Search

Introduction: Type 2 diabetes mellitus (T2DM) is closely associated with the obesity; however, certain proportion of T2DM patients is non-obese or lean (BMI < 18.5 kg/m2). Obesity has long been associated with oxidative stress; however, there are no studies available documenting levels of oxidative stress in the lean patients of T2DM. Therefore, this study was done to compare the levels of makers of oxidative stress (TL, mtDNA, TAS) and their regulators (mRNA expression of TERT, Nrf2 and Nqo1) in lean and obese patients of T2DM. Methods: 60 newly diagnosed patients (treatment naïve) of T2DM were recruited and divided into lean (BMI < 18.5 kg/m2) and obese (BMI > 25 kg/m2) groups. Relative telomere length (T/S) and mtDNA content were estimated via real-time PCR. Serum total antioxidant status (TAS) was measured using a commercially available kit. mRNA expression of TERT, Nrf2 and Nqo1 was measured by real-time PCR. Results: Mean T/S and mtDNA content were lower in the obese group compared to the lean group (P = 0.16 and P = 0.06, respectively). Mean serum TAS levels were higher in obese group compared to the lean group (P = 0.001). mRNA expression of TERT and Nrf2 was increased in obese group compared to the lean group. mRNA expression of Nqo1 was similar in both the groups. Conclusion: Obese patients of T2DM are exposed to a greater degree of OS compared to the lean patients of T2DM. [ABSTRACT FROM AUTHOR]

Globally, liver diseases accounts for 4% of all deaths. Annually, over 2 million deaths occur due to preventable causes of chronic liver diseases and liver cancer like fatty liver diseases (alcoholic or non alcoholic) and viral hepatitis B and C. The burden of chronic liver diseases are increasing, and the epidemiology and demographics of people affected by these diseases are changing. Policy changes, vaccination, screening, lifestyle changes and public health awareness is the key to curb down liver disaeses. To achieve the ultimate goal of reducing mortality and linkage to care for those who need specialized care for liver disease, it is vital to have dedicated preventive hepatology clinics in sync with existing liver or gastroenterology clinics at tertary care level. [ABSTRACT FROM AUTHOR]

Background and Aims: Stress response after surgery induces local and systemic inflammation which may be detrimental if it goes unchecked. Blockade of afferent neurons or inhibition of hypothalamic function may mitigate the stress response. Material and Methods: A total of 50 consenting adult ASA I/II patients undergoing elective abdominal surgery were randomized to receive either dexmedetomidine (Group D) or epidural bupivacaine (Group E) in addition to balanced general anesthesia. Laparoscopic surgery, contraindications to epidural administration, history of psychiatric disorders, obesity (BMI >30 kg/m2), on beta blockers or continuous steroid therapy for >5 days over last 1 year, and known case of endocrine abnormalities or malignancy were excluded. Serum cortisol, blood glucose, and blood urea were estimated. Hemodynamic parameters, total dose of dexmedetomidine, bupivacaine, emergence characteristics, and analgesic consumption over 24 h postoperatively were recorded. Statistical comparisons were done using Student's t-test, repeated measure analysis of variance followed by Dunnett's test, generalized linear model and Chi-square/Fisher's exact test. A P value <0.05 was considered significant. Results: Serum cortisol levels were significantly lower in group E than group D 24 h after surgery (P = 0.029). Intraoperative and postoperative glucose level was lower in group E compared with group D. Time to request of first rescue analgesic was longer in group E than group D (P = 0.040). There was no significant difference between the number of doses of paracetamol required in the postoperative period (P = 0.198). Conclusion: Epidural bupivacaine was more effective than intravenous dexmedetomidine for suppression of neuroendocrine and metabolic response to surgery. Dexmedetomidine provided better hemodynamic stability at the time of noxious stimuli and postoperatively. [ABSTRACT FROM AUTHOR]

Air pollution, the most prevalent form of pollution worldwide, is associated with a wide range of neurological disorders, including neurodegenerative conditions, stroke, autism, depression, and developmental delay. There is accumulating evidence on the association between air pollution and headache disorders, especially migraine. Many classical and non-classical air pollutants have been associated with headache, including particulate matter, nitrogen dioxide, sulfur dioxide, ozone, carbon monoxide, as well as polycyclic aromatic hydrocarbons and volatile organic compounds. There has also been research on the impact of biomass fuels on health-related symptoms, including headache, which form an important source of air pollution in our country. The exact mechanisms underlying headache pathophysiology vis-à-vis air pollution are not precisely defined but include triggering of neuroinflammation and activation of the transient receptor potential ankyrin 1 (TRPA1)-associated pathways. Evidence from different regions of the world indicates a significant association between headache incidence and prevalence, and occurrence of air pollution. Despite growing data, research on adverse effects of air pollution on headache disorders remains limited, and appropriate outcome measures are not holistically defined in these studies. Due to the rapid advancement of the scourge of air pollution, there is a pressing need to expand the arena of research, specifically focused on pathological mechanisms, impact on health and quality-of-life parameters, as well as broader global ramifications. [ABSTRACT FROM AUTHOR]

Man and environment have a strong connection with each other for their functioning. Environmental toxins which can be natural or manmade result in the loss of this balance by causing systemic inflammatory response within the human body, with the brain being the most affected target end-organ. These problems are more prominent in Third World countries, where environmental regulations laws are either relaxed or non-existent. These neurotoxins play a very important aetiological role in the manifestation of various neurodegenerative diseases, neurodevelopmental disorders and psychiatric disorders. Environmental neurotoxicity results from inhibition of mitochondrial activity, excess oxidative stress leading to neuroinflammation, and promoting apoptosis and neuronal cell death. Having the know-how of these neurotoxins will provide insight into the process of neurodegeneration and will result in further designing of studies to delve into processes and mechanisms of neuronal regeneration and axonal sprouting. This review highlights the various central nervous system disorders associated with exposure to environmental neurotoxins and discusses the way forward to prevent or halt the process of neurodegeneration. [ABSTRACT FROM AUTHOR]

