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Introduction: Fine-needle aspiration cytology (FNAC) can be challenging to provide a precise diagnosis in salivary gland cytopathology due to diversity of lesions and cytomorphological convergence between the tumors and within the same tumor of salivary gland. The recently proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a risk stratication-based classication system with an intrinsic risk of malignancy (ROM) for each diagnostic category, which aims to furnish useful information to the clinicians. This study was undertaken to evaluate the diagnostic utility and validity of MSRSGC. A 4-year retrospective Materials and Methods: study was conducted at a tertiary care hospital in Central Gujarat in Western India. A total of 90 cases of FNAC of salivary gland lesions for the period of January 2018 to March 2021 were reviewed. Patient clinical details, FNAC smears and histological slides where available were retrieved from the departmental records. Results: The cases belong to following categories: non-diagnostic (4.4%), non-neoplastic (10%), atypia of undetermined signicance (1.1%), benign neoplasm (68.9%), salivary gland neoplasm of uncertain malignant potential (8.9%), suspicious for malignancy (2.2%), and malignant (4.4%). Out of 90 cases, 62 cases (68.8%) had follow-up. The ROM were 7.6% for category IV—A and 50% for category IV-B. The sensitivity, specicity, positive predictive value, negative predictive value, and likelihood ratio for differentiating between benign and malignant lesions were recorded as 98.1%, 42.9%, 92.8%, 75.0%, and 1.750, respectively. Conclusion: Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC. The Milan system of reporting is a risk stratication system which can improve the overall effectiveness of reporting and care of patients.

BACKGROUND We aimed to evaluate the significance of electromyographic findings in the intrinsic foot muscles (IFMs) of patients with skin biopsy proven small fiber neuropathy (SFN). METHODS This was a single-center retrospective analysis of patients who underwent skin biopsy for intra-epidermal nerve fiber density (IENFD) measurement and electrodiagnostic (EDX) study for evaluation of polyneuropathy. RESULTS A total of 1416 patents with normal lower extremity EDX studies proximal to the foot were included. Active denervation was seen in 16.1% of IFMs in patients with skin biopsy proven SFN and 4.1% of patients without SFN (P < .0001). Reinnervation changes without active denervation were observed in 30.4% of SFN patients and 23.8% of patients without SFN (P = .01). IENFD was lower in SFN patients with active denervation in IFMs than without (P < .0001). CONCLUSIONS Evaluation of active denervation in the IFMs can reveal large fiber dysfunction in SFN patients with otherwise normal routine EDX findings.

Introduction: Patients with intra-parenchymal (IPH) have seizures detected on continuous EEG (cEEG) monitoring, but data that define seizure risk in IPH patients is limited. Methods: A retrospective chart review of 110 consecutive patients that had ICH on CT or MRI imaging and cEEG monitoring from January 2013 to December 2014 was completed. Patients with isolated cerebellar or brainstem hemorrhages were excluded. Primary aim was to examine the incidence of seizures and abnormal EEG patterns in patients with IPH, particularly those patients with deep IPH. Secondary aim was to examine time from EEG placement to first seizure Results: Median age was 73 [IQR 83-60]. 25 (22.73%) of the 110 patients had an abnormal EEG, defined as the presence of periodic lateralized epileptiform discharges (PLEDS) and/or seizures. 40 (36.36%) had subcortical white matter or thalamic or basal ganglia IPH +/- IVH. 5 (12.5%) of these 40 patients had EEG seizures. 66 (60%) patients had cortical IPH +/- IVH. 11 (16.67%) of these 66 patients had seizures. [OR=0.71, CI=0.23 to 2.23, p=0.56]. 4 patients had both deep and cortical IPH and were excluded. A total of 18 (16.36% of the 110) patients had EEG seizures. Of these 18 patients, 5 (27.78%) patients had deep IPH +/- IVH, defined as subcortical white matter, thalamic or basal ganglia IPH. 11 (61.11%) of the 18 had cortical hemorrhage +/- IVH. 2 (10.5 %) additional patients had both cortical and deep IPH. Additionally, of the 25 patients with abnormal EEG, 7(28%) patients had deep IPH +/- IVH 15(60%) of the 25 patients had cortical hemorrhage +/- IVH. Thus 17.5% of patients with deep IPH and 22.7% of patients with cortical IPH had abnormal cEEG.[OR=0.55, CI=0.20 to 1.48, p=0.23]. Average time for EEG placement from admission was 6 hours and 9 minutes. Average time from EEG placement to first seizure was 7 hours and 4 minutes. Discussion: Subcortical IPH is common and can lead to seizure risk. Our results show that a significant portion of the patients with IPH and seizures on cEEG monitoring had subcortical hemorrhages. They accounted for 28% of cases with seizures and abnormal EEG as well as for 13% of all the patients with subcortical ICHs. This data suggests that patients with supratentorial IPH should be evaluated for subclinical seizures.

