Journal of Neurosciences in Rural Practice
 
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REVIEW ARTICLE
Cranioplasty: Review of materials and techniques
Seckin Aydin, Baris Kucukyuruk, Bashar Abuzayed, Sabri Aydin, Galip Zihni Sanus
July-December 2011, 2(2):162-167
DOI:10.4103/0976-3147.83584  PMID:21897681
Cranioplasty is the surgical intervention to repair cranial defects. The aim of cranioplasty is not only a cosmetic issue; also, the repair of cranial defects gives relief to psychological drawbacks and increases the social performances. Many different types of materials were used throughout the history of cranioplasty. With the evolving biomedical technology, new materials are available to be used by the surgeons. Although many different materials and techniques had been described, there is still no consensus about the best material, and ongoing researches on both biologic and nonbiologic substitutions continue aiming to develop the ideal reconstruction materials. In this article, the principle materials and techniques of cranioplasty are reviewed.
  45 8,995 497
ORIGINAL ARTICLES
Depression in elderly patients with Alzheimer dementia or vascular dementia and its influence on their quality of life
Yaroslav Winter, Alexei Korchounov, Tatyana V Zhukova, Natalia Epifanova Bertschi
January-June 2011, 2(1):27-32
DOI:10.4103/0976-3147.80087  PMID:21716831
Background: Alzheimer dementia (AD) and vascular dementia (VD) are the most common causes of dementia in the elderly. Depression is an important co-morbid disorder in these diseases, which is often challenging to recognize. We investigated the prevalence of depression in patients with AD and VD and estimated the influence of depression on the health-related quality of life (HrQoL) in these patients. Materials and Methods: We evaluated prevalence of depression in consecutively recruited patients with AD or VD (n= 98). Depression was diagnosed according to criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and scored using the Geriatric Depression Scale. The EuroQol (EQ-5D and visual analogue scale) was applied to evaluate HrQoL. The severity of cognitive impairment was measured by the Mini-Mental State Examination (MMSE). Multiple regression analysis was used to identify factors predicting severity of depression. Results: The prevalence of depression in AD/VD was 87%. In comparison to the general population, HrQoL measured on the visual analogue scale was reduced by 54% in patients with AD/VD. In the dimension "anxiety/depression" of the EQ-5D, 81% of patients with AD/VD had moderate or severe problems. Depression showed significant association with reduced HrQoL (P<0.01). Independent predictors of more severe depression were older age, male gender, better MMSE scores and being not married. Conclusions: Depression is a prevalent psychiatric co-morbidity in patients with AD/VD, which is often under-diagnosed being masked by cognitive impairment. Depression is a predictor of reduced HrQoL in elder people with AD/VD. Therefore, they should be screened for presence of depressive symptoms and receive adequate antidepressant treatment.
  23 3,234 209
REVIEW ARTICLE
Mild traumatic brain injuries in adults
Dhaval Shukla, B Indira Devi
July-December 2010, 1(2):82-88
DOI:10.4103/0976-3147.71723  PMID:21808509
Mild traumatic brain injury (mTBI) is the commonest form of TBI. Though the name implies, it may not be mild in certain cases. There is a lot of heterogeneity in nomenclature, classification, evaluation and outcome of mTBI. We have reviewed the relevant articles on mTBI in adults, particularly its definition, evaluation and outcome, published in the last decade. The aspects of mTBI like pediatric age group, sports concussion, and postconcussion syndrome were not reviewed. There is general agreement that Glasgow coma score (GCS) of 13 should not be considered as mTBI as the risk of intracranial lesion is higher than in patients with GCS 14-15. All patients with GCS of <15 should be evaluated with a computed tomography (CT) scan. Patients with GCS 15 and risk factors or neurological symptoms should also be evaluated with CT scan. The outcome of mTBI depends on the combination of preinjury, injury and postinjury factors. Overall outcome of mTBI is good with mortality around 0.1% and disability around 10%.
