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Background: Post-spinal anesthesia shivering in cesarean section is a common complication owing to sympatholysis, resulting in vasodilation and heat redistribution from the core to peripheral parts of the body. The physiological consequences of shivering include an increase in cardiac and systemic energy expenditure, oxygen consumption, and carbon dioxide production. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been reported to have anti-shivering effects. The aim of this study is to determine the effectiveness of prophylactic low-dose intravenous (IV) ketamine (0.25 mg/kg) in preventing shivering after spinal anesthesia as compared to placebo in elective cesarean sections. Methods: A randomized, double-blind study was conducted on 80 patients aged 18 to 40 years and American Society of Anesthesiologists grade II undergoing elective cesarean section under spinal anesthesia. Groups K and group S received IV ketamine 0.25 mg/kg diluted to 5 ml in normal saline and 5 ml normal saline IV, respectively, 10 minutes after spinal anesthesia. The incidence and duration of shivering, tympanic membrane temperature, sedation score, hemodynamic parameters, and side effects were recorded. Results: The incidence of shivering in group K was 12.5% compared to 32.5% in group S (P = 0.030). The mean duration of shivering was only 0.75 ± 2.02 min in group K as compared to 2.38 ± 3.57 min in group S (P = 0.014). Mean arterial pressure and heart rate were stable in group K without any significant sedative effect. Conclusion: The use of prophylactic low-dose ketamine (0.25 mg/kg) significantly reduces the incidence and duration of spinal anesthesia-induced shivering compared to placebo. [ABSTRACT FROM AUTHOR]

Purpose: Brachytherapy is the gold‑standard treatment for choroidal melanoma. This study evaluated iodine‑125 brachytherapy by using Ocuprosta seeds with indigenous non‑collimated plaques in Asian patients. Methods: Retrospective single‑center study in a tertiary care hospital of 12 eyes with choroidal melanoma in 12 Asian patients who underwent brachytherapy with Ocuprosta seeds fixed on non‑collimated plaques and had a follow‑up of at least 32 months (mean: 42.4 ± 9.5 months; median: 40 months). Radiotherapy was planned after developing the digital 3D model of the tumor within the eye by using radiological images and clinical pictures. Ocuprosta iodine‑125 seeds were used on indigenous non‑collimated gold plaques to deliver the radiation for precalculated time. “Successful outcome” was taken as a decrease in the volume of the tumor, and “unsuccessful outcome” was defined as no change in the tumor volume or increase in the tumor volume at 24 months after brachytherapy. Results: The mean decrease in tumor volume was 21% (914.5 ± 912.2 mm³ to 495.7 ± 633.6 mm³ ) after brachytherapy, which correlated with the baseline volume of the tumor. Ten eyes (83.3%) showed a reduction in tumor volume, whereas two eyes showed an increase in the volume of the tumor after brachytherapy. One of the cases with a reduction in tumor size developed neovascular glaucoma. Enucleation was done in three eyes. A globe salvage rate of 75% and tumor regression rate of 83% were seen in the present study using Ocuprosta seeds. Conclusions: Iodine‑125 brachytherapy with uncollimated indigenous gold plaques is an effective treatment modality for choroidal melanomas in Asian patients. [ABSTRACT FROM AUTHOR]

Knowledge of extreme meteorological parameters plays an important role, for the selection of any civil structure at nuclear site or to design important nuclear structures to withstand design basis values of meteorological extremes that are likely to occur during the lifetime of these structures. The method used for the evaluation of extreme parameters is least square fit method. In this study, statistical analyses of extreme values of meteorological parameters at Rawatbhata Rajasthan site (RR site) are presented for the period 1980 to 2022 and for rainfall, it is for the period 1964 to 2022. Meteorological parameters such as extreme wind speed and wind gust (5 min) at 10 m and 30 m heights, extreme surface air temperature, extreme atmospheric pressure and extreme rainfall (yearly, monthly, and daily) are evaluated and discussed. From the extreme value analysis, it is observed that the variables for monthly maximum rainfall, annual maximum rainfall, maximum air temperature, maximum atmospheric pressure, maximum hourly wind speed at 10 m and 30 m heights and wind gust (5 min.) at 10 m height obey Fisher-Tippette Type I distribution, whereas daily maximum rainfall, annual minimum rainfall, minimum air temperature, minimum relative humidity, minimum atmospheric pressure and wind gust (5 min.) at 30 m height obey Fisher-Tippette Type II distribution. Distribution function parameters, i.e., location, scale, and shape parameter for each variable, have been determined and design basis values corresponding to return periods of 50 years and 100 years are derived and presented. The derived extreme values are particularly useful for arriving at suitable design values to ensure the safety of civil structures at RR site area with respect to stresses due to weather conditions. The values are also compared with corresponding values at other nuclear reactor sites of Tarapur, Narora, and Kalpakkam. [ABSTRACT FROM AUTHOR]