Background: Among the primary environmental issues affecting global health, air pollution is considered the leading cause of concern. Globally, around 800,000 deaths were attributed to air pollution according to WHO. Evidence suggests that there has been a strong association of air pollution with stroke. Approximately, 25% of stroke mortality was due to air pollution according to a study in 2013. Objective: The aim of this review was to analyze the association between stroke, intracerebral hemorrhage, and subarachnoid hemorrhage and air pollution and its burden globally with a special focus on South Asia along with its association with the COVID-19 pandemic. Results: There is growing research data linking air pollution to cardiovascular disorders including stroke. Short-term and long-term air pollution exposures have been shown to increase stroke incidence in epidemiological data. Air pollution, both gaseous and particle, show a strong and tight temporal relationship with stroke hospitalizations and death. The link between ICH and SAH to air pollution is less strong and less well studied as compared to ischemic stroke. Stroke and air pollution both are highly prevalent in South Asia. It is possible that the high prevalence of stroke in south Asia may be linked to the high frequency of air pollution in addition to other conventional risk factors. Decreased stroke admissions and mortality and reduced cardiovascular mortality reported during coronavirus disease 2019 (COVID) lockdown may be attributable to decreased levels of air pollution. Conclusion: Even though air pollution poses a significant threat to human health, a great number of countries still fail to achieve internationally agreed air quality standards. Air pollution should be recognized among the most significant controllable risk factors for cardiovascular and cerebrovascular disease prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: Although epilepsy is a common neurological condition, there is paucity of nationwide data on treatment patterns and sociodemographic and clinical factors affecting treatment decisions in India.Objective: To assess clinical profiles, usage pattern of antiepileptic drugs (AEDs), and seizure control among patients with epilepsy in India.Methods: This was a cross-sectional, observational, multicenter study on adult patients with epilepsy who were on AEDs for at least six months before enrollment. Data were collected from patient interviews and medical records.Results: Out of 800 enrolled patients, a majority (69.0%) had generalized onset seizure in the six months before enrollment. The median age at epilepsy onset was 20.0 (1.0-64.0) years; 40.0% of the patients were females, 48.5% were married, 99.1% were literate, and 67.0% belonged to the lower or upper-middle socioeconomic class. Overall, 459 patients (57.4%) received AEDs as combination therapy. Most patients received levetiracetam (37.0%), sodium valproate (18.5%), carbamazepine (17.3%), or phenytoin (13.8%) as monotherapy, and clobazam (59.7%), levetiracetam (52.9%), carbamazepine (26.4%), sodium valproate (24.8%), or phenytoin (24.0%) in combination therapy. Quality of life was comparable for first- and third-generation AEDs. Adverse drug reactions were mostly attributed to dose modification or switching between drugs. No serious adverse drug reactions or new safety concerns were identified.Conclusions: Findings from this large, cross-sectional, observational, multicenter study indicate that first-generation AEDs sodium valproate and phenytoin continued to be used in a substantial number of patients on monotherapy and combination therapy in India, even though an increasing trend toward use of second-generation AEDs was noted in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Objective: Oxidative stress plays an important role in atherosclerosis and ischemic stroke. Due to antioxidant properties of Paraoxonase-2, we studied the implication of Paraoxonase-2 gene polymorphism (C1053G) on expression of Paraoxonase-2 gene at mRNA level in ischemic stroke patients. Material and Methods: 40 patients of ischemic stroke and 40 age and sex-matched controls were included. Paraoxonase-2 genotypes were evaluated by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism and expression of Paraoxonase-2 gene at mRNA level was determined by quantitative real time Polymerase Chain Reaction analysed as delta-CT (ΔCT). Result and Discussion: The observed allele frequencies in patients for C and G allele were 0.61 and 0.39 respectively, and were 0.72 and 0.28 in control group. No significant association was found in C allele of C1053G polymorphism and ischemic stroke. The average Δ CT value is significantly (p = 0.0001) higher in patients group (7.68 ± 2.0) as compared to controls (5.70 ± 1.8). We found a significant difference in the average delta-CT value (p = 0.0001), wherein down-regulated paraoxonase-2 gene expression (approximately 0.25 fold) was observed in case of patients as compared to controls. Down-regulated expression of paraoxonase-2 gene was observed in patients with GG genotype as compared to CG and CC genotypes in patients with ischemic stroke (p = 0.0001). Conclusion: Down-regulated Paraoxonase-2 gene expression, as evidenced by low mRNA levels in GG genotype may be one of the contributory factors in the progression of ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate the effect of Vitamin D3 on symptoms, uterine and leiomyoma volume in women with symptomatic leiomyoma and hypovitaminosis D. Materials and Methods: In this pilot, interventional, prospective study, 30 premenopausal women with uterine leiomyoma and concomitant hypovitaminosis D (<30 ng/ml) received Vitamin D3 in doses of 60,000 IU weekly for 8 weeks followed by 60,000 IU every 2 weeks for another 8 weeks. Change in symptoms, uterine, and leiomyoma volume was evaluated at 8 weeks and 16 weeks. Serum Vitamin D3 levels were repeated at 16 weeks of therapy. Results: A significant negative correlation was observed between the baseline 25-hydroxy Vitamin D (25(OH) Vitamin D3) and leiomyoma volume (r = –0.434, P < 0.001). There was significant reduction of menstrual blood loss by 29.89% (P = 0.003) and severity of dysmenorrhea, pelvic pain, and backache by 44.12%, 35%, and 50% (P < 0.001, 0.019, and 0.002), respectively, at 16 weeks. At end of therapy, there was 6% reduction in mean uterine volume and 11% in leiomyoma volume which was not significant. Serum 25(OH) Vitamin D3 was significantly higher than baseline level (17.44 ± 5.82 vs. 39.38 ± 8.22, P < 0.001) at end of therapy. Conclusion: Vitamin D3 supplementation is effective in reducing leiomyoma-related symptoms and stabilizing uterine and leiomyoma volume. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 caused by severe acute respiratory syndrome-CoV-2 is an emerging infectious disease first identified in Wuhan City, Hubei Province, China, which subsequently spread as a global pandemic posing a global threat. As per World Health Organisation worldwide around 38 lac people have been infected and 2.6 lac people have died from the disease and in India 59,662 people are infected with 1981 deaths by May 9, 2020. It is feasible that potentially infectious specimens may be submitted in our laboratory those are the impending source of infection to the laboratory personnel. Using imaging equipment on coronavirus confirmed/suspected patient/carriers is a serious hazard for healthcare providers because there is a risk that the virus could remain on the surface of the computed tomography scan machines or ultrasound (US) probes/patient bed/couch. Here, we have enlisted the rigorous biosafety measures which if executed appropriately can significantly drop the chances of spread of infection to health care workers in these diagnostic sections. [ABSTRACT FROM AUTHOR]

