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Objective: The causes of pancytopenia vary in different populations depending on age, gender, nutrition, geographic location, standard of living, and exposure to certain infections and drugs. As the severity of pancytopenia and its underlying etiology determine the management and prognosis, identifying the correct etiology in a given case is crucial and helps in implementing timely and appropriate treatment. The objectives of this study were to study the clinical profile and hematological parameters of pancytopenic adults and to identify different etiologies of pancytopenia. This observational study was conducted in the Medicine department of a tertiary care teaching hospital. Materials and Methods: The study was conducted on 100 adult patients aged 18–65 years presenting with pancytopenia. All the participants were subjected to detailed clinical examination and relevant investigations including bone marrow (BM) examination. Categorical variables were presented in number and percentage (%). Qualitative variables were correlated using the Chi-square test. A P

Radon (222Rn) and Thoron (220Rn) are radioactive noble gases which are produced in the decay chain of primordial radionuclides 238U and 232Th. These gases have been established as an important source of inhalation radiation dose to human which increases risk of lung cancer. Similarly the terrestrial 226Ra, 232Th, 40K are known to contribute to cumulative external background exposure to humans. In the present study, these radionuclides of concern were measured in the environment of monuments and museums in the state of Punjab and the resultant dose was calculated for the occupants. The calculated Annual Inhalation Dose level varied from 1.5 to 4.0 mSv with mean of 3.0 ± 0.8 mSv. The cumulative dose from all radionuclides 226Ra, 232Th and 40K is 47.0 ± 11.56 nGyh−1, found well within the safe limits of 86 nGyh−1.

In the present work, an exertion has been made to assess the indoor 222Rn and 220Rn levels in dwellings of a Roopnagar district of Punjab, India. These estimations have been done in the rainy, winter, autumn and summer season. The average indoor radon concentration is 44 ± 14.08 Bq m−3, 57.40 ± 17.61 Bq m−3, 32.38 ± 12.59 Bq m−3 and 31.38 ± 7.48 Bq m−3 and thoron concentration are 56.91 ± 19.75 Bq m−3, 64.45 ± 23.90 Bq m−3, 45.98 ± 19.38 Bq m−3 and 43.39 ± 10.45 Bq m−3 for rainy, winter, autumn and summer seasons, respectively. The mean value of equilibrium equivalent radon and thoron concentration during the rainy season is 11.25 ± 2.91 Bq m−3 and 0.62 ± 0.14 Bq m−3 and during winter season is 13.36 ± 3.36 Bq m−3 and 0.85 ± 0.34 Bq m−3 respectively. For autumn season these values are 9.58 ± 1.43 Bq m−3 and 0.46 ± 0.11 Bq m−3, respectively. For summer season these values are 12.10 ± 1.57 Bq m−3 and 0.57 ± 0.99 Bq m−3, respectively. The annual inhalation dose comes out to be 0.98 ± 0.16 mSv.

Human beings are constantly exposed to radioactivity in the environment. As they are major sources of harmful radiation, radionuclides found in the atmosphere might result in a substantial potential risk to living beings. On the Earth's surface, the radioactive elements uranium and radium are naturally present, contributing to radon and thoron gases in the indoor as well as outdoor climate, soil and water. Radon is one of the most important toxins that, after cigarette smoking, is the second most common cause of generating lung cancer. Due to these health-related concerns, a lot of work has been undertaken by numerous research organizations to determine their levels at different locations throughout the world. This paper is an attempt to comprehensively report with different techniques all those studies being carried out in this part of India so that a current assessment of the indoor radon levels should be available for further work in this field. Six northern Indian states, viz. Punjab, Haryana, Himachal Pradesh, Rajasthan , Uttar Pradesh and Uttarakhand are considered for this examination. This study also provides data on exhalation rates and activity concentration of natural radionuclides (226Ra, 232Th, and 40K) present in these states.

