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Background: Suicide is a major public health concern in India especially among children and adolescents. The yearly national statistics show a concerning trend of rising suicide deaths in these age groups. Methods: The present study, taking 26 years of national data from the National Crime Record Bureau during 1995–2021, examined the trend, patterns, means, and modes of children/adolescent suicides in India. We also undertook a time series analysis by using ARIMA (0,2,1) model to forecast the expected suicide rate for the next one decade. Results: A rising trend of suicide rate among children and adolescents was observed in India over the last 26 years. The forecast indicates a continuance of rising suicide cases for the upcoming decade in India. A substantially different trend of suicide rate was observed among early and late adolescents indicating significantly high vulnerability of late adolescents. Among children /adolescents, the most common causes of suicide were family problems, academic failure, illness, and unemployment. Illness has emerged as one of the leading causes of suicide, with a significant rise over time. Poverty and unemployment were also found as the important contributors with a steadily increasing trend of suicide among children and adolescents facing these problems in recent years. Conclusion: The study provides important analysis and information on suicide among children/adolescents in India, by providing useful insights for parents, teachers, policymakers, healthcare practitioners, and stakeholders aiming to prevent and control children and adolescent suicide and boost mental health. The study also provides important leads on risk factors with a forecast of suicide trends for the next 10 years. [ABSTRACT FROM AUTHOR]

Introduction: Secondary surgeries for thyroid cancers are conventionally associated with long term morbidities. This study was conducted to assess the efficacy of our Institutional Surgical Protocol while dealing with such cases, through the complications and levels of disease clearance achieved. Methods: It was a retrospective observational study; patients who underwent reoperative thyroid surgery from January 2020 to January 2023 were included. All patients were operated as per the Institutional Policy. Results: 25 patients were included in the study. Secondary surgeries included Central Neck Dissection with Lateral Neck Dissection (40%), Revision thyroidectomy (24%) and Completion thyroidectomy (12%). The pathological diagnoses of the patients were mainly Well differentiated Thyroid cancers like Papillary Carcinoma (72%) and Follicular Carcinoma (12%). Complications following Secondary surgery included Permanent Hypoparathyroidism (4%) and Permanent Vocal cord palsy (4%). Literature shows an incidence of 5-10% and 0-5% respectively. In 60% of patients, there was no uptake in the Postop Iodine scan which displayed complete disease removal. Conclusion: Our Institutional Protocol results in a significant reduction in post op complications as compared to literature. Adequate disease clearance is ascertained by the lack of uptake in the Postop Iodine Scan. [ABSTRACT FROM AUTHOR]

Background: Multiple causes of UVCP have been reported by different studies, often without agreement on the most common etiology. Studies have demonstrated that the most common etiologies of UVCP vary in both time and/or geographic location. Etiology of acquired vocal cord palsy is variable with time, place and side. Updating the etiology and awareness of the most probable to the rarest diagnosis can help in the management. Aims and Objectives: To analyze the etiology of acquired vocal cord palsy in a tertiary care teaching hospital. Materials and Methods: This retrospective study, was conducted in the Department of ENT, Azeezia Institute of Medical Sciences and Research Kollam, Kerala, India between February 2020 and January 2023 in 168 patients with vocal cord palsy. All patients were evaluated by meticulous history, physical examination, relevant blood tests and Videolaryngoscopy. Endoscopy of the aerodigestive tract was conducted if required. CT, MRI were done when etiology remained elusive after preliminary evaluation. Results and Observations: Of 168 cases, 128 (76%) were unilateral and 40 (24%) bilateral. Left side predominated with 93 (72.4%) cases. The incidence of unilateral vocal cord palsy (UVCP) was highest in the seventh and eighth decades. Malignancy (26.6%) was the commonest etiology of UVCP. Amongst them thyroid cancer was found in 36% followed by lung cancer (25%) and metastases(25%). Surgery (42.5%) was the predominant cause of BVCP with thyroidectomy at fault in 35%. Conclusion: Etiology of vocal cord palsy is diverse. Barring 15-20% of cases a cause can be identified in all. A broader perspective and a comprehensive workup should be adopted so that no system is overlooked. [ABSTRACT FROM AUTHOR]

Background: In otolaryngology outpatient clinics, patients frequently present with unilateral vocal cord paralysis (UVCP). During the pandemic, various new protocols were designed to identify UVCP. An experienced otolaryngologist must conduct a thorough history-taking, examination, and investigation to determine the cause of UVCP. Objectives: To evaluate various causes of UVCP during the pandemic. Methods: Thirty patients with UVCP on 70-degree rigid endoscopy were studied. Detailed general and systemic examinations were done. All COVID-19 precautions were followed during the evaluation, and real-time reverse transcription-polymerase chain reaction was done before the endoscopic procedure. High-resolution computed tomography scan of skull base to mediastinum with contrast was performed for etiology. Patients were treated according to the standard protocols. Follow-up at 1, 3, and at 6 months was performed. Results: The mean age was 42.3 ± 14.83 years. All the patients had presented with a change in voice. Twenty percent had UVCP post a surgical procedure. No cause could be found in 16.67% of patients. Five patients had succumbed to complications relating to their other prevailing conditions. At 6 months, 10 patients continued to have palsy, 9 showed paresis, and 6 showed complete mobility of the cords. Conclusion: During the pandemic, diagnosing and following up such patients were a challenge. Investigating a cause of UVCP, the symptoms of which might be trivial at presentation, leads to discover a much sinister cause. UVCP in post-covid mucormycosis was an entity requiring multimodality management. Pandemic-induced restrictions lead to formulations of newer protocols for tackling this entity. [ABSTRACT FROM AUTHOR]