The prevalence of hepatitis C virus (HCV) infection in Pediatric patients with lymphoproliferative diseases has most commonly been reported with B cell Non-Hodgkin lymphoma. Case studies have reported the requirement of dose reduction or suspension of chemotherapy in 80% of Pediatric ALL cases who are anti-HCV positive owing to hepatotoxicity. The standard of care anti HCV therapy in children aged 3-17 years had been peginterferon and ribavirin for 48 weeks. FDA approved pan-genotypic, anti- HCV regimen, sofosbuvir/velpatasvir [SOF/VEL], for the Pediatric population >6yrs of age or >17 kg body weight in March 2020. We herein report a case of an HCV infected Pediatric B cell ALL patient who was treated with SOF/VEL concomitantly with an intensive chemotherapy regimen. Child tolerated the full dose chemotherapy along with antivirals for 12 weeks and was in morphological remission with sustained virological response. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome is defined as a state of metabolic dysregulation characterized by insulin resistance, a predisposition to Type 2 diabetes mellitus and atherosclerotic vascular disease. The changing hormonal milieu with altered estrogen and testosterone ratio is the cause of metabolic syndrome at menopausal transition. Aims and Objectives: This study was designed to determine the incidence of metabolic syndrome and its various components in premenopausal and postmenopausal women from Punjab. Materials and Methods: This study was conducted on 200 females in the age group of 45–60 years attending outpatient department over a period of 2 years in the Department of Obstetrics and Gynaecology, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar. A detailed history and physical examination were done and recorded on a pro forma. Biochemical assessment comprising fasting blood glucose, triglycerides, and cholesterol was done. Metabolic syndrome was assessed as per the modified NCEP ATP III criteria. Results: Twenty-nine percent women were found to have newly onset metabolic syndrome, the incidence in premenopausal group was 16%, and in postmenopausal group was 42%. Among the components, the incidence of hypertension (58%) was the highest followed by waist circumference (42%). Maximum correlation of metabolic syndrome was found with high-density lipoprotein (odds ratio - 7.250) followed by waist circumference (odds ratio - 7.111). Conclusion: The incidence of metabolic syndrome was found to be higher in postmenopausal women than in premenopausal women. Currently, the need of the hour is lifestyle modification to reduce the emergence of metabolic syndrome and cardiovascular diseases. [ABSTRACT FROM AUTHOR]

The artice focuses on outbreak of COVID‑19 has caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) was first reported in Wuhan, the capital of Hubei, China. Topics include the SARS‑CoV‑2 has spread across China and worldwide is reaching a pandemic level, and the COVID‑19 has triggered substantial morbidity and socioeconomic impact, all continents necessitated drastic measures, including nationwide lockdown and border closures.

The article presents the discussion on air being the immediate environment of all living beings. Topics include human activities directly responsible for polluting indoor and outdoor air with dust, smoke, toxic gases, and chemical vapors leading to adverse health effects; and certain interventions reducing the impact of pollution when the air pollutant levels being high.

Background: Bloodstream infections (BSIs) are among the serious hospital-acquired infections. Data regarding BSIs in intensive care units (ICUs) are available but there is limited information regarding these infections in neurology and neurosurgery intensive care units (NNICUs). Objectives: This study was conducted to find out the occurrence of BSI in NNICU patients of a tertiary care institute in India, along with the microbiological profile and risk factors associated with it. Materials and Methods: One hundred patients admitted in the NNICU of a tertiary care hospital for more than 24 h were included in the study. After detailed history, blood samples were collected from catheter hub and peripheral vein of all patients for culture, followed by identification and antibiotic sensitivity testing of the isolates. Results: Out of 100 patients, laboratory-confirmed bloodstream infection (LCBI) was detected in 16 patients. Five patients had secondary BSI, while 11 had central venous catheter (CVC)-related primary BSI. Gram-positive organisms constituted 64% of the isolates, especially coagulase-negative staphylococci and Staphylococcus aureus. Increased duration of CVC was a significant risk factor for catheter-related BSI (CR-BSI). Conclusion: BSIs pose a significant burden for NNICU patients, and increased duration of catheter insertion is a significant risk factor for CR-BSI. [ABSTRACT FROM AUTHOR]

