Migraine is the most common form of headache disorder globally. The etiology of migraine is multifactorial, with genetic components and environmental interactions considered to be the main causal factors. Some researchers postulate that deficits in mitochondrial energy reserves can cause migraine or an increase in homocysteine levels can lead to migraine attacks; therefore, vitamins could play a vital role in migraine prevention. For instance, riboflavin influences mitochondrial dysfunction and prevents migraine. Genes such as flavoenzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma levels of homocysteine and migraine with aura. Homocysteine catalyzation requires the presence of vitamins B6, B12, and folic acid, which can decrease the severity of migraine with aura, making these vitamins potentially useful prophylactic agents for treating migraine with aura. Menstrual migraine, on the other hand, is associated with increased prostaglandin (PG) levels in the endometrium, indicating a role for vitamin E, which is an anti-PG. Vitamin C can also be used as a scavenger of reactive oxygen species for treating neurogenic inflammation in migraine patients. This paper reviews possible therapies based on vitamin supplementation for migraine prophylaxis, focusing on migraine with aura and menstrual migraine.

MicroRNAs (miRNAs) are short, endogenous, non-coding RNAs that post-transcriptionally regulate gene expression by base pairing with mRNA targets. Altered miRNA expression profiles have been observed in several diseases, including neurodegeneration. Multiple studies have reported altered expressions of miRNAs in the brains of individuals with Alzheimer’s disease (AD) as compared to those of healthy elderly adults. Some of the miRNAs found to be dysregulated in AD have been reported to correlate with neuropathological changes, including plaque and tangle accumulation, as well as altered expressions of species that are known to be involved in AD pathology. To examine the potentially pathogenic functions of several dysregulated miRNAs in AD, we review the current literature with a focus on the activities of ten miRNAs in biological pathways involved in AD pathogenesis. Comprehensive understandings of the expression profiles and activities of these miRNAs will illuminate their roles as potential therapeutic targets in AD brain and may lead to the discovery of breakthrough treatment strategies for AD.

Detection of markers for neurodegenerative disorders (NDDs) within brain tissue of Alzheimer’s disease (AD) or Parkinson’s disease (PD) patients has always been hampered by our inability to access tissue from living human subjects and obtain biopsy samples of key regions implicated in disease occurrence and progression. Currently, diagnosis of NDDs is principally based on clinical observation of symptoms that present at later stages of disease progression, followed by additional neuroimaging and, possibly, CSF evaluation. A way to potentially detect and diagnose NDDs at a far earlier stage is to screen for abnormal levels of specific disease markers within the peripheral circulation of patients with NDDs. Increasing evidence suggests that there is dysregulation of microRNAs (miRNAs) in NDDs. Peripheral blood mononuclear cells as well as biofluids, such as plasma, serum, urine and cerebrospinal fluid, contain miRNAs that can be identified and quantified. This opens the potential for circulating levels of miRNAs within blood or other biofluids to be characterized and used as a non-invasive diagnostic biomarker screen to support early disease detection and possible disease progression monitoring of NDDs such as AD and PD. Plainly, such a potential screen is only possible with a clear understanding of which miRNAs change with disease, and when this occurs during the progression of AD and PD. Such information is becoming increasingly available and in the near future may not only support disease diagnosis but provide the opportunity to evaluate therapeutic interventions earlier in the disease process where their targets may be more relevant to delay AD or PD progression.

Based on disability-adjusted life years, stroke is one of the major causes of death and is among the top five diseases in Nepal. Despite this fact, information on the prevalence, morbidity, and mortality of stroke in Nepal is limited to urban areas, with no official reports published on the epidemiology of stroke throughout the country. The mean age of stroke patients in Nepal is between 59 and 62 years, with males affected more frequently. Hypertension, cigarette smoking, alcohol consumption, and diabetes are the main predisposing factors for stroke, and ischemic stroke is more common (63%) than hemorrhagic stroke (37%). Because of a lack of facilities and specialists, most stroke patients, especially in the rural areas, seek traditional healers to treat their conditions. More governmental and non-governmental organizations should be involved in improving facilities and implementing prevention strategies.