Introduction: The diagnosis of coronary artery disease or acute coronary syndrome (ACS) is difficult in patients of chronic kidney disease (CKD). This study was planned to evaluate the role of cardiac biomarkers in diagnosis of ACS in such patients. To evaluate the role of biochemical cardiac markers in the diagnosis of ACS in patients with CKD and to study the relation of stage of kidney disease and biochemical cardiac biomarkers. Materials and Methods: Atotal of 350 patients in different stages of CKD were enrolled and subjected to measurement of blood levels of creatine kinase (CK) MB and Troponin I (Trop I). The data were analyzed by dividing subjects into groups based on positivity of biomarkers, presence of electrocardiogram (ECG) changes, and stage of CKD. Results: Sensitivity of CK MB and Trop I was 60.81% and 56.76% and specificity was 72.1% and 83.33%, respectively. Although both showed low positive predictive values, the negative predictive value of both CK MB and Trop I was good. Stage of CKD did not significantly affect the level or positivity of the biomarker in patients with ECG changes. Conclusions: CK MB and Trop I potentially rule out the probability of ACS in patients showing negative test results, which should always be interpreted in light of ECG changes in CKD patients.

In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India.This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases.Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.

Radon effect on human health need not be overemphasised. In the present study an attempt has been made to measure the concentration of indoor radon, thoron and annual effective dose received by residents of Nangal area of Roopnagar District of Punjab. Radium concentration and Radon exhalation in soil samples are also calculated. Indoor radon concentration varies from 93.1 Bqm−3 to 127.0 Bqm−3 with an average of 95.4 Bqm−3. The value of thoron concentration varies from 5.4 Bqm−3 to 47.2 Bqm−3 with an average of 24.0 Bqm−3. The observed annual effective dose varies from 2.3 mSv to 3.7 mSv which lies within safe limits recommended by ICRP (International Commission on Radiological Protection). Radon gas concentration in soil samples vary from 8.4 to 64.1 Bqm−3 with an average of 31.4 Bqm−3. The mass exhalation rate in samples vary from 0.2 to 2.7 mBq kg−1 h−1 with an average of 1.1 mBq kg−1 h−1, whereas, surface exhalation rate vary from 6.9 to 52.5 mBq m−2 h−1 with an average of 23.6 mBq m−2 h−1. The radium concentration ranges from 0.5 to 3.5 Bq kg−1 with an average of 1.8 Bq kg−1. The observed values of radium concentration in all soil samples are less than the recommended value 370 Bq kg−1 by OECD (Organization for Economic Corporation and Development).

The interplay between Hepatitis C virus (HCV) and immune system, especially T lymphocytes play a major role in the clearance of virus and in development of liver cell injury resulting in replacement of healthy tissue with fibrous scar tissue.To evaluate the association of CD4/CD8 ratio with viral load and genotype of HCV and to evaluate the correlation of CD4/CD8 ratio and CD4 and CD8 cell counts with liver function tests in HCV infected patients.Forty patients of Chronic Hepatitis C infection were enrolled for study. Immunophenotyping by flowcytometry for measurement of CD4 and CD8 T cell counts was used and the percentages of cells expressing CD4 and CD8 were estimated per lymphocyte population. HCV viral load quantitative was done by Roche Taqman Method.The CD4/CD8 ratio was not found to have any significant correlation with HCV viral load. However, it showed a significant difference in the two HCV genotypes, the ratio being higher in genotype 3 than in genotype 1. It showed no significant correlation with liver function tests except serum albumin which had significant positive correlation with CD4/CD8 ratio. The ratio was also found to be significantly decreased in patients with cirrhosis of liver.Hepatitis C virus genotype but not viral load influences the immune response to HCV infection. The CD4/CD8 ratio significantly decreases in patients with liver cirrhosis than in normal and fatty liver.