  19 4,786 440
ORIGINAL ARTICLES
Objective assessment of utility of intraoperative ultrasound in resection of central nervous system tumors: A cost-effective tool for intraoperative navigation in neurosurgery
Aliasgar Moiyadi, Prakash Shetty
January-June 2011, 2(1):4-11
DOI:10.4103/0976-3147.80077  PMID:21716843
Background: Localization and delineation of extent of lesions is critical for safe maximal resection of brain and spinal cord tumors. Frame-based and frameless stereotaxy and intraoperative MRI are costly and not freely available especially in economically constrained nations. Intraoperative ultrasound has been around for a while but has been relegated to the background. Lack of objective evidence for its usefulness and the perceived "user unfriendliness" of US are probably responsible for this. We recount our experience with this "forgotten" tool and propose an objective assessment score of its utility in an attempt to revive this practice. Materials and Methods: Seventy seven intraoperative ultrasound (IOUS) studies were carried out in patients with brain and spinal cord tumors. Seven parameters were identified to measure the "utility" of the IOUS and a "utility score" was devised (minimum 0 and maximum 7). Individual parameter and overall scores were calculated for each case. Results: IOUS was found to be useful in many ways. The median overall score was 6 (mean score 5.65). There were no scores less than 4 with the majority demonstrating usefulness in 5 or more parameters (91%). The use of the IOUS significantly influenced the performance of the surgery in these cases without significantly prolonging surgery. Conclusions: The IOUS is a very useful tool in intraoperative localization and delineation of lesions and planning various stages of tumor resection. It is easy, convenient, reliable, widely available, and above all a cost-effective tool. It should be increasingly used by neurosurgeons in the developing world where costlier intraoperative localization and imaging is not available freely.
  16 3,751 120
REVIEW ARTICLE
Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds
Paul J Whelan, Kimberly Remski
January-April 2012, 3(1):45-50
DOI:10.4103/0976-3147.91934  PMID:22346191
Heroin dependence is a major health and social problem associated with increased morbidity and mortality that adversely affects social circumstances, productivity, and healthcare and law enforcement costs. In the UK and many other Western countries, both methadone and buprenorphine are recommended by the relevant agencies for detoxification from heroin and for opioid maintenance therapy. However, despite obvious benefits due to its unique pharmacotherapy (eg, greatly reduced risk of overdose), buprenorphine has largely failed to overtake methadone in managing opioid addiction. The experience from the developing world (based on data from India) is similar. In this article we compare the advantages and disadvantages of the use methadone and buprenorphine for the treatment of opioid addiction from both a developed and developing world perspective; and explore some of the reasons why buprenorphine has not fulfilled the expectations predicted by many in the addictions field.
  15 4,247 264
ORIGINAL ARTICLE
Role of nitrosative and oxidative stress in neuropathy in patients with type 2 diabetes mellitus
Marwan S Al-Nimer, Fakhir S Al-Ani, Fatima S Ali
January-April 2012, 3(1):41-44
DOI:10.4103/0976-3147.91932  PMID:22346190
Objectives : Evidences of oxidative and/or nitrosative stress in type 2 diabetes mellitus were demonstrated in experimental and human studies. This study is aimed to assess the serum peroxynitrite and oxidized lipoproteins in patients with type 2 diabetes mellitus presented with clinical and laboratory evidences of peripheral neuropathy. Materials and Methods : Eighty four patients with type 2 diabetes mellitus (51 of them had neuropathy) and 31 apparent healthy subjects were studied in the unit of neurophysiology at the University Hospital of Medical College, Al-Nahrin University in Baghdad, Iraq. Neuropathy total symptom score (NTSS), neuropathy impairment score in the lower leg (NIS-LL), and nerve conduction velocity of sensory (ulnar and sural) and motor (ulnar and common peroneal) nerves were used to assess the neuropathy. Fasting venous blood was obtained from each participant for the determination of serum glucose and oxidized lipoproteins. Results: The electrophysiology study revealed significant decrease in conduction velocity of ulnar (sensory and motor components), sural, and common peroneal nerves in diabetic neuropathy compared to diabetics without neuropathy and healthy subjects. Significant high level of serum peroxynitrite was found in diabetic patients with or without neuropathy compared with non-diabetics. The changes in serum-oxidized lipoproteins in patients with diabetics with or without neuropathy were non-significantly differed from healthy subjects. Neither nitrosative stress nor oxidative stress indices correlated with the variables that are related to the neuropathy. Conclusion: It concludes that evidence of nitrosative and to less extent the oxidative stress is associated with neuropathy in type 2 diabetes mellitus and their indices not correlated with variables related to neuropathy.
