Impact of trigger factors on clinical profile of migraine patients

Background: Migraine is a primary headache disorder. The study was designed to provide a better understanding of the potential role of triggers in the cause of migraine and their impact on its clinical profile and treatment protocol.Methods: A prospective study was conducted between June 2018 to May 2020 in 323 patients suffering from migraine in out-patient department of neurology. Patients were labelled as migraine on the basis of simplified diagnostic criteria for migraine. A structured questionnaire was used to interview patients about triggers and correlated with various clinical variables.Results: All patients had migraine without aura with males 30 (9.3%) and females 293 (90.7%). Episodic migraine found more than chronic daily headache. Trigger factors were present in 234 (72.4%) and absent in 89 (27.6%) patients. Common triggers were hot climate, emotional stress, lack of sleep and fasting. Common foods to precipitate an attack are tomatoes, cheese and collard greens. Mean duration of headache in patients with trigger factors is 5.67±4.99 years with a significant p value (p<0.02). Mean frequency of headache in trigger positive patients is 15.22±8.28 (days/month). Clinical symptoms significant in trigger positive patients are nausea (p<0.0001) (OR=3.94;95% CI=2.02-7.68),vomiting (p=0.0001) (OR=2.62;95% CI=1.50-4.59), photophobia (p<0.0001) (OR=2.69;95% CI=1.56-4.64), phonophobia (p<0.0001) (OR=5.16; 95% CI=2.54-47), pulsating headache (p=0.006) (OR=2.09; 95% CI=1.22-3.56), unilateral location (p<0.0001) (OR=2.88; 95% CI=1.74-4.77).Conclusions: Triggers are not easily modifiable, and avoiding triggers may not be realistic. Healthy life style like exercise, adequate sleep, stress management and eating regularly may prevent triggers and transformation to chronification over time

Dermatological adverse drug reactions with particular reference to Steven-Johnson syndrome and toxic epidermal necrolysis

Background: Drug therapy is an inevitable cause of cutaneous adverse reactions. Aims and Objectives: The primary aim was to identify the incidence and magnitude of various dermatological adverse reactions including Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Moreover, secondary aim was to quantify the risks associated with the use of specific medications. Materials and Methods: A prospective and hospital-based study was conducted in the department of dermatology SMHS hospital on hospitalized cases of cutaneous adverse drug reactions (CADRs). Informed consent was sought and reactions were reported on validated questionnaire based on adverse drug reaction (ADR) monitoring form provided by Central Drug Standard Control organization Ministry of Health and Family Welfare, Government of India. These dermatological reactions were assessed for the clinical pattern, causative agents, and prognosis. The WHO-Uppsala Monitoring centre system for standardized case was used for causality assessment of all cases identified. Results: A total of 101 hospitalized patients with varied dermatological ADRs were reported during the study period. Cases were found more in females (n=75, 74.25%) than in males (n=26, 25.75%). CADRs that were reported in our study were exanthematous rash, fixed drug eruptions, urticarial rashes, SJS, TEN, urticarial vasculitis, anticonvulsant hypersensitivity syndrome, erythema multiforme, contact dermatitis, exfoliative dermatitis, mucosal hyperpigmentation, and nail pigmentation, respectively. After a meticulous drug history, the drugs implicated in causing the cutaneous reactions were anticonvalscents such as phenytoin, carbamazepine, lamotrigine, and phenobarbitone. Other drugs identified were non-steroidal anti-inflammatory drugs such as oxicam, antibiotics such as sulfasalazine, cefixime, cefpodoxime, amoxicillin, fluoroquinolones such as levofloxacin and ciprofloxacin, chemotherapeutic agents such as cyclophosphamide, 5FU, and hydroxurea. Conclusion: The present study concluded that skin is most common target for ADRs. Drug-induced cutaneous reactions can be as simple as a mild rash to rare life-threatening SJS and TEN. Moreover, certain group of patients is at increased risk for developing CADR’s as women are more susceptible than men

Hoffmann's syndrome: a case report

This syndrome is characterized by the presence of hypothyroidism with myxoedema, muscle stiffness and pseudo hypertrophy. We describe the disorder in a 21 year old male, who got admitted with complaints of generalized weakness, cold intolerance, constipation, and hoarse voice, difficulty in walking and progressive enlargement of muscles of thighs and back with crampy pains for two years. Examination revealed mild mental retardation, enlarged tongue, dry and rough skin, enlargement of thighs and back muscles, motor weakness in flexors of hips and knees with delayed relaxation of deep tendon reflexes. Investigations revealed evidence of hypothyroidism with marked elevation of muscle enzymes. Following institution of replacement therapy with thyroxine, the patient showed marked clinical and biochemical improvements after six months, but insignificant decrease in muscle mass. In this report we review relevant literature

Genomic Determinants and Antimicrobial Resistance Pattern of Clinical Isolates of Extended Spectrum Beta Lactamase (ESBL) Producing Escherichia coli