Background: Snake bite is one of the most neglected diseases in South East Asian region. Common Krait (CK) (Bungarus caeruleus) is the deadliest snake found in the dry zones of India. With the polyvalent anti-venom serum (AVS) remaining the cornerstone of treatment of neurotoxic snake envenomation, there is no universally accepted treatment for CK envenomationassociated neuroparalysis, except supportive measures. Aims and Objectives: Our study was conducted to describe the epidemiology, define clinical features, study outcome, and apparent efficacy of calcium gluconate in preventing or reversing neuromuscular paralysis with respiratory failure in CK bite patients. Materials and Methods: This study is a prospective observational study done on 52 CK bite patients. Patients were enrolled according to inclusion and exclusion criteria and were treated with AVS and calcium gluconate infusion according to National Standard Guideline, 2016. Patients developing severe respiratory muscle paralysis were offered mechanical ventilation. Results: Patients developed ptosis and dysphagia, pain abdomen, cyanosis, paralysis of jaw and tongue, perioral numbness, altered sensorium, dysphonia, ophthalmoplegia, and paradoxical breathing. 21.15% of patients developed respiratory failure and needed ventilator support with average critical care unit stay of 3 days and average stay on a ventilator of 2 days. 3 patients expired (case fatality rate 5.77%). The average hospital stay was 3.33 days. Conclusion: Our study shows that early intervention in patients of CK bite with neurotoxic envenomation, with calcium gluconate infusion, leads to less mortality and morbidity compared to other relevant studies. Further large-scale studies are required for better understanding and implementation. [ABSTRACT FROM AUTHOR]

Unani medicine relies on drugs of natural origin for the treatment of various medical conditions. It is practised throughout Asia and particularly in India. The rich natural drug asset of Unani medicine includes both single and compound drugs. Habb-e-Azaraqi is a polyherbal Unani formulation used clinically since decades for the management of various neurological disorders like facial palsy, paralysis, gout and arthritis. The explicit nature of Habb-e-Azaraqi rationalizes its use in nervine disorders. The main ingredient of Habb-e-Azaraqi is Azaraqi mudabbar (detoxified Strychnos nuxvomica L.) which is known for its diverse medicinal uses. This review highlights the traditional uses of Habb-e-Azaraqi, phytochemistry and pharmacological properties of its ingredient. [ABSTRACT FROM AUTHOR]

While the loss of sensorimotor and autonomic function often occurs due to multiple trauma and pathologies, spinal cord injury is one of the few traumatic pathologies that severely affects multiple organ systems both upstream and downstream of the injury. Current standard of care therapies primarily maintains health and avoids secondary complications. They do not address the underlying neurological condition. Multiple modalities including spinal neuromodulation have shown promise as potential therapies. The objective of this study was to demonstrate the impact of activity-based neurorehabilitation in presence of epidural spinal stimulation to enable simultaneous global recovery of sensorimotor and autonomic functions in patients with complete motor paralysis due to spinal cord injury. These data are unique in that it quantifies simultaneously changes multiple organ systems within only 2 months of intense activity-based neurorehabilitation when also delivering epidural stimulation consisting of sub-motor threshold stimulation over a period of 12–16 hours/day to enable ‘self-training’ in 10 patients. Finally, these studies were done in a traditional neurorehabilitation clinical in India using off-the-shelf electrode arrays and pulse generators, thus demonstrating the feasibility of this approach in simultaneously enabling recoveries of multiple physiological organ systems after chronic paralysis and the ability to perform these procedures in a standard, well-controlled clinical environment. [ABSTRACT FROM AUTHOR]

Objective: This study examined the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of people with chronic stroke. Design : This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or on unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants underwent an hour-long training session a day, thrice a week over a 6-wk duration, and followed-up after 12 mos. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing, and Activities-specific Balance Confidence scale were the outcome measures. Results : Compared with the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to posttraining and from baseline to 12-mo follow-up (P < 0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P > 0.05). Conclusions : Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy. [ABSTRACT FROM AUTHOR]

Objectives Post-Diphtheritic Paralysis (PDP), one of the most severe complications of diphtheria, is caused by exotoxin of Corynebacterium diphtheria. This study was planned since there has been a resurgence of diphtheria in India in recent years due to a number of epidemiological factors. Materials & Methods Thirty-five children with PDP were studied in a tertiary care hospital in Southern India. Result Neurological complications occurred in 38.5% of 91 patients with faucial diphtheria. Of the patients, 13 (37.1%) were unimmunized, 12 (34.3%) were partially immunized, two (5.7%) were completely immunized, and eight (22.6%) had unknown status. Isolated bulbar palsy and bulbar palsy followed by limb weakness were seen in 20 (57.1%) and 15 (42.9%) of the patients, respectively. The first symptoms of PDP occurred 5-34 days after the onset of local diphtheria infection. Eleven (31.4%) out of the 35 patients had received antitoxin between days 5-7 of illness. Ventilation-dependent respiratory failure occurred in three (8.6%) patients with PDP. Nine (25.7%) patients had evidence of co-existent myocarditis, while myocarditis with renal failure was seen in two (5.7%) patients. Four (11.4%) patients died, three from severe cardiomyopathy and one from aspiration. Demyelinating neuropathy was noted in 64% of the patients. Children with bulbar palsy recovered in 4-7 weeks, while limb symptoms improved in 6-17 weeks. Conclusion PDP should be considered in any child presenting with bulbar palsy/quadriparesis following previous history of fever/sore throat. Awareness and availability with timely administration of ADS within 48 hours are essential to reduce PDP, as antitoxin seems ineffective if administered after the second day of diphtheritic symptoms. [ABSTRACT FROM AUTHOR]

