Effect of Migraine Headache on Productivity of Patients According to Migraine Disability Assessment Score: A Cross-Sectional Study.

INTRODUCTION: Migraine, a primary headache disorder, is usually recurrent with moderate to severe intensity. Migraine is the third most common cause of disability under the age of 50. There are various scoring systems for assessing this disability, one of which is MIDAS; the Migraine Disability Assessment Score. The objective of our study was to determine the extent of disability among migraine patients, patterns of prophylaxis, and their healthcare-seeking behaviors. METHODS: This survey was done in 50 migraine patients at Jinnah postgraduate medical Centre from April to May 2018. The questionnaire inquired about the demographic information, management of migraine, and effect of this condition on their sleep, and the last part had assessment to know about their functional disability. RESULTS: The majority of the patients were females with a mean age of 31 ± 10 years. Acetaminophen was the most common medication used during a migraine attack, followed by nonsteroidal anti-inflammatory drugs. Only 54% of subjects admitted using prophylaxis, out of which 94% had stopped taking it after some time, with the most common reason being their side effects. ß-blockers were the most common prophylaxis used. Only 32% had a regular follow-up visit with their doctors. Patients were graded according to the MIDAS score as: little or no disability, 22%; mild disability, 14%; moderate disability, 24%; and severe disability, 40%. CONCLUSIONS: The majority of migraine patients were found to have severe disability, which affected their daily work and social activities. Despite an increase in disability rate due to migraine, people do not seek regular medical care for this type of headache in Pakistan.

Etiologic patterns of ischaemic stroke in young adults.

OBJECTIVE: To determine the etiologic patterns of ischaemic stroke in young adults. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2010. METHODOLOGY: All ischaemic stroke patients aged 15 - 45 years were included. The etiologic patterns were classified using TOAST (Trial of ORG 10172 in acute ischaemic stroke) classification and comparisons were made between different stroke subtypes with reference to traditional risk factors like age, smoking, hypertension, diabetes mellitus and dyslipidemia. Results were described in percentages. RESULTS: There were 75 cases and higher proportion of patients had ischaemic stroke due to cardiac etiology below the age of 35 years. Nineteen patients had cardioembolic stroke [8 (42.1%) males and 11 (57.9%) females]; 15 patients had large artery atherosclerosis [males 9 (60%), females 6 (40%)]; 17 patients had stroke of determined etiology (SDE), [6 (35.2%) males and 11 (64.8%) females] among whom 47% were due to venous sinus thrombosis. Twelve patients had stroke of undetermined etiology (SUE), [5 (41.6%) males and 7 (58.4%) females] and 12 patients had stroke due to small vessel disease (SVD) [8 males (66.7%) and 4 (33.3%) females. CONCLUSION: Cardioembolism, venous sinus thrombosis and premature atherosclerosis are common etiologies in young patients with acute ischaemic stroke.

Randomized controlled trial to compare the efficacy and safety of oral paricalcitol with oral calcitriol in dialysis patients with secondary hyperparathyroidism.

AIM: The objective of the study was to compare the efficacy and safety of oral paricalcitol with oral calcitriol for treating secondary hyperparathyroidism. METHODS: We conducted the first multicenter open-labelled parallel group randomized controlled trial in 66 patients on dialysis. Patients were randomized to paricalcitol or calcitriol at a 3:1 dose ratio and adjusted to maintain intact parathyroid hormone (iPTH) level between 150-300 pg/mL, serum calcium ≤2.74 mmol/L and calcium-phosphate product ≤5.63 mmol(2) /L(2). The primary end point was the proportion of patients who achieved >30% reduction in iPTH. RESULTS: At 24 weeks, 22 (61.1%) patients in the paricalcitol and 22 (73.3%) in the calcitriol group had achieved the primary end-point (P-value = 0.29). The cumulative proportion of patients who achieved the end-point at 6 weeks, 12 weeks and 24 weeks were 50%, 80.6% and 86.1%, respectively, in paricalcitol and 53.3%, 86.7% and 86.7%, respectively, in the calcitriol group (P-value = 0.67). Median time to the end-point was 6 weeks in both groups. There were no significant differences in iPTH level at any time during the study. The median reduction in iPTH at 24 weeks was 48.4% in the paricalcitol group and 41.9% in the calcitriol group (P-value = 0.6). The median maximal iPTH reduction was 77.1% (paricalcitol) and 83.7% (calcitriol), P-value = 0.3. Serum calcium and incidence of hypercalcaemia did not differ between groups. 16.7% of patients in both groups had at least one episode of hypercalcaemia (serum calcium >2.74 mmol/L). Other adverse events were similar between groups. CONCLUSION: Our study suggests that oral paricalcitol has similar efficacy and safety to oral calcitriol.

Frequency of QTc prolongation in patients with hemorrhagic stroke.

BACKGROUND: Acute cerebral events play an important role in generating autonomic imbalance especially cardiac rhythm disturbances. This forms the basis of significant lethal abnormalities of heart rate and rhythm like QTc prolongation, ventricular fibrillation, asystole, and ultimately death. This study was conducted to determine the frequency of QTc prolongation in patients presenting with acute haemorrhagic stroke at a tertiary care hospital. METHODS: This descriptive case series was conducted at Medical Unit-I, ward-5, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from 13 October, 2009 to 12 April, 2010. Patients of either gender and age > 18 years who presented within 48 hours of onset of acute hemorrhagic stroke for the first time, confirmed by computerized tomography (CT) scan of brain were included. A 12 lead electrocardiogram (ECG) was performed. Lead III and VI were used for this due to their importance in this aspect. QTc was then calculated by using Bazetts formula. Data was analysed using SPSS-12. RESULTS: Among 95 patients of acute haemorrhagic stroke, 48 (50.5%) had prolonged QTc in lead III, 47 (49.5%) had prolonged QTc in lead VI. The average QTc interval in lead III was 440.4 +/- 45.2 (Range = 364-571). Proportion of prolonged QTc in lead III was higher in males than females. Frequency of QTc III prolongation was higher in comparatively younger age groups than older age groups. CONCLUSION: The frequency of prolonged QTc interval among patients of acute hemorrhagic stroke is alarmingly higher in our setup. Prolonged QTc is a useful predictor of impending clinical deterioration and provide an opportunity for early intervention to reduce severe loss like mortality.

Malarial hepatopathy in falciparum malaria.

OBJECTIVE: To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: This study was conducted at Medical Unit-I (Ward 5), Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. METHODOLOGY: A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease (e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice) was excluded on the basis of history, relevant clinical examination and investigations. RESULTS: Age of the patients ranged from 13-48 years (mean 26.04+/-8.33). All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two (51.6%) had serum bilirubin 3-6 mg%, 20 (32.2%) had 6-10 mg% and 10 (16.1%) had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients (45%) had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 (35.4%), splenomegaly in 48 (77.4%) and both hepatomegaly and splenomegaly in 16 (25.8%). Gallbladder wall thickness was increased in 5 (8.06%) patients. There was no evidence of biliary dilatation. CONCLUSION: A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given.