Showing papers in "Journal of Neurosciences in Rural Practice in 2015"

Psychiatric aspects of Parkinson's disease

Abstract: Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.

Attitudes toward people with mental illness among medical students

Abstract: Background: Globally, people with mental illness frequently encounter stigma, prejudice, and discrimination by public and health care professionals. Research related to medical students′ attitudes toward people with mental illness is limited from India. Aim: The aim was to assess and compare the attitudes toward people with mental illness among medical students′. Materials and Methods: A cross-sectional descriptive study design was carried out among medical students, who were exposed (n = 115) and not exposed (n = 61) to psychiatry training using self-reporting questionnaire. Results: Our findings showed improvement in students′ attitudes after exposure to psychiatry in benevolent (t = 2.510, P

Disorders of the lower cranial nerves

Abstract: Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.

Antenatal and postnatal depression: A public health perspective.

Abstract: Depression is widely prevalent among women in the child-bearing age, especially during the antenatal and postnatal period. Globally, post-partum depression has been reported in almost 10% to 20% of mothers, and it can start from the moment of birth, or may result from depression evolving continuously since pregnancy. The presence of depression among women has gained a lot of attention not only because of the rising incidence or worldwide distribution, but also because of the serious negative impact on personal, family and child developmental outcomes. Realizing the importance of maternal depression on different aspects-personal, child, and familial life, there is a crucial need to design a comprehensive public health policy (including a mental health strategy), to ensure that universal psychosocial assessment in perinatal women is undertaken within the primary health care system. To conclude, depression during pregnancy and in the postnatal period is a serious public health issue, which essentially requires continuous health sector support to eventually benefit not only the woman, but also the family, the community, and health care professionals.

Clinical spectrum and radiographic features of the syndrome of the trephined.

Abstract: Object: Craniectomy is a common neurosurgical procedure. Syndrome of the trephined (ST) occurring after craniectomy results in neurologic symptoms that are reversible with cranioplasty. While well-documented, previous literature consisted of case reports, symptom spectrum and risk factors have not been well characterized. Materials and Methods: A retrospective review of 29 consecutive cases who underwent decompressive craniectomy within a 30-month period was performed. Patients were considered affected by ST if a previously stable neurological deficit improved within 3 weeks after cranioplasty. Prevalence of ST was measured and association with demographic information, clinical symptoms patterns, indication for and size of craniectomy, as well as radiological signs were tested. Results: Seven patients (24%) developed ST. Chronic rehabilitation arrest was more common than acute neurologic decline. Factors such as craniectomy size and patient age did not reach statistical significance in development of ST. Radiographic factors were predictive, with a sunken skin flap contour being most sensitive, while ventricular effacement was most specific. Conclusion: ST may have a higher incidence than previously thought, with a chronic rehabilitation arrest being a more common presentation than an acute decline. Medical providers involved in the post surgical care and rehabilitation of these patients should maintain a high index of suspicion for ST.

Validation of the Tamil version of short form Geriatric Depression Scale-15

Abstract: Background: Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population. Materials and Methods: A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist. Results: A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively. Conclusion: The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population.

Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia, before and after antipsychotic treatment.

Abstract: Background: Treatment with antipsychotics increases the risk of developing diabetes in patients of schizophrenia but this diabetogenic potential of different antipsychotics seems to be different. Moreover, there may be an independent link between schizophrenia and diabetes. So we plan to study the prevalence of glucose dysregulation in patients of schizophrenia before and after treatment with various antipsychotics. Materials and Methods: Fifty patients (32 males and 18 females) diagnosed with schizophrenia were evaluated for glucose dysregulation using oral glucose tolerance test, initially (drug naive) and after antipsychotic treatment. Age- and sex-matched healthy volunteer group of 50 subjects (35 males and 15 females) was taken for comparison. Results were interpreted using American Diabetic Association criteria. Results: Though the glycemic status of the patient group was comparable with healthy controls initially but antipsychotic treatment was associated with glucose dysregulation. For first 6 weeks the antipsychotic (olanzapine, risperidone, haloperidol and aripiprazole)-induced glucose dysregulation was comparable, which was seen to be maximum with the olanzapine-treated group at the end of this study, 14 weeks. Conclusion: We conclude that antipsychotic treatment of nondiabetic drug naive schizophrenia patients was associated with adverse effects on glucose regulation. For initial 6 weeks the antipsychotic-induced glucose dysregulation was comparable, which was seen to be maximum with olanzapine at the end of study, i.e. 14 weeks. Keeping this at the back of mind we can stabilize a patient initially with a more effective drug, olanzapine, and later on shift to one with less metabolic side effects.

