Search

The banking sector in India has contributed to economic growth, parity and equity while equally keeping focus on profit and social objectives. The successive prudential and regulatory reforms introduced in the banking sector have made it more robust and stronger to withstand the bubbles and external shocks. Still, the Indian banking sector in general and public-sector banks (PSBs) in particular have been suffering from the bank frauds. This study endeavors to cover the increasing incidences of banking frauds in PSBs and probes the weaknesses and chinks in the operational risk architecture at the PSBs in India. This study selects Punjab National Bank as a true representative of PSBs and treats it as a critical case study to apply the learning and findings to the PSBs in India. This qualitative analysis of the study revealed that the chinks in the operational risk control mechanism and lax corporate governance are the main reasons behind the increasing incidences of frauds at PSBs. The findings of the study showed that a strong corporate governance and compliance framework, robust risk management architecture, investment in people, technology and systems will go a long way in achieving tighter control and supervision, streamlining processes and, most of all, adhering to a culture of checks and balances.

Background and Aims: Neurolytic splanchnic nerve block (NSNB) is practised in intractable abdominal pain secondary to intra-abdominal malignancies. This review evaluated the efficacy of NSNB. Methods: PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2001 to October 2023. Two independent reviewers extracted the data from the included studies. The quality of randomised controlled trials (RCTs) was assessed using the revised Cochrane risk-of-bias tool (RoB 2), and the Newcastle–Ottawa scale was used for cohort studies. Results: Fourteen articles (4 RCTs, 3 non-randomised prospective, and 7 retrospectives) were included. Ten articles were quantitatively assessed and demonstrated significant pain relief at 1 week (standardised mean difference (SMD): 3.46 [2.09, 4.83], P < 0.001, I2 = 95%), 2 weeks (SMD: 4.45 [2.61, 6.29], P < 0.001, I2 = 95%), 4 weeks (SMD: 3.35 [2.23, 4.47], P < 0.001, I2 = 97%), 8 weeks (SMD: 3.7 [2.71, 4.7], P < 0.001, I2 = 86%), 12 weeks (SMD: 4.01 [2.66, 5.36], P < 0.001, I2 = 95%), and 24 weeks (SMD: 2.54 [1.71,3.37], P < 0.001, I2 = 84%). Daily narcotic consumption and quality of life (QOL) significantly improved post neurolysis, but survival rates showed controversial results. Significant heterogeneity was reported, and sub-group analysis revealed a moderate level of variability [I2 = 47.3%] pertaining to study design as a source of heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Pro GDT recommendation for the primary objective was 'high' for the analysis of RCTs and 'very low' evidence quality for observational studies. Only transient minor complications were reported. Conclusion: NSNB appears to be an efficacious technique that provides substantial pain relief, reduces opioid consumption, and ameliorates QOL.

Early identification of Proteinuria by using urine dipstick among patients with Type II Diabetes in Selected Community Area, Kanchipuram Dist, Tamil Nadu, India. The objectives of the study to assess the Proteinuria by using urine dipstick among Patients with Type II Diabetes. To find out the association between level of Proteinuria with selected demographic variables among Patients with Type II Diabetes.. The sampling technique was non probability- purposive sample technique and the sample size was 200. The demographic variable proforma and the random urine dipstick analysis were done to identify the prevalence of proteinuria. The interpretations were nil, trace, 1+, 2+ and 3+.. Hypothesis were formulated. The level of significance selected was p<0.05. The data was collected and it was analyzed by descriptive and inferential statistics. It presented through tables and figures. The study finding revealed that (47%) of patients were not having proteinuria. Then (38.5%) were having trace, (12%) of patients having 1+, (1.5%) having 2+ and (1%) patients were having 3+ of proteinuria. The study finds also revealed that there was a significant association between the demographic variables such as age X²=8.4120,educational status X²=6.8901, monthly income X²=10.9762, occupational status X²=4.9031, history of diabetes X²=12.14, previous blood glucose level X²=0.9876, family history X²=5.1056, unhealthy habits X²=10.74 were non significant to p<0.05 were as, marital status X²=16.428, dietary pattern X²=17.594 were significant to p>0.05 with the level of prevalence of proteinuria among type II diabetes patients. [ABSTRACT FROM AUTHOR]