  12 2,492 102
ORIGINAL ARTICLES
Effect of fluoride exposure on the intelligence of school children in Madhya Pradesh, India
Sudhanshu Saxena, Anjali Sahay, Pankaj Goel
May-August 2012, 3(2):144-149
DOI:10.4103/0976-3147.98213  PMID:22865964
Objective: To assess the relationship between exposure to different drinking water fluoride levels and children's intelligence in Madhya Pradesh state, India. Materials and Methods: This cross-sectional study was conducted among 12-year-old school children of Madhya Pradesh state, India. The children were selected from low (< 1.5 parts per million) and high (≥1.5 parts per million) fluoride areas. A questionnaire was used to collect information on the children's personal characteristics, residential history, medical history, educational level of the head of the family, and socioeconomic status of the family. Levels of lead, arsenic, and iodine in the urine and the levels of fluoride in the water and urine were analyzed. The children's intelligence was measured using Raven's Standard Progressive Matrices. Data analysis was done using the chi-square, one way analysis of variance, simple linear regression, and multiple linear regression tests. P value <0.05 was considered statistically significant. Results: Differences in participant's sociodemographic characteristics, urinary iodine, urinary lead, and urinary arsenic levels were statistically not significant (P>0.05). However, a statistically significant difference was observed in the urinary fluoride levels (P 0.000). Reduction in intelligence was observed with an increased water fluoride level (P 0.000). The urinary fluoride level was a significant predictor for intelligence (P 0.000). Conclusion: Children in endemic areas of fluorosis are at risk for impaired development of intelligence.
  12 4,570 214
The effect of vitamin A supplementation on stimulated T-cell proliferation with myelin oligodendrocyte glycoprotein in patients with multiple sclerosis
Sima Jafarirad, Fereydoon Siassi, Mohammad-Hossein Harirchian, Mohammad-Ali Sahraian, Mohammad-Reza Eshraghian, Fazel Shokri, Reza Amani, Sama Bitarafan, Sabah Mozafari, Aliakbar Saboor-Yaraghi
September-December 2012, 3(3):294-298
DOI:10.4103/0976-3147.102609  PMID:23188981
Background: Multiple sclerosis (MS) is an autoimmune disease whereby myelin sheath of the central nervous system is destroyed. Vitamin A is known to play a role in the immune system. It has been recognized that some metabolites of vitamin A can be used effectively to treat experimental autoimmune encephalomyelitis (EAE). Aims: The effect of vitamin A as retinyl palmitate on T-cell proliferation in MS patients. Setting and Design: This study is a double blind clinical trial of two test groups over a period of 6 months. Materials and Methods: Thirty five multiple sclerosis (MS) patients were divided into two groups. One group received 25,000 IU/day vitamin A (as retinyl palmitate) and the other group were administered a placebo. The peripheral blood mononuclear cells (PBMCs) were separated and stimulated with myelin oligodendrocyte glycoprotein (MOG) and phytohemagglutinin (PHA) before and after the trial period. BrdU calorimetric assay was performed to measure cell proliferation. Statistical Analysis: Analysis of covariance (ANCOVA) and paired t-test were used to analyze the data. Results: Observations showed statistical significant differences in the reduction of cell proliferation in the presence of MOG and fetal calf serum (FCS) in the culture medium, between patients receiving vitamin A and the placebo (P = 0.046). Although, this difference was not significant between the two vitamin A and placebo groups in MOG treatment with human serum, a decrease was observed in the group of patients taking vitamin A supplements (P = 0.019). Phytohemagglutinin did not cause any change in cell proliferation between the two groups. Conclusion: The results suggest supplementation with retinyl palmitate in patients with MS reduce MOG stimulatory effects on T-cells.