Irritable bowel syndrome: Is it "irritable brain" or "irritable bowel"?

Abstract: Irritable bowel syndrome (IBS) has been recognized as one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. In the Western world, IBS appears to affect up to 20% of the population at any given time but in Asian countries, the median value of IBS prevalence defined by various criteria ranges between 6.5% and 10.1%, and community prevalence of 4% is found in North India. Those attending gastroenterology clinics represent only the tip of the iceberg. The disorder substantially impairs the quality of life, and the overall health-care costs are high. IBS has therefore gained increased attention from clinicians, researchers, and pharmaceutical industries. It is often frustrating to both patients and physicians as the disease is usually chronic in nature and difficult to treat. However, the understanding of IBS has been changing from time to time and still most of its concepts are unknown. In this review we have discussed, debated, and synthesized the evidence base, focusing on underlying mechanisms in the brain and bowel. We conclude that it is both brain and bowel mechanisms that are responsible. The clinical implication of such mechanisms is discussed.

Optic nerve sonography: A noninvasive means of detecting raised intracranial pressure in a resource-limited setting.

Abstract: Objective: The aim was to assess the use of optic nerve sonography (ONS) as a quick, noninvasive diagnostic test tool for detecting raised the intracranial pressure (ICP). Materials and Methods: A prospective blinded observational study was conducted at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. The study population consisted of 160 adult patients referred to the radiology department for cranial computed tomography (CT) scan. There were 80 subjects and 80 controls. Optic nerve sheath diameter (ONSD) was measured by a radiologist using a 7.5 Megahertz ultrasound probe while cranial CT was reviewed by other radiologists blinded to the ONSD. Results: Sixty-nine subjects (86.3%) had intracranial space occupying lesions (SOL) with cranial CT confirmed features of increased ICP, mean binocular ONSD of 5.7 ± 0.59 mm while 11 (13.7%) had intracranial SOL without any cranial CT evidence of increased ICP, mean binocular ONSD of 4.8 ± 0.39 mm. The difference of mean ONSD of the two groups was statistically significant ( P = 0.0001). The controls had a mean binocular ONSD of 4.5 ± 0.22 mm and the difference in mean binocular ONSD for subjects with raised ICP and the controls were also statistically significant ( P = 0.0001). A cut-off value of 5.2 mm (sensitivity 81.2% [95% confidence interval (CI): 69.9–89.6], specificity 100% [95% CI: 71.5–100]) was obtained from the receiver operator characteristics curve as the mean binocular ONSD that best predicts raised ICP confirmed by at least a sign on cranial CT. Conclusions: Optic nerve sonography can differentiate between normal and elevated ICP and may serve as a useful screening tool in resource-limited practice.

Stressful life events, hopelessness, and coping strategies among impulsive suicide attempters.

Abstract: Background: Suicides are among the most important causes of death in the economically productive population. Characteristics of impulsive and nonimpulsive suicide attempters may differ which would have a bearing on planning preventive measures. Aims: This study aimed to characterize the clinical and psychological profile of impulsive and nonimpulsive suicide attempters. Settings and Design: This retrospective comprehensive chart-based study was conducted at a tertiary care hospital in South India. Methods: The study utilized records of patients over a period of 3 years. An attempt was considered impulsive if the time between suicidal idea and the attempt was Statistical Analysis Used: Impulsive and nonimpulsive suicide attempters were compared using appropriate inferential statistical tests. Results: Of 316 patients, 151 were classified as having an impulsive suicidal attempt (47.8% of the sample). The impulsive and nonimpulsive suicide attempters did not differ on demographic characteristics. Use of natural plant products was more common in impulsive attempters (27.2% vs. 12.7%), while physical methods like hanging was less common (0.7% vs. 7.3%). Those with an impulsive attempt were more likely to have a recent contact with a health professional (24.5% vs. 4.5%). Impulsive suicide attempters had higher scores on BHS (Mann-Whitney U = 7680.5, P Conclusion: Impulsive suicide attempters differ from nonimpulsive suicide attempters in clinical features like methods of attempt, presence of hopelessness, and stressors.