Background/aims This study aims to determine the incidence and risk of open-angle glaucoma or ocular hypertension (OHT) following ocular steroid injections using healthcare claims data.Methods We retrospectively reviewed deidentified insurance claims data from the IBM MarketScan Database to identify 19 156 adult patients with no prior history of glaucoma who received ocular steroid injections between 2011 and 2020. Patient demographics and steroid treatment characteristics were collected. Postinjection glaucoma/OHT development was defined as a new diagnosis of glaucoma/OHT, initiation of glaucoma drops, and/or surgical or laser glaucoma treatment. Cox proportional hazards models were used to determine the risk of glaucoma/OHT development within 5 years after first steroid injection.Results Overall, 3932 (20.5%) patients were diagnosed with new glaucoma/OHT, 3345 (17.5%) started glaucoma drops and 435 (2.27%) required a laser or surgical glaucoma procedure within 5 years of first steroid injection. Triamcinolone subconjunctival injections were associated with a lower risk of glaucoma/OHT development than retrobulbar or intravitreal steroid injections (p

Cervicogenic headache (CeH) is caused by the disorder of the cervical spine and its anatomical structures. Patients who fail to respond to conservative therapies can undergo interventional treatment. The purpose of this review is to describe the various interventions and compare their relative efficacies. Although a few reviews have been published focusing on individual interventions, reviewing studies on other available treatments and establishing the most efficacious approach is still necessary. We performed a systematic review of studies available on the various interventions for CeH. The PubMed, Embase, and Cochrane databases were searched for literature published between January 2001 and March 2021. Based on the inclusion criteria, 23 articles were included. Two reviewers independently extracted the data from the studies and summarized them in a table. Eleven of twenty-three studies evaluated the effect of radiofrequency ablation (RFA), 5 evaluated occipital nerve blocks, 2 each for facet joint injections and deep cervical plexus blocks, and 1 study each evaluated atlantoaxial (AA) joint injections, cervical epidural injection, and cryoneurolysis. Most of the studies reported pain reduction except 2 studies on RFA. In conclusion, based on the available literature, occipital nerve blocks, cervical facet joint injection, AA joint injection, deep cervical plexus block, cervical epidural injection may be reasonable options in refractory cases of CeH. RFA was found to have favorable long-term outcomes, while better safety has been reported with pulsed therapy. However, our review revealed only limited evidence, and more randomized controlled trials are needed to provide more conclusive evidence.

Cross-linked guar gum microparticles of curcumin were prepared for controlled release by emulsion gelation method using glutaraldehyde as cross-linking agent. Morphology and surface characteristics of the formulations were assessed by scanning electron microscopy. Particle size of the guar gum microparticles was determined by optical microscopy. The mean particle size ranged from 82 to 250 μ. The % drug loading was found to be in the range of 20 to 51% while the percentage encapsulation efficiency was ranging between 29 to 86%. FT-IR and DSC studies revealed the compatibility of the drug with the polymer. Formulation CGMP3 exhibited maximum % EE of 84%, In vitro drug-release studies were performed in simulated gastric fluid (without enzymes) for 2 h followed by simulated intestinal fluid (without enzymes) for 6 h and continued for 24 h. Formulation CGMP3 exhibited relatively more sustained release profile than the other formulations. All formulations of 1.5% guar gum (CGMP2, CGMP3 and CGMP4) have shown retarded release than 1.0 % guar gum formulations (CGMP6, CGMP7 and CGMP8). Optimal glutaraldehyde concentration was found to be 2%. The optimized formulation subjected to stability studies was found to be stable when observed for particle size and drug content. [ABSTRACT FROM AUTHOR]

Purpose The aim of the study is to report changes in tube shunt placement surgical case times for glaucoma fellows during the course of the academic year. Patients and Methods Electronic health records were retrospectively reviewed to determine patient demographics, surgical case times (defined as procedure start time to procedure end time), and glaucoma fellow involvement. Only cases with a glaucoma fellow as the primary surgeon were included. Operative case times were compared by first and second halves of the academic year (beginning in July and ending in June) using a two-tailed t-test. Results Five hundred and seventy-three individual tube shunt surgeries (385 Ahmed, 188 Baerveldt) performed by 28 glaucoma fellows (17 females, 11 males) at Duke University Eye Center and University of North Carolina Medical Center were included. Overall, case times were significantly shorter in the second half of the academic year as compared with the first (55.3 ± 17.1 minutes vs. 61.0 ± 17.4 minutes, p