The present study explains the effect of concomitant administration of synbiotics with the polysaccharide based colon targeted delivery system. As the gut microflora get deranged on administration of mesalamine, drug release from such delivery systems is expected to be jeopardised because the release trigger is dependent solely on the colonic microbiota. To overcome this limitation, mesalamine was formulated as microspheres with guar gum and xanthan gum (prebiotics). These were combined with probiotics containing Lactobacillus acidophilus, L. rhamnosus, Bifidobacterium longumand Saccharomyces boulardi. Dissolution studies of the prepared formulation conducted in simulated colonic fluid clearly demonstrated its superiority over the marketed, delayed release dosage forms of mesalamine. The therapeutic benefit of the concomitant administration of synbiotic with mesalamine was evidenced by the comparative evaluation of faecal contents, weight gain trend and histopathological studies conducted in rats. The results suggest that co-administration of synbiotics with mesalamine can be used as a convenient methodology to achieve efficient and cost-effective targeting of the drug to colon.

Introduction: Hypertension and atherosclerosis though separate entities, are interrelated as hypertension plays an important role in the pathogenesis of atherosclerosis. This study was undertaken to study the association of carotid intimal medial thickness with left ventricular hypertrophy (LVH) in hypertensive patients. Materials and Methods: Hundred hypertensives (JNC-7, Stage 1 and 2) between 30 and 55 years were enrolled in this prospective observational study conducted at a tertiary care teaching institute of Punjab, India. Electrocardiogram, Carotid Doppler, and Echocardiography were carried out in addition to routine biochemical investigations. Results: Increased carotid intimal medial thickness (CIMT) had statistically significant association with age, duration of hypertension, high systolic and diastolic blood pressure (BP), left ventricular hypertrophy and left ventricular mass index but was not associated with body mass index, low-density lipoproteins, and total cholesterol. Conclusions: LVH and arterial wall changes occur concurrently, and therefore, management of hypertension should not be limited just to control of BP but should also include therapy for carotid plaques and increased CIMT.

Uranium and radium are the naturally occurring radioactive elements present in earth’s crust which on decay leads to radon and thoron gases in indoor and outdoor environment, soil and water. These gases further decay and decay products are harmful as well. Radon, being a naturally occurring radioactive gas can cause many health related malignancies to humans who have continuously exposed to its radiations. Radon is considered a significant contaminant that is second most frequent cause of lung cancer after cigarette smoking. Due to these health-related issues a lot of work has been done to find out its levels at various places in the world by different research groups. The present work deals with assessment of annual effective dose rates due to indoor radon and thoron in some of the dwellings of Punjab. It has been shown that the higher radon concentration is 303.37 Bq.m−3 and lowest is 53.72 Bq.m−3 with the average value of 155.47±65.38 Bq.m−3. Surface exhalation rate in soil samples varies from 5.16 mBq.m−2.h−1 to 29.14 mBq.m−2.h−1 with the average value of 14.93±6.28 mBq.m−2.h−1. Mass exhalation rate in samples varies from 1.25 mBq.kg−1.h−1 to 7.04 mBq.kg−1.h−1 with average value of 3.61±1.52 mBq.kg-1.h−1. The mean values of radon concentration and exhalation rates are nearly the same and less than the world wide average. Therefore, the health hazards related to radiation are expected to be negligible in the studied area.

In order to study the health risk factors caused by indoor radon and thoron gases, environmental testing of these gasses has been carried out in various dwellings in the Fatehgarh district of Punjab. The average concentration of indoor 222Rn (CR) and indoor 220Rn (CT) is 59.8±15.9 Bq/m3 and 70.6±22.4 Bq/m3. The equivalent dose rate for lung (H) ranges from 33.54 to 82.60 nSv with mean dose of 47.85±12.73 nSv. The Effective dose rate to lungs (DLung) due to radon emitted alpha particles and progenies ranges from 1.68 to 4.13 nGy h-1 with mean of 2.39±0.63 nGy h-1. The effective dose rates trachea-bronchial (DT-B) and pulmonary + pulmonary lymph (DP+PI) ranges from 2.01 to 4.96 nSv with average value of 2.86±0.63 nSv. The rate of lung dose DRL owing to radon varies from 4.03 to 9.91 nSv with average value of 5.74±1.52 nSv. The average of the 222Rn and 220Rn inhalation dose in the study region is not as much of the 222Rn and 220Rn overall average inhalation dose worldwide.