Impact of psychoeducation intervention module on parents of children with autism spectrum disorders: A preliminary study.

Abstract: Context: Parents of children with autism spectrum disorders (ASD) in India face a host of challenges, while seeking care which ranges from unavailability of information to difficulty in availing services. Aims: To develop a psycho-education intervention module for parents of children with ASD and to study its impact on parent stress and knowledge. Settings and Design: Child Guidance Clinic Department of Psychiatry, Government Medical College and Hospital, Chandigarh. Interventional study. Methodology: Parents of children diagnosed with ASD as per Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria, recruited through consecutive sampling. Total number of 18 participants participated in the two phase study. Phase I included preparation of a parent training module through a four stage process and Phase II was evaluation of impact of the final version of the module on parental stress and knowledge. Statistical Analysis: Wilcoxon Signed-Rank test using SPSS version 17.0. Results: There was an improvement in all the domains of parenting stress and knowledge. Social stress score and total stress score showed significant improvement. Conclusions: Parent psycho-education intervention module on ASD decreases parenting stress, and improves knowledge about ASD. Psycho-education intervention module is a feasible and acceptable way of parent empowerment.

Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India.

Abstract: Central nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis. Aims and objectives: To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis. Methods and Materials: This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test). Results: 13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively. Mean total count of CSF leukocyte and lymphocyte percentage was 46.07±131 cell/cumm and 98.66±3.09% respectively. Tablet doxycycline with or without injection azithromycin was used and that shows good response 15.38% of patients died and all of them had multi organ dysfunction. Conclusion: Meningoencephalitis is a common manifestation of scrub typhus and diagnosis requires high degree of clinical suspicion which if diagnosed early and specific treatment started, patients usually recover completely with few complications.

An estimation of the prevalence of intellectual disabilities and its association with age in rural and urban populations in India

Abstract: Background: Intellectual disability (ID) is a global public health concern. Prevalence of ID and its association with age and other demographic factors is required for planning purposes in India. Objective: This study analyzed the age-adjusted prevalence of ID in rural and urban populations and its correlation with age in children and adults. Materials and Methods: Disability data published in the report (2002) of National Sample Survey Organization were analyzed, using Z -test to measure differences in age-adjusted prevalence. Spearman rho was calculated to determine strength and direction of the association, and regression analysis was used to predict prevalence rate, based on age in rural and urban population settings. Results: Overall, India has a prevalence of 10.5/1000 in ID. Urban population has slightly higher rate (11/1000) than rural (10.08/1000; P = 0.044). Age was found to be highly correlated with prevalence of ID in rural children (ϱ =0.981, P = 0.019) as well as in children (ϱ = −0.954, P = 0.000) and adults (ϱ = −0.957, P = 0.000) in urban population. The possibility of confounding or the existence of covariates for children in urban settings was noted. Conclusion: Results of this study match findings in other epidemiological studies. However, multistage, large-scale studies are recommended for investigating prevalence rates with different severity levels of ID.

Identifying autonomic nervous system dysfunction in acute cerebrovascular attack by assessments of heart rate variability and catecholamine levels.