Purpose: This study was done to evaluate the clinical profile in pediatric patients (0-16 years) presenting with acute onset esotropia due to sixth nerve palsy and its management options in a tertiary care set up of Southern India.Methods: A total of 12 patients presenting to our OPD with acute onset esotropia due to sixth nerve palsies were included in this retrospective study. All patients were observed for 6 months and managed with prism and/or patching while waiting for spontaneous resolution and later managed surgically. Neuroimaging was done in all cases.Results: The mean deviation of esotropia at presentation was 30.17 ± 5.7 Prism Diopter (range 12-50 Prism Diopter 95% CI, SD 10.11). Mean age of the patients during presentation was 8.6 ± 2.4 years (range: 1-15 years, SD 4.27). Among the common causes of sixth nerve palsy in our study population were trauma and idiopathic intracranial hypertension followed by tumor and miscellaneous causes. Only three patients underwent surgical correction of residual deviation after a waiting period of 6 months for self-resolution. Spontaneous resolution was observed in 41.6% patients, and surgical correction (unilateral resection-recession) was done in 25% of the patients with good surgical outcome.Conclusion: At 1-year follow up, the motor outcome was satisfactory except for one patient who had diffuse pontine glioma and had worsening neurological symptoms on follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy.Methods: This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management.Results: A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third (n = 35, 38.88%) followed by sixth (n = 23, 25.55%) and fourth nerve (n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital (n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve (n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy (n = 27, 77.14%). The radio-imaging yield was maximum (n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery.Conclusion: The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy. [ABSTRACT FROM AUTHOR]

A case study of a 62‑year man presented with weakness of the right hand6 months earlier as electromyography had shown extensive denervation and reinnervation all the segments. Topics include Oculomotor abnormalities (OMA) are smooth pursuit and saccadic abnormalities followed by supranuclear ophthalmoplegia and total external ophthalmoplegia; and severe muscle loss precluded endothermic muscular heat generation necessary to maintain normothermia in a cold environment.

Organophosphate (OP) poisoning is the most common poisoning in India, accounting for almost half of the hospital admissions due to poisoning. Delayed neuropathy is initiated by an attack on a nervous tissue esterase. Although uncommon, delayed neurotoxicity has been consistently reported in literature. This mechanism is implicated not only in damaging peripheral nervous system but also in causing central processes leading to myelopathy. We report a series of three adolescent patients who came to our hospital with delayed neurological manifestations of organophosphorus poisoning, which came out to be OP-induced myeloneuropathy after detailed analysis and evaluation. [ABSTRACT FROM AUTHOR]

Scrub typhus (ST), a zoonotic disease, is currently being recognized as a significant contributor to the changing landscape of infectious diseases in India. As one of the important causes of febrile illness, in many parts of the country, general practitioners need to include it as part of the workup for cases of fever of unknown origin. While very amenable to early treatment with a simple regime of doxycycline, delayed diagnosis can result in a spectrum of complications. We report here one such complication of a case of ST manifesting with isolated lateral rectus palsy, which, to the best of our knowledge, has been reported only thrice in the world previously. Family physicians also need to be aware of the availability in India of affordable serological testing for ST that is useful for rapid and inexpensive diagnosis, leading to timely treatment. [ABSTRACT FROM AUTHOR]

Hypokalemic paralysis is an important and reversible cause of acute flaccid paralysis. The treating physician faces unique diagnostic and therapeutic challenges. We did a prospective study and included all patients with acute flaccid weakness and documented serum potassium of <3.5 mEq/L during the period between January 2009 and August 2015. We studied the incidence, etiology, clinical profile, and acid--base disturbances in patients presenting with hypokalemic paralysis and analyzed the significance of periodic and non-periodic forms of hypokalemic paralysis on patient's outcome. Two hundred and six patients were studied with a mean follow-up of 3.6 ± 1.2 years. Mean age was 37.61 ± 2.2 years (range 18--50 years). Males were predominant (M:F ratio 2.1:1). The nonperiodic form of hypokalemic paralysis was the most common (61%). Eighty-one (39%) patients had metabolic acidosis, 78 (38%) had normal acid--base status, and 47 (23%) patients had metabolic alkalosis. The most common secondary cause was distal renal tubular acidosis (RTA) (n = 75, 36%), followed by Gitelman syndrome (n = 39, 18%), thyrotoxic paralysis (n = 8, 4%), hyperaldosteronism (n = 7, 3%), and proximal RTA (n = 6, 4%). Patients with non-periodic paralysis had more urinary loss (40.1 vs. 12.2 mmol, P = 0.04), more requirement of potassium replacement (120 vs. 48 mmol, P = 0.05), and longer recovery time of weakness (48.1 vs. 16.5 h, P = 0.05) than patients with periodic paralysis. Non-periodic form of hypokalemic paralysis was the most common variant in our study. Patients with periodic paralysis had significant incidence of rebound hyperkalemia. [ABSTRACT FROM AUTHOR]