Background: Morphoea is a sclerosing disorder of skin and subcutaneous tissue. Paediatric morphoea shows increased prevalence of various auto-immune diseases, bone deformities, and systemic abnormalities. There is paucity of studies on various immunological, skeletal, and thyroid function abnormalities in paediatric morphoea. Aims and Objectives: To describe immunological, skeletal, and thyroid function abnormalities present in paediatric morphoea patients. Materials and Methods: This cross-sectional study was conducted from January 2021 to March 2023 in the Dermatology outpatient department in a tertiary care hospital. All paediatric morphoea patients were included in this study. All were subjected to detailed history, clinical examination, and investigations including complete blood count, serum IgE, anti-nuclear antibody, thyroid function tests, anti-thyroid peroxidase antibodies, and radiological investigations. Results: A total of 42 children were recruited, out of which 61.90% were females and 38.09% were males. The majority were in the age group of 4–8 years. The most common type of morphoea was encoup de sabre. Anaemia was present in 14.28% patients. Serum IgE levels were raised in 33.33% patients. Thyroid stimulating hormone was raised in 11.9% patients. 33.33% had raised anti-thyroid peroxidase levels. Anti-nuclear antibody titres and rheumatoid factor were raised in 7.14% and 4.76% patients, respectively. Magnetic resonance imaging brain revealed abnormalities in three patients as hyper-intensities in subcortical white matter. Conclusion: Morphoea in children can be associated with varied immunological, osteoarticular, and neurological abnormalities. This study highlights the multi-system involvement in morphoea and the need for larger data and well-designed therapeutic trials for generating evidence-based treatment of this potentially disfiguring disease. [ABSTRACT FROM AUTHOR]

This article from Neurology India discusses a case study of a 15-year-old girl with vanishing white matter disease (VWMD). The girl presented with delayed puberty, ataxic gait, and tremulousness of hands. Magnetic resonance imaging (MRI) revealed white matter hyperintensities and mineral deposits in various regions of the brain. The patient also had primary ovarian failure. This case report highlights the presence of mineralization in the white matter in a case of VWMD, expanding our understanding of the clinical and radiological features of the disease. [Extracted from the article]

Background: Approximately, 80% of civilian cranial gunshot injuries in India are mainly due to unlicensed mostly country-made guns, called the "Desi-Kattas," manufactured by the traditional gunsmiths. These injuries constitute a unique subgroup, with respect to the make and design along with the unique wound ballistics compared to the factory-made firearms.Objective: This study is aimed at defining the prognostic factors in predicting the outcomes related to cranial gunshot injuries due to these desi-kattas.Methods: Ten patients with kata-related cranial gunshot injury underwent surgical intervention at our institution, between 2014 and 2018. Their clinical status, imaging features, and outcomes were retrospectively analyzed.Results: Ten patients with kata-related gunshot injuries to the head were identified. Homicidal injuries were documented in six cases. Five had a GCS of 13-15 at presentation. Exit wounds were noted in 50% of the suicidal cases. Multilobar involvement was seen in 70% of cases, with the bullet crossing the midline in only 40% cases. Decompressive craniectomy was required in five cases. Eight patients had a Glasgow Outcome Score of four or more at 6 months of follow-up. There was one death during the follow-up period, while the other patient remains to be in vegetative state.Conclusion: The Katta-related cranial injuries constitute low-muzzle velocity injuries with the majority of the patients sustaining nonfatal injuries, especially homicidal. The presence of positive CT findings and the crossing of the bullet across the midline on CT brain predicts dismal prognosis. Optimal neurosurgical approach should consist of minimal local debridement and attain water seal dural closure. [ABSTRACT FROM AUTHOR]

The article focuses on a rare case of azathioprine-induced pancytopenia coupled with pneumonia and sepsis in a 62-year-old patient treated for airborne contact dermatitis, highlighting the potential severity and life-threatening nature of adverse reactions to this drug. Topics include the patient's clinical course, and the need for monitoring and management strategies in such instances, emphasizing the importance of continuous hematological surveillance during and after azathioprine treatment.

Background: Intraoperative trans-esophageal migration of pulled-out screws, especially while using the zero-profile implant system, has been rarely reported in the literature.Objective: In this technical note, we are describing a simple technique to retrieve a trans-esophageally migrated pulled-out screw using a suction catheter.Material and Methods: A 32-year-old female presented with spastic quadriparesis. She underwent C5-C6 anterior cervical discectomy and fusion (ACDF). Nine months following the surgery, X-ray cervical spine showed implant loosening and failure of fusion across the instrumented disc space. However, during revision surgery, the loosened screw could not be located visually in the initial attempts, though it could be felt by probing the prevertebral space with the index finger. Intraoperative X-rays showed that the screw migrated curiously in the cranial direction as the surgical field was probed further manually. The screw was then finally retrieved using Magill's forceps assisted by video laryngoscopy assisted by intermittent negative pressure application via a blunt-tipped suction catheter.Results: She was discharged home on a Philadelphia collar, and at 1 year of follow-up, she was completely asymptomatic.Conclusion: Perforation of the aerodigestive tract by a displaced cervical spine implant is an uncommon complication. Manipulation during surgery may cause the implants embedded into the wall of the aerodigestive tract to become dislodged and then migrate into the pharyngeal lumen. In resource-constrained situations or when intraoperative endoscopy is not available, a trial of screw retrieval using a suction catheter may be attempted. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-month-old girl diagnosed with primary cutaneous B-cell lymphoma, a rare condition in infants. It states that the child presented with a single red raised lesion on her right pre-auricular area, and histological and immunohistochemical findings confirmed cutaneous B-cell lymphoma, but despite initial chemotherapy, she was lost to follow-up, highlighting the rarity and diagnostic challenges of this condition in infants.

