Clinical profile of recurrent headache in rural children of Rajasthan: A cross-sectional study

Context: Recurrent headache is a commonly encountered clinical entity in rural children. Aims: This study aims to record the clinical profile of recurrent headache in rural children of Rajasthan. Settings and Design: A cross-sectional, observational study in a pediatric outpatient department of a tertiary care teaching hospital. Methods and Materials: A total of 164 children of either sex, between 5 and 17 years of age, presenting with complaints of a recurrent headache were included in the study. All relevant clinical details collected from patients and their relatives were recorded in a structured pro forma. A detailed examination was performed to rule out underlying problems associated with a headache. Headache subtypes were classified according to the International Classification of Headache Disorders, 3rd edition beta, 2013. Pediatric migraine disability assessment test score and Faces pain rating scale were utilized to assess the disability and severity, respectively. Statistical analysis involved summarizing the continuous variables as mean and standard deviation while nominal/categorical variables were expressed as percentages. Results: The mean age was 11.5 years and the M:F ratio was 1:1.1. Adolescents in 13–17 years age group constituted 61.5% (n=101) of the study sample with 58.4% (n=59) female subjects. Primary headaches - tension-type headache (n=77, 46.9%), migraine (n=43, 26.2%), and new daily persistent headache (n=5, 3%) were observed in 125 (76.1%) cases. Common causes of secondary headache were somatization disorder (n=27, 16.5%), ophthalmic problems (n=7, 4.3%), medication overuse (n=3, 1.9%), intracranial tumor (n=1, 0.6), and postictal (n=1, 0.6). Conclusions: Recurrent headache in rural children has distinct etiological profile which mandates a meticulous evaluation for initiating appropriate management

Risk of intracranial meningioma in patients with acromegaly: a systematic review

Acromegaly is a rare endocrine disorder caused by hypersecretion of growth hormone (GH) from a pituitary adenoma. Elevated GH levels stimulate excess production of insulin-like growth factor 1 (IGF-1) which leads to the insidious onset of clinical manifestations. The most common primary central nervous system (CNS) tumors, meningiomas originate from the arachnoid layer of the meninges and are typically benign and slow-growing. Meningiomas are over twice as common in women as in men, with age-adjusted incidence (per 100,000 individuals) of 10.66 and 4.75, respectively. Several reports describe co-occurrence of meningiomas and acromegaly. We aimed to determine whether patients with acromegaly are at elevated risk for meningioma. Investigation of the literature showed that co-occurrence of a pituitary adenoma and a meningioma is a rare phenomenon, and the majority of cases involve GH-secreting adenomas. To the best of our knowledge, a systematic review examining the association between meningiomas and elevated GH levels (due to GH-secreting adenomas in acromegaly or exposure to exogenous GH) has never been conducted. The nature of the observed coexistence between acromegaly and meningioma -whether it reflects causation or mere co-association -is unclear, as is the pathophysiologic etiology.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022376998

Goals Or Means: How Psychological Distance Influences Depletion Effects

This paper examines how construal level influences the performance of consecutive self-control which requires sustained effort and is vulnerable to self-control resource depletion effect. We propose that at higher-level construals, individuals focus on self-relevant goals (e.g., one's health goal) and will allocate self-control resources to the second self-control task depending on the importance of the task to their goal. At lower-level construals, individuals attend to resource accessibility and will perform self-control based on their perceived fatigue involved in exerting self-control resource. In three experiments we test this proposition in the consumer health context and examine the underlying processes. [to cite]

Silicone-Induced Granuloma after Injection for Cosmetic Purposes: A Rare Entity of Calcitriol-Mediated Hypercalcemia

Hypercalcemia is often a clue to the presence of unsuspected illness. We present an interesting case of an HIV-positive transgender female with a rare cause of silicone-induced granulomatous hypercalcemia. Although there have been a few case reports of silicone injections in dialysis patients causing hypercalcemia, this metabolic derangement secondary to silicone granulomas continues to be a unique entity with an unclear pathophysiology. We present a 45-year-old transgender HIV-positive female, with extensive silicone injections who presented with symptomatic hypercalcemia. Workup for malignancy and hyperparathyroidism was negative. 1,25-Dihydroxyvitamin D level and 24-hour urine calcium level were elevated. CT scan showed extensive high-density reticulonodular densities in the buttocks and gluteal muscle fascia extending upwards to the lumbar region, along with prominent external iliac and inguinal lymph nodes. Nuclear imaging showed diffuse heterogeneity and increased uptake in the buttocks, most consistent with granuloma calcifications, and an inguinal lymph node biopsy confirmed a foreign body giant cell reaction. The patient was started on prednisone and this resulted in decrease in serum and urinary calcium levels. Physicians should have a high index of suspicion for silicone-induced hypercalcemia considering the growing prevalence of body contour enhancement with injections, implants, and fillers using this material

