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Background Patients with cerebral small vessel disease may suffer from varying levels of cognitive deficit and may progress on to vascular dementia. The extent of involvement, as seen on conventional magnetic resonance (MR) measures, correlates poorly with the level of cognitive decline. The purpose of this study was to investigate the utility of diffusion tensor imaging (DTI) as a marker for white matter damage in small vessel disease and to assess its correlation with cognitive function. Methods Thirty consecutive patients with cerebral small vessel disease underwent conventional MR imaging, DTI, and neuropsychological assessment. Results On tractographic analysis, fractional anisotropy was significantly reduced while mean diffusivity significantly increased in several white matter tracts. The alteration in DTI indices correlated well with cognitive function. No significant correlation was identified between T2 lesion load and cognitive performance. Conclusions Tractographic analysis of white matter integrity is a useful measure of disease severity and correlates well with cognitive function. It may have a significant potential in monitoring disease progression and may serve as a surrogate marker for treatment trials. [ABSTRACT FROM AUTHOR]

Background: Several studies reported prognostic value of biomarker in intracerebral hemorrhagic (ICH) but they are either preliminary observation or inadequately powered to analyse independent contribution of biomarkers over and above clinical and neuroimaging data. Objective: To examine whether the biomarker can significantly add to the predictive accuracy of prognosis of ICH. Method/design: In a multi-centric prospective cohort study, 1020 patients with ICH within 72 hours of onset are being recruited. After obtaining written informed consent from patients/proxy, venous blood sample (10 ml) is being collected and analysed for C-reactive protein (CRP) level, S100B, Glial fibrillary acidic protein (GFAP), Troponin, change in leukocyte count and Copeptin levels. The patients are telephonically followed using stroke scales (Barthel Index and modified Rankin Scale) at 3, 6, 12 months and 2 years after the recruitment. Discussion: This protocol will aim at predicting the short term or long term prognosis with the use of clinical, neuroimaging and biomarkers in order to help clinician to stratify patients for early referral or intervention. [ABSTRACT FROM AUTHOR]

Aim & Objectives: A pilot study to test the safety, feasibility and efficacy of using autologous bone marrow mononuclear cells in patients with spinal cord trauma, ALS, muscular dystrophy and stroke patients. Materials and Methods: Fifty five patients of different neurological disorders were selected for this study. The mean age of the patients was 38 yrs, ranging from 21yr to 55 yrs. These patients were randomly selected with no bias. Equal number of controls was studied who were not given cell therapy. After obtaining informed consent 50 ml bone marrow was aspirated from posterior superior iliac spine, mononuclear cells were separated by Ficoll density separation method. After the viability test 28-50 million cells were injected intrathecally, intravenously, intrarterially or intraspinal routes depending on the indication. Results: Of the 55 cases selected for this study, thirty seven cases were of traumatic paraplegia, thirteen cases of amyotrophic lateral sclerosis, three cases of muscular dystrophy and two cases of stroke. A total volume of 3.5 ml containing average of 50.8 x 10 7 of BM-MNC was injected to the patients. The range varied from 28.2 x 10 7 to 125.6 x 10 7 BM-MNC with viability of 95%. All cultures were negative for bacteria and fungi. Of these mononuclear cells approximately 1% cells were CD 34 positive. There were no immediate side affects after administration of BM -- MNC. All the patients were followed up for a duration of six months to one year. There was no deterioration in their symptoms as compared to patients who were not given cell therapy. The patients of traumatic paraplegia felt that there is some improvement in their bladder function. Conclusion: The use of autologous bone marrow cells for the treatment of neurological disorders is a low -- cost, relatively simple, and easy-to-perform option, once its safety and efficacy is proved. Because these disorders has an enormous social and economic impact, result in major impairment and suffering to the patient and his family, there is a pressing need for multicentric, randomized clinical trials with autologous bone marrow mononuclear cells. [ABSTRACT FROM AUTHOR]

