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Byline: T. B. Ganapathy, C. Balasubramaniam Intramedullary lipomas are rare tumours of the spinal cord. The account for about 1% of spinal neoplasms (Neurosurgery, 12, 1983, 460). Their association with [...]

Byline: Indira. Jayakumar, S. Ranjit, C. Balasubramaniam Hyponatremia in acute CNS diseases is often attributed to the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Other causes may be in operation [...]

Since the enactment of IRDAI Act and opening up of life and general insurance businesses to private companies in 1999, competition and efficiency in the operations of the sector have become the key drivers of change. This article highlights the significant developments in the insurance sector and presents the impacts of digitalisation drive in the sector. The article further discusses the role of IRDAI in the contemporary scenario and creation of competitive advantage for better performing companies in the economy. [ABSTRACT FROM AUTHOR]

Corporate governance is an instrument for strengthening overall effectiveness of corporate enterprise in the corporate world and helps to optimize the goals of corporate entities within the boundary of corporate environment. With the above backdrop, the present paper deals with various issues of corporate governance relating to its concept and importance. This paper also describes various committee issues of corporate governance in the Indian economy and relates it with Indian banking system. Indian banking sector plays a catalytic role because of the critical nature of the relationship with business/ corporate sector and large public ownership. The change over from administered controls era to liberalization era followed by implementation of financial sector reforms end prudential norms have brought about new issues and challenges for implementation of corporate governance guidelines in the banking sector. [ABSTRACT FROM AUTHOR]

Background: Prolonged screen time and abnormal postures can cause backache, neck pain, headache, and finger pain. Studies have shown that excessive usage of gadgets has increased during the coronavirus disease 2019 (COVID-19) pandemic, causing health and ocular hazards. This study used qualitative research methods to understand the health and ocular effects of gadget usage following the COVID-19 postlockdown in optometry students., Materials and Methods: A qualitative study using a semi-structured face-to-face interview was conducted for undergraduate and postgraduate students in different optometry institutes who underwent at least 3 months of online teaching learning during the pandemic after obtaining informed consent. The interviews were conducted online; the sessions were audio-recorded, transcribed, and analyzed. Thematic analyses were conducted to understand the challenges faced., Results: Twenty participants were interviewed, of which 70% ( n = 14) were females. Thematic analysis identified seven major themes: gadget usage (frequency of usage, type of device, and time spent), challenges during online classes (comprehension, distraction, and network issues), ocular effects (asthenopic symptoms and ocular symptoms), health effects (musculoskeletal disorders), ways to relieve symptoms, recreational activities (breaks and entertainment), and environment and ergonomics (posture and study area and preferred lighting). All the participants reported ocular/health-related symptoms, including eye strain, burning sensation, headache, back pain, finger pain, and neck pain post the lockdown period due to prolonged gadget usage and poor ergonomic postures., Conclusions: Given the significant increase in digital usage following the pandemic, the study's findings are currently relevant. The prolonged usage of gadgets and poor ergonomic postures have led to ocular and musculoskeletal problems among optometry students. To improve gadget usage without any health-related consequences, students should have access to information regarding ergonomics, increasing the blink rate, and taking regular digital breaks., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Oman Ophthalmic Society.)

Background and Objective: To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time, and these are notoriously prone to complications. In this article, the author analysis his series of ventriculoperitoneal shunts and discusses his technique, nuances and avoidance of shunt complications., Methods and Materials: The author will review common issues related to hydrocephalus shunt management with a review of 549 procedures and associated complications., Results: Key features and basic principles of complication avoidance in shunt surgery is provided. The analysis looks into the complications and ways to avoid them based on the author's experience., Conclusions: Specific measures may be adopted to minimize or avoid these complications. These will be discussed based on the author's series and experiences., Competing Interests: None