Surveillance for acute flaccid paralysis (AFP) is a fundamental cornerstone of the global polio eradication initiative (GPEI). Active surveillance (with visits to health facilities) is a critical strategy of AFP surveillance systems for highly sensitive and timely detection of cases. Because of the extensive resources devoted to AFP surveillance, multiple opportunities exist for additional diseases to be added using GPEI assets, particularly because there is generally 1 district officer responsible for all disease surveillance. For this reason, integrated surveillance has become a standard practice in many countries, ranging from adding surveillance for measles and rubella to integrated disease surveillance for outbreak-prone diseases (integrated disease surveillance and response). This report outlines the current level of disease surveillance integration in 3 countries (Nepal, India, and Nigeria) and proposes that resources continue for long-term maintenance in resource-poor countries of AFP surveillance as a platform for surveillance of vaccine-preventable diseases and other outbreak-prone diseases. [ABSTRACT FROM AUTHOR]

Laryngeal tuberculosis is relatively rare and usually is secondary to active pulmonary tuberculosis. Latent Tuberculosis infection (LTBI) is a more prevalent form of tuberculosis in high burden countries like India and pose a more diagnostic challenge because of its subclinica! nature. A 45 year old man presented to Ear Nose Throat (ENT) OPD with noisy breathing for 9 months. Endoscopic evaluation of airway showed bilateral immobile cords and as further investigation didn't reveal any cause, it was considered as idiopathic bilateral abductor cord palsy. Patient was also evaluated for active tuberculosis and was ruled out. Patient underwent LASER assisted posterior cordectomy on right side. However, m post-operative period he had granulations over the glottic area which further compromised the airway. Hence he was taken for granulation removal and revision cordectomy. Histopathological examination of granulations was suggestive of tubercular granulations. Patient was given Anti-tuberculois treatment (A TT) for 6 months and decannulated successfully at the end. The role of LTBI and its diagnostic challenge are discussed m this case report. [ABSTRACT FROM AUTHOR]

Thyrotoxicosis can present as a sporadic form of hypokalaemic periodic paralysis. The condition is associated with massive intracellular shift of potassium, mainly in skeletal muscles. As the total body stores of potassium remain normal, overzealous potassium supplementation targeting serum potassium level results in a poor outcome. We present a fatal case of thyrotoxic hypokalaemic periodic paralysis. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the disparities in the effectiveness of vaccines when used in lower-income countries like Bangladesh and Nicaragua compared to developed countries like the U.S. and Finland, as well as the efforts to resolve the issue as of February 2016. Also cited are the study by pediatrician T. Jacob John on the effectiveness of the polio vaccine in India in the mid-1900s, and the efforts to boost the effectiveness of the rotavirus vaccine in Bangladesh.

Background & Objectives: Focus on non-polio enteroviruses (NPEVs) causing acute flaccid paralysis (AFP) due to myelitis has increased with the containment of the poliovirus. Enterovirus-B88 (EV-B88) has been associated with the AFP cases in Bangladesh, Ghana, South Africa, Thailand and India. In India, EV-B88 infection was linked to AFP a decade ago; however, to date, no complete genome has been made available. In this study, the complete genome sequence of EV-B88 was identified and reported from two different States (Bihar and Uttar Pradesh) in India using the next-generation sequencing technique., Methods: Virus isolation was performed on the three AFP suspected cases as per the WHO-recommended protocol. Samples showing cytopathic effects in the human Rhabdocarcinoma were labelled as NPEVs. Next-generation sequencing was performed on these NPEVs to identify the aetiological agent. The contiguous sequences (contigs) generated were identified, and reference-based mapping was performed., Results: EV-B88 sequences retrieved in our study were found to be 83 per cent similar to the EV-B88 isolate from Bangladesh in 2001 (strain: BAN01-10398; Accession number: AY843306.1). Recombination analyses of these samples demonstrate recombination events with sequences from echovirus-18 and echovirus-30., Interpretation & Conclusions: Recombination events in the EV-B serotypes are known, and this work reconfirms the same for EV-B88 isolates also. This study is a step in increasing the awareness about EV-B88 in India and emphasizes future studies to be conducted in the identification of other types of EV present in India.

Objective: The objective of the study is to develop and validate a predictor score for assessing the requirement of mechanical ventilation (MV) in patients with Guillain-Barre syndrome (GBS). Study design: The study was conducted in patients admitted with GBS in neurointensive care unit in a tertiary care hospital. The demographic, clinical factors, electrophysiological, and spirometric data of all consecutive patients were prospectively collected. The study was undertaken in 2 stages. In the first stage, data were collected for development of a predictor score. In the second stage, the score developed was validated on a separate set of patient data. Results: The data collected were compared between the 2 groups (ventilated vs nonventilated). On univariate analysis, time taken to reach maximum deficit, neck weakness, bulbar weakness, facial weakness, single breath count (SBC), forced vital capacity, and phrenic nerve latency predicted the need for MV. On multivariate analysis, only neck weakness, bulbar weakness, SBC, and forced vital capacity were independent predictors of MV. There was a good correlation between SBC and the spirometric tests and phrenic nerve distal motor latency, as reflected in receiver operating characteristics curve. The predictor score developed using the regression coefficient of independent predictors showed that the best cutoff score for prediction of ventilation was 60 (sensitivity, 0.95; 1 - specificity, 0.065). Internal cross validation of the neck weakness, SBC, and bulbar palsy (NSB) score showed good correlation (Pearson R = 0.76; P = .00). There was no statistically significant difference between predicted and observed outcomes (sensitivity, 95%; specificity, 93%). Conclusion: Several independent risk factors were found to predict the requirement for MV in patients with GBS at admission. However, after scoring and analyzing them, it was found that combining a few of them was more useful to predict the need for MV. A model using NSB score, developed using clinical variables, accurately predicted the requirement of MV. In addition, among the NSB score parameters, simple bedside SBC could adequately assess the adequacy of vital capacity. [ABSTRACT FROM AUTHOR]