Aim: To study the prevalence of electrophysiological abnormalities in HIV infected individuals and to study their clinical correlation. Objective: To identify electrophysiological tests of diagnostic importance Materials and Methods: Forty HIV patients (Group 1-Asymptomatic-10, Group II- Neuro-AIDS-08, Group-III- Neuro-AIDS with other diseases-05, Group-IV Other AIDS defining diseases-11) and 20 age matched controls were studied. Clinical assessment, CD4/CD8 counts, Nerve conduction studies, Visual evoked potentials (VER), Brain stem auditory evoked potentials (BAER), Somatosensory evoked responses (SSEP) and P-300 were done in all Results: Eighty eight percent patients showed demyelinating neuropathy starting in common peroneal nerve. In asymptomatic individuals VER were abnormal in 15%, BAER in 20%, SSEP- 75% and P-300 in 22% in patients with other AIDS defining illnesses than Neuro-AIDS, Visual evoked responses were abnormal in 24%, BAER 41%, SSEP 46%, P-300 in 19%. Overall Nerve conduction velocity was abnormal in 88%, VER-15%, BAER 40%, and SSEP- in 59% of individuals tested. The abnormalities are fairly common even when the CD-4 count is >250/cumm. Conclusion: Sub-clinical electrophysiological abnormalities are common in asymptomatic and non-Neuro-AIDS patients and guide further management strategies [ABSTRACT FROM AUTHOR]

Purpose: To propose an automated approach for detecting and classifying Intracranial Hemorrhages (ICH) directly from sinograms using a deep learning framework. This method is proposed to overcome the limitations of the conventional diagnosis by eliminating the time-consuming reconstruction step and minimizing the potential noise and artifacts that can occur during the Computed Tomography (CT) reconstruction process., Methods: This study proposes a two-stage automated approach for detecting and classifying ICH from sinograms using a deep learning framework. The first stage of the framework is Intensity Transformed Sinogram Sythesizer, which synthesizes sinograms that are equivalent to the intensity-transformed CT images. The second stage comprises of a cascaded Convolutional Neural Network-Recurrent Neural Network (CNN-RNN) model that detects and classifies hemorrhages from the synthesized sinograms. The CNN module extracts high-level features from each input sinogram, while the RNN module provides spatial correlation of the neighborhood regions in the sinograms. The proposed method was evaluated on a publicly available RSNA dataset consisting of a large sample size of 8652 patients., Results: The results showed that the proposed method had a notable improvement as high as 27% in patient-wise accuracies when compared to state-of-the-art methods like ResNext-101, Inception-v3 and Vision Transformer. Furthermore, the sinogram-based approach was found to be more robust to noise and offset errors in comparison to CT image-based approaches. The proposed model was also subjected to a multi-label classification analysis to determine the hemorrhage type from a given sinogram. The learning patterns of the proposed model were also examined for explainability using the activation maps., Conclusion: The proposed sinogram-based approach can provide an accurate and efficient diagnosis of ICH without the need for the time-consuming reconstruction step and can potentially overcome the limitations of CT image-based approaches. The results show promising outcomes for the use of sinogram-based approaches in detecting hemorrhages, and further research can explore the potential of this approach in clinical settings., (© 2023 American Association of Physicists in Medicine.)