Background and Aims: Ventilator-associated pneumonia (VAP) is a major challenge in intensive care units (ICUs). This challenge is even more discernible in a neurological setting owing to the predispositions of patients. Data on VAP in the neurology and neurosurgery ICUs (NNICUs) are scanty in developing countries. This study was conducted to find out the occurrence of VAP, its risk factors, microbiological profile, and antibiotic resistance in patients admitted to the NNICU of a tertiary care institute in India. Materials and Methods: Endotracheal aspirate and blood samples were collected from 100 patients admitted to the NNICU. Complete blood count, microscopic examination, culture and sensitivity testing of aspirate were done. Chest x-ray was also performed to aid in the diagnosis of VAP. Results: Incidence rate of VAP was found to be 24%. Acinetobacter baumannii was the most common pathogen (24.3%) isolated from patients with VAP, and all of these isolates were sensitive to meropenem. Duration of mechanical ventilation (P < 0.0001) and associated comorbid illness (P = 0.005) were found to be significantly associated with VAP, and the duration of mechanical ventilation was found to be the only independent risk factor (P < 0.0001). Conclusions: This study highlights the risks and microbiological perspective of ventilator use among neurology patients so that adequate preventive strategies can be adopted on time. [ABSTRACT FROM AUTHOR]

Transcranial Doppler (TCD) is the only diagnostic tool that can provide continuous information about cerebral hemodynamics in real time and over extended periods. In the previous paper (Part 1), we have already presented the basic ultrasound physics pertaining to TCD, insonation methods, and various flow patterns. This article describes various advanced applications of TCD such as detection of right-to-left shunt, emboli monitoring, vasomotor reactivity (VMR), monitoring of vasospasm in subarachnoid hemorrhage (SAH), monitoring of intracranial pressure, its role in stoke prevention in sickle cell disease, and as a supplementary test for confirmation of brain death. [ABSTRACT FROM AUTHOR]

The article offers information on importance of etiology‑based workup and diagnosis in acute multiple infarcts in multiple cerebral circulations (AMIMCC.) Topics discussed include prognosis of acute multiple infarcts that reflect variations in terms of geographical distribution, location of infarcts, and age pattern of patients; role of geographical distribution in disease causation; and correlation of topographic patterns of AMIMCC with different vascular pathologies and stroke mechanisms.

The article discusses the importance of stroke-related education to the staff in emergency departments in hospitals. The importance of skill-enhancing stroke education among members of the team including physicians, paramedical staff, and nurses and therapists to ensure compliance to clinical practice guidelines is discussed. The advantage of having a standardized and framed algorithm of stroke care according to the existing manpower and infrastructure is also mentioned.

The article focuses on an analysis of electrical stimulation impact over dysphagia patients with early stroke conditions. Topics discussed include assessment of mortality rate among stroke patients with consideration of risk factors for several diseases such as pneumonia; assessment of patients through flexible fiberoptic endoscopic evaluation of swallowing (FEES) methods; and combination of neuromuscular electrical stimulation (NMES) with traditional dysphagia therapy (TDT).

Transcranial Doppler (TCD) can be aptly called as the doctor's stethoscope of the brain. Since its introduction in 1982, by Rune Aaslid, TCD has evolved as a diagnostic, monitoring, and therapeutic tool. During evaluation of patients with acute ischemic stroke, TCD combined with cervical duplex ultrasonography provides physiological information on the cerebral hemodynamics, which is often complementary to structural imaging. Currently, TCD is the only diagnostic tool that can provide real time information about cerebral hemodynamics and can detect embolization to the cerebral vessels. TCD is a noninvasive, cost-effective, and bedside tool for obtaining information regarding the collateral flow across various branches of the circle of Willis in patients with cerebrovascular disorders. Advanced applications of TCD help in the detection of right-to-left shunts, vasomotor reactivity, diagnosis, and monitoring of vasospasm in subarachnoid hemorrhage and as a supplementary test for confirmation of brain death. This article describes the basic ultrasound physics pertaining to TCD insonation methods, for detecting the flow in intracranial vessels in addition to the normal and abnormal spectral flow patterns. [ABSTRACT FROM AUTHOR]

Although the clinical features in some patients with cerebrovascular ischemia may be ill defined, majority of the patients present with focal neurological deficits caused by an arterial occlusion, and the clinical presentations are usually referable to the involved arterial territory. Therefore, vascular imaging constitutes an important component of the diagnostic workup. Cervical duplex ultrasonography of carotid and vertebral arteries is employed to evaluate the extracranial vasculature while transcranial Doppler provides important information about intracranial hemodynamic changes in cerebrovascular ischemia. These two components of cerebrovascular ultrasonography are fast and reproducible, and can be performed at the bedside. They provide real-time information about the status of cervico-cranial arterial patency and various hemodynamic alterations, including collateral flow. The information obtained from cerebrovascular ultrasonography is useful for diagnostic as well as prognostic purposes. Furthermore, it can be used to monitor cerebral blood flow for extended periods and aid in decision making for various interventions. The hemodynamic information obtained from cerebrovascular ultrasonography helps in determining the underlying mechanisms of brain ischemia, and is complementary to the clinical examination and other imaging modalities.We describe the technique of performing cervical duplex sonography, diagnostic criteria for arterial stenosis, characterizing plaque morphology, measuring intima-media thickness and various pitfalls while performing the test. [ABSTRACT FROM AUTHOR]

