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Byline: S. Sheetal, Robert. Mathew Efficacy of current pharmacological therapy for dementia is very much limited and hence research focused on non-pharmacological treatment (NPT) of dementia becomes very important. Among [...]

Background: Picture-naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. Aims: In this cross-sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture-naming performance in patients with MCI and dementia. Methods & Procedures: A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR-PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross-cultural adaptation guidelines and item-wise factor analysis and correlations established separately across five languages, the final version of the ICMR-PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR-PNT were examined, and sensitivity and specificity were examined. Outcomes & Results The ICMR-PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F[subscript 2], [subscript 615] = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR-PNT scores and a positive correlation between Addenbrooke's Cognitive Examination--III (ACE-III) and ICMR-PNT scores in control and patient groups. Conclusions & Implications: The ICMR-PNT was developed by following cross-cultural adaptation guidelines and establishing correlations using item-wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Byline: S. Sheetal, Robert. Mathew An 82-year-old, right-handed lady, a retired college professor, who was an introvert, confined to domestic and occupational activities, was noted to have behavioral changes for [...]

Microorganisms in wastewater treatment plants (WWTPs) are essential for water purification to protect public and environmental health. However, the diversity of microorganisms and the factors that control it are poorly understood. Using a systematic global-sampling effort, we analysed the 16S ribosomal RNA gene sequences from ~1,200 activated sludge samples taken from 269 WWTPs in 23 countries on 6 continents. Our analyses revealed that the global activated sludge bacterial communities contain ~1 billion bacterial phylotypes with a Poisson lognormal diversity distribution. Despite this high diversity, activated sludge has a small, global core bacterial community (n = 28 operational taxonomic units) that is strongly linked to activated sludge performance. Meta-analyses with global datasets associate the activated sludge microbiomes most closely to freshwater populations. In contrast to macroorganism diversity, activated sludge bacterial communities show no latitudinal gradient. Furthermore, their spatial turnover is scale-dependent and appears to be largely driven by stochastic processes (dispersal and drift), although deterministic factors (temperature and organic input) are also important. Our findings enhance our mechanistic understanding of the global diversity and biogeography of activated sludge bacterial communities within a theoretical ecology framework and have important implications for microbial ecology and wastewater treatment processes.

Byline: Robert. Mathew, N. Archana, S. Sheetal Background: Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, dementia, urinary incontinence, and dilation of ventricular system with normal opening [...]

Byline: Avanthi. Paplikar, Gowri. Iyer, Feba. Varghese, Suvarna. Alladi, Apoorva. Pauranik, Shailaja. Mekala, Subhash. Kaul, Meenakshi. Sharma, R. Dhaliwal, Aralikatte. Saroja, Santosh. Dharamkar, Aparna. Dutt, Gollahalli. Divyaraj, Amitabha. Ghosh, Rajmohan. [...]

Background: Diagnosis of tuberculous meningitis (TBM) is a challenge because of the manifold clinical presentation, and diagnosis is often delayed. Objectives: We wanted to share our experience of directly observed treatment short course (DOTS) in TBM. We did a retrospective analysis to look at the presentation, management and outcome of TBM patients from November 2006 to April 2008. Materials and Methods: TBM was diagnosed based on clinical criteria. We excluded patients with HIV. Results: We had 11 patients on DOTS regime. One died following hepatitis and another patient died of unrelated gastroenteritis. The only patient on daily regime died. Our patients generally presented late, at a median duration 20 days from onset of symptoms, and 50% had stage 3 disease at presentation. The median delay in diagnosis was 4.5 days. Discussion: We found DOTS to be effective in TBM but not without side effects.

Byline: Robert. Mathew, Neelima. Renjith, P. MathuranathBackground: Cube copying test is often used as screening test for dementia. However, there is a paucity of an effectively scoring system, and very [...]

Intracranial hemorrhage (ICH) is the most serious complication of idiopathic thrombocytopenic purpura (ITP) and is potentially fatal. It is rare, affecting 1% or less of patients and is usually subarachnoid or intracerebral. Isolated subdural hematoma (SDH) is rare and only few cases have been reported. Two cases of acute SDH (ASDH) are reported which resolved with conservative management. One of the patients later developed intracerebral hematoma also. In ITP, contrary to traumatic ASDH, the brain parenchyma is well preserved and hence conservative management may be safe in selected patients. However, only a prospective randomized control study will give the final answer. Both the patients developed the hematoma consequent to low platelet count, which was not detected earlier due to inadequate follow-up. In a developing country, where proper follow-up is often lacking these problems are likely to be more common and are probably underreported. Increased awareness is therefore important to ensure proper follow-up and early intervention.