Abstract: Objective: This study aimed to evaluate changes in the autonomic nervous system caused by cerebral lesions due to acute stroke. We assessed heart rate variability and catecholamine levels in lieu of stroke lesion localization. Materials and Methods: A total of 60 stroke patients and 31 healthy controls were enrolled in the study. Plasma epinephrine and norepinephrine levels were measured on the first, third, and seventh days following the stroke event. Heart rate variability was evaluated with time-domain and frequency-domain analyses via 24-hour Holter monitor recordings. Results: On the first and third day following the stroke, norepinephrine levels were significantly higher in all patient groups as compared to controls. Epinephrine levels on the first, third and seventh days after the stroke were significantly higher in patients with lesions in the right middle cerebral artery territory than controls. In frequency-domain analysis, patients with right middle cerebral artery territory lesions had greater low frequency and low frequency to high frequency ratio values than controls. Time-domain analysis revealed significant decreases in the standard deviation from the mean for 5-minute 288 R-R intervals in patients with lesions in the right middle cerebral artery and posterior cerebral artery territory when contrasted with controls. Patients with lesions in the right middle cerebral artery territory demonstrated the highest increase in the percentage of consecutive R-R intervals differing by more than 50 ms (pNN50) as compared to the control group. Conclusion: These findings indicate that autonomic dysfunction favoring an increase in sympathetic activity occurs in acute stroke patients.

Computerized tomographic study of normal Evans index in adult Nigerians.

Abstract: Background: The evaluation of degree of ventricular enlargement should be based on established indices rather than on personal experience as this is highly subjective. Our aim was to establish normal values for Evans index in a Nigerian adult population as none has been found in the Nigerian medical literature. Materials and Methods: Axial computerized tomographic brain scans of 488 normal subjects were reviewed retrospectively. Of them, 319 (65.36%) of the patients were males and 169 (34.63%) were females; their ages ranged from 18 to 84 years with a mean age of 37.26 years. The images were acquired using a multi-slice GE Sigma excite scanner. Evans index was measured as the linear ratio of the total width of the frontal horns of the cerebral lateral ventricles to the maximum intracranial diameter. Results: The mean value for Evans index for the studied population was 0.252 ± 0.04. The EI increased with age and it was slightly higher among males. The difference in Evans value in males and females was not statistically significant. Individuals above 60 years old had the highest Evans values in both sexes. Conclusion: This study has established ranges of normal value for Evans index in a Nigerian population. It agrees with the diagnostic cut-off value of > 0.3 for hydrocephalus and it compares well with that of the Caucasians.

Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients.

Abstract: Background: Deep venous thrombosis (DVT) contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported. Materials and Methods: From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3 rd , 7 th , and 14 th days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients. Results: Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups ( P Conclusions: Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical patients. Multiple factors were identified as predictive of DVT in neurosurgical patients, including the presence of a tumor, an age greater than 50 years, hypertension, and immobility.

Methylphenidate use among medical students at Ben-Gurion University of the Negev.

Abstract: Introduction: Methylphenidate is a psychotropic agent commonly used for the treatment of attention deficit disorder with or without hyperactivity and narcolepsy in children and adults. The awareness to attention deficit disorder as well as the non-medical use of methylphenidate for cognitive enhancement has increased during the past years. Objectives: To evaluate the medical and non-medical use of methylphenidate among medical students in the Ben-Gurion University of the Negev. Materials and Methods: Medical students were asked to report methylphenidate use, symptoms and diagnosis of attention deficit disorder using a structured questionnaire. Results: A total of 229 students participated in the study, out of which 105 (45.9%) were in the pre-clinical years of medical school. Twenty-two students (9.6%) were previously diagnosed with attention deficit disorder. Lifelong use of methylphenidate was reported by 39 (17%) students, while 31 students (13.5%) reported using methylphenidate during the preceding 12 month. In the beginning of medical school, only 7% of the students used methylphenidate, most of them began using it during pre-clinical academic years. Discussion: High rates of attention deficit disorder compared to the general population were reported by medical students. The rate of methylphenidate use is similar to recent report from a US medical school, and is considerably higher than in college students population. Conclusions: Many medical students are using methylphenidate without a medical indication. Further study is needed to evaluate the effect of methylphenidate on academic performance of healthy adults.

Mental health literacy among caregivers of persons with mental illness: A descriptive survey.