Cranial implants are commonly used for surgical repair of craniectomy-induced skull defects. These implants are usually generated offline and may require days to weeks to be available. An automated implant design process combined with onsite manufacturing facilities can guarantee immediate implant availability and avoid secondary intervention. To address this need, the AutoImplant II challenge was organized in conjunction with MICCAI 2021, catering for the unmet clinical and computational requirements of automatic cranial implant design. The first edition of AutoImplant (AutoImplant I, 2020) demonstrated the general capabilities and effectiveness of data-driven approaches, including deep learning, for a skull shape completion task on synthetic defects. The second AutoImplant challenge (i.e., AutoImplant II, 2021) built upon the first by adding real clinical craniectomy cases as well as additional synthetic imaging data. The AutoImplant II challenge consisted of three tracks. Tracks 1 and 3 used skull images with synthetic defects to evaluate the ability of submitted approaches to generate implants that recreate the original skull shape. Track 3 consisted of the data from the first challenge (i.e., 100 cases for training, and 110 for evaluation), and Track 1 provided 570 training and 100 validation cases aimed at evaluating skull shape completion algorithms at diverse defect patterns. Track 2 also made progress over the first challenge by providing 11 clinically defective skulls and evaluating the submitted implant designs on these clinical cases. The submitted designs were evaluated quantitatively against imaging data from post-craniectomy as well as by an experienced neurosurgeon. Submissions to these challenge tasks made substantial progress in addressing issues such as generalizability, computational efficiency, data augmentation, and implant refinement. This paper serves as a comprehensive summary and comparison of the submissions to the AutoImplant II challenge. Codes and models are available at https://github.com/Jianningli/Autoimplant_II., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michal Španěl is affiliated with TESCAN 3DIM that sponsored the challenge., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Diet-induced models of chronic kidney disease (CKD) offer several advantages, including clinical relevance and animal welfare, compared with surgical models. Oxalate is a plant-based, terminal toxic metabolite that is eliminated by the kidneys through glomerular filtration and tubular secretion. An increased load of dietary oxalate leads to supersaturation, calcium oxalate crystal formation, renal tubular obstruction, and eventually CKD. Dahl-Salt-Sensitive (SS) rats are a common strain used to study hypertensive renal disease; however, the characterization of other diet-induced models on this background would allow for comparative studies of CKD within the same strain. In the present study, we hypothesized that SS rats on a low-salt, oxalate rich diet would have increased renal injury and serve as novel, clinically relevant and reproducible CKD rat models. Ten-week-old male SS rats were fed either 0.2% salt normal chow (SS-NC) or a 0.2% salt diet containing 0.67% sodium oxalate (SS-OX) for five weeks.Real-time PCR demonstrated an increased expression of inflammatory marker interleukin-6 (IL-6) ( p < 0.0001) and fibrotic marker Timp-1 metalloproteinase ( p < 0.0001) in the renal cortex of SS-OX rat kidneys compared with SS-NC. The immunohistochemistry of kidney tissue demonstrated an increase in CD-68 levels, a marker of macrophage infiltration in SS-OX rats ( p < 0.001). In addition, SS-OX rats displayed increased 24 h urinary protein excretion (UPE) ( p < 0.01) as well as significant elevations in plasma Cystatin C ( p < 0.01). Furthermore, the oxalate diet induced hypertension ( p < 0.05). A renin-angiotensin-aldosterone system (RAAS) profiling (via liquid chromatography-mass spectrometry; LC-MS) in the SS-OX plasma showed significant ( p < 0.05) increases in multiple RAAS metabolites including angiotensin (1-5), angiotensin (1-7), and aldosterone. The oxalate diet induces significant renal inflammation, fibrosis, and renal dysfunction as well as RAAS activation and hypertension in SS rats compared with a normal chow diet. This study introduces a novel diet-induced model to study hypertension and CKD that is more clinically translatable and reproducible than the currently available models.

Male infertility is solely responsible for 20-30% of infertility cases. Oxidative damage of sperm DNA is positively linked with oligoasthenoteratozoospermia (OAT), and male infertility. The antioxidants are being explored worldwide to combat OAT, sperm DNA fragmentation and reactive oxygen species. The objective of the study was to assess the effectiveness of an antioxidant blend in improving sperm count, semen parameters and reducing DNA fragmentation index (DFI) in sub-fertile males. A prospective, double-blind, randomized, placebo-controlled trial was conducted in 300 sub-fertile males (25-45 years) from ten study sites in India. Subjects were randomized in either the antioxidant blend treatment group or placebo group. We assessed changes in sperm count, motility, normal morphology, semen volume, and percent DFI before and after treatment (90 days). To further stratify data on different criteria post hoc analysis was performed. Statistical analysis was performed using SPSS 10.0 software. There were improvements in sperm count, semen volume, sperm motility, and sperm normal morphology in the treatment group. There was improvement in sperm count in severe oligospermia subjects (sperm count < 5 million/mL, 5-10 million/mL, 10.1-15 million/mL), and high-extremely higher baseline DFI (20-30%, 31-40% and above 40%), as per post hoc analysis. There was no premature discontinuation and adverse events were reported during the study, indicating safety and well-tolerability of treatment. Study results confirmed the well-researched fact of antioxidants being effective to reduce oxidative stress and thus improve sperm DNA integrity and also improved semen parameters in males aged 40 and above., Trial Registration: Clinical Trials Registry-India Identifier: CTRI/2020/12/029590., Competing Interests: Conflict of Interest: - Authors: Rohit Shelatkar is a part of Vitabiotics UK. Meyer Organics Pvt. Ltd. is a group company of Vitabiotics. Other authors declare no conflict of interest - Reviewers: Nothing to declare - Editors: Nothing to declare, (Copyright © 2023 Translational and Clinical Pharmacology.)