This article briefly outlines the proposed national epilepsy control program. The content of the article is based on four meetings held by invitation of the Ministry of Health. Invitees by ministry - Drs. D. C. Jain, M. Gourie Devi, V. Saxena, S. Jain, P. Satish. Chandra, M. Gupta, K. Bala, V. Puri, K. S. Anand, S. Gulati, S. Johri, P. S. Chandra, M. Behari, K. Radhakrishnan, D. Bachani. Presentations were made by Dr. M. Tripathi.The program will involve all neurologists across the country in teaching and training at state levels and a central monitoring committee. [ABSTRACT FROM AUTHOR]

Worldwide, a large number of children are prescribed drugs on an outpatient basis. Medication errors are fairly common in these settings. Though this matter has been well recognized as a cause of concern, limited data is available from ambulatory settings. Medication errors can be defined as errors that may occur at any step, starting from ordering a medication, to dispensing, administration of the drug and the subsequent monitoring. The outcomes of such errors are variable and may range between those that are clinically insignificant to a life-threatening event. The reasons for these medication errors are multi-factorial. Children are unable to administer medications to themselves and also require a strict weight-based dosing regimen. The risk factors associated with medication errors include complex regimens with multiple medications. Overdosing and under-dosing (10-fold calculation errors), an increased or a decreased frequency of dosing or an inappropriate duration of administration of the medication, are frequently detected errors. The lack of availability of proper formulations adds to the confusion. The low level of literacy among the caregivers can aggravate this problem. There is a lack of proper reporting and monitoring mechanisms in most ambulatory settings, hence these errors remain unrecognized and often go unreported. This article summarizes the current available literature on medication errors in ambulatory settings and the possible strategies that can be adopted to reduce the burden of these errors in order to improve child care and patient safety. Voluntary, anonymous reporting can be introduced in the healthcare institutions to determine the incidence of these errors. [ABSTRACT FROM AUTHOR]

Hoover's sign was described by Dr. Charles Franklin Hoover more than 100 years back to differentiate between the organic and functional weakness of pyramidal origin. This test is usually performed in the lower limbs and is valuable when on bedside one is not sure about the nature of hemiparesis. A subject with hemiparesis of organic cause while asked to flex the hip of normal leg against resistance will not exert pressure on the hand of examiner placed under the heel on the affected side while in hysterical weakness heightened pressure will be felt on the examiner's hand. The presumed genesis of this sign could be the crossed extensor reflex or the principle of synergistic contraction. It is a useful clinical test in differentiating functional and organic paresis with moderate sensitivity (63%) and high specificity (100%), but there are some limitations which should be kept in mind while evaluating a patient. [ABSTRACT FROM AUTHOR]

Joseph Babinski (1857-1932) was born on November 17, 1857. He worked in a clinical arena dominated by Charcot and a focus on hysteria. His primary aim was in trying to find the reliable clinical signs to distinguish organic from non-organic disease of the nervous system. He was considered as masterly diagnostician, relying considerably less on neuropathological reports. Babinski's first attention to the reflex of the toes occurred during a chance observation of the contrasting responses between two female patients, one a hysteric and the other a hemiplegic. He first published description of his famous "sign" in 1896. Babinski's love for research works could be gauzed from his desire to publish and by the age of 27 years, he had to this credit, 12 important articles, mainly concerned with histological and neurological themes and one of his articles on the basic description of muscle spindles was considered to be a significant one. He was awarded the doctorate degree in 1885. Babinski introduced the concept of pithiatism, meaning "curable by suggestion." He anticipated the emergence of neurosurgery in France and only 6 days prior to his death he is on record to have said that his most vital contribution to the cause of neurosciences was not the sign he described, but that he could goad Clovis Vincent and Martel to take up neurosurgery as a specialty. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 2 1/2-year-old child who experienced a 20-day fever and was not responding to cefixime. Upon medical examination, the patient presented a moderate degree of hepatosplenomegaly with pallor. It discusses the involvement of Gullain-Barré syndrome as a complication in children with typhoid fever.

The authors discuss the article "Electrophysiological observations in critically ill Guillain-Barre syndrome" by M. Nagappa and colleagues. They outline the results of the study which highlighted the importance of electrophysiological abnormalities and its role in predicting the duration of mechanical ventilation. They describe the role played by critical illness polyneuropathy, the syndrome of acute weakness affecting limb and respiratory muscles in patients with Guillain-Barre syndrome (GBS).

Phenytoin is a commonly used antiepileptic medication in the pediatric age group, but it has a narrow therapeutic range. Various adverse effects have been reported commonly. We report a relatively rare case of encephalopathy in a child from overdose of injectable phenytoin due to ignorance of the previous treatment. Scrutiny of medical records and history is of utmost importance while administering such medications. [ABSTRACT FROM AUTHOR]

