Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort.

BACKGROUND AND PURPOSE: Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS: This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS: In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS: Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.

Delayed auditory conduction in diabetes: is metformin-induced vitamin B12 deficiency responsible?

The present study aims to evaluate the functional integrity of the auditory pathway in patients with diabetes taking metformin. A further aim is to assess its association with vitamin B12 deficiency induced by metformin. Thirty diabetics taking metformin and 30 age-matched non-diabetic controls were enrolled. Stimulus-related potentials and vitamin B12 levels were evaluated in all the subjects. The diabetics showed deficient vitamin B12 levels and delayed wave III latency and III-V interpeak latency in the right ear and delayed Na and Pa wave latencies in the left ear compared with the controls. The dose and duration of metformin showed no association with the stimulusrelated potentials. Therefore, although vitamin B12 levels were deficient and auditory conduction impairment was present in the diabetics on metformin, this impairment cannot be attributed to the vitamin B12 deficiency.

Pulmonary Functions, Oxidative Stress and DNA Damage in Workers of a Copper Processing Industry.

BACKGROUND: Occupational exposure to excessive level of copper results in many adverse health effects. OBJECTIVE: To measure pulmonary function, oxidative stress, and extent of DNA damage in workers of a copper processing industry. METHODS: 30 men working in a copper processing industry and 30 men matched for age and socioeconomic status (comparison group) were included in this study. Pulmonary function test parameters were measured for all participants. Serum malondialdehyde (MDA), ferric reducing ability of plasma (FRAP), glutathione (GSH) content in RBCs and 8-OHdG were assayed by ELISA. Extent of DNA damage in leucocytes was assayed by comet assay. RESULTS: Pulmonary function parameters, FVC, FEV1, PEFR, and MVV measured in workers were significantly (p<0.05) lower than those observed in the comparison group. Compared to the comparison group, MDA was significantly (p=0.002) increased in studied workers; TAOC (p=0.017), and GSH (p=0.020) were significantly lower in workers than the comparison group. There was significant DNA damage in leucocytes in workers compared to the comparison group (difference in olive tail moment p<0.001). PEFR, FEF25-75%, and MEF50% were negatively correlated with MDA. CONCLUSION: The observed DNA damage would be due to increased oxidative stress resulting from excessive exposure to copper.

Microbial biotransformation: a tool for drug designing (Review).

For centuries microbial biotransformation has proved to be an imperative tool in alleviating the production of various chemicals used in food, pharmaceutical, agrochemical and other industries. In the field of phar- maceutical research and development, biotransformation studies have been extensively applied to investigate the metabolism of compounds (leads, lead candidates, etc.) using animal models. The microbial biotransfor- mation phenomenon is then commonly employed in comparing metabolic pathways of drugs and scaling up the metabolites of interest discovered in these animal models for further pharmacological and toxicological evaluation. Microorganisms can conveniently afford drugs difficult obtained via synthesis. The plethora of reported microbial biotransformations along with its added benefits has already invoked further research in bioconversion of novel and structurally complex drugs. This review alternatively discusses the prospect of microbial biotransformation studies as a significant element ameliorating drug discovery and design in terms of cost-effectiveness, environment protection and greater structural diversity as compared to animal models used to study metabolism. To explicate the microbial biotransformation paradigm in drug designing 3 main areas in this aspect have been analyzed: 1--lead expansion: obtaining pharmacologically improved metabo- lites from bioactive molecules; 2--biosynthesis of precursors/intermediates involved in the production of bioactive molecules; 3--resolution of racemic mixture to obtain enantiomers possessing different pharma- cological profiles.

Pulmonary dysfunctions, oxidative stress and DNA damage in brick kiln workers.

Brick kilns in the suburban areas in developing countries pose a big threat to the environment and hence the health of their workers and people residing around them. The present study was planned to assess the lung functions, oxidative stress parameters and DNA damage in brick kiln workers. A total of 31 male subjects working in brick kiln, and 32 age, sex and socioeconomic status matched controls were included in the study. The lung volumes, capacities and flow rates, namely, forced expiratory volume in first second (FEV(1)), forced vital capacity (FVC), FEV(1)/FVC, expiratory reserve volume, inspiratory capacity (IC), maximal expiratory flow when 50% of FVC is remaining to be expired, maximum voluntary ventilation, peak expiratory flow rate and vital capacity were significantly decreased in the brick kiln workers. Increased oxidative stress as evidenced by increased malonedialdehyde levels and reduced glutathione content, glutathione S-transferase activity and ferric reducing ability of plasma were observed in the study group when compared with controls. Our results indicate a significant correlation between oxidative stress parameters and pulmonary dysfunction, which may be due to silica-induced oxidative stress and resulting lung damage.