Purpose: Childhood malnutrition is a multifactorial disease, responsible for nearly half of all deaths in children under five. Lately, the probable association of a dysbiotic gut to malnutrition is also being eagerly investigated. The current study is an attempt to investigate this purported association through assessing the abundance of major gut bacterial phyla (Firmicutes, Bacteroidetes, Actinobacteria and Proteobacteria), probionts (Bifidobacteria and Lactobacillus), butyrogens (Faecalibacterium and Roseburia) and pathogens (Escherichia and Klebsiella)., Methods: The study was conducted in the suburbs of Chandigarh, India in the year 2017. The children enrolled in the study were part of Anganwadis (Rural Child Care Centres) set up under Integrated Child Development Scheme (ICDS) of Government of India where community-based management approach is being widely used for treatment of malnutrition. We used qPCR based absolute quantification as well as the 16S rRNA amplicon sequencing approach for our study. The study population included 30 children in the age group of 2-5 years who were categorized into three groups Healthy, Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM), with 10 children in each group. The selection of participants was made based on Z scores. Further, statistical tools like the One-way ANOVA, PCA and PLSDA were employed to analyze and compare the gut bacterial profile., Results: Our investigation through the qPCR (Absolute quantification) approach revealed a significantly higher abundance of Actinobacteria in healthy, in comparison to children suffering from Severe Acute Malnutrition (SAM). Consequently, the same trend was also reflected with respect to Bifidobacterium, a prominent member of the Actinobacteria phylum. Conversely, a significant higher abundance of Lactobacillus with the diminishing nutritional status was recorded. Escherichia showed a significant higher abundance in healthy subjects compared to the malnourished; however, no such difference in abundance of Klebsiella was observed. The other target phyla [Bacteroidetes, Firmicutes and Proteobacteria] and genera (Faecalibacterium and Roseburia) showed differences in abundance; however, these were non-significant. Similarly, the bacterial taxonomy analysis of 16S rRNA gene amplicon sequencing data revealed the higher abundance of phylum Actinobacteria and its member Bifidobacterium with lower prevalence of Lactobacillus in healthy children., Conclusion: The pattern of gut microbiota profile in malnourished subjects suggests a dysbiotic gut depleted in Bifidobacteria, a core member of the consortia of beneficial anaerobes of the healthy child gut., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Rosette-forming glioneuronal tumor is a rare World Health Organization grade I neoplasm, primarily involving the posterior fossa. Most cases have been reported in young adults. Although maximal surgical resection is advocated, a precise treatment modality is yet to be established. We describe an unusual presentation of rosette-forming glioneuronal tumor occurring in the optic pathway in a child. As the site of the tumor was not amenable to resection, he underwent radiotherapy and is currently well on follow-up.

A 2-year-old female child with craniosynostosis was referred to our unit for definitive management. She presented with a turricephalic head, hypoplastic midface and obstructive sleep apnoea. Routine preoperative workup included radiographs, CT and polysomnography. She was provisionally planned for calvarial remodelling and midface advancement using transfacial pin fixated distractor (TPF). This involves insertion of a K-wire from one zygoma to the other, a few millimetres below the orbits, traversing across maxilla and nasal cavity. The ends of K-wire are then connected to the distractor anchored firmly to the temporal bone. During insertion, the K-wire transected the nasogastric tube. This technical disaster was circumvented by endoscopic-guided disengagement prior to recovery. The purpose of this paper is to discuss the probable causes that lead to such untoward instances and strategies to avoid and manage the same., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction and Purpose: CSF diversion shunts are notoriously prone to complications. The most difficult to manage among them is shunt infection, which warrants a prolonged hospital stay. The aim of this paper is to review the pattern of infections, the pathology, and management of shunt infections with special reference to a tertiary pediatric center in a developing country., Materials and Methods: This is a review of shunt infections in general and a retrospective study of all cases operated in the hospital from 2000 to 2015., Results: The authors analyze the data and try to discern patterns, which may enable newer interventions to treat as well as decrease the burden of shunt infections in the future., Conclusion: It is difficult to determine the true incidence of shunt infections as there is no definition of what constitutes a shunt infection. There are no standardized international guidelines as to how to deal with an infected shunt. Though the ability to treat shunt infection has improved and the incidence of shunt infection has decreased over time, there is still no consensus on the best way to manage it. The prevention is predominantly based on common sense and has helped but a more scientific algorithm is the need of the hour.

Syringohydromyelia is a frequent finding in cases of tethered cord syndrome. The classical teaching is that the development and progression of a syrinx is a chronic process. We present a case report of an acute onset syringomyelia in an infant, who underwent an excision of a lumbosacral transitional lipoma and detethering of the cord. Immediately after recovery, the infant was found to have flaccid paraplegia. An emergency magnetic resonance imaging revealed a large acute onset syringomyelia for which he underwent an emergency midline myelotomy and release of fluid from the syrinx. Though the eventual recovery was good, this made us re-visit our understanding of the concept of syringohydromyelia. The case details and a plausible hypothesis for the rapid development of the syrinx are presented.