  11 1,272 126
Comparison of antinociceptive effect of the antiepileptic drug gabapentin to that of various dosage combinations of gabapentin with lamotrigine and topiramate in mice and rats
Keshab Raj Paudel, SK Bhattacharya, GP Rauniar, BP Das
July-December 2011, 2(2):130-136
DOI:10.4103/0976-3147.83577  PMID:21897674
Introduction: Newer anticonvulsants have a neuromodulatory effect on pain perception mechanisms in a hyperexcitable and damaged nervous system. Aim: This study was designed to study the analgesic effects of gabapentin alone and in combination with lamotrigine and topiramate in experimental pain models. Materials and Methods: Adult albino mice (n=490) weighing 20-30 g and rats (n=130) weighing 100-200 g were injected intraperitoneally with gabapentin, lamotrigine, and topiramate alone and in different dose combinations. The hot-plate method, tail-flick method, capsaicin-induced mechanical hyperalgesia, and formalin assay were used to assess the antinociceptive effects. Results: Of the three antiepileptic drugs, when given separately, gabapentin was more efficacious than either topiramate or lamotrigine in all the pain models. Combination of 25 mg/kg gabapentin with 25 mg/kg topiramate was more efficacious (P<.05) than 50 mg/kg gabapentin alone in the capsaicin-induced mechanical hyperalgesia test. Similarly, 50 mg/kg gabapentin with 50 mg/kg topiramate or 5 mg/kg lamotrigine was more efficacious (P<.05) than 50 or 100 mg/kg gabapentin alone in late-phase formalin-induced behaviors. Conclusions: Combination of gabapentin with either lamotrigine or topiramate produced better results than gabapentin alone in capsaicin-induced mechanical hyperalgesia test and in late-phase formalin-induced behaviors.
  10 2,958 105
Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes
PP Saramma, R Girish Menon, Adesh Srivastava, P Sankara Sarma
January-March 2013, 4(1):24-28
DOI:10.4103/0976-3147.105605  PMID:23546343
Background : Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods : This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1 st January to 31 st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results : Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion : Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.
  10 2,200 179
REVIEW ARTICLES
Endoscopic third ventriculostomy
Yad Ram Yadav, Vijay Parihar, Sonjjay Pande, Hemant Namdev, Moneet Agarwal
May-August 2012, 3(2):163-173
DOI:10.4103/0976-3147.98222  PMID:22865970
Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow up.
  10 3,585 232
CASE REPORTS
Paraspinal gossybipoma: A case report and review of the literature
Baris Kucukyuruk, Huseyin Biceroglu, Bashar Abuzayed, Mustafa O Ulu, Ali M Kafadar
July-December 2010, 1(2):102-104
DOI:10.4103/0976-3147.71725  PMID:21808514
Spinal or paraspinal retained surgical sponges (gossybipoma or textiloma) are rare incidents and mostly asymptomatic in chronic cases, but can be confused with other masses such as a hematoma, an abscess or a tumor. In chronic cases, the presentation can be as late as decades after the initial surgery; however, some gossybipomas cause infection or abscess formation in the early stages. The authors report a 40-year-old woman with a history of operation for lumbar disk herniation before 8 months, and got admitted with a complaint of serous fluid leakage from the operation wound. In this report, the authors discuss the clinical presentation, the radiologic findings and the differential diagnosis of gossybipoma.
  9 1,685 127
ORIGINAL ARTICLES
Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age
Patrick Mulligan, Bethwel Raore, Shuling Liu, Jeffrey J Olson
July-September 2013, 4(3):250-256
DOI:10.4103/0976-3147.118760  PMID:24250154
Background: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.
  9 2,390 242
POINT OF VIEW
Implications and expectancies of the "Atahualpa Project": A population-based survey designed to reduce the burden of stroke and cardiovascular diseases in rural Ecuador
Oscar H Del Brutto
July-September 2013, 4(3):363-365
DOI:10.4103/0976-3147.118776  PMID:24250190
  9 589 72
ORIGINAL ARTICLES
Inca - interparietal bones in neurocranium of human skulls in central India
RR Marathe, AS Yogesh, SV Pandit, M Joshi, GN Trivedi
January-June 2010, 1(1):14-16
DOI:10.4103/0976-3147.63094  PMID:21799611
Inca bones are accessory bones found in neurocranium of human skulls. Occurrence of Inca bones is rare as compared to other inter sutural bones such as wormian bones. These Inca ossicles are regarded as variants of the normal. The reporting of such occurrences is inadequate from Central India. Objectives: To find the incidence of Inca variants in Central India. Materials and Methods: In the present study, 380 dried adult human skulls were examined. All specimen samples were procured from various Medical colleges of Central India. They were analyzed for gross incidence, sexual dimorphism and number of fragments of Inca bones. Results: Gross incidence of Inca bones was found to be 1.315 %. Incidence rate was higher in male skulls than female skulls (male: 1.428%; female: 1.176%). The Inca bones frequently occurred signally. Out of the five observed Inca ossicles, two were fragmented. Conclusions: This data gives idea regarding gross incidence, sexual dimorphism and number of fragments of Inca bones in neurocranium of human skulls from Central India. The knowledge of this variable is useful for neurosurgeons, anthropologists and radiologists.