Stress, autonomic reactivity and blood pressure among undergraduate medical students.

INTRODUCTION: Medical training is highly stressful particularly for those who are beginning their medical education. The present study was undertaken to find out the level of stress, hypertension and its etiological factors among undergraduate medical students. METHOD: One hundred and seventeen undergraduate medical students between 17-21 years of age got examined for blood pressure and stress level. Twelve hypertensives selected from the above subjects and twenty normotensives underwent cold pressure test to assess autonomic reactivity to laboratory induced stress. RESULTS: 10.25% of the subjects were found to be hypertensive and 6.83% pre hypertensive. On the stress scale 53% had mild stress, 7% showed moderate stress while none had stress as a major problem. There was no correlation between BP and stress score. On CPT, BP increased significantly in both the hypertensive and normotensive group but came back to basal levels within 5 minutes indicating normal autonomic response. Rise of BP was higher in hypertensive group. The diastolic and mean BP increased significantly on CPT in subjects having family history of hypertension. The subjects taking more of junk and oily foods had a higher systolic BP. Forty percent of normotensive subjects had more than 20 mm Hg rise in systolic BP on CPT. CONCLUSIONS: Adolescents must be routinely screened to detect asymptomatic hypertension. Advice on risk factor modification by appropriate lifestyle changes may prevent long term effects of hypertension on target organs.

The role of DSC1 components cdc10+, rep1+ and rep2+ in MCB gene transcription at the mitotic G1-S boundary in fission yeast.

In this paper, we describe the transcription profile of a group of genes at the G1-S boundary of fission yeast in synchronously dividing mitotic cells, under a variety of different conditions. This transcription profile is unaffected in cells where either cdc10+ or cdc10-C4 are constitutively overexpressed. In contrast, overexpression of either rep1+ or rep2+ results in constitutive expression of MCB-regulated genes, suggesting that these polypeptides have important regulatory properties in controlling MCB transcription. Finally, we examine the pattern of MCB-regulated transcription in cells where the G1 period is extended. Surprisingly, we find that the wee1-50 mutation causes MCB transcription throughout the cell cycle, whereas cells re-fed after nitrogen starvation have normal expression patterns. The implications of these observations for understanding MCB-regulated transcription are discussed.

Auditory evoked potential responses in menopausal women: a normative study.

Three types of auditory evoked potential responses i.e. auditory brainstem response (ABR), middle latency response (MLR) and slow vertex response (SVR) were studied in 22 post-menopausal Indian women to have a normative value for each response. Recordings were done on computerised evoked potential recorder using 10/20 system of electrode placement and standard click stimuli. The results were comparable with similar studies done in the western world indicating that there is no ethnic variation in evoked potential responses. The latencies of ABR waves showed an increase in menopausal females when compared with young adults indicating a delay in neural transmission which might be due to changed hormonal milieu of sex hormones after menopause. The normative values of MLR and SVR which represent the thalamo-cortical and cortical auditory projections are being reported in Indian menopausal women for the first time.

Study of serum lipid and lipoprotein in pre-eclampsia with special reference to parity.

A cross sectional study was done to determine serum lipid and lipoprotein cholesterol in pre-eclamptic women in their third trimester, taking normal pregnant women in third trimester as controls. The values were compared in patients of different parity. It was observed that serum triglycerides (TG), cholesterol (Chol), LDL-c, VLDL-c, phospholipids (PL) and total lipids (TL) were significantly raised, while HDL-c, was significantly lower in pre-eclampsia compared to normal pregnancy. TG and VLDL-c were found to be increased significantly with parity.

Thyroid functions in pre-eclampsia and its correlation with maternal age, parity, severity of blood pressure and serum albumin.

Maternal thyroid function was investigated in 32 pre-eclamptic women and 10 normal pregnant women in their third trimester. Serum total tri-iodothyronine (TT3) and total thyroxine (TT4) were decreased significantly (P < 0.001) and TSH was increased significantly (P < .001) in pre-eclampsia as compared to normal pregnancy. There was no influence of parity and maternal age on thyroid functions. TT3 and TT4 decreased significantly (P < .001) with increase of serum albumin, while there was no correlation of TT4 with serum albumin.