Enzymes are well known biocatalysts that execute a multitude of chemical reactions in the metabolism of almost all organisms. From an industrial perspective, only a restricted number of enzymes are commercially available and a few of them have found applications in large quantities. Microbial fibrinolytic enzymes are among the most important hydrolytic enzymes and have been studied extensively since the advent of enzyme technology. Alkaline fibrinolytic enzyme produced under solid state fermentation by Bacillus cereus GD55 was purified by ammonium sulphate fractionation (70%) and subjected to chromatographic methods. The purified enzyme produced 11.59 fold with recovery 6.8% by DEAE-Sephadex A-50 column chromatography and molecular weight was estimated to be 31 kDa by SDS-PAGE. This enzyme exhibited good compatibility with the commercial detergent Rin. The fibrinolytic potential of the enzyme was evidenced by the complete removal of blood stains from cotton cloth within 50 min of treatment. Bacillus cereus GD55 alkaline fibrinolytic enzyme with a diversity of activities, has great potential for application in a wide range of industry. [ABSTRACT FROM AUTHOR]

Electrocution injuries, particularly high voltage, are uncommon, but can be devastating. Thermal burns, arrhythmias and myonecrosis are commonly known and monitored complications of electrical injuries. Direct thermal trauma to internal viscera is also known and almost all internal organs have been reported to be affected, bowel being the most common. However, bowel perforation occurring in a delayed fashion is one rare, dreaded and erratic complication of electrocution, making it a dangerous pitfall if missed. Alimentary tract perforations can present on a delayed basis in high voltage electrocution injuries; advise for clinical follow up must incorporate this possibility at the time of discharge. Presentation of delayed visceral injuries is subtle & atypical, and post burn immunosuppression may play a part for such presentation. We suggest that all victims of high voltage electrocution with abdominal wall burns receive diagnostic laparoscopy and/or CECT abdomen as part of workup of their injuries. Any non-enhancing segment of bowel on CECT, howsoever small, should be prudently evaluated with laparoscopy.

Purpose: To describe a case of anterior ischemic optic neuropathy as a presenting sign of granulomatosis with polyangiitis. Observations: A previously healthy 50-year-old female developed right eye, then left eye, redness and pruritis and was diagnosed with allergic versus viral conjunctivitis. Five days later, she noted an acute decline in vision in the right eye, corresponding with a decrease on Snellen testing from 20/30 to 20/100 with correction. She was noted to have a right relative afferent pupillary defect, 2+ pallid disc edema, and OCT (Spectralis, Heidelberg Engineering, Carlsbad, CA) findings of significant retinal nerve fiber thickening. Review of systems revealed a three-month history fatigue, right-sided headaches, jaw claudication, bronchitis, cough without hemoptysis, and epistaxis, as well as interval development of a petechial rash across her body, migratory polyarthralgias, fevers, and tachycardia. ESR and CRP were markedly elevated, and the patient was admitted to the hospital for a systemic vasculitis workup. She was started on IV methylprednisolone. Her vision improved dramatically with steroids, measuring 20/50 with correction in the right eye after 24 hours and returning to baseline after five days. An extensive workup including imaging, bloodwork, and biopsies led to a diagnosis of granulomatosis with polyangiitis, with PR3-positive ANCA. Conclusions: Ocular findings, including anterior ischemic optic neuropathy, may be the presenting signs for patients with granulomatosis with polyangiitis. Prompt recognition and treatment with high-dose steroids and immunomodulatory therapy is important for visual recovery. Importance: Prompt recognition of potential vasculitis-related vision loss can lead to timely initiation of vision-saving treatment.