Dealing With Anxiety: How Effective Health Messages Undermine Self-Control

Health messages that convince consumers of their heightened risk also tend to increase anxiety. The current paper examines the deleterious consequences of such anxiety. We show that processing high versus low health risk messages enhances feelings of anxiety which impair subsequent self-control. Three studies document this effect, examine underlying processes, and identify the condition that overcomes this effect. Anxiety generated from health messages did not undermine subsequent healthful behaviors when the subsequent behaviors were related to the health message domain, because here individuals took a cognitive perspective and engaged in health practice as a way of reducing uncertainty. [to cite]

Health Messages: the Roles of Emotions and Type of Healthcare Advocacies

Healthcare messages can promote health behaviors to detect disease. Alternatively, healthcare messages can encourage behaviors to prevent disease. This research examines how emotions enhance or hinder the effectiveness of disease prevention or detection advocacies. Across several emotions and different health scenarios, we find converging evidence of the results. [to cite]

Emerging diagnostic methods and imaging modalities in cushing’s syndrome

Endogenous Cushing’s syndrome (CS) is a rare disease characterized by prolonged glucocorticoid excess. Timely diagnosis is critical to allow prompt treatment and limit long-term disease morbidity and risk for mortality. Traditional biochemical diagnostic modalities each have limitations and sensitivities and specificities that vary significantly with diagnostic cutoff values. Biochemical evaluation is particularly complex in patients whose hypercortisolemia fluctuates daily, often requiring repetition of tests to confirm or exclude disease, and when delineating CS from physiologic, nonneoplastic states of hypercortisolism. Lastly, traditional pituitary MRI may be negative in up to 60% of patients with adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas (termed “Cushing’s disease” [CD]) whereas false positive pituitary MRI findings may exist in patients with ectopic ACTH secretion. Thus, differentiating CD from ectopic ACTH secretion may necessitate dynamic testing or even invasive procedures such as bilateral inferior petrosal sinus sampling. Newer methods may relieve some of the diagnostic uncertainty in CS, providing a more definitive diagnosis prior to subjecting patients to additional imaging or invasive procedures. For example, a novel method of cortisol measurement in patients with CS is scalp hair analysis, a non-invasive method yielding cortisol and cortisone values representing long-term glucocorticoid exposure of the past months. Hair cortisol and cortisone have both shown to differentiate between CS patients and controls with a high sensitivity and specificity. Moreover, advances in imaging techniques may enhance detection of ACTH-secreting pituitary adenomas. While conventional pituitary MRI may fail to identify microadenomas in patients with CD, high-resolution 3T-MRI with 3D-spoiled gradient-echo sequence has thinner sections and superior soft-tissue contrast that can detect adenomas as small as 2 mm. Similarly, functional imaging may improve the identification of ACTH-secreting adenomas noninvasively; Gallium-68-tagged corticotropin-releasing hormone (CRH) combined with PET-CT can be used to detect CRH receptors, which are upregulated on corticotroph adenomas. This technique can delineate functionality of adenomas in patients with CD from patients with ectopic ACTH secretion and false positive pituitary lesions on MRI. Here, we review emerging methods and imaging modalities for the diagnosis of CS, discussing their diagnostic accuracy, strengths and limitations, and applicability to clinical practice.</p

OCIMUM KILIMANDSCHARICUM : A SYSTEMATIC REVIEW

The medicinal plants are widely used by the traditional medical practitioners for curing various diseases in their day to day practice. Ocimum is one of the most popular culinary herb known for its medicinal properties. The genus of Ocimum belongs to the family Labiatae. It includes at least 150 species and numerous cultivars. Ocimum kilimandscharicum Guerke is an aromatic under shrub with pubescent quadrangular branchlets. The leaves of Ocimum kilimandscharicum Guerke are acrid, thermogenic, aromatic, anti-bacterial, insecticidal, antiviral, appetizing, ophthalmic and deodorant. This review summarizes the most interesting studies on the various pharmacognosy and pharmacological works done on the Ocimum kilimandscharicum Guerk