Abstract: Background: Despite of growing evidence of mental disorders in developing countries, research on mental health literacy is limited from India. Aim: To examine mental health literacy among caregivers of persons with mental illness Materials and Methods: A cross-sectional descriptive survey was carried out among 161 randomly selected caregivers of persons with mental illness at outpatient department of a tertiary care centre. Data was collected through face to face interview using a structured questionnaire. Results: Regarding the causes of mental illness, a majority agreed that genetic inheritance (69%), substance abuse (64%) and brain disease (59.6%) are main factors for developing mental illness. Although more than two-thirds agreed that anyone could suffer from mental illness, 61.5% also agreed that people with mental health problems are largely to blame for their condition. The majority of the participants also agreed that mentally ill are not able to maintain friendships (45.9%), are dangerous (54%), and not capable to work (59.1%). Just over half (55.9%) of the participants would not want people to know if they had a mental illness and nearly half of them also expressed that they would feel ashamed if a family member had a mental illness. Conclusion: Based on the findings of the present study researchers suggest that there is an urgent need to educate and change the attitudes of caregivers through mental health literacy programs specifically designed for them.

Immunohistochemical expression of glial fibrillary acidic protein and CAM5.2 in glial tumors and their role in differentiating glial tumors from metastatic tumors of central nervous system.

Abstract: Background and Objectives: Immunohistochemistry (IHC) has become an important tool in the diagnosis of metastatic brain tumors. The judicious use of a panel of selected immunostains is unquestionably helpful in diagnostically challenging cases. In our study, the best combination of immune markers useful in differentiating metastatic carcinoma from high-grade gliomas in central nervous system (CNS) are glial fibrillary acidic protein (GFAP) and cytokeratin (CK) (CAM5.2). Materials and Methods: The study was conducted on 80 cases of glial tumors including metastatic tumors to the CNS. Histopathological diagnosis was established on routine hematoxylin and eosin staining of the sections. Special IHC markers, GFAP, and CAM5.2 were used to differentiate glial from metastatic tumors. Result: Of total 80 cases, 40 cases of astrocytic tumors, 2 cases of ependymoma, 2 cases of mixed glial tumors, and 16 cases of glioblastoma multiforme were positive for GFAP. Twelve cases of oligodendroglioma were negative for GFAP. The sensitivity of GFAP in glial tumors was statistically significant as 81.1% and specificity 100%, whereas sensitivity and specificity of CAM5.2 in metastatic tumors were 100%. Conclusion: IHC plays an important role in diagnosing tumors of CNS and markers such as GFAP and CK (CAM5.2) are quite effective in differentiating glial tumors from metastatic tumors of CNS.

Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data.

Abstract: Introduction: The extent of neuromeningeal cryptococcosis (NMC) has increased since the advent of HIV/AIDS. It has non-specific clinical signs but marked by high mortality. Objective: To analyze the characteristics of the NMC in sub-Saharan Africa. Materials and Methods: We have conducted a literature reviewed on the NMC in sub-Saharan Africa from the publications available on the basis of national and international data with keywords such as Cryptococcus, Epidemiology, Symptoms, Outcomes and Mortality and their equivalent in French in July 2011. All publications from 1990 to 2010 with 202 references were analyzed. The following results are the means of different studied variables. Results: We selected in final 43 publications dealing with the NMC which 24 involved 17 countries in Africa. The average age was 36 years old. The average prevalence was 3.41% and the average incidence was 10.48% (range 6.90% to 12%). The most common signs were fever (75%), headaches (62.50%) and impaired consciousness. Meningeal signs were present in 49% of cases. The mean CD4 count was 44.8cells/mm 3 . The India ink and latex agglutination tests were the most sensitive. The average time before the consultation and the hospital stay was almost identical to 27.71 days. The average death rate was 45.90%. Fluconazole has been the most commonly used molecule. Conclusion: The epidemiological indicators of NMC varied more depending on the region of sub-Saharan Africa. Early and effective taking care of patients to reduce diagnostic delay and heavy mortality remains the challenges.