Sir, Gliomas are characterized by their infiltrative growth pattern and migration along white matter fiber tracts, leading to diffuse growth and involvement of adjacent gyrus. Once in the basal cisterns, tumor cells can proliferate rapidly as basal cisterns offer the least resistance pathway for tumor cell to spread as seen in our case.[[6]] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Insular gliomas with exophytic extension to the sylvian cistern: A glioma growth pattern that has gone previously unnoticed. [Extracted from the article]

The article presents a case study of a 25-year-old male patient with complaint of weakness on the left side of the body and was taken to outpatient services. A presence of an occipitalized atlas and significant motion were revealed in the cervical spine after x-ray. She was diagnosed with myelopathy following the absence of axis (C2) posterior elements resulting to C2-C3 instability.

Introduction: At the time of selection, police personnel undergo various health and fitness tests but subsequently health assessments are not done regularly. Unhealthy lifestyle and challenging work environment predispose them to various somatic sequelae, including cardiovascular diseases, musculoskeletal, gastrointestinal, and psychological disorders, etc., There is limited epidemiological data on the morbidity profile among police personnel in India. Aim: To study the morbidity profile and the treatment-seeking behavior among police personnel in National Capital Region (NCR), India. Materials and Methods: A cross-sectional study was conducted between May and November, 2014 on 300 police personnel working in the NCR, India. We administered a predesigned, pretested questionnaire (α = 0.63) to the study participants based on World Health Organization-STEPS tool for assessing morbidity profile, lifestyle risk factors, and treatment-seeking behavior after obtaining informed consent from the study participants. Results: Health complaints were reported by around half (n = 149, 49.6%) of the participants with the morbidity risk of 0.71 per person. The most common complaints were related to the cardiovascular and musculoskeletal system. Only around half of the affected participants took any treatment. Hospitalization rate reflected from past 1-year hospital admissions among participants was (n = 23, 7.7%). Data analysis suggested morbidity status of police personnel to be significantly associated with lifestyle risk factors such as abdominal obesity (n = 129, 86.5%), obstructive sleep apnea (n = 54, 36.2%), and distress (n = 48, 32.2%). Conclusion: Busy and challenging work life and poor control of health lead to high morbidity among police personnel. Regular health checks and lifestyle promotional activities are highly recommended to maintain a healthy police force. [ABSTRACT FROM AUTHOR]

Background: Limb‑girdle muscular dystrophy (LGMD) is the most common adult‑onset class of muscular dystrophies in India, but a majority of suspected LGMDs in India remain unclassified to the genetic subtype level. The next‑generation sequencing (NGS)‑based approaches have allowed molecular characterization and subtype diagnosis in a majority of these patients in India. Materials and Methods: (I) To select probable dysferlinopathy (LGMD2B) cases from other LGMD subtypes using two screening methods (i) to determine the status of dysferlin protein expression in blood (peripheral blood mononuclear cell) by monocyte assay (ii) using a predictive algorithm called automated LGMD diagnostic assistant (ALDA) to obtain possible LGMD subtypes based on clinical symptoms. (II) Identification of gene pathogenic variants by NGS for 34 genes associated with LGMD or LGMD like muscular dystrophies, in cases showing: absence of dysferlin protein by the monocyte assay and/or a typical dysferlinopathy phenotype, with medium to high predictive scores using the ALDA tool. Results: Out of the 125 patients screened by NGS, 96 were confirmed with two dysferlin variants, of which 84 were homozygous. Single dysferlin pathogenic variants were seen in 4 patients, whereas 25 showed no variants in the dysferlin gene. Conclusion: In this study, 98.2% of patients with absence of the dysferlin protein showed one or more variants in the dysferlin gene and hence has a high predictive significance in diagnosing dysferlinopathies. However, collection of blood samples from all over India for protein analysis is expensive. Our analysis shows that the use of the “ALDA tool” could be a cost‑effective alternative method. Identification of dysferlin pathogenic variants by NGS is the ultimate method for diagnosing dysferlinopathies though follow‑up with the monocyte assay can be useful to understand the phenotype in relation to the dysferlin protein expression and also be a useful biomarker for future clinical trials. [ABSTRACT FROM AUTHOR]