The aim was to present a rare case of recurrent craniopharyngioma remote from the primary site of origin. A young girl was operated for sellar region craniopharyngioma. For a small residual tumor, she underwent radiotherapy. Follow-up imaging did not reveal any residual tumor or recurrence. Surveillance magnetic resonance imaging after 5 years revealed a recurrence in the right Sylvian fissure. This tumor was totally excised. Recurrence of craniopharyngioma is well-known, but recurrence at a site remote from the original site after radiotherapy is extremely rare. One such case is being presented.

Purpose: Postoperative CSF leak is a known complication of spinal surgery especially after surgery for neural tube defects (NTD). The problem can metamorphose into a severe infection. This article hopes to shed some light on the management of these problems and suggests precautions so as to reduce their occurrence., Materials and Methods: A retrospective analysis of 102 children, between the ages of 1 day and 12 years, operated for various spinal pathologies, over the past 2.5 years by the same surgeon (CB) was done. The various methods of dural closure were noted. The methods of management of postoperative CSF leaks were analysed, and the patients were followed till discharge., Results: The incidence of CSF leak was found to be 12.7%. The methods of management included lumbar drain only (n = 7), lumbar drain with re-exploration (n = 3), lumbar drain followed by lumboperitoneal shunt (n = 2) and only lumboperitoneal shunt (n = 1). The use of fibrin glue did not seem to significantly prevent the incidence of CSF leak in cases., Conclusions: Primary and meticulous dural closure is sine qua non in preventing postoperative CSF leak. A lumbar drain is a convenient and economical method of managing the problem initially failing which more invasive methods like re-exploration may be employed.

In pediatric neurosurgery departments in India, craniosynostosis is being increasingly identified and dealt with during the past several years. The management of this problem is well established in units that have a strong pediatric bias, whereas it is still in infancy in certain departments. Some misconceptions exist regarding this condition with reference to clinical, genetic aspects and management-in particular, the surgical indications. The experience gained for more than 2 decades of treating this condition as well as the problems faced in the management of this condition will be discussed. Although the terms craniostenosis and craniosynostosis do not mean quite the same thing, the terms are used interchangeably and will be done so in this communication.

Craniostenosis is a common problem in the pediatric neurosurgery departments. The management of this problem is still evolving. Some misconceptions exist regarding this condition particularly regarding the indications for surgery. The author started performing this surgery nearly two decades ago. The experience gained over time as well as the problems encountered are discussed.

2010 was a vintage year for virtual patients (VPs) with an almost continuous sequence of publications and presentations at the major conferences. Notable examples include AMEE and its subsidiary e-Learning Symposium, the 2nd International Conference on VPs, and a large number of keynote presentations in national and international e-Learning and educational conferences. The increase in international collaboration, coupled to a reduction in VP creation costs and simpler creation tools, has all contributed to this sharp increase in interest. VPs have finally become embedded in the curriculum: in problem-based learning; as core components of lectures, tutorials and seminars; as assessment tools. The medical education community can increasingly turn its attention to the ways in which VPs can be used with the greatest efficiency and pedagogic value. Meanwhile, where will technology next take the VP? It is now possible to consider the extension of the current, relatively lightweight, VP into a truly interactive patient simulation, moving towards the concept of an 'e-human' or 'digital avatar'. At that stage, the simulation may take on new capabilities, offering authentic patient management, clinical and communication skills training, and the potential capability to mimic the health or disease of any citizen.

Medical schools are integrating more technology into the training of health care practitioners. Electronic Virtual Patients (VPs) provide interactive simulations to facilitate learning. The time, cost and effort required to create robust VPs on an individual school basis are significant; sharing of VPs by medical schools allows for access to a broad range of VPs across a variety of disciplines with lower investment. When this digital content is shared with other schools and distributed widely, digital copyright issues come into play. Unless all intellectual property rights (IPRs) and plans of the authors regarding the VP are confirmed upfront, the ability of the school to share the VP may be inhibited. Schools should also identify under what licensing/sharing model they plan to distribute the VPs - how do you plan to share the VPs and what will allow users to do with the VPs in the context of IPRs? This article highlights the role of IPRs in VPs and discusses a case-study of a European Virtual Patient collaboration to demonstrate how IPRs were managed.