Summary Background It has been suggested that the pathophysiology of temporal lobe epilepsy may relate to abnormalities in various brain structures, including the amygdala. Patients with mesial temporal lobe epilepsy (MTLE) without MRI abnormalities (MTLE-NMRI) represent a challenge for diagnosis of the underlying abnormality and for presurgical evaluation. To date, however, only few studies have used quantitative structural Magnetic Resonance Imaging-based techniques to examine amygdalar pathology in these patients. Material/Methods Based on clinical examination, 24-hour video EEG recordings and MRI findings, 50 patients with EEG lateralized TLE and normal structural Magnetic Resonance Imaging results were included in this study. Volumetric magnetic resonance imaging (MRI) studies of the amygdalas and hippocampi were conducted in 50 non-epileptic controls (age 7–79 years) and 50 patients with MTLE with normal MRI on a 1.5-Tesla scanner. Visual assessment and amygdalar volumetry were performed on oblique coronal T2W and T1W MP-RAGE images respectively. The T2 relaxation times were measured using the 16-echo Carr-Purcell-Meiboom-Gill sequence (TE, 22–352). Volumetric data were normalized for variation in head size between individuals. Results were assessed by SSPS statistic program. Results Individual manual volumetric analysis confirmed statistically significant amygdala enlargement (AE) in eight (16%) patients. Overall, among all patients with AE and a defined epileptic focus, 7 had predominant increased volume ipsilateral to the epileptic focus. The T2 relaxometry demonstrated no hyperintense signal of the amygdala in any patient with significant AE. Conclusions This paper presented AE in a few patients with TLE and normal MRI. These findings support the hypothesis that there might be a subgroup of patients with MTLE-NMRI in which the enlarged amygdala could be related to the epileptogenic process.

BACKGROUND- Eosinophilia is abnormally high number of eosinophils in the blood. Normally, eosinophils constitute 1 to 6% of the peripheral blood leukocytes, at a count of 350 to 650 per cubic millimeter. Eosinophilia can be categorized as mild (less than 1500 eosinophils per cubic millimeter), moderate (1500 to 5000 per cubic millimeter), or severe (more than 5000 per cubic millimeter). Eosinophilia may be primary or secondary. The aim of the study was to determine the incidence of eosinophilia and evaluate the patients thoroughly for the cause of eosinophilia. METHOD- The study was conducted in the Pathology department in the medical college and hospital in rural are of Punjab. Complete blood count and peripheral blood film study was done in almost all the patients visiting the hospital. The patients with eosinophilia were segregated and were made to fill the detailed proforma. The information included family history, chief complaints, food habits, disease history and drug history. A thorough general examination and diagnostic work up followed. RESULT- In all 3442 (10.7%) patients visiting the hospital had eosinophilia; out of this 2136 (62%) patients had mild eosinophilia, 1297 (37.7%) had moderate and 9 (0.3%) had severe eosinophilia. 2451(71.2%) patients were males and 991 (28.8%) were females. Age group of patients varied from 3 yrs to 74 yrs. The chief complaints of our patients were related to fever, cough, rashes, breathlessness, wheezing etc. other major group of patients had symptoms of abdominal pain, diarrhea, pallor, pica and loss of appetite. CONCLUSION- Eosinophilia appears to be a common occurrence in the in the rural population around our hospital. The most common etiologies were due to parasitic, protozoal or fungal infestations and infections. Allergy related problem also constituted a significant health problem in the local population. DOI: 10.21276/apalm.2017.1044