Advanced research in health science has broadened our view in approaching and understanding the pathophysiology of diseases and has also revolutionised diagnosis and treatment. Ever since the establishment of Braak's hypothesis in the propagation of alpha-synuclein from the distant olfactory and enteric nervous system towards the brain in Parkinson's Disease (PD), studies have explored and revealed the involvement of altered gut microbiota in PD. This review recapitulates the gut microbiome associated with PD severity, duration, motor and non-motor symptoms, and antiparkinsonian treatment from recent literature. Gut microbial signatures in PD are potential predictors of the disease and are speculated to be used in early diagnosis and treatment. In brief, the review also emphasises on implications of the prebiotic, probiotic, faecal microbiota transplantation, and dietary interventions as alternative treatments in modulating the disease symptoms in PD., (© 2022. The Author(s).)

Background and Purpose: Very few large scale multicentric stroke clinical trials have been done in India. The Indian Council of Medical Research funded INSTRuCT (Indian Stroke Clinical Trial Network) as a task force project with the objectives to establish a state-of-the-art stroke clinical trial network and to conduct pharmacological and nonpharmacological stroke clinical trials relevant to the nation and globally. The purpose of the article is to enumerate the structure of multicentric stroke network, with emphasis on its scope, challenges and expectations in India., Methods: Multiple expert group meetings were conducted by Indian Council of Medical Research to understand the scope of network to perform stroke clinical trials in the country. Established stroke centers with annual volume of 200 patients with stroke with prior experience of conducting clinical trials were included. Central coordinating center, standard operating procedures, data and safety monitoring board were formed., Discussion: In first phase, 2 trials were initiated namely, SPRINT (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India) and Ayurveda treatment in the rehabilitation of patients with ischemic stroke in India (RESTORE [Rehabilitation of Ischemic stroke Patients in India: A Randomized controlled trial]). In second phase, 4 trials have been approved. SPRINT trial was the first to be initiated. SPRINT trial randomized first patient on April 28, 2018; recruited 3048 patients with an average of 128.5 per month so far. The first follow-up was completed on May 27, 2019. RESTORE trial randomized first patient on May 22, 2019; recruited 49 patients with an average of 3.7 per month so far. The first follow-up was completed on August 30, 2019., Conclusions: In next 5 years, INSTRuCT will be able to complete high-quality large scale stroke trials which are relevant globally., Registration: URL: http://www.ctri.nic.in/; Unique Identifier: CTRI/2017/05/008507.

Fringe projection profilometry (FPP) is a widely used non-contact optical method for 3D profiling of objects. The commonly used linear fringe pattern in FPP has periodic intensity variations along the lateral direction. As a result, the linear fringe pattern used in FPP cannot uniquely represent the lateral shift induced by the objects having surface discontinuities. Thus, unambiguous surface profiling of objects, especially with surface discontinuities, using a single linear fringe image having a single fringe frequency, is unfeasible. This paper proposes using a radially symmetric circular fringe pattern as the structured light pattern for accurate unambiguous surface profiling of sudden height-discontinuous objects. To the best of our knowledge, this is the only method that can reconstruct discontinuous height profiles with the help of a single fringe image having a single frequency. The performance of the proposed algorithm is evaluated on several synthetic and real objects having smooth variations and discontinuities. Compared to the well-known fringe projection methods, the results depict that for a tolerable range of error, the proposed method can be applied for the reconstruction of objects with 4 times higher dynamic range and even at much lower fringe frequencies.