The present article was aimed to study demographic and clinical pattern, periodicity and precipitating events for hypokalemic paralysis and to assess the response to treatment both during acute attacks and as prophylaxis in comparison with available literature. Forty patients with hypokalemic paralysis were admitted in Narayana Medical College and Hospital during the last two years, in all the medical units and neurology wards. Patients were assessed clinically, with symptomatology and precipitating factors were evaluated. There were total 40 patients in the present study. Younger more including male gender. Mean age was 30.95 years. Common precipitating factor were diarrhea, fever, strenuous activity, following dextrose administration, in patients with diabetic ketoacidosis, however in majority of the cases we could not identify the precipitating factors. Most common electrocardiographic change on ECG was U' wave (36 cases) followed by flat 'T' wave (14 patients) and ECG was normal in 4 patients. Hypokalemic paralysis was predominantly seen in younger males. Vomiting, diarrhea were important precipitating factors. The response to oral potassium chloride supplementation was good as only few patients requiring intravenous potassium chloride. The approach to hypokalemic paralysis patient includes a vigorous search for the underlying etiology and potassium replacement therapy. [ABSTRACT FROM AUTHOR]

Background: Acute hypokalemic paralysis, characterized by acute flaccid paralysis is primarily a calcium channelopathy, but secondary causes like renal tubular acidosis (RTA), thyrotoxic periodic paralysis (TPP), primary hyperaldosteronism, Gitelman's syndrome are also frequent. Objective: To study the etiology, varied presentations, and outcome after therapy of patients with hypokalemic paralysis. Materials And Methods: All patients who presented with acute flaccid paralysis with hypokalemia from October 2009 to September 2011 were included in the study. A detailed physical examination and laboratory tests including serum electrolytes, serum creatine phosphokinase (CPK), urine analysis, arterial blood gas analysis, thyroid hormones estimation, and electrocardiogram were carried out. Patients were further investigated for any secondary causes and treated with potassium supplementation. Result: The study included 56 patients aged 15-92 years (mean 36.76 ± 13.72), including 15 female patients. Twenty-four patients had hypokalemic paralysis due to secondary cause, which included 4 with distal RTA, 4 with Gitelman syndrome, 3 with TPP, 2 each with hypothyroidism, gastroenteritis, and Liddle's syndrome, 1 primary hyperaldosteronism, 3 with alcoholism, and 1 with dengue fever. Two female patients were antinuclear antibody-positive. Eleven patient had atypical presentation (neck muscle weakness in 4, bladder involvement in 3, 1 each with finger drop and foot drop, tetany in 1, and calf hypertrophy in 1), and 2 patient had respiratory paralysis. Five patients had positive family history of similar illness. All patients improved dramatically with potassium supplementation. Conclusion: A high percentage (42.9%) of secondary cause for hypokalemic paralysis warrants that the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis. [ABSTRACT FROM AUTHOR]

Nonpolio acute flaccid paralysis is increasing in India. To determine viral causes, we conducted cell culture and molecular analysis identification of nonpolio human enteroviruses associated with acute flaccid paralysis during March-August 2010 in northern India. The predominant nonpolio enterovirus found was echovirus 13, a serotype rarely isolated in India. [ABSTRACT FROM AUTHOR]

Objective: There is paucity of reports on thyrotoxic periodic paralysis (TPP) from India. We report the patients with TPP and compare them with idiopathic hypokalemic periodic paralysis (IHPP). Materials and Methods: Patients with hypokalemic periodic paralysis (HPP) treated during the past 11 years were evaluated retrospectively. Their demographic parameters, family history, clinical features, precipitating factors, severity of weakness, laboratory parameters and rapidity of recovery were recorded. The demographic, clinical and laboratory parameters of TPP and IHPP were compared. Results: During the study period, we managed 52 patients with HPP; nine (17.3%) of whom had TPP and 27 (52%) had IHPP. The demographic, precipitating factors, number of attacks and severity of limb weakness were similar between the TPP and IHPP groups, except in the IHPP group, bulbar weakness was present in four and respiratory paralysis in six, needing artificial ventilation in two patients. Serum potassium was significantly lower in TPP (2.21 ± 0.49) compared with IHPP (2.67 ± 0.59, P = 0.04). Four patients with TPP had subclinical thyrotoxicosis and two had subclinical hyperthyroidism. Rebound hyperkalemia occurred in both TPP and IHPP (three versus eight patients). The recovery was faster in IHPP (26.7 ± 15.4 h) compared with TPP (34.0 ± 14.0 h), but was statistically insignificant. Conclusion: TPP constitutes 17.3% of HPP, and absence of clinical features of thyrotoxicosis and subclinical hyperthyroidism in TPP is not uncommon. Clinical features, demographic profile and rebound hyperkalemia are similar in both TPP and IHPP. The serum potassium level is significantly low in the TPP compared with the IHPP group. [ABSTRACT FROM AUTHOR]

The article focuses on the qualitative study which presents the effects of the polio eradication programmes that were implemented in several districts of Uttar Pradesh, India. The study investigates the care and support for children with acute flaccid paralysis (AFP) after their diagnosis as the programmes that were introduced includes the motive of detecting surveillance of AFP to detect and diagnose cases of polio at early stage.

