Prevalence of migraine in patients of allergic rhinitis

Background: Migraine and allergic rhinitis are common disorders. Studies have shown increased frequency of migraine headaches in patients with allergic rhinitis. The aim of this study is to identify how age, sex and degree of allergic sensitization influences the occurrence, severity and treatment outcome of migraine headaches in patients with allergic rhinitis.Methods: The study was conducted between 2014 and 2018 in a tertiary care hospital. 150 patients diagnosed with allergic rhinitis clinically were selected and total serum IgE levels were estimated. These patients were subjected to a detailed history taking to determine the characteristics of headache. All classifiable headache diagnoses had met criteria of the International Classification of Headache Disorders-II-2004. Severity of headache was assessed based on MIDAS score. The data was accessed based on age, sex, serum IgE levels, frequency and severity of migraine attacks and the treatment outcome using statistical methods.Results: The prevalence of migraine in this study was 68% among those who had allergic rhinitis. In this study out 150 patients 111 were females and 39 were males. Comparatively females’ patients 84 (75.7%) were found to be more prone for migraine. Majority patients were in the age group of 20 to 40 years (cumulative percentage of 67.3%). There was a negative correlation between age and IgE levels with r= -0.092. In comparison patients with higher levels of IgE (mean 3633) had more severe headaches. Patients with higher levels of IgE required a longer duration of treatment.Conclusions: This study shows that allergic rhinitis is a risk factor for development of migraine. Apart from high prevalence of migraine in patients with allergic rhinitis it is evident from the study that female sex, younger age group and high degree of allergic sensitization also play an important role as the severity of migraine and treatment course depend on these parameters. Hence the treatment for migraine in patients should aim at reducing the allergic sensitization in addition to concurrent treatment for migraine

Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia

Cardiovascular changes in patients presenting with vertigo

Background: The term dizziness often used to refer to a host of complaints which present in a similar manner. Of these vertigo is the most common. A thorough knowledge of cardiovascular changes that occur in subjects presenting with peripheral vertigo will help the treating medical practioner to promptly identify the cause of symptoms and prevent any confusion that may alter the course of treatment. The aim of this study to identify the changes in cardiovascular parameters that occur in patients with vertigo.Methods: Study was conducted at a tertiary care hospital during a period of two years during which 100 subjects where studied. Of these 50 where healthy adults which was taken as control group. Remaining 50 subjects where those who were admitted to hospital with a diagnosis of peripheral vertigo and termed as case group. Cardiovascular parameters where accessed in terms of pulse rate, rhythm, blood pressure and ECG Recordings among both the groups taken in static position and with 30 degree head tilt backwards and 45 degree angulation on either sides as is done during Dix-Hallpike’s maneuver immediately, after 3 minutes and 10 minutes of positioning the patient.Results: The study showed that there is no significant change in cardiovascular parameters in patients with vertigo when compared with healthy individuals in static position. Immediately following change in position of head there is sudden fall in pulse as well as blood pressure which then gradually comes back to baseline levels in healthy individuals. When there is a labyrinthine dysfunction in those who have hyper active labyrinth the pulse rate and Blood pressure increases sharply immediately after change in position then gradually comes back to baseline level. In hypo active labyrinth the pulse rate and blood pressure falls marginally compared to normal individuals and in dead labyrinths there is a significant fall in pulse rate and blood pressure immediately following change in position which then gradually reverts back to normal.Conclusions: From our study it is quite clear that there are considerable changes in cardiac parameters in patients presenting vertigo which should be kept in mind while evaluating the patients to prevent misdiagnosis. The study also proves a close coordination between vestibular system and central cardiovascular regulatory mechanisms during positional changes to maintain hemodynamic stability.