Disease in agricultural field is a big problem that causes a massive loss in production. In this present investigation, we have reported a soil-borne bacterium Bacillus cereus IB311 which is antagonistic to plant pathogens (Pseudomonas syringae and Agrobacterium tumefaciens), and could make a substantial contribution to the prevention of plant diseases. To prove the practical application, the strain was directly applied in agricultural field. The results demonstrated that B. cereus IB311 has increased the production (20% and 26% in term of average pod number per plant, average seed number per pod, and seed yield per experimental plot) in ground nut (Arachis hypogaea var. Koushal, G201) and sesame (Sesamum indicum var. Kanak), respectively. To reduce the production cost, the biomass production was optimized through response surface methodology (RSM). Interactions of three variables (glucose, beef extract and inoculum) were studied using Central Composite Design. According to our analysis, optimum production of Bacillus cereus IB311 (5.383 µg/ mL) may be obtained at glucose 1.985%, beef extract 1.615% and inoculums size 0.757%. Therefore, we strongly believe that the application of this strain in agricultural field as bio-controlling agent will definitely enhance the production yield and will reduce the disease risk.

Background: Haematoma expansion due to raised blood pressure in spontaneous intracerebral haemorrhage may determine outcome. The aim of this study was to determine safety and efficacy of lowering blood pressure in acute spontaneous intracerebral haemorrhage., Methods: This open label, multicentric trial randomized patients ≥18 years with spontaneous intracerebral haemorrhage with no secondary cause within 72 h of onset to tight BP control arm where treatment was initiated if mean arterial pressure (MAP) was ≥115 mm of Hg and conventional BP control arm where treatment was initiated if MAP was ≥130 mm of Hg. The MAP was maintained in the respective arm for another 72 h after which both arms had MAP below 115 mm of Hg. Primary outcome was modified Rankin Scale at 90 days., Results: 118 patients, 59 in each arm were included. Follow up was available for all. Baseline characteristics were similar. At 90 days there was no significant difference between median mRS between the two arms. Odds Ratio for "poor outcome" (mRS 3-6) in the tight control arm (safety of the intervention) against "good outcome" (mRS 0-2) was not significant (OR 0.70 [95% CI 0.34-1.47] p  = 0.35). Efficacy of the intervention in the form of Odds Ratio for "good outcome" in the tight control arm was not significant (OR 1.43 [95% CI 0.68-2.99], p  = 0.35)., Conclusion: In patients with spontaneous intracerebral haemorrhage who present within 72 h of the onset of symptoms, MAP can be safely lowered if it crosses 115 mm of Hg but it does not improve clinical outcome.

Background Patients with cerebral small vessel disease may suffer from varying levels of cognitive deficit and may progress on to vascular dementia. The extent of involvement, as seen on conventional magnetic resonance (MR) measures, correlates poorly with the level of cognitive decline. The purpose of this study was to investigate the utility of diffusion tensor imaging (DTI) as a marker for white matter damage in small vessel disease and to assess its correlation with cognitive function. Methods Thirty consecutive patients with cerebral small vessel disease underwent conventional MR imaging, DTI, and neuropsychological assessment. Results On tractographic analysis, fractional anisotropy was significantly reduced while mean diffusivity significantly increased in several white matter tracts. The alteration in DTI indices correlated well with cognitive function. No significant correlation was identified between T2 lesion load and cognitive performance. Conclusions Tractographic analysis of white matter integrity is a useful measure of disease severity and correlates well with cognitive function. It may have a significant potential in monitoring disease progression and may serve as a surrogate marker for treatment trials.