Background The majority of people with epilepsy have a good prognosis and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop refractory epilepsy, especially those with partial seizures. In this review we summarise the current evidence regarding zonisamide, when used as an add-on treatment for drug-resistant partial epilepsy. Objectives To evaluate the efficacy and tolerability of zonisamide when used as an add-on treatment for people with drug-resistant partial epilepsy. Search methods We searched the Cochrane Epilepsy Group Specialized Register (12 February 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 1) (January 2013), MEDLINE (Ovid, 1946 to 12 February 2013), SCOPUS (13 February 2013), ClinicalTrials.gov (12 February 2013) and the WHO International Clinical Trials Registry Platform ICTRP (13 February 2013). In addition, we contacted Eisai Limited (makers and licensees of zonisamide) and experts in the field to seek any ongoing/unpublished studies. Selection criteria Randomised, placebo-controlled, add-on trials of zonisamide in people with drug-resistant partial epilepsy. Data collection and analysis Two review authors independently selected trials for inclusion and extracted data. Outcomes were: (1) 50% or greater reduction in total seizure frequency; (2) treatment withdrawal; (3) adverse effects. Primary analyses were intention-to-treat. We estimated summary risk ratios (RRs) for each outcome. All studies were assessed for risk of bias using the Cochrane risk of bias tool and the quality of evidence was assessed using the GRADE approach and presented in a summary of findings table. Main results Five trials (949 participants) were included. The overall RR with 95% confidence interval (CI) for 50% reduction in seizure frequency compared to placebo for 300 to 500 mg/day of zonisamide was 2.00 (95% CI 1.58 to 2.54). The RR for 50% reduction in seizure frequency compared to placebo for any dose of zonisamide (100 to 500 mg per day) was 1.92 (95% CI 1.52 to 2.42). The number needed to treat (NNT) was 6 for this outcome. Two trials provide evidence of a dose response relationship for this outcome. The RR for treatment withdrawal for 300 to 500 mg/day of zonisamide compared to placebo was 1.64 (95% CI 1.20 to 2.25) and for 100 to 500 mg per day was 1.47 (95% CI 1.07 to 2.01). NNT for this outcome was 21. The CIs of the following adverse effects indicate that they are significantly associated with zonisamide: ataxia 3.77 (99% CI 1.28 to 11.11); somnolence 1.83 (99% CI 1.08 to 3.11); agitation 2.35 (99% CI 1.05 to 5.27) and anorexia 2.71 (99% CI 1.29 to 5.69). Across the 5 studies, risk of bias domains were rated as low is bias or unclear. None of the evidence for outcomes was downgraded for quality. Authors' conclusions Zonisamide has efficacy as an add-on treatment in people with drug-resistant partial epilepsy. In this review minimum effective and maximum tolerated doses cannot be identified. The trials reviewed were of a maximum stable-dose phase of 18 weeks in duration and results cannot be used to confirm longer periods of effectiveness in seizure control. The results cannot be extrapolated to monotherapy or to people with other seizure types or epilepsy syndromes.