  8 4,717 361
Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients
Aparna Pandey, Kiran Saxena, Meena Verma, Anuradha Bharosay
January-June 2011, 2(1):50-54
DOI:10.4103/0976-3147.80099  PMID:21716874
Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE), at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative 'sandwich' enzyme-linked immunosorbent assay kits obtained from R and D Systems. Hyperglycemia was defined as blood glucose concentration ≥ 7 mmol / L, and measured using the glucose oxidase method immediately. Results: Significantly increased NSE and lipid profile levels were found in ischemic stroke patients as compared to the control. Hyperglycemic ischemic stroke patients had increased levels of NSE, lipid profile, and National Institute of Health stroke scale scores (NIHSS score) compared to normoglycemic ischemic stroke patients. In addition the serum NSE level of hyperglycemic stroke patients was also positively correlated with the blood sugar level (r = 0.734 P < 0.001). Conclusions: Hyperglycemia predicts an increased risk of poor outcome after ischemic stroke and it is reflected by a significantly increased level of Neuron-Specific Enolase.
  8 2,027 108
Quality of life in patients with epilepsy in India
Pushparaja H Shetty, Ravishankar K Naik, AO Saroja, K Punith
January-June 2011, 2(1):33-38
DOI:10.4103/0976-3147.80092  PMID:21716845
Background: People with epilepsy have impairment in their quality of life (QOL) due to effect of epilepsy on various aspects of their life and the medication effects. Systematic studies on QOL in epilepsy from developing countries are sparse. Objectives: To assess the QOL in people with epilepsy and to evaluate various factors affecting the QOL in them. Materials and Methods: People with generalized and partial epilepsy on medication aged more than 18 years were included in the study. The QOL was assessed with QOLIE-89 instrument. Statistical significance was evaluated by the use of Chi-square test and one-way analysis of variance (ANOVA). Results: Sixty people with epilepsy were studied among whom the older patients had lower overall QOL scores compared to younger patients. Female patients had lower scores compared to males. Married people had lower quality of health score. Patients with simple partial seizures had lowest overall QOL mean score. There was reduction in the overall QOLIE scores with increasing duration of the epilepsy. Patients who had their last seizure within 10 months prior to evaluation had lower mean overall scores. Conclusion: QOL was impaired in people with epilepsy with increased impairment in women, older patients, simple partial seizures, and those with recent seizure.
  8 2,212 157
Acute neuromuscular weakness associated with dengue infection
Harmanjit Singh Hira, Amandeep Kaur, Anuj Shukla
January-April 2012, 3(1):36-39
DOI:10.4103/0976-3147.91928  PMID:22346188
Background: Dengue infections may present with neurological complications. Whether these are due to neuromuscular disease or electrolyte imbalance is unclear. Materials and Methods: Eighty-eight patients of dengue fever required hospitalization during epidemic in year 2010. Twelve of them presented with acute neuromuscular weakness. We enrolled them for study. Diagnosis of dengue infection based on clinical profile of patients, positive serum IgM ELISA, NS1 antigen, and sero-typing. Complete hemogram, kidney and liver functions, serum electrolytes, and creatine phosphokinase (CPK) were tested. In addition, two patients underwent nerve conduction velocity (NCV) test and electromyography. Results: Twelve patients were included in the present study. Their age was between 18 and 34 years. Fever, myalgia, and motor weakness of limbs were most common presenting symptoms. Motor weakness developed on 2 nd to 4 th day of illness in 11 of 12 patients. In one patient, it developed on 10 th day of illness. Ten of 12 showed hypokalemia. One was of Guillain-Barré syndrome and other suffered from myositis; they underwent NCV and electromyography. Serum CPK and SGOT raised in 8 out of 12 patients. CPK of patient of myositis was 5098 IU. All of 12 patients had thrombocytopenia. WBC was in normal range. Dengue virus was isolated in three patients, and it was of serotype 1. CSF was normal in all. Within 24 hours, those with hypokalemia recovered by potassium correction. Conclusions: It was concluded that the dengue virus infection led to acute neuromuscular weakness because of hypokalemia, myositis, and Guillain-Barré syndrome. It was suggested to look for presence of hypokalemia in such patients.