Escherichia coli (E. coli) bacteria have been identified to be the cause of variety of health outbreaks resulting from contamination of food and water. Timely and rapid detection of the bacteria is thus crucial to maintain desired quality of food products and water resources. A novel methodology proposed in this paper demonstrates for the first time, the feasibility of employing a bare fiber Bragg grating (bFBG) sensor for detection of E. coli bacteria. The sensor was fabricated in a photo-sensitive optical fiber (4.2 µm/80 µm). Anti-E. coli antibody was immobilized on the sensor surface to enable the capture of target cells/bacteria present in the sample solution. Strain induced on the sensor surface as a result of antibody immobilization and subsequent binding of E. coli bacteria resulted in unique wavelength shifts in the respective recording of the reflected Bragg wavelength, which can be exploited for the application of biosensing. Functionalization and antibody binding on to the fiber surface was cross validated by the color development resulting from the reaction of an appropriate substrate solution with the enzyme label conjugated to the anti-E. coli antibody. Scanning electron microscope image of the fiber, further verified the E. coli cells bound to the antibody immobilized sensor surface., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Normal human brain exhibits approximately bi-fold symmetry with respect to its midsagittal plane (MSP). The objective of this work is to investigate the effect of doubling atlases (i.e., reference images) used in multi-atlas fusion methods by exploiting the inherent bilateral symmetry of human brain. To this end, we perform automated segmentation of 15 subcortical structures using Local Weighted Voting (LWV) fusion method with varying number of atlases. We consider three specific scenarios for atlases while performing fusion: (i) fusion with original OASIS atlases, (ii) with atlases obtained by flipping the original atlases based on their MSP, and (iii) with both original and flipped atlases. Evaluations are performed on the publicly available OASIS dataset of 20 normal human brain MR images. One of the key findings of this study is that when the number of atlases available for fusion is less than 10, fusion by combining both the original and flipped atlases provided more accurate segmentations than using only the original atlases, or only the flipped atlases.

In recent years, fusing segmentation results obtained based on multiple template images has become a standard practice in many medical imaging applications. Such multiple-templates-based methods are found to provide more reliable and accurate segmentations than the single-template-based methods. In this paper, we present a new approach for learning prior knowledge about the performance parameters of template images using the local intensity similarity information; we also propose a methodology to incorporate that prior knowledge through the estimation of the optimal MAP parameters. The proposed method is evaluated in the context of segmentation of structures in the brain magnetic resonance images by comparing our results with some of the state-of-the-art segmentation methods. These experiments have clearly demonstrated the advantages of learning and incorporating prior knowledge about the performance parameters using the proposed method.

We present MBIS (Multivariate Bayesian Image Segmentation tool), a clustering tool based on the mixture of multivariate normal distributions model. MBIS supports multichannel bias field correction based on a B-spline model. A second methodological novelty is the inclusion of graph-cuts optimization for the stationary anisotropic hidden Markov random field model. Along with MBIS, we release an evaluation framework that contains three different experiments on multi-site data. We first validate the accuracy of segmentation and the estimated bias field for each channel. MBIS outperforms a widely used segmentation tool in a cross-comparison evaluation. The second experiment demonstrates the robustness of results on atlas-free segmentation of two image sets from scan-rescan protocols on 21 healthy subjects. Multivariate segmentation is more replicable than the monospectral counterpart on T1-weighted images. Finally, we provide a third experiment to illustrate how MBIS can be used in a large-scale study of tissue volume change with increasing age in 584 healthy subjects. This last result is meaningful as multivariate segmentation performs robustly without the need for prior knowledge., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Stroke is a leading cause of death and disability in the world. Identifying the genes underlying stroke risk may help us to improve our understanding of the mechanisms that cause stroke and also identify novel therapeutic targets. To have sufficient power to disentangle the genetic component of stroke, large-scale highly phenotyped DNA repositories are necessary. The BRAINS (Bio-repository of DNA in stroke) study aims to recruit subjects with all subtypes of stroke as well as controls from UK, India, Sri Lanka and Qatar. BRAINS-UK will include 1500 stroke patients of European ancestry as well as British South Asians. BRAINS-South Asia aims to recruit 3000 stroke subjects and 3000 controls from across India and Sri Lanka. BRAINS-Middle East aims to enrol 1500 stroke patients from Qatar. The controls for BRAINS-Middle East will be recruited from a population-based Qatari Biobank. With the addition of new recruitment centres in India and Qatar, we present an updated version of the BRAINS study protocol. This is the first international DNA biobank for stroke patients and controls from the Middle East. By investigating the influence of genetic factors on stroke risk in European, South Asian and Middle Eastern populations, BRAINS has the potential to improve our understanding of genetic differences between these groups and may lead to new population-specific therapeutic targets.