Smooth(er) Stellar Mass Maps in CANDELS: Constraints on the Longevity of Clumps in High-redshift Star-forming Galaxies

We perform a detailed analysis of the resolved colors and stellar populations of a complete sample of 323 star-forming galaxies at 0.5 < z < 1.5, and 326 star-forming galaxies at 1.5 < z < 2.5 in the ERS and CANDELS-Deep region of GOODS-South. Galaxies were selected to be more massive than 10^10 Msun and have specific star formation rates above 1/t_H. We model the 7-band optical ACS + near-IR WFC3 spectral energy distributions of individual bins of pixels, accounting simultaneously for the galaxy-integrated photometric constraints available over a longer wavelength range. We analyze variations in rest-frame color, stellar surface mass density, age, and extinction as a function of galactocentric radius and local surface brightness/density, and measure structural parameters on luminosity and stellar mass maps. We find evidence for redder colors, older stellar ages, and increased dust extinction in the nuclei of galaxies. Big star-forming clumps seen in star formation tracers are less prominent or even invisible on the inferred stellar mass distributions. Off-center clumps contribute up to ~20% to the integrated SFR, but only 7% or less to the integrated mass of all massive star-forming galaxies at z ~ 1 and z ~ 2, with the fractional contributions being a decreasing function of wavelength used to select the clumps. The stellar mass profiles tend to have smaller sizes and M20 coefficients, and higher concentration and Gini coefficients than the light distribution. Our results are consistent with an inside-out disk growth scenario with brief (100 - 200 Myr) episodic local enhancements in star formation superposed on the underlying disk. Alternatively, the young ages of off-center clumps may signal inward clump migration, provided this happens efficiently on the order of an orbital timescale.Comment: Accepted by The Astrophysical Journal, 27 pages, 1 table, 16 figure

No More Active Galactic Nuclei in Clumpy Disks Than in Smooth Galaxies at z~2 in CANDELS / 3D-HST

We use CANDELS imaging, 3D-HST spectroscopy, and Chandra X-ray data to investigate if active galactic nuclei (AGNs) are preferentially fueled by violent disk instabilities funneling gas into galaxy centers at 1.3<z<2.4. We select galaxies undergoing gravitational instabilities using the number of clumps and degree of patchiness as proxies. The CANDELS visual classification system is used to identify 44 clumpy disk galaxies, along with mass-matched comparison samples of smooth and intermediate morphology galaxies. We note that, despite being being mass-matched and having similar star formation rates, the smoother galaxies tend to be smaller disks with more prominent bulges compared to the clumpy galaxies. The lack of smooth extended disks is probably a general feature of the z~2 galaxy population, and means we cannot directly compare with the clumpy and smooth extended disks observed at lower redshift. We find that z~2 clumpy galaxies have slightly enhanced AGN fractions selected by integrated line ratios (in the mass-excitation method), but the spatially resolved line ratios indicate this is likely due to extended phenomena rather than nuclear AGNs. Meanwhile the X-ray data show that clumpy, smooth, and intermediate galaxies have nearly indistinguishable AGN fractions derived from both individual detections and stacked non-detections. The data demonstrate that AGN fueling modes at z~1.85 - whether violent disk instabilities or secular processes - are as efficient in smooth galaxies as they are in clumpy galaxies.Comment: ApJ accepted. 17 pages, 17 figure

A CANDELS - 3D-HST Synergy: Resolved Star Formation Patterns at 0.7 < z < 1.5

We analyze the resolved stellar populations of 473 massive star-forming galaxies at 0.7 < z < 1.5, with multi-wavelength broad-band imaging from CANDELS and Halpha surface brightness profiles at the same kiloparsec resolution from 3D-HST. Together, this unique data set sheds light on how the assembled stellar mass is distributed within galaxies, and where new stars are being formed. We find the Halpha morphologies to resemble more closely those observed in the ACS I band than in the WFC3 H band, especially for the larger systems. We next derive a novel prescription for Halpha dust corrections, which accounts for extra extinction towards HII regions. The prescription leads to consistent SFR estimates and reproduces the observed relation between the Halpha/UV luminosity ratio and visual extinction, both on a pixel-by-pixel and on a galaxy-integrated level. We find the surface density of star formation to correlate with the surface density of assembled stellar mass for spatially resolved regions within galaxies, akin to the so-called 'main sequence of star formation' established on a galaxy-integrated level. Deviations from this relation towards lower equivalent widths are found in the inner regions of galaxies. Clumps and spiral features, on the other hand, are associated with enhanced Halpha equivalent widths, bluer colors, and higher specific star formation rates compared to the underlying disk. Their Halpha/UV luminosity ratio is lower than that of the underlying disk, suggesting the ACS clump selection preferentially picks up those regions of elevated star formation activity that are the least obscured by dust. Our analysis emphasizes that monochromatic studies of galaxy structure can be severely limited by mass-to-light ratio variations due to dust and spatially inhomogeneous star formation histories.Comment: Accepted by The Astrophysical Journal, 18 pages, 1 table, 10 figure