Microbial fibrinolytic proteases are of considerable interest in view of their specific activity and stability at biological pH. This review describes different isolation methods which enable the screening and selection of promising organisms for industrial production. Further, strain improvement using mutagenesis and/or recombinant DNA technology can be applied to augment the efficiency of the producer strain to a commercial status. The various nutritional and environmental parameters affecting the production of fibrinolytic proteases are delineated. The purification and properties of these fibrinolytic proteases is discussed, and the use of fibrinolytic proteases is highlighted. [ABSTRACT FROM AUTHOR]

This work has been undertaken for the Screening and isolation of Keratinase producing strains of Bacteria were carried out from Ten soil samples, collected from various regions of Bangalore and used to screen for Keratinase production by using feather powder agar plate assay. In the present study, an attempt was made to isolate efficient Keratinase producing bacteria from diverse poultry waste. Different isolates were screened for possessing the ability to produce Keratinase. About 6 bacterial isolates were found to be promising to produce Keratinase. The organisms were tested for various biochemical tests, which leads to their identification as Bacillus licheniformis, Bacillus cerus, and Staphylococcus aureus. [ABSTRACT FROM AUTHOR]

The prospective observational study was conducted in the Ophthalmology department of M.S.Ramaiah Medical and Teaching Hospital, during the period 1st November 2005 to 1st April 2007. The objective of the study was to determine the proportion of premature infants who were managed in our NICU who developed ROP and to find out the risk factors contributing to the development of ROP. 75 NICU infants who fulfilled the criteria of gestational age less than 36 weeks and birth weight less than 2000 grams were taken up for the study. First examination was carried out between 4-6 weeks postnatally and subsequent examinations were done at 2 to 3 weeks interval or even earlier if necessary, till retina is fully vascularised. ICROP classification was used. 11 babies(14.67%) developed ROP and 6 babies required laser treatment. In our study stage 1 ROP was found in 5 babies, Stage 2 plus in 1 baby, Stage 3 plus in 1 baby, Stage 3 Zone II in 2 babies, Stage 3 Zone I in 1 baby, Stage 3 Zone III in 1 baby. Most cases had similar stages of ROP in both eyes. Incidence of ROP was more(45.55%) in babies weighing 1251-1500 gms. The incidence of ROP among babies born before 28 weeks, between 29 to 30 weeks between 31-32 weeks and between 33-34 weeks was 27.30% , 27.30%, 27.30% and 18.20% respectively. Propable high risk factors for the development of ROP were compared between the infants who developed ROP and who did not develop ROP. Lower gestational age, lower birth weight, exposure to Oxygen, hyperoxia, mechanical ventilation, apnoea and twin pregnancy were statistically significant in developing ROP. Our study concluded that ROP is an important complication of prematurity for which screening should be started at 4 weeks postnatal age. The factors contributing to the development of ROP are lower gestational age, low birth weight, exposure to Oxygen hyperoxia, mechanical ventilation, apnoea and twin pregnancy. [ABSTRACT FROM AUTHOR]

Hypotony maculopathy is a condition that may result in visual deterioration from choroidal folds or optic disc edema. Optic disc edema can result from altered translaminar pressure gradients (lowered intraocular pressure, increased cerebrospinal fluid pressure, or increased orbital pressure). We report a case of bilateral optic disc edema in a patient with glaucoma and thyroid-related orbitopathy. The patient's disc edema was initially presumed to be secondary to her orbitopathy, but persisted after bilateral orbital decompression. Ultimately, disc edema and choroidal folds in the right eye resolved after trabeculectomy revision and an increase in intraocular pressure. This case serves as a reminder of the causes of optic disc edema and demonstrates delayed reversal of hypotony maculopathy.

PURPOSE:To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. DESIGN:Cross-sectional, observational study. SUBJECTS:Twenty-eight normal, 30 POAG, and 31 NTG subjects. METHODS:One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. MAIN OUTCOME MEASURES:Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. RESULTS:Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p

Pravastatin Sodium has a cholesterol lowering agent. It has shorter half-life and undergoes first-pass metabolism. Frequent dose is required in case of conventional dosage form. The purpose of the study is to formulate and evaluate microcapsules containing Pravastatin Sodium by complex with cholestyramine resins coated with Eudragit RLPO and Eudragit RSPO polymers for achieving control release. Complexation of drug on resin was carried out by batch method. Microencapsulation was carried out by nonaqueous solvent evaporation method. Pharmacokinetic studies were done by using rats. The intermediate stability studies were carried out on the most satisfactory formulations. FTIR, X-ray diffraction, and DSC spectra of drug, drug-resinates, and polymers revealed no chemical interaction. The % DEE and % yield were observed for formulations of f1 to f7 that were varied from 97.1 ± 0.8 to 98.9 ± 0.5% and 95.0 ± 3.25 to 98.8 ± 7.1%, respectively. Most satisfactory formulation, f6, showed drug release up to 72.6%. No changes in % DEE and % CDR were observed after stability studies. Microcapsules of f6 formulation achieved best performance regarding in vitro drug release and from pharmacokinetic evaluation mean residence time was found to be 6.3 h, thus indicated, Pravastatin Sodium microcapsules were released and absorbed slowly over a prolonged period of time.