Functional Electrical Stimulation (FES) facilitates ambulatory function after paralysis by electrically activating the muscles of the lower extremities. The Odstock Dropped Foot Stimulator (ODFS, Odstock, UK) called ODFS Pace, was used for heel-switch triggered FES-assisted walking. The ODFS is recommended as an intervention for neurologically impaired gait in the Royal College of Physicians (UK) Clinical Guidelines on Stroke. Based on the guidelines by the National Institute of Clinical Excellence (NICE, UK), we started first clinical study in India on ODFS Pace as an orthotic intervention for daily use. In this preliminary study, we also investigated improvement in volitional walking following 6 sessions (3 times per week, for 2 weeks) of 30 minutes of FES-assisted treadmill walking on 7 chronic (>6 months after stroke) stroke survivors. We found that short-duration, moderately intensive FES-assisted gait therapy improved volitional gait in 3 out of 7 stroke survivors suffering from foot drop. Even in absence of improvement in volitional walking, there were no adverse effects and the subjects found heel-switch triggered FES-assisted walking mostly "easy" (6 out of 7). Therefore FES is promising as an orthotic intervention for daily use; however, tailoring the intensity and/or frequency based on patient's ability may make it viable as a therapeutic intervention. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Case definitions of GBS were recently developed in response to the 2009 H1N1 vaccination programme but have undergone limited field testing. We validate the sensitivity of the Brighton Working Group case definitions for Guillain–Barré Syndrome (GBS) using a population-based cohort in India. Methods: The National Polio Surveillance Unit of India actively collects all cases of acute flaccid paralysis (AFP) in children <15 years old, including cases of GBS. Cases of GBS with available cerebrospinal fluid (CSF) and nerve conduction studies (NCS) results, neurological examination, clinical history, and exclusion of related diagnoses were selected (2002–2003). Relevant data were abstracted and entered into a central database. Sensitivity of the Brighton GBS criteria for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF or NCS, and level 1 which employs both, were calculated. Results: 79 cases of GBS (mean age 6.5 years, range 4.0–14.5; 39% female) met the case definition. GBS cases were ascending (79%), symmetrical (85%), and bilateral (100%); involving lower extremity hypotonia (86%) and weakness (100%), upper extremity hypotonia (62%) and weakness (80%), areflexia/hyporeflexia (88%), respiratory muscles (22%), bulbar muscles (22%), and cranial nerves (13%). Four limbs were involved in 80% of cases. Mean time to maximal weakness was 5.2 days (range 0.5–30 days) with nadir GBS disability scores of 3 (7%), 4 (67%), 5 (15%), 6 (10%), or unclear (1%). CSF (mean time to lumbar puncture 29 days) was normal in 29% with cytoalbuminologic dissociation in 65% (mean protein 105mg/dL, range 10–1000; mean cell count 11/μL, range 0–220, n =4 with >50cells/μL). Significant improvement occurred in 73% whereas death (9%) occurred 6–29 days after sensorimotor symptom onset. The majority of cases (86%) fulfilled Brighton level 3, level 2 (84%), and level 1 (62%) of diagnostic certainty. Conclusion: The diagnosis of GBS can be made using Brighton Working Group criteria in India with moderate to high sensitivity. Brighton Working Group case definitions are a plausible standard for capturing a majority of cases of GBS in field operations in low income settings during AFP surveillance. [Copyright &y& Elsevier]

Introduction: Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. Materials and Methods: The patients presenting with neurological complications with positive serology (IgM antibody) for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. Results: Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. Conclusion: Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study. [ABSTRACT FROM AUTHOR]

Background. On the basis of studies from developed countries, the case-fatality ratio (CFR) of poliomyelitis generally ranges from 2%-5% among children <5 years of age to 10%-30% among adults. However, little information is available for poliomyelitis-related CFR in developing countries. We conducted a study to determine the CFR in India, 1 of the 4 remaining countries with endemic wild poliovirus (WPV) circulation, during outbreaks of WPV infection during 2002 and 2006 and during the inter-epidemic years of 2003-2005. Methods. We conducted a descriptive analysis with use of data from the acute flaccid paralysis surveillance system in India. Variables analyzed included age, caregiver-reported vaccination status, date of paralysis onset, laboratory results, final case classification, and survival outcome. Our analysis also accounted for surveillance changes that occurred in 2005, impacting case definitions and final classification. Results. In 2006, 45 deaths occurred among 676 WPV cases in India, yielding a CFR of 6.7%. By comparison, in 2002, there were 66 deaths among 1600 reported WPV cases (CFR, 4.2%) and during 2002-2005, CFR was 1.5%-5.2%. All 45 deaths were among 644 (95%) WPV cases in children aged <5 years (CFR, 7.0%). Among those who died, 33 (73%) were children aged <2 years (CFR, 7.1%). Conclusions. The CFR among children aged <2 years in India is high compared with previously published CFRs for young children, in part because of improved case finding through enhanced surveillance techniques. Fatal cases emphasize the lethal nature of the disease and the importance of achieving polio eradication in India. [ABSTRACT FROM AUTHOR]

