The importance of HbA1C test in prediabetes with special reference to Purvarupavastha of Prameha-A literary review

Diabetes mellitus is a metabolic disorder causing hyperglycaemia with defect in metabolism of carbohydrates, fats, and proteins due to defect in insulin secretion, or its utilization or both. Prediabetes is a condition in which the blood glucose levels do not meet the criteria for diabetes or too high to be considered normal (ADA). It is an early stage of DM. So it is important to diagnose Diabetes Mellitus type 2 in the previous stage that is prediabetes. It is already in practice to diagnose it with laboratory blood tests. But additionally, we can also take help of Prameha purvarupas as premonitory symptoms in patients prediabetes. HbA1C is a useful parameter to diagnose prediabetes. There is mild or no symptoms mentioned for prediabetes. Purvarupas of Prameha mentioned in Ayurvedic samhitas can be useful to know early stage of Diabetes mellitus type 2, clinically. The purpose of this article is to highlight the importance of Purvarupa of Prameha to diagnose prediabetes. So, the need of hour is to focus on screening and diagnosing pre-Diabetes earlier, by spreading knowledge and awareness among society which will play a key role to reduce the conversion of pre-diabetes to diabetes mellitus.

Reliability Assessment in Wireless Apparatus Using LoRa and Sigfox in Catch Basin

The importance of preventing damage from pluvial flooding has been increasing under global climate change. The discovery of premonitory symptoms of pluvial flooding enables effective evacuation and inundation prevention activities. However, apparatuses that automatically detect this in real time are not widespread. There are difficulties in the cost of installing them and the agreements made by the parties concerned, especially in cities. To solve this problem, we devised an apparatus to be installed inside a catch basin that detects its water level. The water level in the catch basin may indicate a sign of pluvial flooding, and the number of people involved in operating the catch basin is smaller than that of facilities on the ground. In order to reduce the cost of installation and operation, we adopted Low Power Wide Area (LPWA), which is a communication method that enables wireless transmission of detected information over long distances for a long time using batteries. So far, for catch basins, a wireless transmission experiment was conducted using LoRa, which is part of LPWA. However, Sigfox, which uses the same frequency as LoRa but has a different wireless system, has not been verified. In this study, the reliability of wireless communication was assessed by apparatuses using LoRa and Sigfox side by side in each catch basin in two places in a densely populated city. The number of experiment days and transmissions differed depending on the apparatus, with the number of days ranging from 97–151 and the number of transmissions from 2328–3748. The reliability in the experiment ranged from 99.97–99.53%. The experimental results showed that wireless transmission was possible with high reliability using either the LoRa or Sigfox system from inside these catch basins. This study expands the options for communication infrastructure that can be used for apparatuses that detect premonitory symptoms of pluvial flooding. This will enable a reduction in installation costs and will expand the range of areas of potential installation.

Premonitory symptoms in migraine from China: A multi-clinic study of 4821 patients

Objective To observe the prevalence and characteristics of premonitory symptoms in Chinese migraineurs and explore their associations with migraine-related factors. Method Migraineurs who visited a tertiary headache clinic and one of nine neurology clinics between May 2014 and November 2019 were studied. Result Among the 4821 patients meeting the migraine criteria (International Classification of Headache Disorders, 3rd edition), 1038 (21.5%) patients experienced at least one premonitory symptom. The most common premonitory symptoms were neck stiffness, dizziness, yawning and drowsiness. The logistic regression analysis demonstrated that aura, photophobia, aggravation by routine physical activity, triggers, family history, depression, coffee consumption and physical exercise were associated with an increased probability of experiencing premonitory symptoms ( p ≤ 0.001). The premonitory symptoms of migraine with and without aura differ in prevalence and most common symptoms. The cluster analysis revealed pairwise clustering of the following premonitory symptoms: Photophobia/phonophobia, concentration change/dysesthesia, loquacity/overactivity, yawning/drowsiness, fatigue/dizziness, and mood change/irritability. The correlation analysis of triggers and premonitory symptoms revealed that temperature change, environment change, sleep disorder, activity and stress were related to multiple premonitory symptoms, and that food, light, menstruation, alcohol and odor were related to special premonitory symptoms ( p ≤ 0.001). Conclusion The prevalence of premonitory symptoms among migraineurs in China is 21.5%. Some factors influence the probability of experiencing premonitory symptoms. Paired premonitory symptoms in the clustering analysis may share similar origins. Certain triggers associated with multiple premonitory symptoms may induce brain dysfunction; however, other triggers that overlap with corresponding special premonitory symptoms may be premonitory symptoms or a form of premonitory symptom.

Prevalence of pre-cluster symptoms in episodic cluster headache: Is it possible to predict an upcoming bout?

