The prevalence of headache disorders in children and adolescents in Mongolia: a nationwide schools-based study

Background The Global Campaign against Headache collects data from children (7–11 years) and adolescents (12–17 years) both to inform health and education policies and to contribute to the Global Burden of Disease (GBD) study. This survey in Mongolia was part of this global enquiry. Methods Following the generic protocol for the global enquiry, this was a schools-based cross-sectional survey. Self-completed structured questionnaires were administered, within classes, in seven schools in four districts of the Capital city and three rural areas of Mongolia, selected to represent the country’s diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache (UdH). Results Of 4515 potential participants, 4266 completed the questionnaire (children 2241 [52.5%], adolescents 2025 [47.5%]; males 2107 [49.4%], females 2159 [50.6%]). Children were therefore slightly over-represented, although overall mean age was 11.3 ± 3.3 years (range: 6–17; median 11). The non-participation proportion was 4.5%. Observed lifetime prevalence of headache was 81.0%. Gender- and age-adjusted 1-year prevalence was 59.4% (migraine: 27.3%; tension-type headache [TTH]: 16.1%; UdH: 6.6%; all headache on ≥15 days/month: 4.2%; probable medication-overuse headache: 0.7%). All headache types except UdH were more prevalent among females than males, and all were more prevalent among adolescents than children, although UdH represented a higher proportion of all headache in children (13.0%) than in adolescents (10.0%). Headache yesterday was reported by 15.9% of the sample, 26.0% of those with headache. Conclusions At least in adolescents, headache in Mongolia is no less common than in adults. The clear difference from similar studies in other countries was a lower prevalence of UdH, perhaps a consequence of reporting bias in a non-troublesome headache (mild and short-lasting by definition). This study informs policy in Mongolia and, with no similar study yet from elsewhere in Western Pacific Region, makes an important contribution to the global enquiry

Overview of diagnosis and management of paediatric headache. Part I: diagnosis

Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life

3-Phenyl-5-p-tolyl-4-(3,4,5-trimethoxy-benzylamino)-4H-1,2,4-triazole

WOS: 000185644100091In the title molecule, C25H25N4O3, the dihedral angles between the phenyl, p-tolyl and trimethoxybenzylamino rings and the triazole ring are 34.3 (1), 52.9 (1) and 59.5 (1)degrees. The crystal structure is stabilized by N-H...N and C-H...N interactions

TRANSHIATAL ESOPHAGECTOMY FOR ESOPHAGEAL-CARCINOMA

Between 1979 and 1990 transhiatal oesophagectomy and reconstruction with stomach was performed in 148 patients with carcinoma of the oesophagus. Ninety-seven patients were men and 51 were women; ages ranged from 21 to 88 years with a mean of 57.4 years. Dysphagia and weight loss were the usual clinical symptoms. The mean duration of symptoms was 14 weeks. Squamous cell carcinoma was present in 129 patients (87.2 per cent), 18 patients (12.2 per cent) had adenocarcinoma, and one had lymphoma (0.7 per cent). In two-thirds of the patients tumours were located in the middle thoracic (50 of 148 patients) or distal thoracic oesophagus (59 of 148 patients). Three-quarters of the patients had tumours determined as stage III. The mean length of hospital stay after operation was 12.8 days. Anastomotic leakage occurred in 15 cases (10.1 per cent). Pulmonary complications other than pneumothorax were observed in 36 cases (24.3 per cent). The 30-day postoperative mortality rate was 8.1 per cent (12 of 148 patients). Respiratory insufficiency was observed as the major cause of death (six of 12 patients). Mediastinitis due to necrosis of the transposed stomach in the mediastinum was the cause of death in three cases. Two-year actuarial survival rates in patients with cervical, upper, middle and lower thoracic tumours were 20, 22, 26 and 30 per cent respectively. Transhiatal oesophagectomy is safe and offers limited morbidity and mortality, although pulmonary complications and anastomotic leakage in the early postoperative period still pose a significant risk, especially for elderly patients in poor condition