The growing prevalence of antibiotic-resistant bacteria is a worldwide public health apprehension, and Escherichia coli (E. coli) is one of the most commonly implicated bacterial species. Among E. coli isolates, extended-spectrum β-lactamase (ESBL)-producing strains have been identified as a key contributor to antibiotic resistance. Penicillin’s, cephalosporins, and monobactams are only a few of the β-lactam antibiotics that can be rendered inactive by ESBLs. This investigation’s goals were to determine the prevalence of ESBL-producing E. coli isolates found in clinical samples and to analyze the distribution of the blaTEM, blaSHV, and blaCTX-M genes among them. Additionally, we aimed to determine the antibiotic susceptibility patterns of these isolates to other antibiotics. Clinical isolates from urine, ear swab, and wound/pus swabs were collected from patients with suspected E. coli bacterial infections from different regions of north India viz., SKIMS-JVC medical college and NABL accredited Dr. Qadri’s Lab both from Srinagar Kashmir valley region and SMSR, SU from Greater Noida UP. Standard laboratory techniques were used to identify E. coli isolates, and the combined disc method and other phenotypic confirmation techniques were used to confirm ESBL formation. PCR amplification and sequencing were used to find the blaTEM, blaSHV, and blaCTX-M genes. The Kirby-Bauer disc diffusion method was used to test the antimicrobial susceptibility of various bacteria to different antibiotics. A total of 210 E. coli isolates were collected from different clinical samples and only 158 isolates showed positive results for ESBL by DDST and phenotypic confirmatory tests. Of these, 124 (78.48%) were ESBL-producing isolates. We found that blaTEM was the most prevalent gene (45.16%), followed by blaCTX-M (34.16%) and blaSHV (12.09%). Antimicrobial resistance profiles were assessed for each of the 120 isolates. Ampicillin and Cefepime were the most resistant drugs to ESBL-producing isolates, followed by Gentamicin, Ceftriaxone, and Cefixime

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Efficacy of bacteriophage Lysed Pasteurella marker vaccine in laboratory animal models with a novel DIVA for haemorrhagic septicaemia

Objective: The present study aimed at evaluating the efficacy of an improved phage lysate marker vaccine for haemorrhagic septicaemia in mice and rabbit model and development of a DIVA ELISA based on iron restricted outer membrane protein (IROMP). Method: The experimental vaccine was prepared by lysing P. multocida B:2 grown under iron restricted conditions with a Pasteurella bacteriophage and addition of an alum adjuvant to enhance the immunogenicity. The vaccine was administered in mice and rabbits divided into two group each. Phage lysate vaccine (PL-VacI) was administered to group I mice and rabbits whereas group II mice and rabbits received alum precipitated HS vaccine (HS-VacII). Antibody titres were monitored 0, 30, 60, 90, 210 and 240 dpv. An IROMP (130 kDa) based indirect ELISA was also developed to differentiate between infected and vaccinated animals. The Pasteurella phage isolated in present study was sequenced at Georgia Genomic Facilty, Georgia. Result: The sequence of PMP-GAD-IND (Pasteurella bacteriophage) was deposited in GenBank under no KY203335. The group I mice and rabbits vaccinated with Phage lysate vaccine (PL-VacI) group revealed significantly higher antibody titres than group II mice and rabbits receiving alum-precipitated bacterin (HS-VacII) by MAT, IHA and ELISA (P < 0.05 and P < 0.001). The peak log 10 values (3.46) in case of group I mice by ELISA were attained at 90DPI whereas in group II mice the peak values at 90DPI were 2.82. Mean log10 titres by ELISA in group I and II rabbits were 2.43 and 2.35 respectively at 30DPI whereas at 120DPI the titres were 3.29 and 2.75, respectively. The DIVA ELISA detected presence of a novel 137 kDa IROMP/siderophore antibody in sera of group I mice and rabbits (PL-VacI) absent in sera of mice and rabbits given HS-VacII. Conclusion: The bacteriophage based marker vaccine (PL-VacI) had a more effective and longer immune response against HS in mice and rabbit in comparison to the widely used alum precipitated HS vaccine (HS-VacII). Moreover, the development of a recombinant IROMP based indirect ELISA could serve as an excellent tool to differentiate between infected and vaccinated cattle and buffaloes for effective control of HS. Keywords: Haemorrhagic septicaemia, P. multocida, Mice, Rabbits bacteriophage, IROMP(s), DIVA, Marker vaccine, Alum precipitated HS vaccin

Estimation of titers of antibody against Pasteurella multocida in cattle vaccinated with haemorrhagic septicemia alum precipitated vaccine

Aim: The present study was carried out in 100 cattle to assess the antibody response to Haemorrhagic Septicaemia alum precipitated vaccine by Microtiter Agglutination Test (MAT), Indirect Haemaaglutination Assay (IHA) and Monoclonal Antibody based Indirect Enzyme Linked Immunosorbent Assay (ELISA). Materials and Methods: One hundred cattle from a local gaushala of Ludhiana were vaccinated with alum precipitated Haemorrhagic Septicaemia vaccine. Serum was collected at 0, 42, 84 and 128 days post immunization and antibody titers at different stages were estimated by MAT, IHA and ELISA. Results: The animals exhibited the classical pattern of humoral immune response with gradual increase and achievement of peak antibody titers plateau by 42DPI and gradual decline by 128 DPI. The IHA titers in cattle were significantly higher (P<0.05) at 42 days post immunization than the corresponding MAT titers on the same day. ELISA titers were significantly higher (P<0.05) than MAT and IHA titers at 42 DPI. IHA was found to be more sensitive than MAT, and the titers were higher by ELISA than by MAT and IHA throughout the observation period. Conclusion: The results indicate that animals vaccinated with commercial alum precipitated HS vaccine could not develop and sustain adequate levels of antibody for long duration