Background and Purpose: Demonstration of lepra bacilli is essential for definite or unequivocal diagnosis of pure neuritic leprosy (PNL) on nerve biopsy. However, nerves always do not show bacilli owing to the changes of previous therapy or due to low bacillary load in tuberculoid forms. In absence of granuloma or lepra bacilli, other morphologic changes in endoneurium and perineurium can be of help in making a probable diagnosis of PNL and treating the patient with multidrug therapy. Materials and Methods: Forty-six biopsies of PNL were retrospectively reviewed and histologic findings were compared with 25 biopsies of non leprosy neuropathies (NLN) including vasculitic neuropathy and chronic inflammatory demyelinating polyneuropathy (CIDP). The distribution of endoneurial infiltrate and fibrosis, perineurial thickening, and myelin abnormalities were compared between PNL and NLN biopsies and analyzed by Chi-square test. Results: Out of 46 PNL casses, 24 (52.17 %) biopsies were negative for acid fast bacilli (AFB). In these cases, the features which favor a diagnosis of AFB-negative PNL were endoneurial infiltrate (51.1%), endoneurial fibrosis (54.2%), perineurial thickening (70.8%), and reduced number of myelinated nerve fibers (75%). Interpretation and Conclusion: Nerve biopsy is an efficient tool to diagnose PNL and differentiate it from other causes of NLN. In absence of AFB, the diagnosis of PNL is challenging. In this article, we have satisfactorily evaluated the various hisopthological features and found that endoneurial inflammation, dense fibrosis, and reduction in the number of myelinated nerve fibers are strong supportive indicators of PNL regardless of AFB positivity. [ABSTRACT FROM AUTHOR]

Background: With the widespread use of neuroimaging and hematological workup, many of the previously held concepts about cerebral sinus venous thrombosis (CSVT) are changing. Objective: The objective of this study was to investigate the risk factors, clinical profile, and outcome of the fully investigated cases of CSVT from a major university referral hospital in South India. Materials and Methods: Consecutive patients of CSVT confirmed by definite neuroimaging criteria and fully investigated for prothrombotic states, between June 2002 and September 2010, were prospectively studied in the Venous Stroke Registry of Nizam's Institute of Medical Sciences, Hyderabad, South India. Results: Of the 428 patients, 230 (53.7%) were men and the mean age was 31.3 years (range 8-65 years). Seizures were noted in 126 (29.4%) patients, stroke like presentation was found in 122 (28.5%) patients, and benign intracranial hypertension like presentation was found in 78 (18.2%) patients. Common risk factors were anemia in 79 (18.4%), hyperhomocysteinemia in 78 (18.2%), alcoholism in 67 (15.6%), oral contraceptive pill intake in 49 (11.4%), postpartum state in 42 (9.8%), anticardiolipin antibodies in 31 (7.2%), and protein S deficiency in 53 (12.3%) patients. Good outcome at 90 days (modified Rankin Scale £ 2) was observed in 273 (71.2%) of 383 patients available for follow-up. In-house mortality was noted in 33 (7.7%) and recurrence in 22 (5.1%) patients. Conclusions: Compared to the previous studies, prevalence of CSVT was higher in men. Anemia, hyperhomocysteinemia, alcoholism, oral contraceptive use, and postpartum state were the most common risk factors. Overall prognosis was good, but a small percentage of patients died or showed recurrence. [ABSTRACT FROM AUTHOR]

Background: With the widespread use of neuroimaging and hematological workup, many of the previously held concepts about cerebral sinus venous thrombosis (CSVT) are changing. Objective: The objective of this study was to investigate the risk factors, clinical profile, and outcome of the fully investigated cases of CSVT from a major university referral hospital in South India. Materials and Methods: Consecutive patients of CSVT confirmed by definite neuroimaging criteria and fully investigated for prothrombotic states, between June 2002 and September 2010, were prospectively studied in the Venous Stroke Registry of Nizam's Institute of Medical Sciences, Hyderabad, South India. Results: Of the 428 patients, 230 (53.7%) were men and the mean age was 31.3 years (range 8-65 years). Seizures were noted in 126 (29.4%) patients, stroke like presentation was found in 122 (28.5%) patients, and benign intracranial hypertension like presentation was found in 78 (18.2%) patients. Common risk factors were anemia in 79 (18.4%), hyperhomocysteinemia in 78 (18.2%), alcoholism in 67 (15.6%), oral contraceptive pill intake in 49 (11.4%), postpartum state in 42 (9.8%), anticardiolipin antibodies in 31 (7.2%), and protein S deficiency in 53 (12.3%) patients. Good outcome at 90 days (modified Rankin Scale £ 2) was observed in 273 (71.2%) of 383 patients available for follow-up. In-house mortality was noted in 33 (7.7%) and recurrence in 22 (5.1%) patients. Conclusions: Compared to the previous studies, prevalence of CSVT was higher in men. Anemia, hyperhomocysteinemia, alcoholism, oral contraceptive use, and postpartum state were the most common risk factors. Overall prognosis was good, but a small percentage of patients died or showed recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the hepatoprotective activity of Terminalia paniculata against paracetamol induced hepatic damage in rats. Methods: The plant material was shade dried, powdered and extracted with ethanol. Liv 52 and silymarin were used as standard drugs and 2% gum acacia as a control (vehicle). Alteration in the levels of biochemical markers of hepatic damage like AST, ALT, ALP and lipid peroxides were tested, and phytochemical tests were also performed. Results: Paracetamol (2 g/kg) increased the serum levels of alanine aminotransfer (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and the lipid peroxides. Treatment of Liv 52, silymarin and ethanolic extract of Terminalia paniculata (200 mg/kg) altered levels of biochemical marker and showed significant hepatoprotective activity. Ethanolic extract revealed the presence of phenolic compound and flavanoids. Our findings suggested that ethanolic bark extract of Terminalia paniculata possessed hepatoprotective activity in a dose dependent manner. Conclusions: Terminalia paniculata possesses hepatoprotective activity. It could be an effective and promising preventive agent against PCT induced hepatotoxicity. [Copyright &y& Elsevier]