Host responses, i.e., formation of reaction and barrier zones, were studied in the xylem of Douglas-fir, beech, oak, and sycamore trees, after wounding and artificial inoculation with brown-, soft-, and white-rot fungi. The objective of this study was to determine whether strongly invasive wood-decay fungi trigger a higher magnitude of host response than weakly invasive fungi. Differences in active host response, observed microscopically, depended on wood anatomy. Restriction of discoloration and decay by reaction zones was primarily influenced by the content and distribution of parenchyma cells within the sapwood of each host. By contrast, barrier-zone anatomy showed similarities to the basic xylem structure of each host, except for some cell types that were either reduced in number or absent. Regardless of the decay fungus inoculated, individual trees of each host responded differently. With the exception of beech trees inoculated with the soft-rot fungus Kretzschmaria deusta (Hoffm.: Fr.) P. Martin and the white-rot fungus Trametes versicolor (L.: Fries) Pilat, host response appeared to be nonspecific, as the degree of fungal invasiveness did not influence the magnitude of host response within the xylem of investigated trees. Key words: xylem, wood decay fungi, reaction zone, barrier zone, hardwood, softwood. Les auteurs ont etudie les reactions de l'hote, i.e. la formation de zones de barrage et de reaction, dans le xyleme de tiges le Douglas, de hetre, de chene et de sycomore apres blessures et inoculations artificielles avec des champignons de carie, brune, molle et blanche. L'etude visait a determiner si les champignons de carie tres envahissants declenchent une plus forte reaction de la part de l'hote que les champignons faiblement envahissants. L'observation microscopique montre que les reactions actives de l'hote dependent de l'anatomie du bois. Les restrictions de la decoloration et de la pourriture par les zones de reaction sont surtout influencees par le contenu et la distribution des cellules de parenchyme dans l'aubier de chaque hote. Au contraire, l'anatomie des zones de barrage montre des similitudes dans la structure de base du xyleme de chaque hote, sauf pour certains types de cellules qui sont soient reduits ou soient absents. Independamment du champignon de carie inocule, les individus de chaque hote reagissent differemment. Avec l'exception des hetres inocules avec le champignon de la pourriture molle, Kretzschmaria deusta (Hoffm.: Fr.) P. Martin et le champignon de la carie blanche Trametes versicolor (L.: Fries) Pilat, les reactions de l'hote ne semblent pas specifiques puisque le degre de capacite d'envahissement fongique n'a pas influence l'amplitude de la reaction de l'hote dans le xyleme des arbres observes. Mots-cles : xyleme, champignons de carie blanche, zone de reaction, zone de barrage, bois franc, bois mou. [Traduit par la Redaction], Introduction Host responses in the xylem have been studied in several host species (Sharon 1973; Moore 1978; Mulhern et al. 1979; Bauch et al. 1980; Smith 1980; Tippett and Shigo [...]

Byline: Robert. Mathew, Sauda. Pavithran Background: Literature on cognition in normal pressure hydrocephalus (NPH) is sparse and more so on cognition in advanced NPH. Objective: To study the cognitive profile [...]

Byline: Sunitha. Robert, Robert. Mathew Sir, Primary progressive freezing gait (PPFG) is a neurodegenerative atypical Parkinson syndrome, which begins with start hesitation or ignition failure, causes gait freezing during the [...]

Objective In the background of a large population of bilinguals globally, the study aimed to develop standards of neuropsychological testing in the context of bilingualism. Because bilingualism is known to affect cognitive processes, bilinguals and monolinguals were compared on their performance on cognitive tests, to investigate the possibility of the need for separate normative data for the two groups. Method A comprehensive neuropsychological test battery, standardized across five Indian languages: the Indian Council of Medical Research-Neuro Cognitive Tool Box (ICMR-NCTB) was administered to 530 participants (267 monolingual and 263 bilinguals matched for age and education). A systematic method of testing cognition in bilinguals was developed; to identify the appropriate language for testing, ensure language proficiency of examiner, and to interpret the bilingual responses. Additionally, the performance of bilinguals on the ICMR-NCTB was compared with monolinguals. Results Cognitive testing in the bilingual context was performed in the most proficient language of the participants, by examiners well versed with the language. Results from the language-based tests suggested that the frequent occurrence of borrowed- and language-mixed words required consideration while scoring. The reported bilingual effect on cognitive processes did not reflect as differences in the performance between bilinguals and monolinguals. Conclusions Observations from the study provide robust recommendations for neuropsychological testing in the context of bilingualism. Results indicate that separate normative data may not be required for bilinguals and monolinguals. The study will be relevant and provide a reference framework to address similar issues in the large population of bilinguals in other societies. [ABSTRACT FROM AUTHOR]

Objectives: While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings. Methods: A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India. Results: Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed. Conclusions: A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India. [ABSTRACT FROM AUTHOR]

Byline: P. Mathuranath, Joseph. Cherian, Robert. Mathew, Annamma. George, Aley. Alexander, Sankara. Sarma Objective: To derive population norms on the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) and the inclusive [...]