Abstract: Polio Eradication Initiative (GPEI) was launched in 1988 with a multinational effort (World Health Assembly resolution) to control, eliminate and eradicate Poliomyelitis from the world by 2008. Prior to 1988, 3,50,000 children were getting paralyzed due to Poliomyelitis. The objective was to achieve global immunity against wild polio viruses (WPVs) by the year 2008. By the year 2000, there were only 2971 confirmed cases with the elimination of P2 Virus since 1999. Polio incidence remained around 2000 cases a year. During the years 2000–2007, there was a mixture of success and unanticipated set backs, viz. there was a continued reduction in the number of Polio cases but continued circulation of the Polio Virus in the four Polio endemic countries—India, Pakistan, Afghanistan and Nigeria. By the year 2009, 210 Countries were Polio free, of which 134 were certified and there were only 1606 cases in 4 endemic countries with 23 infected countries. The Advisory Committee On Polio Eradication (ACPE) initiated the “Program of Work 2009” and the “Strategic Plan 2010–2012”. As of 1st June, in 2010, only 21 Cases were reported from India (WPV1–3 & WPV3–18) as against 59 cases for the corresponding period in 2009. 2 cases, due to cVDPV2, were reported from UP. bOPV 1 & 3 were introduced in the endemkic zones of western UP and Kosy river belt in Bihar since January 2010. This is an encouraging trend for the first time in 22 years since the inception of GPEI. The interruption of WPV 3 could happen by the low force of transmission (FoT) season of 2011. The hope is that by 2011, India would achieve the elimination of WPVs 1&3. Since Polio eradication means the elimination of both wPV and vDPV, India should move to the bOPV 1&3 — eIPV sequential / exclusive eIPV schedule, as recommended by the India Experts Advisory Group (IEAG), in future even in the pre eradication phase and continue the same strategy in the post eradication phase as guided by the WHO. By all positive signals, India could obtain “Polio free certification” from the World Health Organization (WHO) by the year 2015. [Copyright &y& Elsevier]

Background & objectives: Stroke is a leading cause of deaths, and disabilities in India. Reliable and good quality data on epidemiological characteristics of stroke are essential to plan, implement and evaluate stroke prevention and control programmes. A feasibility study was undertaken in Bangalore to examine the possibility of establishing stroke surveillance and to develop methodology for a larger programme. Methods: The study adapted WHO STEPs-STROKE methodology to collect data on hospitalized stroke events and fatal stroke events in the city of Bangalore. In STEP I, Information was collected from 1,174 stroke patients in three large hospitals and were followed till discharge and 28 days; outcome was measured as death or disability. Stroke cases fulfilling diagnostic criteria, evaluated by neurologists and CT/MRI confirmed cases were included. Brief information on major risk factors was collected from all stroke patients / family members and from medical records by trained research officers. In STEP II, death records of Bangalore Mahanagara Palike for 2004 (n=23,312) were analyzed to identify stroke related deaths. Results: Using WHO-STEPs approach, a methodology was developed for stroke surveillance in a geographically defined population. By STEP 1 method - 7 per cent of medical and 45 per cent of neurological admissions were due to stroke with a fatality rate of 9 per cent at hospital discharge and 20 per cent at 28 days. With a mean age of 54.5 (± 17.0) yr and male preponderance, nearly half had one or more risk factors. Weakness or paresis (92%) was the commonest presentation and ischaemic stroke was most frequent (73.8%). One third of total stroke patients were dependent at both discharge and 28 day follow up. By STEP if method the proportional mortality rate for Bangalore city was observed to be 6 per cent and more than 50 per cent of total stroke deaths had occurred in 10 major hospitals. Interpretation & conclusions: The present study has shown that stroke surveillance is possible and feasible. Institution based (hospitals and vital registry data) stroke surveillance supplemented with periodical population based information can provide comprehensive information on vital aspects of stroke like mortality, risk factors, disability and outcome. There is a need to develop stroke surveillance in a phased manner along with mechanisms to apply data for prevention and control programmes. [ABSTRACT FROM AUTHOR]

The article reports an update on polio eradication efforts by the Indian government since January 2007, as of May 29, 2009. It references the introduction of the use of monovalent oral polio vaccine type 1 (mOPV1). Details of the immunization activities each year in 2007, 2008 and 2009 are presented. Surveillance was also conducted for acute flaccid paralysis (AFP) to identify poliomyelitis cases.

Aim: This study is an overview of non-polio enterovirus (NPEV) circulating in North India studied from the perspective of poliomyelitis eradication. Wild polio cases declined because of intensive oral polio vaccine immunization. As we approach global eradication of poliovirus (PV), NPEV causing acute flaccid paralysis (AFP) are equal cause of concern. Methods: A total of 46 653 AFP samples (World Health Organization) and apparently 1000 healthy contacts living in the same geographical area were studied (2004–2007). Serological identification of NPEV was done using RIVM-specific pools (The Netherlands). Untyped (UT)-NPEVs were sequenced directly from reverse transcription–polymerase chain reaction using pan-enterovirus (Pan-EV) primer (CDC, Atlanta, GA) targeting highly conserved 5′un-translated regions of the enterovirus. Results: In this study, 12 513 NPEVs were isolated from the collected stool samples. Seroneutralization had identified 67% of NPEV isolates, whereas 32.6% remained as UT- NPEV. Of the typed NPEVs, Coxsackie-B accounted for 32.3%; followed by echoviruses-11, 12, 13, 7 between 8 and 28%. In sequencing few UT-NPEVs, some were identified also as echovirus-30, 11 and 18 which were probably present in mixtures as they remained UT-NPEV in ENT. Newly classified human enterovirus virus-86 (HEV) (EU079026), HEV-97(EU071767) and HEV-B isolate (EU071768) were isolated in AFP samples. Conclusions: This study provided definitive information about circulation, prevalence and new emerging NPEV in the polio-endemic region of India, hence they should be considered in AFP surveillance. This would help in adopting and planning new strategies in post-PV eradication era in the country. This is the right time to prepare for the future tasks while we head towards a polio-free region. [ABSTRACT FROM AUTHOR]