Background: Despite the increasing use of recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke, uncertainty persists about the short- and long-term outcome of the thrombolysed patients. Objective: To identify predictors of major neurological improvement at 24 h after intravenous rt-PA administration in patients of acute ischemic stroke and their relationship with outcome at 12 months. Materials and Methods: We analyzed the data of the patients with acute ischemic stroke treated as per the National Institute of Neurological Disorders and Stroke (NINDS) criteria with intravenous rt-PA between January 2000 and June 2009 at a tertiary care center in south India. Major neurological improvement was defined by an 8-point improvement in National Institute of Health Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 h. Good outcome was defined as a 12-month modified Rankin Scale (mRS) of 0 to 1. Results: Of the 72 patients with acute ischemic stroke treated with intravenous rt-PA, 23 (32%) patients had major neurological improvement at 24 h. Age <60 years (OR 1.9, 95% CI 1.7 to3.2), admission glucose levels <8 mmol/L (OR 3.87, 95% CI 1.9 to 9.2) and mild to moderate baseline stroke severity (NIHSS median score 10+ 6) were associated with major neurological improvement after adjusting for co variables. Major neurological improvement at 24 h was an independent predictor of good outcome (mRS=1) at 12 months (OR 13.9, 95% CI 6.84 to 40.2). Conclusions: Age <60 years, glucose levels <8 mmol/L and mild to moderate stroke severity (NIHSS median score 10±6) was associated with major neurological improvement after intravenous rt-PA. Major neurological improvement at 24 h after the administration of intravenous thrombolysis independently predicted good outcome at 12 months. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 37‑year‑old female who was suspected with syndrome of adult onset Leigh. Topics discussed include thiamine deficiency which was reported in patient along with periaqueductal grey and hypothalamic region, non implementation of lactate stress testing in encoded genes of nuclear DNA and findings of muscle biopsy on electron microscopy.

Aim: Utility of major histocompatibility complex (MHC) Class I antigen immunostaining was studied to differentiate idiopathic inflammatory myopathies from dystrophies. Materials and Methods: Forty muscle biopsies including seven dermatomyositis (DM), six polymyositis (PM), two sporadic inclusion body myositis (sIBM), 20 dystrophies (one Duchenne, three Becker's, four alpha, one gamma sarcoglycanopathy, nine limb girdle, one myotonic and one fascioscapulohumeral muscular dystrophy) and five controls were stained with antibody for MHC Class I antigen (Novocastra clone W6/32 HL 1:100 dilution). Results: Polymyositis and sIBM showed MHC class I antigen positivity along sarcolemma of single and small groups of muscle fibers. The regenerating fibers in the perifascicular area in DM showed intense cytoplasmic positivity of MHC class I antigen. Muscle fibers in all dystrophies except regenerating fibers and control normal muscle were negative for MHC. Capillaries and lymphocytes were positive controls. There were no false positives in the study. Conclusion: MHC Class I immunostaining can be used as a complementary diagnostic tool for the diagnosis of idiopathic inflammatory myopathies. [ABSTRACT FROM AUTHOR]

Introduction: Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection, predominantly affecting people in an immunocompromised state. Aggressive surgical therapy, with repeated debridement in combination with intravenous amphotericin B can lead to a high rate of cure.Aim: To determine the predictors of mortality in rhinocerebral mycosis.Materials and Methods: The demographic data, clinical features, radiological (MRI/CT) findings, treatment details of patients with a diagnosis of rhinocerebral mycosis confirmed on histopathology were analyzed retrospectively. The outcome was assessed as alive and dead. Univariate analysis with odds ratio (OR) was employed in data analysis. Chi-square test was used for P value.Results: There were 38 patients. The age range was 7-82 (mean 48.68) years; 30 (79%) were males. Craniofacial pain was the most common initial presenting symptom, noted in 29 (76.3%). Rhino-orbital involvement was noted in 24 (63.2%) and 12 (31.6%) had associated focal neurological deficits. Immunocompromised state was noted in 24 (63.2%). Eighteen (47.4%) patients died. The predictors for mortality: odds ratio (95% CI) were 2.45 (1.01-3.89) for elderly age, 5.67 (4.13-7.21) for intracranial extension, 2.6 (1.26-3.94) for immunocompromised state, 2.62 (1.25-3.99) for infection with zygomycosis and 2.33 (1.01-3.65) for anemia.Conclusion: Rhinocerebral mycosis is associated with high mortality in spite of aggressive therapy. Intracranial extension with focal neurological deficits is a major predictor of mortality in rhinocerebral mycosis. [ABSTRACT FROM AUTHOR]