Background. Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL) among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls. Methods. Female diagnosed migraine patients (n= 100) and healthy controls (n=100) completed the Malay version of the World Health Organization QOL Brief (WHOQOL-BREF) questionnaire. Only migraine patients completed the Malay version of the Migraine Disability Assessment questionnaire. Results. Females with migraines had significantly lower total WHOQOL-BREF scores (84.3) than did healthy controls (91.9, P<0.001). Similarly, physical health (23.4 versus 27.7, P<0.001) and psychological health scores (21.7 versus 23.2, P< 0.001) were significantly lower than those for healthy controls. Seventy-three percent of patients experienced severe disability, with significantly higher number of days with headaches (13.8 days/3 months, P< 0.001) and pain scores (7.4, P< 0.013). Furthermore, migraine patients with lower total QOL scores had 1.2 times higher odds of having disability than patients with higher total QOL scores. Conclusions. The present study showed that migraine sufferers experienced significantly lower QOL than the control group from a similar population. Disability was severe and frequent and was associated with lower QOL among the migraine patients.

Migraine is a neurovascular disease that has classically been attributed to multifactorial aetiologies, with genetic components and environmental interactions considered the main influence. Genes such as flavoenzyme 5, 10- methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma homocysteine levels. This elevation in homocysteine results in an array of metabolic disorders and increased risk of complex diseases, including migraine. Catalysation of homocysteine requires the presence of vitamins B6, B12 and folate. Deficiencies in these cofactor vitamins result in hypomethylation, which triggers migraine. Because migraine predominantly affects females, it is hypothesised that fluctuating oestrogen levels, which are governed by oestrogen receptor 1 polymorphisms, are important. Another important factor is homocysteine, the production of which is dependent upon MTHFR and B vitamins. Gene expression is modulated through epigenetic mechanisms, which involve methionine. Additionally, folate plays a major role in DNA synthesis. We propose that vitamin B intake, coupled with MTHFR and oestrogen receptor 1 polymorphisms, causes differential DNA methylation and gene expression that may contribute to the occurrence of migraine.

The study of prescriptions using prescribing indicators enables us to detect some common problems of prescribing and to focus subsequent efforts to correct them. This study was designed to define the extent and pattern of drug prescribing with emphasis on that of antibiotics among medical outpatients of teaching hospital of College of Medical Sciences Bharatpur, Nepal. The data contained on randomly selected original prescriptions of patients attending medical OPD in between January2008 and June2008 were collected prospectively on duplex prescriptions and analyzed. A total of 955 drugs were prescribed to 339 patients. The average number of drugs per encounter was 2.81. Drugs prescribed by generic name were 20.31% and those matched to national essential drugs list were 49.63%. Encounters with antibiotics were 43.95%. Antibiotics were the most frequently prescribed therapeutic class. Azithromycin, ciprofloxacin and amoxycillin were three most frequently prescribed antibiotics. Respiratory tract infection was the most common indication, for which antibiotics were given. Selections of antibiotics were rational for most of the indications but bacteriological confirmation prior to institution of antibiotics were not done in any case. Polypharmacy, inclination for branded products and overuse of antibiotics were revealed as problems requiring educational interventions and strict antibiotic policy as subsequent efforts to rectify them. Key words: Antibiotics; medical outpatients; prescribing indicators; teaching hospital. DOI: 10.3126/jcmsn.v6i2.3610   Journal of college of Medical Sciences-Nepal, 2010, Vol.6, No-2, 7-13

Chronic infection can cause slow progressive dementia, cortical atrophy and amyloid deposition in the atrophic form of general paresis. Due to the fact that specific bacterial ligands can increase the expression of proinflammatory molecules that can activate innate and adaptive immune systems, inflammation may play a significant role in the pathogenesis of Alzheimer's disease (AD). Furthermore, there is a significant association between AD and various types of spirochete. Periodontitis is a prevalent and persistent peripheral infection that is associated with gram-negative anaerobic bacteria and is capable of showing localized and systemic infections in the host. Periodontal disease related pathogens and their inflammatory products contribute to systemic inflammation and the pathogenesis of AD. In this minireview, we propose a hypothetical link between periodontitis, type 2 diabetes and AD. We also present the possible mechanistic links between periodontitis-related inflammation, type 2 diabetes and AD. Since this condition is treatable, periodontitis may be a readily-modifiable risk factor for AD.