Stress is a non-specific immune response of the body known toalter the physiological homeostasis of the organism resulting invarious neuronal endocrinal and visceral functions. Derailmentof the immune system contributes for the alteration in thehomeostasis and resulting in stress related disturbances.Stress responses are composed of alterations in behavior,autonomic function and the secretion of multiple hormonesincluding adrenocorticotropin hormone (ACTH) andcortisol/corticosterone, adrenal catecholamine, oxytocin,prolactin and renin. The concept of “Adaptogen” as a group ofmedicinal substances was first adopted by Lazarev.Adaptogens are the substances that push the organism into “astate of non-specific heightened resistance (SNIR)” in order tobetter resist stressors and adapt to extraordinary challenges.They normalize the body functions; strengthen systems andfunctions that are compromised by stress and have aprotective effect against a wide variety of environmental andemotional stress. Till date various substances (natural,synthetic) and techniques (yoga, exercise) have been used tocontrol the stress and stress related disorder. Among thoseadaptogens are the substances on which less research has beencarried out hence in this article we have made an attempt toreview the history, potential and different plausible mode ofaction of adaptogen along with different experimental animalmodel for the evaluation of an adaptogen.

In this work we devised a method to create smaller eye drops of the glaucoma medication timolol maleate by altering the dropper tip design and changing the physical properties of the formulation. Most ocular diseases are treated with topical application of eye drops. After instillation of an eye drop, typically, less than 5% of the applied drug penetrates the cornea and reaches the intraocular tissues; the major fraction of the instilled drug is absorbed and enters the systemic circulation. Ophthalmic solutions are available in multidose or single-dose glass/plastic dropper bottles that deliver drops with a volume that ranges from 25 μL to 70 μL (average 40 μL). Because of the low capacity of the precorneal area, the optimal drop volume is about 20 μL; with larger volumes there is the risk of adverse systemic effects due to absorption of the drug via the nasal mucosa. Thus, both from the biopharmaceutical and economic point of view, drops of only 5-15 mL volume should be instilled into the eye. In this present work we devised a method to reduce the size of the drop by inserting a glass capillary tube into the dropper tip and by changing the physical properties of the formulation (by altering the concentration of Tween 80™, i.e., 0.05% and 0.1% of Tween 80™). We measured the drop sizes of the different timolol eye drop formulations available in the market and estimated the yearly cost of the medications. Our timolol maleate formulation with 0.1% concentration of Tween 80™ delivered through the dropper tip with the inserted glass capillary was shown to be better than the other formulations available in the market in terms of ability to deliver smaller drops, meaning that each bottle would last longer and that the yearly cost of treatment would be lower.

Purpose: This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions., Methods: We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity., Results: There were 10 males and seven females with a mean age of 10.4 years (range:6-14 years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades., Conclusion: Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: External ventricular drain (EVD)-related infection (ERI) is a common complication in cranial neurosurgery practice with high mortality. The risk factors associated with ERI are not well studied in low- and middle-income countries (LMIC) like India. Identifying the risk variables is a necessity to design robust evidence-based care bundles for ERI prevention., Materials and Methods: This is a single-center prospective cohort study. Patients with and without ERI during the 2-year study period were analyzed along with literature review to identify the risk variables associated with ERI. The Institute for Healthcare Improvement (IHI) comprehensive flowchart was used to develop the concept care bundle for ERI prevention., Results: A total of 211 EVD were inserted during the study period. 15 ERI (7.1%) were identified based on IDSA criteria, with an average infection rate of 11.12 per 1000 EVD days. Gram negative bacteria (GNB) were the predominant pathogen (12/15, 80%), with Klebsiella pneumoniae (6/15, 40%) being the most common bacteria isolated. In multivariate analysis, the risk variables associated with ERI were use of broad spectrum pre-surgical antimicrobial prophylaxis for long duration, choice of posterior craniometric points for EVD insertion, EVD duration >7 days, EVD leak and surveillance cerebrospinal fluid (CSF) sampling at periodic intervals. Based on the risk variables identified in this study and literature review, a consensus decision on the care elements for the insertion and maintenance phases was chosen for the concept care bundle for ERI prevention., Conclusion: An evidence-based concept care bundle for ERI prevention is proposed for further multicentric evaluation and validation., How to Cite This Article: Ponnambath DK, Divakar G, Mamachan J, Biju S, Raja K, Abraham M. Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection: Results of a Single-center Prospective Cohort Study and Literature Review. Indian J Crit Care Med 2024;28(8):760-768., Competing Interests: Source of support: Nil Conflict of interest: NoneConflict of interest: None, (Copyright © 2024; The Author(s).)