Background: Limb girdle muscular dystrophy (LGMD) is a heterogeneous group of disorders characterized by limb girdle weakness. There are no clear clinical features that distinguish various types of LGMD.Materials and Methods: We studied 26 patients with chronic progressive weakness in limb girdle distribution without early facial involvement with muscle biopsies suggestive of dystrophy/myopathy and positive for dystrophin antibodies. Immunohistochemistry studies of muscle biopsies were done on all patients to classify different types of sarcoglycanopathies.Results: The mean age of presentation was in the third decade. There were 14 male and 12 female patients. The common pattern of inheritance was autosomal recessive, seen in 53.8%. The more frequent type of LGMD was sarcoglycanopathy (SGP) (53.8%). Amongst the SGPs, alpha-SGP (26.9%) was the most common followed by beta-SGP (15.3%), gamma-SGP (3.8%) and delta-SGP (7.6%). Calf hypertrophy was noted in 53.5% of LGMD and 57.1% of SGPs, extensor digitorum brevis hypertrophy in 42% of LGMD and 35.7% of SGPs, winging of scapula in 39.2% of the LGMD group and 35.7% of the SGPs, valley sign in 28.5% of the LGMD group and 21.4% of the SGPs. Hip abductor sign was positive in 71.4% of LGMD and 64.2% of SGPs. Differential weakness of knee flexors was more common in SGP (57.1%). The mean creatine phosphokinase (CK) value was 2519IU/L and was elevated in 92.8% patients. Muscle biopsy showed a dystrophic pattern in 75% of LGMD and a myopathic pattern in the remaining. Symptomatic cardiac involvement was seen in one patient. ECG changes were seen in 44% of LGMD patients and 50% of the SGP. The common changes noted were T wave inversion in V1, V2 (16%), left ventricular hypertrophy LVH (12%) and right bundle branch block (RBBB) in 12% of the LGMD group.Conclusion: Sarcoglycanopathy is a more frequent form of LGMD whereas alpha type is the most common among the SGP. The four types of SGP do not differ in the pattern of muscle involvement. A relatively earlier onset, selective weakness of knee flexors and a very high CK may help differentiate SGP from other forms of LGMD. Immunohistochemistry is very useful in classifying the different types of LGMD prior to genetic analysis. [ABSTRACT FROM AUTHOR]

Background and Objective: Myasthenic crisis is a life-threatening complication of myasthenia gravis (MG) and when treated aggressively is associated with good outcome.Materials and Methods: Retrospective study of case records of patients with episodes of myasthenic crisis.Results: Twenty-one (22%) of the 95 patients with MG (9 with thymoma), experienced 23 episodes of myasthenic crisis, 3 (33%) in patients with thymoma. The crisis episodes occurred within 2 years of disease onset in 11 (52%) patients. Infection was the most common primary precipitant of the crisis occurring in 65%. The median duration of the crisis episode was 11 days (7-39 days), and the median neurological intensive care unit stay was 15 days (range 9-47 days). Fifteen (65%) episodes were treated with small volume plasma exchange (PE) and 8 (35%) episodes received intravenous immunoglobulin (IVIg). The time taken for disease stabilization, the median number of days for extubation, was 8 days (range 7-12) in the PE group and 10 days (range 7-39) in the IVIg group. Disease stabilization could not be achieved in one patient in the IVIg group. Ventilator-associated pneumonia (VAP) was the commonest complication, seen in 30%. Two (8%) of the 23 episodes of crisis were fatal, one resulting from VAP and septicemia, and the other due to crisis itself. All the 19 patients who survived to discharge had complete resolution of admission symptoms.Conclusions: In patients with myasthenic crisis, both therapeutic options, PE and IVIg, are equally effective in disease stabilization. To achieve good outcomes all efforts should be directed at decreasing the duration of intubation and also aggressively treating the associated medical complications. [ABSTRACT FROM AUTHOR]

Neurological melioidosis is a very rare and very few cases have been reported from India. Presentation is an extremely varied and as this disease is associated with high mortality, high index of suspicion is needed to diagnose and treat. In this context, we report a patient presenting as Guillain Barre syndrome evaluated as melioidosis. [ABSTRACT FROM AUTHOR]