Bronchial artery embolization (BAE) is an established minimally invasive approach for the treatment of massive or recurrent hemoptysis. There are several minor complications associated with the procedure. A rare complication of the procedure is spinal cord infarction due to embolization of anterior spinal artery. A 48-year-old male patient of old pulmonary tuberculosis presented with fibrocalcified lesions in the right upper lobe on chest X-ray and recurrent hemoptysis. Angiography revealed bleeding from a branch of single right intercostobranchial trunk. The day following the procedure, the patient complained of weakness and pain in lower limbs. Magnetic resonance imaging dorsolumbar spine revealed acute spinal cord infarct from D2 to D5 vertebral levels. This case demonstrates that spinal cord ischemia may occur during BAE, despite all the precautionary measures.

Background and Aims: Modern treatment of liver abscesses comprises combination of antibiotics and image-guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD). However, there is debate regarding the choice of these interventions as the first line of management. Our aim was to compare the results of ultrasound-guided PCD with PNA in the management of liver abscesses. Materials and Methods: A total of 66 patients (55 males; 11 females, 18–65 years) who were diagnosed with liver abscesses were randomly divided into two groups of 33 patients each, namely ultrasound-guided PNA group (with a maximum of three attempts) and the PCD group. The outcomes of the treatment of the patients of these groups were documented and analyzed. Results: PNA was effective in 20 (61%) of the 33 patients after one (n = 14), two (n = 4), or three (n = 2) aspirations while PCD was therapeutic in all 33 patients after one (n = 29) or two (n = 4) procedures and without any major complications in both groups. All abscesses 45 mm or less in longest dimension were efficaciously managed, by both PCD as well as PNA while the later failed in case of multiloculated abscesses. The mean duration of intravenous antibiotics and time to clinical relief were significantly lesser in the PCD group. However, a period of hospital stay and time to complete resolution of abscess cavities did not differ significantly between the groups. Conclusions: Overall, PCD is more effective than PNA in the management of liver abscesses; the later, however, can be employed for smaller and simple abscesses.

Early recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS) through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.

Aims. To acquire normative data of hippocampal volumes and T2 relaxation times, to evaluate and compare qualitative and quantitative assessments in evaluating hippocampi in patients with different durations of intractable epilepsy, and to propose an imaging protocol based on performance of these techniques. Methods. MRI analysis was done in 50 nonepileptic controls and 30 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and T1W MP-RAGE images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. Volumetric data was normalized for variation in head size between individuals. Patients were divided into temporal (n = 20) and extratemporal (n = 10) groups based on clinical and EEG localization. Results. In controls, right hippocampal volume was slightly more than the left with no effect of age or gender. In TLE patients, hippocampal volumetry provided maximum concordance with EEG. Visual assessment of unilateral pathology concurred well with measured quantitative values but poorly in cases with bilateral pathologies. There were no significant differences of mean values between extratemporal group and controls group. Quantitative techniques detected mild abnormalities, undetected on visual assessment. Conclusions. Quantitative techniques are more sensitive to diagnose bilateral and mild unilateral hippocampal abnormalities.

Background. Mother’s milk is the best for the babies. Protective and preventive role of breast milk was evaluated in this study by assessing the relation of type of feeding and duration of hospital stay or morbidity.Methods. This prospective study was conducted in a tertiary care hospital and 232 infants in the age group of 14 weeks to 6 months formed the sample. There are two groups of infants, that is, one for breastfed and one for top fed infants. Statistical analysis was done and results were calculated up to 95% to 99% level of significance to find effect of feeding pattern on hospital stay due to various diseases and morbidity.Results. Prolonged hospital stay, that is, >7 days, was lesser in breastfed infants and results were statistically significant in case of gastroenteritis (pvalue < 0.001), bronchopneumonia (pvalue = 0.0012), bronchiolitis (pvalue = 0.005), otitis media (pvalue = 0.003), and skin diseases (pvalue = 0.047). Lesser morbidity was seen in breastfed infants with gastroenteritis (pvalue 0.0414), bronchopneumonia (pvalue 0.03705), bronchiolitis (pvalue 0.036706), meningitis (pvalue 0.043), and septicemia (pvalue 0.04).Conclusions. Breastfed infants have shorter hospital stay and lesser morbidity in regard to various diseases as compared to top fed infants.