Background Early symptoms prior to a cluster headache bout have been reported to occur days or weeks before the actual beginning of the cluster headache bouts. This study aimed to describe the prevalence of pre-cluster (premonitory) symptoms and examine the predictability of an upcoming cluster headache bout. Methods 100 patients with episodic cluster headache were included in this retrospective cross-sectional study. All patients underwent a semi-structured interview including 25 questions concerning pre-cluster symptoms. Results Pre-cluster symptoms were reported by 86% of patients with a mean of 6.8 days (interquartile range 3–14) preceding the bout. An ability to predict an upcoming bout was reported by 57% with a mean 4.6 days (interquartile range 2–7) before the bout. Occurrence of shadow attacks was associated with increased predictability (odds ratio: 3.06, confidence interval: 1.19–7.88, p-value = 0.020). In remission periods, 58% of patients reported mild cluster headache symptoms and 53% reported occurrence of single shadow attacks. Conclusions The majority of episodic cluster headache patients experienced pre-cluster symptoms, and more than half could predict an upcoming bout, suggesting the significant potential of early intervention. Furthermore, the experience of mild cluster headache symptoms and infrequent shadow attacks in remission periods is common and suggest an underlying pathophysiology extending beyond the cluster headache bouts.

Are some patient-perceived migraine triggers simply early manifestations of the attack?

Objective To study the agreement between self-reported trigger factors and early premonitory symptoms amongst a group of migraineurs in both spontaneous and pharmacologically provoked attacks. Methods Fifty-three subjects with migraine with and without aura, with ≤ 22 headache days/month, with spontaneous premonitory symptoms associated with migraine attacks were recruited nationally. A detailed history was taken by a study investigator to confirm diagnosis and extended phenotyping was performed to identify patient-reported triggers for migraine attacks, premonitory symptom phenotype and headache characteristics, using a standardised physician-administered questionnaire. The same subjects were exposed to a 0.5 mcg/kg/min nitroglycerin infusion over 20 min, to determine if similar migraine symptoms could be triggered. The triggered attacks were phenotyped in the same way as spontaneous ones. Percentage agreement and Cohen’s kappa measure of agreement were used to identify concordance between patient-reported triggers and the corresponding spontaneous and triggered premonitory symptoms. Percentage agreement of > 60% and/or a kappa value > 0.3 with P < 0.05 were considered significant. Results There was statistically significant agreement between perception of light as a migraine trigger and spontaneous premonitory photophobia; perception of sound as a trigger and triggered premonitory phonophobia; skipping meals as a trigger and spontaneous premonitory food cravings; and food triggers and spontaneous premonitory food cravings. There was good agreement between stress and premonitory triggered mood change. Conclusions At least some patient-reported triggers, such as light, sound, foods and skipping meals, may represent early brain manifestations of the premonitory phase of the migraine attack.

Migraine

The vast majority of patients presenting with headache and no physical signs will have migraine, or, less commonly, a variant such as cluster headache. Some migraine patients will have a typical visual, sensory, or speech aura, while others will have less clear-cut premonitory symptoms. A careful history will establish whether there are any atypical features that might warrant further investigation and/or suggest an alternative diagnosis. It is essential that the initial assessment ascertains the frequency and severity of the attacks, as this will determine whether analgesic or prophylactic treatment or both should be offered. The patient’s previous medication should be recorded, noting the largest doses given and the reason why each had been discontinued. Many will be overusing analgesics, particularly opiates, and these can easily lead directly to a chronic drug-induced headache. The real skill in headache management is ensuring that the patient’s history is fully and accurately recorded.

Headache and non-headache symptoms provoked by nitroglycerin in migraineurs: A human pharmacological triggering study

Background Studying a spontaneous migraine attack is challenging, particularly the earliest components. Nitroglycerin is a potent, reliable and reproducible migraine trigger of the entirety of the migraine attack, making its use experimentally attractive. Methods Fifty-three subjects with migraine with a history of spontaneous premonitory symptoms were exposed to a 0.5 mcg/kg/min nitroglycerin infusion. Eighty-three percent (n = 44) developed typical premonitory and headache symptomatology. Fifty-seven percent (n = 25) were invited back to further study visits, during which they were re-exposed to nitroglycerin or placebo infusion in a double-blind randomised design. The phenotype of premonitory symptoms and headache was captured and compared to spontaneous attacks and between triggered attacks using agreement analysis. Results More premonitory symptoms were triggered with nitroglycerin than placebo (mean symptom difference = 4, t20 = 7.06, p < 0.001). The agreement in triggering for the most commonly reported premonitory symptoms (concentration difficulty and tiredness) was >66%. The retriggering agreement for all but one premonitory symptom was >60%. The agreement in timing to onset of premonitory symptoms was reliable across two triggered attacks. The agreement with spontaneous attacks and between attacks for headache and its associated symptoms, including laterality, was less reliable. Conclusions Nitroglycerin can reliably and reproducibly provoke premonitory symptomatology associated with migraine. This forms an ideal model to study the earliest manifestations of migraine attacks.

To Eat or Not to eat: A Review of the Relationship between Chocolate and Migraines

Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.