Aim of Study: Metabolic syndrome (MS) is a chronic inflammatory state and is characterized by oxidative stress. This study aims to evaluate the expression of antioxidant genes i.e. nuclear factor erythroid 2-related factor 2 (Nrf-2) and NAD (P) H:quinine oxidoreductase-1 (NQO1) in young patients of MS. Materials and Methods: Participants were recruited from the undergraduate medical students of the parent institute. Patients (n = 15) of MS were diagnosed on the basis of NCEP- ATP III criteria. The mRNA expression of Nrf-2 and NQO-1 genes was measured in whole blood samples of patients as well as healthy controls (n = 15), with the help of real time PCR. The relative expression was analysed by qPCR using dye (Syto9, Invitrogen) based chemistry. Specific primers were used for Nrf-2 and NQO-1 genes while B2M and β-Actin was used as an internal control. Fold change in the expression was calculated using delta delta Ct method. Results: Mean age in control group was 19.7 years and in patient group was 20.6 years. The expression of both Nrf-2 and NQO-1 was increased in the patients. Keeping B2M as normalizer, expression of Nrf-2 was 3.2 times and NQO-1 was 3.4 times higher patients. Keeping β-Actin as normalizer, expression of Nrf-2 was found to be 2.3 times and NQO-1 was 2.4 times more in patients of MS. Conclusions: Nrf-2, a transcription factor is a key regulator of antioxidant genes. Various antioxidant genes including NQO-1 are its downstream targets. The results of our study indicate that expression of master regulator (Nrf-2) as well as the antioxidant gene (NQO- 1) is increased in young patients of MS. The increased expression of antioxidant enzymes indicate that the protective mechanism in the young patients to counter oxidative damage seen in MS may be mediated through increased expression of antioxidant enzymes. [ABSTRACT FROM AUTHOR]

Objectives and Aim of the Study: To evaluate and compare the mRNA expression of NFKB1 gene (p50) in the patients of Type II Diabetes mellitus (T2DM) with and without hypertriglyceridemia. Materials and Methods: There were two groups for this pilot study GI: T2DM patients with normal triglycerides (TG <150 mg/dl) and GII: T2DM patients with raised triglycerides (TG >200 mg/dl). Twenty two patients were recruited for this study, in each group, after taking the informed consent. The gene expression was measured in the peripheral blood samples of these patients, with the help of real time PCR (Rotorgene Q). To study the mRNA expression NFKB1 gene RNA was isolated using Tri-Reagent BD as per the manufacturer's protocol. This was followed by cDNA synthesis using a kit (MBI Fermentas) as per the manufacturer's protocol. The relative expression was analysed by qPCR using dye (Syto9, Invitrogen) based chemistry. Specific primers were used for NFKB1 gene while B2M and 18s was used as an internal control. Fold change in the expression was calculated using delta delta Ct method. Results: The mRNA expression of NFKB1 gene was increased (3.3 fold, B2M as reference, 6.4 fold, 18s as reference) in the patients of T2DM with hypertriglyceridemia when compared with those patients without hypertriglyceridemia. Conclusion: NFKB1 gene codes for the p50 subunit that is the part of NF-κB (p65/p50 heterodimer) which is pro-inflammatory. P50 can also act as a homodimer (p50/p50) and is anti-inflammatory. Probably this increase in the p50 expression is a protective response, to prevent damage to other organs, in the patients with T2DM with hypertriglyceridemia. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes and hypetriglyceridemia are very closely associated. The objective of this study was to understand the relation between the two as well as pathophysiology of increased risk of atherosclerosis in diabetes. The aim of this study is to evaluate role of Apo A-V in causing hypertriglyceridemia in type 2 Diabetes (T2DM) and its relation with inflammation and oxidative stress. Materials and Methods: Known cases of T2DM were categorised based on NCEP ATP III criteria into Group I (TG ≤150 mg/dl) and Group II (TG ≥200 mg/dl). Apart from routine biochemical investigations serum levels of Apo A-V protein, IL-6, free fatty acids and MDA were estimated. Results: Serum Apo A-V protein levels were found to be significantly lower (p = 0.04) in the Group 2 and MDA was higher (p = 0.049). Though serum IL-6 and FFA levels were to be higher in Group 2 the difference was not statistically significant (p =0.338 and 0.291 respectively). MDA correlated positively with TG levels (p = 0.000) and negatively with HDL (p = 0.000). However Apo A-V protein levels did not correlate with either TG levels or IL-6 and MDA. Discussion: Significant lower values of Apo A-V in the Group with hypertriglyceridemia proves its role in modulation TG levels. However in our study, its independent effect on TG metabolism appears to be minimal. Significantly higher levels of MDA, a marker of oxidative stress, in patients with hypertriglyceridemia and its strong correlation with TG shows that TGs contributes to the oxidative stress in T2DM. In addition higher FFA and IL-6 levels in these patients also indicate that TGs contributes to underlying inflammation. Thus oxidative stress and inflammation which may be an important patholphysiological mechanism behind vascular and other complications associated with the hypertriglyceridemia in T2DM. [ABSTRACT FROM AUTHOR]

The article discusses the use of Kernig`s and Brudzinski’s sign in diagnosis of meningitis. Kernig’s sign shows restriction in passive extension at the knee in patients; Brudzinski’s signs include the obscure cheek sign, Brudzinski’s reflex, and Brudzinski neck sign. The mechanism of genesis of both signs were based on the meningeal and nerve roots inflammation and the sensitivity of both signs were low, however, the high specificity suggests high likelihood for meningitis.