Background: Patients undergoing surgical resection of brain tumors frequently exhibit a spectrum of hemodynamic fluctuations necessitating careful fluid management. This study aimed to evaluate the feasibility of dynamic predictors of fluid responsiveness, such as delta down (DD), aortic velocity time integral variability (VTIAoV), and superior vena cava collapsibility index (SVCCI), in patients undergoing neurosurgery for brain tumors., Methods: In this prospective study, 30 patients scheduled to undergo elective neurosurgery for brain tumor resection were enrolled. Baseline measurements of vitals, anesthetic parameters, and study variables were recorded post-induction. Subsequently, patients received a fluid bolus of 10 mL/kg of colloid over 20 min, and measurements were repeated post-loading. Data were presented as mean ± standard deviation. The normally distributed continuous variables were compared using Student's t -test, with P < 0.05 considered statistically significant. The predictive capability of variables for fluid responsiveness was assessed using Pearson's coefficient analysis (r)., Results: Of the 30 patients, 22 were identified as volume responders (R), while eight were non-responders (NR). DD >5 mmHg effectively distinguished between R and NR ( P < 0.001), with a good predictive ability (r = 0.759). SVCCI >38% differentiated R from NR ( P < 0.001), with excellent predictability (r = 0.994). Similarly, VTIAoV >20% was also a good predictor ( P < 0.05; r = 0.746)., Conclusion: Our study revealed that most patients undergoing surgical resection of brain tumors exhibited fluid responsiveness. Among the variables assessed, SVCCI >38% emerged as an excellent predictor, followed by VTIAoV >20% and DD >5 mm Hg, for evaluating fluid status in this population., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Purpose: Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience., Materials and Methods: The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed., Results: There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up., Conclusions: Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required.

Choroid plexus carcinomas (CPCs) are rare intraventricular lesions encountered in the pediatric population. The dreaded perioperative complication causing high mortality and morbidity in patients undergoing excision of CPC is massive intraoperative hemorrhage, which results in massive blood transfusion, and coagulopathy. Hence, the main crux of perioperative management is to tackle intraoperative hemorrhage and coagulopathy by instituting goal-directed blood transfusion guided by multimodality monitoring. This case series and literature review aims to present our institutional experience wherein the patients had a favorable outcome post-excision of CPC owing to goal-directed blood transfusion protocol guided by multimodality monitoring in the perioperative period., (Copyright © 2024 Copyright: © 2024 Neurology India, Neurological Society of India.)