Carpal tunnel syndrome: Analyzing efficacy and utility of clinical tests and various diagnostic modalities

Abstract: Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but not adequately studied in India. Objectives: To study clinical tests, nerve conduction studies (NCS), ultrasonography (USG), and magnetic resonance imaging (MRI) in diagnosing CTS. Materials and Methods: We diagnosed CTS in 54 patients (93 hands) out of 60 screened patients with symptoms compatible with CTS, including 19 control patients (23 hands). We conducted provocative tests and calculated Boston Carpal tunnel Questionnaire (BCTQ) symptom (S) and function (F) scores. NCS positive patients were classified into mild, mild-to-moderate, moderate, severe, and all-CTS groups. Median nerve anteroposterior, transverse, circumference (CIR), and cross-sectional area (CSA) at inlet (I), middle (M), and outlet (O) each was measured by USG in all patients. MRI was done in 26 patients (39 hands). Results: Phalen, hand elevation and pressure provocation tests had higher sensitivity, Tinel's test had higher specificity and tethered median nerve and tourniquet tests had low sensitivity and moderate specificity. USG had low sensitivity but high specificity, and MRI had moderate sensitivity. USG in patients compared to controls was significantly abnormal in CSA-I, CIR-I, and CSA-O. Significant correlation was found between BCTQ-S and NCS and BCTQ-S and CIR-O. CIR-M, CIR-O, CSA-M, and CSA-I had correlation with NCS. MRI was significant in moderate and in moderate + severe groups combined and associated pathologies were detected in 59% patients. Conclusion: NCS remain gold standard but USG and MRI help increase sensitivity and detect mass lesions amenable to surgery.

A pure non-gestational ovarian choriocarcinoma with delayed solitary brain metastases: Case report and review of the literature.

Abstract: Choriocarcinoma is the most malignant tumour of gestational trophoblastic origin. Most ovarian choriocarcinomas are gestational in origin and usually metastasize to the ovary from uterine or tubal choriocarcinoma. Non gestational choriocarcinoma (NGOC) of the ovary is exceedingly rare and usually seen along with other germ cell tumors. Non gestational choriocarcinoma has been found to be resistant to single-agent chemotherapy and has a worse prognosis than gestational choriocarcinoma. We are reporting long term follow up of published rare case of pure non gestational ovarian choriocarcinoma (NGOC) with concurrent metastases to the spleen and adrenal glands, who developed a delayed solitary brain metastases, two years after completion of primary treatment. Surgery along with triple agent chemotherapy and radiotherapy was found to give good remission in this aggressive disease.

National sample survey organization survey report: An estimation of prevalence of mental illness and its association with age in India.

Abstract: Background: The Indian population suffers with significant burden of mental illness. The prevalence rate and its association with age and other demographic indicators are needed for planning purpose. Objective: This study attempted to calculate age-wise prevalence of mental illness for rural and urban settings, and its association with age. Materials and Methods: Data published in National Sample Survey Organization (2002) report on disability is used for the analysis. Spearman correlation for strength of association, z -test for difference in prevalence, and regression statistics for predicting the prevalence rate of mental illness are used. Result: Overall population have 14.9/1000 prevalence of mental illness. It is higher in rural setting 17.1/1000 than urban 12.7/1000 ( P ϱ = 0.910, P = 0.001) and urban ( ϱ = 0.940, P = 0.001). Conclusion: Results of this study confirm other epidemiological research in India. Large-population epidemiological studies are recommended.

Epidemiological, clinical and prognostic profile of childhood acute bacterial meningitis in a resource poor setting.