Background: The health of Infants to a great extent depends upon the feeding practices and its awareness among the mothers. This study was conducted in Tertiary care hospital to find the correlation between feeding pattern with nutritional status.Methods: Infants in the age group of 14 weeks to 1 year formed the sample of the study. The nutritional status was assessed in relation to breast feeding practice among infants ≤6 months. Among infants >6 months of age, the nutritional status was assessed in relation to adequacy and timely start of weaning. Correlation was observed, and test of significance was applied through chi square test.Results: Total 591 infants were included in the study out of which 232 infants were ≤6 months of age [120 (51.72%) were exclusively breastfed and 112 (48.28%) were top fed]. Out of these breast feed infants, 86/120 (71.67%) had normal nutrition compared to 54/112 (48.21%) of top-fed babies. Infants >6 months of age were 359 in number [116 (32.31%) were having adequate complementary feed, 111 (30.92%) were having inadequate complementary feed and 132 (36.77%) did not receive any complementary feed]. Out of these infants in the age group of >6 months, 56.90% of adequate complementary feed group, 27.03% of receiving inadequate complementary feed and 27.27% of not received complementary feed were having normal nutritional status. The association between nutritional status and breast feeding in ≤6 months and complementary feed in >6 months has been found to be statistically significant (p value < 0.05, d.f =1).Conclusions: Breastfeeding as well as adequate complementary feed has positive correlation to nutritional status in infants even when compared with the malnourished infants of grade I, II, III and IV.

Purulent pericarditis resulting from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is rare in immunocompetent adults. Here, we present the case of disseminated MRSA infection with origin in tibial osteomyelitis, resulting in bacteremia, purulent pericarditis with tamponade, and panophthalmitis in a previously healthy individual.

Mycophenolate mofetil (MMF), the bioavailable form of mycophenolic acid (MPA), has been proposed as adjuvant therapy for human immunodeficiency virus type 1 (HIV-1) infection. MPA can inhibit viral replication and might blunt virus-induced immunopathology. However, other effects of this inhibitor might be detrimental in an HIV-infected patient. We therefore studied the effect of MPA on selected cellular processes of relevance to HIV infection. We found that MPA did not alter the expression of the primary HIV coreceptor CCR5 on primary resting lymphocytes, but modestly increased CCR5 expression after activation. Conversely, MPA modestly decreased the secretion of the CCR5 ligand RANTES in resting lymphocytes, but had no effect after activation. It has been suggested that the use of inhibitors of host nucleoside metabolism may enhance clinical toxicities induced by HIV-1 nucleoside reverse transcriptase inhibitors (NRTIs). We found no evidence that MPA induced mitochondrial dysfunction or enhanced dysfunction induced by NRTIs in an HepG2 cell line model of mitochondrial toxicity. Further, MPA did not selectively enhance apoptosis in HIV-1-infected lymphocytes. Our findings support the testing of MMF to augment suppression of viral replication. However, careful study will be required to demonstrate that MMF is beneficial when used without antiretroviral therapy, to inhibit residual replication, or to deplete the pool of latently infected nonactivated cells.

