Prevalence of headache in Kashmir Valley, India

Background: Headache disorders represent a major public health problem globally. It is more so in developing countries with rising trend in young adults affecting negatively their quality of life. There has been very little information on the epidemiology of headache disorder in Kashmir India which has witnessed prolonged and large scale militancy related disturbance. A prospective population based study was undertaken in Srinagar district of Kashmir to determine the prevalence of headache disorder. Methods: The study was a cross sectional survey using cluster sampling with a culturally adapted version of pretested questionnaire translated into local language, in Hazratbal Community Block of Srinagar. In the first phase households were screened. Individuals with headache were then examined by a senior neurologist for migraine and non migraine disorder. Results: The overall prevalence of headache was 66.2 % with female preponderance. Occurrence of headache was as high as 79.90 % in adults of 19-45 years. The prevalence rate declined after the age of 45 years in both the genders. Women had higher prevalence rate than men in all age groups and for all headache categories. Age distribution showed prevalence rate of migraine of 45.69% in young adults of 19-45 years; females 55.44% and males 32.79 %. Non migraine headache was more common than migraine type, and was more prevalent in young age group in both the genders, highest in adolescents (74.20 %). Conclusion: The high prevalence rate of headache both migrainous and non migrainous in Kashmir may be related to the stress the community has been subjected to from militancy related conflict since 1990.

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.

Clinico-radiological profi le of strokes in Kashmir valley, North-West India: A study from a university hospital

Background: Globally, ischemic stroke outnumber hemorrhagic strokes. However, it was observed that hemorrhagic stroke is more common in Kashmir valley. The present study was conducted to substantiate this notion, and to identify the possible risk factors. Methods: This prospective study was conducted on 6,906 patients with fi rst ever stroke admitted to S. M. H. S. Hospital, an associated teaching hospital of the Government Medical College, Kashmir, from January 1996 to June 2009. Other than clinical history, examination and routine biochemistry, cranial CT scan (non-contrast) was performed in all the cases within three days of the stroke onset. MRI brain, CSF analysis, screening for cardiovascular disorders, prothrombotic states and collagen profi le were performed wherever deemed necessary. Results: There was predilection of stroke among the males and rural population. Eighty three percent of patients developed fi rst-ever stroke in sixth and seventh decade. Fifty four percent of cases had a Glasgow coma score of >10 on admission. Intracerebral hemorrhage was observed in 64.7% patients with male preponderance. Putamen (53.5%) was the most common, site of hemorrhage, followed by thalamus (29.7%). Hypertension, smoking and multiple risk factors were observed in 92.3%, 70.3% and 67.9% cases respectively. Poor antihypertensive medication compliance was observed in 55.9% cases. Conclusions: Intracerebral hemorrhage was the commonest stroke-type observed in Kashmir accounting for close to two third of strokes with male preponderance.

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.

Comparison of locally available gum in co-trimoxazole test formulation with standard formulation: in vitro and in-vivo evaluation

The six commercially available gums were selected and on the basis of solubility, swelling, odour, sedimentation and fungal growth, the gum tragacanth, Acacia and almond gum were considered for further study Aqueous solution of 4%, 5% and 6% of each selected gum were prepared and rheograms were drawn.Almond gum was found to be good in the physical characteristics as well as on theology basis, so it was incorporated as a suspending agent in co-trimoxazole suspension instead of synthetic suspending agent. Thereby, compared with three brands of well known co-trimoxazole suspension. The pH of three bands and test formulation was found to be within the range. The viscosity of test formulation was observed to be greater than Bactipront and comparable with Bactrim and Septran.In sedimentation study test formulation was found to be best because it did not showed any separation. For stability evaluation, viscosity measurement was carried on at 28oC, 40oC and 50C for fifteen days. All the products showed decrease in viscosity at 40oC and 50C but test formulation decrease in viscosity was less than Bactipront and Septran.For in vivo comparison the bidavailability parameters, time to reach peak plasma concentration, the first moment of plasma concentration time curve, absorption half life and mean residence time of formulation III were similar statistically with formulation I but peak plasma concentration. Area under the curve and Absorption rate constant of formulation III were statistically different with formulation I. When formulation III was compared with formulation II it was seems to be similar in all bioavailability parameters except peak plasma concentration.For in vivo comparison the bidavailability parameters, time to reach peak plasma concentration, the first moment of plasma concentration time curve, absorption half life and mean residence time of formulation III were similar statistically with formulation I but peak plasma concentration. Area under the curve and Absorption rate constant of formulation III were statistically different with formulation I. When formulation III was compared with formulation II it was seems to be similar in all bioavailability parameters except peak plasma concentration.In case of disposition parameters the values of formulation 111 were statistically similar with formulation I in all the parameters like elimination half life, the elimination rate constant, zero time plasma concentration, apparent volume of distribution and total body clearance. When formulation III was compared with formulation II the value of elimination half life and apparent volume of distribution were found to be similar, while there was statistically difference in the elimination rate constant, zero time plasma concentration, and the total body clearance values