This paper presents a new and original variational framework for atlas-based segmentation. The proposed framework integrates both the active contour framework, and the dense deformation fields of optical flow framework. This framework is quite general and encompasses many of the state-of-the-art atlas-based segmentation methods. It also allows to perform the registration of atlas and target images based on only selected structures of interest. The versatility and potentiality of the proposed framework are demonstrated by presenting three diverse applications: In the first application, we show how the proposed framework can be used to simulate the growth of inconsistent structures like a tumor in an atlas. In the second application, we estimate the position of nonvisible brain structures based on the surrounding structures and validate the results by comparing with other methods. In the final application, we present the segmentation of lymph nodes in the Head and Neck CT images, and demonstrate how multiple registration forces can be used in this framework in an hierarchical manner., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Folstein's Mini Mental Status Examination (MMSE) often fails to identify executive dysfunction even if quite severe. Detailed neuropsychological tests and extensive bedside tests are available to evaluate executive function, but most of them are time consuming. This study was done to determine the value of a Clock Drawing Test (CDT) as a simple tool to identify cognitive dysfunction in various neurological disorders and to assess its utility as an adjunct to MMSE in identifying executive dysfunction in a a busy out patient department (OPD)., Methods: A total of 81 patients suffering from neurological disorders and 81 controls were studied. All subjects received the MMSE and the CDT. The CDT is divided into an unprompted task that is sensitive to executive control (CDT 1) and a copying task which is not (CDT 2)., Result: All the three tests (CDT 1, CDT 2 and MMSE) could recognize cognitive and executive function deficits, when compared with age and sex matched controls (p < 0. 001). CDT scores correlated strongly with the level of executive function deficits. CDT+MMSE detected 95% cases as abnormal as compared to 47% detected by MMSE alone., Conclusion: CDT along with MMSE can detect executive control deficits and cognitive deficits. The CDT 1 tests executive control performance, while CDT 2 tests posterior cortical deficits.

The Indian armed forces have over 5000 cases of human immunodeficiency virus (HIV) infection since 1990. The spouses of the affected soldiers are at a constant risk of contracting infection if not informed of their husband's HIV status. The onus of counselling the spouse has been delegated to the commanding officer (CO) of the soldier as per policy. The spouses usually reside at their hometown away from the soldier's unit and bridging this "geographical discordance" and offering effective counselling becomes a tricky issue for the commanding officer (CO). This article examines the effectiveness of this strategy as practised in Indian armed forces.

Background: Guillain-Barré syndrome is the most common cause of acute neuromuscular paralysis and is considered a post-infectious disease., Methods: Twenty patients with Guillain-Barré syndrome admitted to the Neurosciences Centre at the All India Institute of Medical Sciences from November 1997 to August 1998 were investigated for evidence of antecedent infections. This case-control study included 2 controls for each patient, one a household control and the other an age- and sex-matched hospital control suffering from a neurological illness other than Guillain-Barré syndrome. Evidence of recent Campylobacter jejuni infection was investigated by culture and serology, and for Mycoplasma pneumoniae by serology., Results: There was evidence of recent C. jejuni infection in 35% of the patients compared with 25% of household controls and none of the hospital controls. M. pneumoniae infection was seen in 50% of patients compared with 25% of household controls and 15% of hospital controls. About one-third of the patients (30%) had evidence of both infections. The association of both infections in patients was found to be statistically significant as compared to hospital controls., Conclusion: C. jejuni and M. pneumoniae may be important antecedent illnesses in patients with Guillain-Barré syndrome in India.

A soldier presented in Jan 2002 with features of proximal myopathy and diplopia. Clinically he had features of myasthenia gravis, which was confirmed by significantly positive neostigmine test, decremental response on electrophysiological study and raised acetylcholine receptor antibody titres. He also tested positive for HIV during evaluation of a cervical lymph node detected incidentally. He responded well to neostigmine and has remained asymptomatic on follow up.