Previously, we described a plasmid pMEa, synthesizing the anchored form of Japanese encephalitis virus (JEV) envelope protein that generated virus-neutralizing antibodies in mice upon intra-muscular injection. The immunized mice showed significant protection against lethal JEV challenge. In order to improve the efficacy of plasmid DNA immunization against JEV, methods need to be employed that would enhance neutralizing antibody titers. Plasmid DNA adsorbed to cationic microparticles has recently been shown to significantly improve its immunogenicity. In the present study, we have adsorbed the plasmid pMEa on cationic microparticles and have compared its immunogenicity with the naked plasmid DNA. As seen in ELISA, the microparticle-adsorbed DNA induced higher titers of anti-JEV antibodies when compared to those induced by the naked DNA. No difference, however, was seen in JEV neutralization titers. The microparticle-adsorbed DNA induced a mixed Th1-Th2 kind of immune responses as opposed to Th1 type of immune responses elicited by the naked DNA.

Sir, A 60-year-old female presented with acute onset altered sensorium, vertical gaze ophthalmoparesis, side-to-side, and up-and-down 2-4 Hz head tremors that were aggravated on sitting or standing and disappeared on sleeping along with mild memory disturbances. An urgent magnetic resonance imaging (MRI) of the brain demonstrated symmetric bilateral restricted diffusion in paramedian thalami and rostral midbrain on diffusion-weighted MRI [Figures ​[Figures11 and ​and2]2] showing the “V” sign which was consistent with acute infarcts and compatible with occlusion of the artery of Percheron. Magnetic resonance angiography (MRA) showed patent posterior circulation including the tip of the basilar artery and both posterior cerebral arteries. Figure 1 Diffusion-weighted image (a) and corresponding apparent diffusion coefficient map (b) showing V-shaped area of diffusion restriction in midbrain consistent with acute infarcts Figure 2 Fluid-attenuated inversion recovery-weighted image showing symmetrical hyperintense signal in bilateral paramedian thalami which were also showing diffusion restriction and hence consistent with acute infarction The thalami and midbrain have a complex blood supply with multiple feeding arteries. The medial parts of the thalami are supplied by the perforating thalamic arteries (also named as paramedian arteries), which arise from the posterior circulation.[1,2] Percheron delineated four normal variations of the neurovascular anatomy of the thalami and midbrain. In variation II-b, the bilateral perforating thalamic arteries originate from one central artery known as the artery of Percheron, which arises from the P1 segment of one posterior cerebral artery.[3] This artery is a single trunk that provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery leads to bilateral thalamic and mesencephalic infarctions. These infarcts are typically defined by a triad of altered mental status, vertical gaze palsy, and memory deterioration. However, the clinical diagnosis is difficult in majority of the cases because the complex arterial anatomy causes large clinical variability.[4,5] Our patient presented with all the three typical features of this stroke syndrome along with head tremors. The “V” sign on MRI appears as a well-defined pattern of V-shaped hyperintensity on axial fluid-attenuated inversion recovery and/or diffusion-weighted images along the pial surface of the midbrain adjoining the interpeduncular fossa.[4] Since artery of Percheron is too small to be visualized by computed tomography angiography or MRA, the angiographic studies are frequently normal in these cases.[4] To conclude, the artery of Percheron is an uncommon entity which originates from the first segment of the posterior cerebral artery and gives rise to bilateral medial thalamic and midbrain perforators. Our patient had artery of Percheron infarct along head tremors which has not been reported before. The etiology of head tremors might be due to red nucleus involvement. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest

Schwannomas (neurilemmomas) are benign encapsulated, slow growing peripheral nerve sheath tumors. Primary orbital schwannomas are uncommon, accounting for about 1–4% of orbital tumors. Characteristically, they arise from the first division of the trigeminal nerve. Oculomotor schwannomas are rare tumors with only one case reported till date. Here, we report a 28-year-old male presenting with an axial proptosis of left eyeball with progressive loss of vision. Magnetic resonance imaging of orbit revealed a large left-sided orbital mass extending into cavernous sinus. Surgical excision of the mass was done, and based on clinical, histological, and immunohistochemical analysis, a final diagnosis of oculomotor nerve schwannoma with left orbital extension was made.