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In a clinic, many a times, a patient comes with multiple symptoms. After trying to pinpoint a disease, you cannot fit him in any usual diagnosis like anaemia, diabetes mellitus, TB, etc. In such situations, I opt for the following tests. I am mentioning 5 types of investigations, which should be carried out, if you cannot make a diagnosis even after a good clinical examination.
Type I : CBC, Routine urine, ESR, SMA 12
Type II : Tests like ANA to rule out a connective tissue disorder.
Type III : Endocrine investigations, which should include tests like T3, T4, TSH and Cortisol levels.
Type IV : Metabolic investigations: Do not forget to ask for Vit. D3, B-12 levels, Vit B-6, or Vitamin E.
Type V : Do not forget to ask for tests for viruses like HBsAg, HIV and Anti HCV.
INCREASING THE EFFECT OF TRIPTANS IN MIGRAINE
The introduction of the triptans was a major step forward in migraine therapy. Many migrainous patients, however, do not respond satisfactorily, which leaves room for improvement. Abouch Krymchantowski and colleagues recently reported a study in which they investigated the combination of the gastrokinetic drug, trimebutine, and rizatriptan for the treatment of migraine.
During migraine attacks patients usually have nausea or vomiting or both, and relative gastric stasis. Orally administered drugs are consequently absorbed slowly during migraine attacks. The prokinetic antiemetic metoclopramide might normalise the absorption of aspirin during migraine attacks, and the combination of metoclopramide and effervescent aspirin is an effective treatment.
The Lancet, 2006; 368 : 1313.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
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