Virtual Patients are interactive computer programs that simulate real life clinical scenarios for educational purposes. The European Commission co-funded Electronic Virtual Patient (eViP) programme is a collaboration among 8 universities working towards creating a shareable bank of virtual patients. eViP is creating an application profile of the MedBiquitous Virtual Patient specification to enable the exchange of interoperable virtual patient activities across institutions.

Purpose: To report the prevalence of intraocular lens (IOL) opacification and related clinical features in patients implanted with Hydroview IOL., Setting: Gloucestershire Eye Unit, Gloucestershire, United Kingdom., Methods: A total of 1330 eyes of 1265 patients who had cataract surgery with Hydroview IOL implantation between September 2000 and April 2001 were reviewed between April and October 2004. The visual acuity, visual symptoms, IOL status, and associated ocular comorbidity were recorded., Results: One hundred ninety-three (14.5%) of 1330 eyes had evidence of IOL opacification. A total of 56 (4.2%) had visually significant opacification and had IOL exchange. The prevalence of IOL opacification ranged from 1.1% in patients who had surgery in September 2000 to 36.3% in the December 2000 group. In eyes with IOL opacification, the visual symptoms were decreased vision (57%), glare (32%), and mistiness of vision (27%). One hundred forty-four eyes (75%) with IOL opacification had visual acuity of 6/12 or better; 21.5% of diabetic eyes had IOL opacification compared with 14.3% of nondiabetic eyes (P =.06); 20.5% of glaucomatous eyes had IOL opacification compared with 14.0% of nonglaucomatous eyes (P = .033)., Conclusions: This is the first large sample recall of patients implanted with the Hydroview H60M IOL. The overall prevalence of IOL opacification was 14.5%, with peak prevalence in patients who had surgery in December 2000.

We report our observation of a distinct membrane on the posterior surface of the Hydroview (Bausch & Lomb Surgical) intraocular lens during laser capsulotomy in 6 patients. In 3 patients, the retrolental membrane was noted during 4 to 6 weeks of follow-up after laser capsulotomy. The technique of a 2-stage laser capsulotomy in this group of patients is described. The possible cause and significance for this observation are also discussed.

Malignant tumours of jugular foramen are very rare in infants. To our knowledge there have been no earlier reports. The case of an infant who had a malignant schwannoma in the region of the jugular foramen is now reported. The difficulties of identifying a particular nerve as the origin of such a tumour are also indicated.

A high resolution, three dimensional, computer model of the cardiac conduction system has been developed. Cardiac geometry was constructed from sectional images of VHP project of the National Library of Medicine. The heart was modeled as a matrix of cells that fill its anatomical structure. The intracellular distance was 1 mm and the total number of cells were 457,482. Electrophysiological parameters like action potential, absolute refractory period and conduction velocity were assigned to each of the cells. The pattern of the excitation sequence propagation as well as potentials on the body surface points were computed on a single processor. The working memory and the time for computation of the algorithms were minimized using efficient data structures. The time to compute an excitation sequence over one cardiac cycle was 4 hours. The algorithms were also implemented on a distributed network of personal computers running on a QNX operating system. The speed of computation of the excitation sequence algorithm was improved by a factor of 2.52 when the algorithm was implemented on a network of three Intel-66 MHz machines.

A case of spinal cord compression due to an enterogenous cyst is described.

A case of child who developed mutism following surgery for medulloblastoma is described. Recovery was spontaneous.

Intraoperative sonography is not employed as often as it should be. This report describes the techniques of intraoperative sonography during craniotomy. The authors have performed this in 15 cases. Details of three cases wherein the lesion was localised easily at operation are given. Surgical excision can be done after this procedure without producing any major deficit.

Craniofacial surgery aims to allow proper expansion of the brain and the creation of an acceptable appearance. Early surgery represents an important means to attain these goals, with the choice of surgical technique being as critical as timing.

Tumors caused by radiation treatment are not unknown. They may be benign or malignant. Among these, postradiation meningiomas (PRM) are considered to be a distinct entity. A case of a child who developed a PRM is presented. She received radiation therapy for a presumed thalamic glioma 11 years earlier. An unusual and interesting aspect of this tumor was its attachment to the membrane of the old subdural hematoma, following a shunting procedure. There was no dural attachment. The pathology of PRMs and meningiomas in children are discussed in light of our recent experience.