Background: Device-associated CNS infections is a major subgroup of healthcare associated CNS infections. Healthcare-associated ventriculitis or meningitis differs considerably from community-acquired meningitis in its epidemiology, pathogenesis, clinical presentation and management., Objectives: This study aimed to identify the infection rates, the associated risk factors, and outcomes of these life-threatening infections., Methods: This was a 2-year single center prospective cohort study. Patient's clinical data, laboratory parameters, treatment and their outcomes were collected using data collection tool, and device days were collected from the hospital information system (HIS). Patients were categorised using IDSA criteria as contamination or colonisation or infection. Cox regression model was used for multivariate analysis to estimate hazard risk., Results: A total of 578 CSF diversion catheters were inserted in 472 patients. The average rate for EVD and LD infection were 11.12 and 11.86 per 1000 device days respectively. The average infection rates for VP and LP shunts were 6% and 5.2% per procedure, respectively. The commonest etiological agent causing CSF diversion catheter-related infection (CDRI) was Klebsiella pneumoniae (n = 14, 40%). The risk factors which were independently associated with increased infection risk by cox regression analysis were drain insertion ≥7 days [HR:11.73, p -0.03], posterior approach of EVD insertion (occipital) [HR:9.53, p - 0.01], pre-OP ASA score>3 [HR:8.28, p - 0.013] presence of EVD/LD leak [HR: 17.24, p < 0.0001], male gender [HR:2.05, p-0.05] and presence of associated peri-operative scalp infections [HR:3.531, p-0.005]. Shift to narrow spectrum surgical prophylactic antibiotic [Coefficient: -1.284, p-0.03] and reduction in CSF sampling frequency [Coefficient: -1.741, p-0.02] were found to be negatively associated with CDRI., Conclusions: The study demonstrated drain insertion ≥7 days, posterior approach of EVD insertion, presence of EVD/LD leak, male gender and presence of associated peri-operative scalp skin and soft tissue infections were associated with increased risk of infection., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. DINOOP K. P. reports financial support was provided by Indian Council of Medical Research. Dr. Dinoop K P reports a relationship with Indian Council of Medical Research that includes: funding grants. The Corresponding author (Dr. Kavita Raja) is currently holding the position of Associate Editor of the Indian Journal of Medical Microbiology (IJMM)., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Split cord malformations are disorders of gastrulation. Disorders of secondary neurulation occur later and are traditionally considered separate from the former. Complex split cord malformations involving both the cord and the conus and encompassing the epochs of gastrulation, primary neurulation, junctional neurulation, and secondary neurulation have not been described in literature. We present a four-year-old boy with such a malformation and postulate the embryological mechanism involved. The clinical vignette of this unique case has been described. We report a good clinical outcome in this patient with surgical management.

Objective: We sought to reclassify the "anatomic risk zones of colloid cysts" as proposed by Beaumont et al, by proposing newer landmarks, and to assess predictive value for the risk of occurrence of hydrocephalus with the new classification compared with the old., Methods: A retrospective cohort of 122 cases of colloid cyst of third ventricle were categorized into zones 1, 2, or 3 based on Beaumont's classification (old zone) and our classification (new zone) based on radiologic images. We attempted to recategorize these zones by assigning new anatomic landmarks. The difference in zonal distribution of colloid cyst and association with hydrocephalus was studied using the 2 methods of zonal classification., Results: Per the old zone classification, 3/122 patients were in zone 2, whereas 21/122 were in zone 2 per the new zone classification. The new zone method had a higher specificity (36.21% vs. 5.263 %) and positive predictive value (63.37% vs. 54.23%) for occurrence of hydrocephalus in patients with colloid cyst. The Spearman correlation showed better correlation with the new method for occurrence of hydrocephalus (rho = 0.4 [P < 0.00000] vs. 0.2 [P = 0.011])., Conclusions: Symptomatic colloid cysts are more likely to develop hydrocephalus and sudden acute deterioration. The colloid cyst risk score is a step towards objective decision making, with scope for modification such as the one that we have attempted with new zone classification to achieve superior prognostic ability., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Giant cell tumors (GCTs) of the skull are rare and only a few case series with limited number of cases have been reported till date. In the cranium, GCT usually occurs in the sphenoid and temporal bone, occipital condyle GCTs are very rare. We report a rare presentation of GCT of the occipital condyle manifested as occipital condyle syndrome. Despite gross total resection, they can recur aggressively; the presence of cortical breach might be an indicator of aggressiveness prompting early post-operative imaging and adjuvant therapy., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practice.)

Competing Interests: There are no conflicts of interest.

Purpose: Spinal angiolipomas are benign spinal epidural tumors consisting of mature fat cells with angiomatous components. These tumors are rare in children and there are no definite management guidelines., Method: To the best of our knowledge, only five cases of spinal angiolipomas have been reported in children below 12 years. This article discusses the presentation, diagnostics, and surgical tips for the management of a case of spinal angiolipoma., Result: In this paper, we present a one and half-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal angiolipoma and underscore the importance of early surgery in a benign disease for a good outcome., Conclusion: Overall neurological recovery and prognosis following timely intervention for spinal angiolipomas are good.