Abstract: Background: Childhood bacterial meningitis is a neurologic emergency that continues to kill and maims children particularly in developing countries with poor immunization coverage. Objective: This study set out to assess the hospital incidence, pattern of presentation, etiologic agents, outcome and determinants of mortality among the children admitted with bacterial meningitis at the Wesley Guild Hospital (WGH), Ilesa. Patients and Methods: We carried out a retrospective review of admitted cases of bacterial meningitis in children aged one month to 15 years at the WGH, Ilesa over a three year period by looking at the hospital records. Factors in the history and examinations were compared among survivors and those that died to determine factors significantly associated with mortality in these children. Results: Eighty-one (5.5%) of the 1470 childhood admissions during the study period had bacterial meningitis. Male preponderance was observed and two-thirds of the children were infants. More cases were admitted during the wet rainy season than during the dry harmattan season. Haemophilus influenzae type B and Streptococcus pneumoniae were the leading etiologic agents and ciprofloxacin and ceftriaxone adequately cover for these organisms. Twenty-two (27.2%) of the 81 children died, while 34 (42.0%) survived with neurologic deficits. Children with multiple seizures, coma, neck retraction, hyponatremia, hypoglycorrhachia, turbid CSF as well as Gram positive meningitis at presentation were found to more likely to die ( P Conclusion: Childhood bacterial meningitis often results in death and neurologic deficit among infants and young children admitted at the WGH, Ilesa. Children diagnosed with meningitis who in addition had multiple seizures, neck retraction and coma at presentation are at increased risk of dying.

Hashimoto encephalopathy: A study of the clinical profile, radiological and electrophysiological correlation in a Tertiary Care Center in South India

Abstract: Background: Hashimoto encephalopathy (HE) is a poorly understood and often misdiagnosed entity with variable clinical spectrum. There are many uncertainties that still remain about this condition and the pathological significance of thyroid peroxidase (TPO) antibody. Objective: To characterize the clinical, laboratory and radiologic findings in patients with HE. Design: Retrospective analysis of clinical features and diagnostic test data. Main Outcome Measures: Clinical features, laboratory, radiologic, electroencephalography (EEG) findings associated with HE and therapeutic outcome. Results: Thirteen consecutive patients were identified as having HE. The median age at onset was 48.5 years (range, 19-62 years). There was a female preponderance (76.9%). Clinical manifestations were cognitive impairment and behavioral changes in 10 (76.9%), sleep disturbance in 9 (69.2%), seizures in 6 (46.1%), headache in 4 (30.8%), psychosis or paranoia in 5 (38.5%), transient symptoms in 6 (46.1%), myoclonus in 4 (30.8%), ataxia or gait disorder in 4 (30.8%). The most frequent laboratory abnormalities were increased TPO (n = 13) in all cases, increased thyroid stimulating hormone levels (n = 6), and increased erythrocyte sedimentation rate (n = 5). The cerebrospinal fluid protein level was elevated in 8 of 9 patients (88.8%). Magnetic resonance imaging abnormalities were present in 2 patients (15.4%). EEG changes were seen in 7 patients (53.8%). All but two patients showed significant therapeutic benefit with steroids. Conclusions: HE has a wide range of clinical, laboratory, and radiologic findings. All patients with an unexplained encephalopathy should be screened for this condition as treatment response is excellent. To the best of our knowledge, this is the largest single center clinical series of HE from the Indian subcontinent.

Bilateral optic nerve infarction in rhino-cerebral mucormycosis: A rare magnetic resonance imaging finding.

Abstract: Mucormycosis is an emerging disease in diabetes and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is one of the common forms of the disease. Mucormycosis leading to ischemic optic neuropathy is a rare complication. The role of magnetic resonance imaging (MRI) in the diagnosis of ischemic optic neuropathy is limited and uncommonly reported. We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.

The natural history of Dandy-Walker syndrome in the United States: A population-based analysis.

Abstract: Background: Dandy-Walker syndrome (DWS) is a congenital disorder typically manifesting with hydrocephalus. The classic anatomic hallmarks of DWS are hypoplasia of the cerebellar vermis, anterior-posterior enlargement of the posterior fossa, upward displacement of the torcula and transverse sinuses, and cystic dilatation of the fourth ventricle. Aims: Although optimal treatment of DWS typically requires neurosurgical intervention to prevent intracranial pressure increases incompatible with life, the natural history of this disorder has yet to be evaluated on a nationwide level. Settings and Design/Materials and Methods: The Kids' Inpatient Database covering 1997-2003 was used for analysis. Children younger than age 18 admitted for DWS (ICD-9-CM = 742.3) were analyzed with a matched control group. The primary procedure codes for operative CSF drainage were coded into the analysis. The incidence of DWS was 0.136%; 14,599 DWS patients were included. Statistical Analysis Used: Multiple logistic regression models were used. Odds ratios (OR) were reported with 95% confidence intervals. Results and Conclusions: Mortality (OR = 10.02; P P P P < 0.0001). Although DWS is associated with a 10-fold increase in mortality, operative CSF drainage nearly halves the mortality rate. Based on these findings (Class IIB evidence), it is likely that the increased mortality associated with DWS is directly attributable to the nearly 80% of DWS patients who did not receive operative CSF drainage for hydrocephalus. Consequently, increased access to neurosurgical intervention could reduce the mortality rate of DWS towards that of the general population.