Are Compton-Thick AGN the Missing Link Between Mergers and Black Hole Growth?

We examine the host morphologies of heavily obscured active galactic nuclei (AGNs) at z ~ 1 to test whether obscured super-massive black hole growth at this epoch is preferentially linked to galaxy mergers. Our sample consists of 154 obscured AGNs with N_H > 10^(23.5) cm^(-2) and z 1.5. Using visual classifications, we compare the morphologies of these AGNs to control samples of moderately obscured 10^(22) cm^(-2) < N_H < 10^(23.5)cm^(-2) and unobscured (N_H < 10^(22) cm^(-2)) AGN. These control AGNs have similar redshifts and intrinsic X-ray luminosities to our heavily obscured AGN. We find that heavily obscured AGNs are twice as likely to be hosted by late-type galaxies relative to unobscured AGNs (65.3_(-4.6)^(+4.1)%) versus 34.5_(-2.7)^(+2.9)%) and three times as likely to exhibit merger or interaction signatures (21.5_(-3.3)^(+4.2)%) versus 7.8_(-1.3)^(+1.9)%). The increased merger fraction is significant at the 3.8σ level. If we exclude all point sources and consider only extended hosts, we find that the correlation between the merger fraction and obscuration is still evident, although at a reduced statistical significance (2.5σ). The fact that we observe a different disk/spheroid fraction versus obscuration indicates that the viewing angle cannot be the only thing differentiating our three AGN samples, as a simple unification model would suggest. The increased fraction of disturbed morphologies with obscuration supports an evolutionary scenario, in which Compton-thick AGNs are a distinct phase of obscured super-massive black hole (SMBH) growth following a merger/interaction event. Our findings also suggest that some of the merger-triggered SMBH growth predicted by recent AGN fueling models may be hidden among the heavily obscured, Compton-thick population

Inspiralling Supermassive Black Holes: A New Signpost for Galaxy Mergers

We present a new technique for observationally identifying galaxy mergers spectroscopically rather than through host galaxy imaging. Our technique exploits the dynamics of supermassive black holes (SMBHs) powering active galactic nuclei (AGNs) in merger-remnant galaxies. Because structure in the universe is built up through galaxy mergers and nearly all galaxies host a central SMBH, some galaxies should possess two SMBHs near their centers as the result of a recent merger. These SMBHs spiral to the center of the resultant merger-remnant galaxy, and one or both of the SMBHs may power AGNs. Using the DEEP2 Galaxy Redshift Survey, we have examined 1881 red galaxies, of which 91 exhibit [O III] and Hbeta emission lines indicative of Seyfert 2 activity. Of these, 32 AGNs have [O III] emission-line redshifts significantly different from the redshifts of the host galaxies' stars, corresponding to velocity offsets of ~50 km/s to ~300 km/s. Two of these AGNs exhibit double-peaked [O III] emission lines, while the remaining 30 AGNs each exhibit a single set of velocity-offset [O III] emission lines. After exploring a variety of physical models for these velocity offsets, we argue that the most likely explanation is inspiralling SMBHs in merger-remnant galaxies. Based on this interpretation, we find that roughly half of the red galaxies hosting AGNs are also merger remnants, which implies that mergers may trigger AGN activity in red galaxies. The AGN velocity offsets we find imply a merger fraction of ~30% and a merger rate of ~3 mergers/Gyr for red galaxies at redshifts 0.34 < z < 0.82.Comment: 10 pages, 4 figures, published in ApJ. Modified from original version to reflect referee's comment