Antibacterial Activity of Some Medicinal Plants of Kashmir, J&K, India

The study was conducted to find out the activity of some medicinal plants against bacterial isolates. The bacterial isolates from milk samples of infected quarters of cows were investigated for in-vitro drug sensitivity by standard disc diffusion technique (Bauer et al., 1966). Cultural examination of milk samples was done by method described by Quin et al. (2004) in which predominant isolates were Staph. (55.55%), E. coli (22.22%), Strepto. agalactiae (16.66%) and other isolates as 5.5% and were subjected to in-vitro antibacterial sensitivity test to selected herbal extracts and standard antibiotic (cefuroxime) (Table-1). The four different aqueous concentrations of the herbs namely Fumaria indica, Adiantum capillus, Nepata cataria, Levandula stoeches and Borago officinalis collected from registered herbal shops prepared by standard procedure as 25mg/ml, 50mg/ml, 75mg/ml and 100mg/ml were used. The results indicated that aqueous extract of Fumaria indica, Adiantum capillus and Napeta cataria against Staphylococcus aureus, E.coli, Streptococcus agalactia and K. pneumonia exhibited maximum zone of inhibition 20.0±1.21, 21.0±0.19, 13.0±0.37 17.0±0.21; 18±0.41, 12±0.21, 13±0.31, 15±0.31 and 15±0.33, 16.01±0.19 14.09±0.37, 13.31±0.41 at 100 mg/ml respectively which was significantly low as compared to standard drug (cefuroxime) at 30 microgram concentration. Aqueous extract of Levandula stoeches against Staphylococcus aureus and E.coli exhibited maximum zone of inhibition 18.0±0.33 and 13.0±0.141 at 100 mg/ml respectively. Borago officinalis has shown nil to non-significant bacterial growth inhibition activity

Dual versus Monotherapy in the Prophylaxis of Acute and Chronic Migraine

Migraine, a primary headache disorder, is a debilitating condition with reduced productivity, increased disability, and a very high economic burden. The present study aimed to individualize the treatment protocols for episodic and chronic migraine in order to reduce the duration, frequency, and severity of attacks, as well as the disability associated with migraine by comparing monotherapy and dual therapy

Short Variable Regions flaA Gene (SVR-flaA) Diversity and Virulence Profile of Multidrug−Resistant Campylobacter from Poultry and Poultry Meat in India

Human gastrointestinal infections caused by Campylobacter species is the second most important foodborne illness after salmonellosis worldwide. Poultry represent one of the main sources of Campylobacter organisms. In the present study, the short variable region of flagellin gene (SVR-flaA) typing was carried out to determine the variation among the circulating strains of Campylobacter jejuni and Campylobacter coli. The C. jejuni and C. coli isolated from poultry and poultry meat were screened for the presence of virulence determinants like cadF, flaA, cdtB, and wlaN gene. The screening for wlaN gene is crucial in view of the fact that most patients with Guillian Barre’s (GB) syndrome with a preceding history of diarrheal illness have been found to harbor wlaN gene−positive C jejuni strains. Out of the 200 samples comprising poultry meat and cloacal swabs, 21.5% of samples were found to harbor Campylobacter spp. of which 2.5% were Campylobacter jejuni, and 19% were confirmed as Campylobacter coli. The cadF, flaA, cdtB virulence genes were detected in all the Campylobacter spp. isolated in the present study. The presence of the wlaN gene in the Campylobacter jejuni isolated in the present study may pose a public health threat with long−term human health implications. The SVR-flaA typing of twelve Campylobacter isolates obtained in the present study revealed that Campylobacter coli flaA sequence OL471375 is a new strain with a novel allele type 1,675 and peptide sequence 5 which stands deposited in pubMLST database for Campylobacter. The other flaA-SVR gene sequences identified in this study were OL471369, OL471370, OL471371, OL471372, OL471373, and OL471374. Among twelve Campylobacter spp., three distinct DdeI-RFLP patterns were observed, each varying in size from 100 to 1,000 base pairs. Antimicrobial profiling of the Campylobacter spp. isolated in the present study revealed that 50% of the strains were multidrug resistant. All the Campylobacter spp. were resistant to ciprofloxacin (CIP), ampicillin (AMP), penicillin (PEN), and nalidixic acid (NAL) whereas 57.1% of strains were resistant to tetracycline (TET) and erythromycin (ERY) 28% to amoxicillin (AMX) and enrofloxacin (ENO), 85% to amikacin (AMK). The high degree of resistance to fluoroquinolones observed in the present study is crucial in view of fluoroquinolones being drugs of choice for the treatment of human Campylobacter infections