Opportunistic infections usually occur in patients with an immunocompromised state, and can be severe. Cryptoccocal meningitis is a fatal condition if left untreated, and is usually found in such patients. We report the case of an adult patient with cryptoccocal meningitis secondary to intestinal lymphangiectasia. A 30-year-old female was admitted to our hospital for meningitis. Biochemical and radiological investigations were performed. A cerebrospinal fluid latex agglutination test showed positive cryptoccocal antigen. In addition, there were features of humoral and cell-mediated immunity deficiency (lymphopenia, hypoalbuminemia, hypogammaglobulinemia), with a negative human immunodeficiency virus (HIV) test by enzyme-linked immunosorbent assay and polymerase chain reaction. An upper gastroduodenoscopy was performed, which showed multiple lymphangiectasias, and a biopsy confirmed the diagnosis of primary intestinal lymphangiectasia (PIL). The patient was treated with intravenous amphotericin B and oral flucytosine, and the meningitis resolved. PIL should be suspected in patients with cryptoccocal meningitis, combined with humoral and cell-mediated immunity with a negative HIV test. The management issues, in addition to antifungal therapy, include nutritional supplements for the protein losing enteropathy. [ABSTRACT FROM AUTHOR]

We describe the clinical presentation, course and pathologic findings found in three adult patients with lipid storage myopathy. Excessive lipid storage was found in Type 1 fibers of muscle. Clinical improvement on oral levo-carnitine therapy suggests the possibility of carnitine deficiency as the most likely etiology in two of the patients and one had mitochondrial myopathy confirmed on genetic analysis. [ABSTRACT FROM AUTHOR]

The article discusses the medical case of a 50-year-old male with bifrontal headache and memory loss. It states that multiple nodular enhancing meningeal granulomas were revealed by magnetic resonance imaging (MRI). It says that the patient was diagnosed with neurosarcoidosis with necrotizing sarcoid granulomatosis (NS-NSG).

Aim: To study the clinical, electro-physiological subtypes outcome and prognostic factors of GBS and to correlate with antiganglioside antibodies. Methods: We studied the case records of all patients with GBS admitted from January 2000 to January 2006 in our hospital. Clinical, electro-physiological features of all patients were reviewed and grouped according to Ho et al. criteria. Outcome and follow up was evaluated using Hughes's grading. Serological assay for antiganglioside antibodies against GM1, GM2, GM3, GDIa, GDIb, GT1b and GQ1b were done using ELISA. Results: Out of the 204 patients studied, 146 (71.56%) were males and 58 (28.43%) were female with mean age 34.5 ± 19.6 years (2-79 years). Different patterns of GBS were AIDP 119 patients (58.3%); AMAN 30 patients (14.7%). AMSAN 18 patients (8.8%), unclassified 33 patients (16.1%). Antecedent event was noted in 100 patients (49.02%), dysautonomia in 33 patients (16.18%), ventilatory support was required in 31 patients (15.2%). Mortality was seen in 14 patients (6.8%). Multivariate analysis showed age >40 years, ventilatory failure and APB CMAP <1 mv are the predicting factors for poor outcome. Antibodies were significantly positive in AMAN. Absence of antibodies was associated with poor recovery. [ABSTRACT FROM AUTHOR]

Presents a response from the author to a letter to the editor on his article about the myasthenic crisis.

Aim: To study the clinical & electrophysiological subtypes and anti ganglioside antibodies in pediatric GBS (Guillian-Barre syndrome). Methods: We studied children who were referred for electrophysiological evaluation after being diagnosed clinically as GBS from August 2006 to August 2007. Nerve conduction studies and serum anti ganglioside antibodies were done. Clinical and electrophysiological results were correlated with anti ganglioside antibody results. Results: Of the 38 children, male to female ratio was 2.1: 1. Motor weakness seen in 97 % of patients, cranial nerve palsies in 72%, and autonomic disturbances in 16 %. Antecedent illness seen in 64%. Of the 38 children 21 had AIDP and 13 had AMAN. There was no difference in the severity of illness in both AMAN and AIDP groups. Preceding diarrhea is more common in AMAN group compared to AIDP group (46 % vs 4.7 %) while sensory symptoms were more common in the latter (66.6 % vs 23 %). IgM GM2 is commonest ganglioside antibody. Anti GM3 antibodies is exclusively seen in AMAN. IgG GD1b is significantly seen in higher % (46 %) of AMAN patients. IgG GT1b is seen in 38 % of AIDP compared to 23 % of AMAN patients. Conclusion: This study confirms that acute motor axonal neuropathy is an important Guillain Barre Syndrome subtype in Indian children, is associated with diarrhea, and showed specific antiganglioside antibodies. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether Helicobacter pylori eradication would improve clinical response to L-dopa in patients with advanced Parkinson's disease. Materials and Methods: Patients with idiopathic advanced Parkinson's disease were screened for H. Pylori infection with an IgG ELISA serological test. Those positive were given eradication therapy. All patients were assessed at baseline and immediately, 1 and 2 weeks after treatment with the Unified Parkinson's Disease Rating Scale I-III (UPDRS I-III) at best on and practically defined off conditions. Onset, duration and total daily on time with L-dopa were assessed, the latter two using Hauser's diaries. Finally these parameters were compared within each group and H. pylori positive versus negative at baseline and at 0,1, & 2 weeks after treatment. Results: Twenty-eight patients (10 post dbs) were screened - 18 (64%) were positive for H. pylori infection. There was highly significant improvement (P< 0.05) within the treatment group for on UPDRS I-III, UPDRS III, onset, duration and total daily on time at 0, 1 & 2 weeks compared to baseline but off stage total UPDRS I-III & off UPDRS III did not improve significantly (P>0.05). This was also seen on comparing treated versus untreated groups, However there was no significant difference for off total UPDRS I-III and off UPDRS III (P>0.05). Conclusion: H. pylori eradication significantly improves the clinical status of infected patients with advanced Parkinson's disease. [ABSTRACT FROM AUTHOR]