Headache is often a clinically important concomitant of epilepsy but gets overshadowed by seizures and goes untreated. This study was undertaken to study the pattern of headache & its association with seizures in patients with comorbid epilepsy & headache. Out of 75 patients enrolled, 45 (60%), were males and 30 (40%) females. Age of the patients ranged from 15-50 years (mean age 24.32 years). Duration of epilepsy ranged from 6 months to 20 years (mean 5.53 years) & was ≥ 3 years in 48/75 (64%) cases. Seizure type was GTCS in 69.33% & SPS with secondary generalization in 16% cases. 78.67% had uncontrolled (1 or more seizures in last 6 months) epilepsy. Symptomatic epilepsy was observed in 57.33% cases (Neurocysticarcosis-33/43 (76.74%). Headache frequency was more in patients with GTCS & uncontrolled epilepsy of ≥ 3 years. Majority of the patients (81.33%) had bilateral headache. Commonest site of headache was the frontal region (40% cases). Character of headache was throbbing (49.33%) or a pressure like sensation (41.33%) in the majority. The intensity of headache was mild in 14.67%, moderate in 61.33% and severe in 24% cases. Duration of headache was 3 to 24 hours in 46.67% cases. Headache was purely postictal in 42.67%, interictal in 20% & preictal in 1.33% cases, with mixed pattern in other cases. Nature of headache was migranous in 26.67% and non-migranous in 73.33% cases. Migranous headache was more common in patients with symptomatic (57.33%) as compared to idiopathic epilepsy (42.67%). In patients with symptomatic epilepsy, headache was observed more commonly with left (66.67%) as compared to right sided (33.33%) lesions. EEG was abnormal in 12 % cases only. 66.67% cases were on monotherapy. There was partial relief in headache after starting antiepileptic drugs in 44% cases. In conclusion, a complex interplay exists between epilepsy and headache & the contribution of headache to the morbidity of epilepsy should not be ignored. Antiepileptic drugs effective in the management of both epilepsy and headache may prove to be a better choice in such cases. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case study of a six-year-old female child suffering three days of recurrent episodes of myoclonus of sudden onset due to piperazine.

A letter to the editor is presented in response to the article "McLeod Syndrome: Report of an Indian Family With Phenotypic Heterogeneity," by A. Chakravarty et al. which appeared in a 2011 issue.

Material and Methods: The study included consecutive subjects who met the diagnostic criteria for clinically probable vasculitic neuropathy admitted in the Department of Neurology, G.B. Pant Hospital, New Delhi over a period of six years (2002-2008). They were subjected to relevant investigations, including electrophysiological tests and nerve biopsy to fulfill our aim. Results: Out of a total of 96 cases of neuropathy, 18(18.75%) constituted vasculitic neuropathy. Mean age of presentation was 46.27+ 19.88 years (range.13-82) [male: female=14(77.77%):4(22.22%)]. Mean duration of illness was 15.05 months [median.3.5(range.1-48)]. Onset was subacute in all, with progressive course. Majority had lower-limb onset [15(83.33%)] with asymmetrical presentation in 7(38.88%). All had predominantly distal symptoms, with both weakness and sensory deficits in 13(72.22%), pure motor presentation in one, pure sensory deficits in two, and paresthesiae/pain (burning/aching) in six(33.33%) with two having unbearable burning pain in feet(a score of 10 on numerical pain rating scale). Topographically, 12(66.66%) were mononeuritis multiplex, four distal symmetrical sensorimotor polyneuropathy, one symmetrical pure sensory polyneuropathy and one polyradiculoneuropathy. Associated conditions included hypertension (7/18), diabetes type-2(2/18), steroidinduced diabetes (1/18), bronchial asthma (2/18), hypothyroidism (1/18), Graves. disease (1/18). Constitutional symptoms were fever (8/18), rash(3/18), abdominal pain(2/18), weight loss(2/18), hemoptysis and hematuria(one each) and none in six. Anemia (Hb.8-10g %) was found in 11(61.11%), leucocytosis (>11000/mm3) in 11(61.11%), raised ESR(>20mm in Ist hour) in 12(66.66%)(>50mm in 8), eosinophilia in two. ANA, dsDNA, RA, APLA, p-ANCA were positive in two cases each, while one each had c-ANCA and HBsAg positivity. None was however positive for HIV or hepatitis C. Electrophysiology revealed sensorimotor axonopathy in 16(88.88%)] with secondary demyelination in four, pure sensory in one and demyelinating pattern in two. Sural nerve biopsy was performed in 10 cases which revealed vasculitic pathology in 8(80%). Six(33.33%) proved to be non-systemic vasculitic neuropathy, rest comprised of SLE(three), Churg-Strauss(two), PAN(two), Wegener's granulomatosis(one), hepatitis B(one), carbimazoleinduced vasculitis(one) and one undiagnosed. Conclusion: There should be a high index of suspicion to detect vasculitic neuropathies (systemic/non-systemic) due to the availability of potential therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background and Aims: The Intracerebral Haemorrhage Score (ICH) is a measure of prognosis of patients admitted with a haemorrhagic stroke. We aimed to evaluate this in our patients. Methods: Thirty consecutive patients were studied for ICH score, age 41-93, mean 73±13 years. Outcome was measured as death versus discharge and functional recovery. Results: There was no significant difference in the pre-stroke Rankin (0.76 vs 0.85, P=0.8) and Barthel scores (19 vs 18, P=0.8) of the discharged vs deceased patients. There was a significant difference between the two groups for blood volume on CT scan, (50 mls vs 124 mls; P=0.01) and ICH score (1.82 vs 4.5, P <0.001). All patients with a score of 0 to 2 survived, 67% of patients with score 3 survived whereas only 28% of the score 4 survived and none of the patients with score 5 and 6 survived. Only 6% of patients with scores 0 to 3 died (16 patients) vs 85% of the scores 4 to 6 (14 patients); P <0.001. Patients with the score of 0-3 had a significantly better post stroke functional recovery with Barthel index of 15.5 vs 1.3, P <0.001 and post-stroke Rankin score of 2.25 vs 5.6, P<0.001. Logistic regression revealed ICH score to be the most significant variable to predict mortality. Conclusion: The ICH score for haemorrhagic stroke has a prognostic value for mortality and functional recovery; patients with a lower score have a better functional recovery whereas those with a higher score have a high mortality. [ABSTRACT FROM AUTHOR]