A prospective case-control study was conducted to determine the association between Campylobacter jejuni infection and childhood Guillain-Barré syndrome in the Indian population. We found evidence of recent Campylobacter jejuni infection in 27.7% of patients with Guillain-Barré syndrome, as compared with 2.3% in neurological controls (P =.003) and 2.3% in nonneurological controls (P =.003). Of the 15 patients with Campylobacter jejuni infection, 8 (53.3%) reported having had diarrhea within 12 weeks before the onset of the neurologic illness. Our results suggest association between recent Campylobacter jejuni infection and bulbar weakness (P =.043). No statistical difference was observed between the Campylobacter jejuni positive and negative groups with respect to age, other clinical features, albuminocytological dissociation, and residual paralysis at follow-up. It is concluded that subclinical Campylobacter jejuni infection is an important antecedent illness in childhood Guillain-Barré syndrome in the Indian population. [ABSTRACT FROM AUTHOR]

Study design:Postal survey from August 2004 to May 2006.Objective:To ascertain the morbidity trends in individuals with paraplegia in India and to find its association with demographic characteristics.Settings:India.Methods:The questionnaire was mailed to the identified individuals (n=600) whose addresses were obtained from the medical records section of our hospital and by contacting non-government organizations (NGOs), working for individuals with paraplegia in various cities. The causes of morbidities surveyed were respiratory complications, use of catheter, pressure sores, spasticity, postural hypotension, pain and fractures. Data were analysed using nonparametric test of association (Goodman Kruskal Tau).Results:A total of 276 (46%) individuals responded. Of all the morbidities studied, pain was the leading cause (57.2%) followed by spasticity (39.1%), pressure sore (28.3%), postural hypotension (10.1%), respiratory complications, and fractures (5.8%). We found significant associations between various morbidities and demographics and between morbidities themselves.Conclusion:The most common cause for morbidity was pain. Ambulation reduced the incidence of secondary complications.Sponsorship:This study was funded in part by Indian Association of Physiotherapists.Spinal Cord (2007) 45, 664–670; doi:10.1038/sj.sc.3102037; published online 13 February 2007 [ABSTRACT FROM AUTHOR]

The article summarizes the progress toward the eradication of polio in India from January 2005 through June 2006. Surveillance of acute flaccid paralysis remains at high levels of performance. A number of cases of wildpolio virus occurred during the period. Several strategies have been implemented to improve immunization activities in India.

Organophosphate compound (OPC) poisoning with suicidal intent is common in Indian ICUs. The effect of OPCs is to produce a persistent depolarization of the neuromuscular junction leading to muscle weakness. After initial recovery from cholinergic crisis, some patients have resurgence of respiratory muscle paralysis requiring continued ventilatory support. This is termed intermediate syndrome (IMS). This could be due to a change in the type of neuromuscular block to a non depolarisation block characterized by a fade on tetanic stimulation. However peripheral nerve stimulation using train-of-four ratio (TOF) and/tetanus have failed to consistently show such a change. We elected to study whether electro physiological monitoring using repetitive nerve stimulation might show a decremental response during IMS. 9 out of 45 patients required ventilation for more than 6 days and showed overt signs of intermediate syndrome - proximal muscle weakness, twitching and respiratory weakness. Only 2 patients out of the 9 had a decremental response on RNS at 3Hz indicating a post-junctional dysfunction at the motor endplate, Both patients had consumed a very large quantity of OPC and were deeply comatose for >4 days and required ventilation for >12 days. All other patients with IMS showed no changes on RNS. The exact type of poison consumed varied with each individual patient. RNS is a poorly sensitive marker in diagnosing intermediate syndrome after OPC poisoning. We need to develop more sensitive markers to diagnose IMS [ABSTRACT FROM AUTHOR]

Describes the characteristics of compatible poliomyelitis cases and assesses the programmatic implications of clusters of such cases in India. Definition of compatible cases; Distribution of compatible poliomyelitis cases in India; Need to identify factors and methods to decrease in the number of acute flaccid paralysis cases; Effect of the eradication of the diseases on the use of scarce resources.

Examines the acute flaccid paralysis (AFP) surveillance strategy used in India for polio eradication. Deployment of Surveillance Medical Officers for active AFP surveillance; Reports of AFP occurrences; Timely case investigations and collection of stool specimens; Linkages to support polio laboratory network; Training of government surveillance officers; Impact of the strategy.

Ninety cases of the neurological manifestations associated with acute haemorrhagic conjunctivitis caused by Enterovirus 70 (EV 70) are reported. The patients were seen during the widespread epidemics in 1971 and 1981. Male adults were predominantly affected by a "polio-like" paralysis of the limbs and/or cranial nerves. Root pains were often complained of early in the disease. In the absence of a necropsy, clinical and neurophysiological examinations helped to localise the lesions. Significant antibody titres against EV 70 were demonstrated in the serum and more relevantly in the CSF. Though other viruses can cause sporadic and epidemic conjunctivitis and similar paralysis independently, the combination of a haemorrhagic conjunctivitis and a neurological disease mostly simulating poliomyelitis is caused by EV 70 alone. It is therefore suggested that this combination be called "Enterovirus 70 disease". Because of its neurovirulence, it is important to identify this virus at the very beginning of an epidemic of conjunctivitis, so as to limit its spread by strict public health measures. [ABSTRACT FROM AUTHOR]

The article focuses on the study of the first 34 admission of general paresis at the Department of Psychiatry of Erskine Hospital in Mumbai, India. According to the author, this diagnosis was based on clinical and positive blood and cerebrospinal fluid serology. The factors considered in the study include sex and age distribution, occupation, and forms of psychiatric presentation. The result showed that electroencephalography and pneumoencephalography were not helpful in diagnosis, and that cerebral biopsy demonstrated the Treponema pallidum in two cases.