Aim: To detect value of Interictal EEG in prediction of post surgical outcome in patients with hippocampal sclerosis. Methods: 24 hour awake and sleep interictal and ictal EEG data was analyzed in 60 patients with medial temporal sclerosis on MRI and histopathologically verified HS. All patients had at least 12 months follow up after surgery. Patients were grouped into those with preponderantly unilateral (> 75% of all discharges or exclusively unilateral) and those with bilateral interictal epileptiform discharges. Oligospikers were defined as those with < 1 spike/hour. Univariate analysis with odds ratio (OR) was employed in data analysis. Chi square test was used for P value. The interictal EEG findings were correlated with ictal EEG onset and outcome (favorable -- Engel's Class 1&2 and poor Classes 3-5). Results: Among 60 patients, all seizures arose from expected side in 55. Patients with bilateral spikes had poor outcome (28%) compared with unilateral spikes (5%) {OR -- 7.69(C.I. 5.94-9.44) and P < 0.001}. Unilateral interictal discharge is a predictor of ipsilateral seizure origin {OR 8.94 (C.I. 6.68-11.20). [ABSTRACT FROM AUTHOR]

Background: Rimmed vacuoles are considered a pathological hallmark of distal myopathy, oculopharyngeal muscular dystrophy (OPMD), and inclusion body myositis (IBM). The pathogenetic mechanism of its formation is uncertain. Objective: To determine if rimmed vacuoles occur in other forms of myopathies including muscular dystrophies. Materials and Methods: All cases in which rimmed vacuoles were seen on muscle biopsies performed in our Institute between Jan 2006 and May 2007 were reviewed. The clinical features, demographic profile and pathological phenotype were analysed. Cases clinically considered to be muscular dystrophy were subjected to Immunohistochemistry for dystrophins, sarcoglycans and dysferlin for further characterization. Results: Of 542 muscle biopsies performed between Jan 2006 and May 2007, all cases of muscular dystrophies (n=75) excluding Duchenne muscular dystrophies were screened for presence of rimmed vacuoles. Nineteen cases (M:F 10:9, age range 7-63 yrs) were found to have rimmed vacuoles on histopathological examination of muscle biopsy. Five of these had clinical and pathological features characteristic of distal myopathy, one case each were diagnosed as oculopharyngeal muscular dystrophy and inclusion body myositis respectively. Nine cases with rimmed vacuoles were characterized as muscular dystrophy with 5 showing deficiency of alpha sarcoglycan and four with absence of dysferlin demonstrated on immunohistochemistry. Conclusion Rimmed vacuoles maybe seen in conditions other than distal myopathy, oculopharyngeal muscular dystrophy and inclusion body myositis suggesting that its occurrence maybe an epiphenomenon occurring as a degenerative change and may not be useful as a diagnostic hallmark. [ABSTRACT FROM AUTHOR]

Purpose: Asymptomatic carotid artery stenosis (ACAS) is a marker for stroke, coronary atherosclerosis and death. This study was aimed to find the prevalence of ACAS in individuals >40 years and whether certain high-risk groups should be routinely screened for it. There is no data available on this subject from India. Design: Prospective descriptive study. Methods: From 1st September 2003 to 29th August 2006, 1500 patients over 40 years of age attending neurological out patient department, without present or past history of stroke or transient ischemic attacks in ocular or hemispheric distribution were subjected to carotid duplex examination with a 7-10 MHz Doppler probe. Results: There were 1016 men and 484 women. Mean age was 54.1 years (range 40-98 years). Overall, significant stenosis in internal carotid arteries (>50% diameter reduction) was detected in 78 (5.2%) patients. Among the subgroups significant carotid artery atherosclerosis was detected in 44/539 (8.1%) in hypertensive, 37/348 (10.6%) in diabetics, 29/211 (13.7%) in smokers, 23/235 (9.7%) in alcoholics and 38/261 (14.58%) in subjects with hyperlipdemia. Further, the prevalence was 25/346 (7.2%) in those with two risk factors, 22/139 (15.8%) in those with three risk factors, 12/48 (25%) in those with more than three risk factors, whereas it was only 9/575 (1.5%) in those with no risk factors. Conclusions: Individuals, >40 of age, even if asymptomatic for cerebrovascular disease should be screened for carotid stenosis, if they have one or more risk factors. [ABSTRACT FROM AUTHOR]