Aim: Cerebral venous sinus thrombosis (CVT) is a major cause of young stroke especially in postpartum female. Outcome may vary from mortality to complete recovery. Aim of this study was to find out clinical and radiological features of cerebral venous sinus thrombosis. Methods: We analyzed our stroke registry from year January 2000 to June 2008 and subjects of CVT were analyzed for clinical and radiological features. Magnetic resonance imaging (MRI) including Magnetic resonance venogram (MRV) was done in all patients. Follow-up data was also collected regarding their long-term outcome. All subjects received two weeks of low molecular weight heparin followed by oral anticoagulation to maintain INR between 1.5- 2.5. Result: A total of 14 subjects (9 females & 5males) were studied. Four presented during postpartum period including one meningitis. Presenting symptoms included altered sensorium (12), headache and vomiting (11), seizure (9), fever (1) , hemiparesis (4) and aphasia (2). Six had generalized tonic clonic seizure (GTCS) and three had focal seizure with secondary generalization. MRI was suggestive of haemorrhagic infarct in ten, non haemorrhagic infarct in two and intracerebral haemorrhage in two subjects. Five subjects had exculsive involvement of superior saggital sinus and nine had multiple venous sinuses involvement on MRV imaging. Five subjects were diagnosed to have risk factor for CVT; three had positive antiphospholipid antibody and two had hyperhomocystinemia. Conclusions: Altered sensorium, features of raised intracranial pressure in form of headache and vomiting and seizure are most common presenting symptom in CVT patients. Involvement of superior saggital sinus in isolation is most common to be involved. Early diagnosis and management carry good prognosis. [ABSTRACT FROM AUTHOR]

Aim and Objectives: Multiple Sclerosis may have varied presentation. The Multiple Sclerosis can present Relapsing Remitting Multiple Sclerosis (RRMS), Primary Progressive Multiple Sclerosis (PPMS), Secondary Progressive Multiple Sclerosis (SPMS), Progressive Relapsing Multiple Sclerosis (PRMS) and Neuromyelitis Optica (NMO). Aim of this study was to define clinical type of Multiple Sclerosis and their radiological spectrum. Method: Forty seven consecutive subjects of Multiple Sclerosis who fulfilled clinical, radiological and electro-physiological criteria of Multiple Sclerosis and NMO were included. They were classified into different types depending upon their clinical presentation and radiological findings. Patient presenting with acute attack received one gram methylprednosolone for five days. Twelve patients of RRMS received mitoxantrone as secondary prophylaxis and three received interferon alpha. Result: We evaluated 47 patients of MS, among which 61.70% (29/47) were females and 38.30% (18/47) were male. Among these patients, RRMS comprised 83% (39/47), PPMS 8.51% (4/47), SPMS 2.12% (1/47) and NMO 6.37 % (3/47). Among these 39 cases of RRMS males were 33.33% (13/39) and females 66.77% (26/39), and among PPMS cases males were 75.00% (3/4) and females 25.00 %(1/4). However only one patient was of SPMS and three were of NMO. These patients presented to us within 3-5 years mean duration of illness in 56.41% (22/39), only one patient presented to us within one year. This might be due to referral bias at our institute. Presenting symptom in RRMS was optic neuritis in 38.46% (15/39), others being sensory deficit in 21% (8/39), paraparesis in 20.51% (8/39), bladder involvement in 17.94% (7/39), hemiparesis in 5.13% (2/39), monoparesis in 5.13% (2/39), quadriparesis in 5.13% (2/39), facial weakness in 5.13% (2/39) and ataxia in 7.69% (3/39). MRI was suggestive of brain involvement in 56% while both brain and spine MRI were abnormal in 44%. VEP was done in 26 patients and was abnormal in 87% (24/26)while BAER was done in 17 patients and was abnormal in 71%(12/17). Oligoclonal bands were done in 9 RRMS patients and were found to be positive in 67 % (6/9). Two out of three patients of NMO had more than three relapses. Conclusion: RRMS was the commonest type of MS at our centre. Incidence of SPMS and NMO was very low. Most common presenting symptom in RRMS cases were optic neuritis. [ABSTRACT FROM AUTHOR]

Periodic lateralized epileptiform discharges (PLEDs) are EEG abnormalities consisting of repetitive spike or sharp wave discharges, which are focal or lateralized over one hemisphere, recur at intervals of 0.5-5 seconds, and continue through most of the duration of the EEG study. This study was done to know the various c1 inicoetiological correlates of these periodic discharges. The EEGs of Patients attending the neurology O.P.D, referred from associated hospitals or other private hospitals and admitted in the wards of G.B Pant Hospital were screened for inclusion in the study. All the EEGs showing Periodic Discharges were included in the study. We targeted one hundred consecutive EEGs showing periodic pattern. Out of these 60 were males and the rest were females. The mean age of onset of seizures was 5.89 years+-9.23. The periodicity was true in 72% of the subjects whereas pseudoperiodic discharges were seen in 28%. The most common diagnosis was SSPE which comprised 38% of the total subjects. The next common was Non convulsive status epilepticus {NCSE (13%)}, followed by Hypoxic ischemic encephalopathy (perinatal) (12%) and Lenox Gaustat syndrome (3%). 29% of subjects were suspected to have SSPE but in seven of these anti measles antibodies in C.S.F were negative and in others, it was not done. Out of all the periodic EEGs, 55 were long period discharges. The remaining EEGs (11 out of 100) were rhythmic. All the periodic discharges were generalized periodic discharges and there was no EEG revealing periodic lateralized epileptiform discharges. [ABSTRACT FROM AUTHOR]