Magnitude and determinants of depression in acute stroke patients admitted in a rural tertiary care hospital.

Abstract: Background: Depression is one of the most frequent neuropsychiatric disturbances after a cerebrovascular stroke. The frequency of depression in stroke patients has varied widely in different populations. Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. Settings and Design: A cross-sectional hospital-based study was performed in acute stroke patients admitted in the department of Medicine of a rural teaching tertiary care hospital in central India. Materials and Methods: In all consecutive acute stroke inpatients, the intensity of depression was assessed by a trained person through a questionnaire, Montgomery-Asberg Depression Rating Scale (MADRS), who is blind of the diagnosis and investigations of the patient. Another study person collected the data including demographics, co-morbid diseases or risk factors. Radiological imaging data was noted from the CT/MRI head reports of stroke patients. Results: Of the total 107 stroke patients, 60 (56%) were males and 47 (44%) were females. Sixty-one (57%) of the 107 stroke patients had depression. Of the 107 stroke patients, 35 (33%) had mild depression, 22 (20%) had moderate depression and 4 (4%) had severe depression. The age, gender, education status and co-morbidities of the stroke patient were not associated with depression. The association of socio-economic status and left-sided lesions with depression was found to be statistically significant ( P Conclusion: Post-stroke depression was present in more than half of the stroke patients and was related to socio-economic status and left-sided hemisphere lesions.

Pupil to limbus ratio: Introducing a simple objective measure using two-box method for measuring early anisocoria and progress of pupillary change in the ICU.

Abstract: Introduction: Measurement of static pupillary size in the ICU is of importance in cases of acutely expanding intracranial mass lesions. The inaccuracies with subjective assessment of pupillary size by medical personnel preclude its use in emergent neurological situations. Objective: To determine if the ratio of pupil to limbus diameter (PLD ratio) measured by a two-box method is a reliable measure of pupil size for detecting early anisocoria and measuring pupillary changes. Materials and Methods: The PLD ratio was defined as the ratio of the pupillary diameter measured at a para-horizontal axial plane with the limbus diameter measured at the same or parallel axial plane. A two-box method was used to estimate the diameters of imaged pupils. Eyes were imaged using an iPhone 4S cellphone camera. Background illumination was measured and kept constant. The pupils of a 78-year-old woman, who presented with a large intra-axial parenchymal hemorrhage, were imaged. The patient had left pupillary miosis in dark but not in bright light. After presenting this case along with the images of the pupillary examination, a group of 21 medical staff were asked several questions on the pupillary examination. Reliability of PLD ratio were assessed via standard error of mean (S.E.M) of PLD ratios for 3 different subjects each imaged under constant illumination and fixation but from different angles to the optical axis. Results: Analysis of questionnaire data together with PLD ratios revealed that ~ 14% and 10% of participants could estimate the pupillary size in darkness and bright light respectively but none were simultaneously accurate indicating that subjective assessment of pupillary size was unreliable. The approach towards a systematic pupillary examination was inconsistent among the participants. The PLD ratio was found to be a reliable measure of pupillary size with standard error of mean below 0.1 mm for the three subjects tested. Conclusion: Static pupillary sizes can be objectively and consistently evaluated using PLD ratios using a two-box method. PLD ratios are resistant, within limits, to changes in imaging angle or choice of para-horizontal axes for measurement.