Diabetes mellitus was more prevalent among Saudis living in urban areas of 25.5% compared to rural Saudis of 19.5% [p<0.00001]. Despite the readily available access to healthcare facilities in KSA, a large number of diabetics 1116 [27.9%] were unaware of having DM. The overall prevalence of DM in adults in KSA is 23.7%. A national prevention program at community level targeting high risk groups should be implemented sooner to prevent DM. We further recommend a longitudinal study to demonstrate the importance of modifying risk factors for the development of DM and reducing its prevalence in KSA