  8 3,345 137
REVIEW ARTICLE
Effect of plant extracts on Alzheimer's disease: An insight into therapeutic avenues
M Obulesu, Dowlathabad Muralidhara Rao
January-June 2011, 2(1):56-61
DOI:10.4103/0976-3147.80102  PMID:21716802
Alzheimer's disease (AD) is a devastative neurodegenerative disorder which needs adequate studies on effective treatment options. The extracts of plants and their effect on the amelioration of AD symptoms have been extensively studied. This paper summarizes the mechanisms like acetylcholinesterase (AChE) inhibition, modification of monoamines, antiamyloid aggregation effect, and antioxidant activity which are actively entailed in the process of amelioration of AD symptoms. These effects are induced by extracts of a few plants of different origin like Yizhi Jiannao, Moringa oleifera (Drumstick tree), Ginkgo Biloba (Ginkgo/Maidenhair tree), Cassia obtisufolia (Sicklepod), Desmodium gangeticum (Sal Leaved Desmodium), Melissa officinalis (Lemon Balm), and Salvia officinalis (Garden sage, common sage).
  8 7,991 450
ORIGINAL ARTICLES
Distribution of depressive disorders in the elderly
Ankur Barua, MK Ghosh, N Kar, MA Basilio
July-December 2010, 1(2):67-73
DOI:10.4103/0976-3147.71719  PMID:21808506
Background: The community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20% depending on cultural situations. Objective: To determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world. Materials and Methods: A retrospective study based on meta-analysis of various study reports. Setting: Community-based mental health surveys on geriatric depressive disorders conducted in the continents of Asia, Europe, Australia, North America, and South America. Study Period: All the studies that constituted the sample were conducted between 1955 and 2005. Sample Size: After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 4,87,275 elderly individuals in the age group of 60 years and above, residing in various parts of the world were included for the final analysis. Inclusion Criteria: The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of elderly population in the world, who were selected by simple random sampling technique. Exclusion Criteria: All the unpublished reports and unavailable or unanalyzed or inaccessible articles from the internet were excluded from the study. Statistical Analysis: The median prevalence rate and its corresponding interquartile range (IQR), Chi-square test, and Chi-square for Linear Trend were applied. A P value < 0.05 was considered as statistically significant. Results and Conclusion: The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% [IQR = (4.7%-16.0%)]. The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% [IQR = (11.6%-31.1%)]. Although there was a significant decrease trend in world prevalence of geriatric depression, it was significantly higher among Indians in recent years than the rest of the world.
  7 3,644 353
Investigation of in vitro cytotoxicity of the redox state of ionic iron in neuroblastoma cells
Ajay Vikram Singh, Varun Vyas, Erica Montani, Daniele Cartelli, Dario Parazzoli, Amanda Oldani, Giulia Zeri, Elisa Orioli, Donato Gemmati, Paolo Zamboni
September-December 2012, 3(3):301-310
DOI:10.4103/0976-3147.102611  PMID:23188983
Background: there is an intimate relation between transition metals and cell homeostasis due to the physiological necessity of metals in vivo. Particularly, iron (ferrous and ferric state) is utilized in many physiological processes of the cell but in excess has been linked with negative role contributing in many neurodegenerative processes. Objective: the aim of this study was to investigate which oxidation state of ionic iron (Ferrous (II) versus Ferric (III)) is more toxic to neuronal cells (SHSY5Y). Materials and Methods: The neuroblastoma (SHSY5Y) cells were exposed to varying concentration of ferric and ferrous iron. Morphological studies using immunofluorescence staining and microscopic analysis as confirmed by intracellular glutathione (GSH) test demonstrated oxidative stress to cells in iron microenvironment. In addition, MTT assay was performed to evaluate the viability and metabolic state of the cells. Results: the results showed that ferrous form has significantly higher toxicity compared to the ferric ionic state of higher concentration. In addition, microscopic analysis shows cell fenestration at higher concentrations and swelling at intermediate ferric dosages as demonstrated by atomic force microscopy (AFM). Interestingly, the addition of a differentiation inducing factor, trans-retinoic rcid (RA) retains significant viability and morphological features of the cells irrespective of the ionic state of the iron. AFM images revealed clustered aggregates arising from iron chelation with RA. Conclusions: the results indicate that Fe (II) has more toxic effects on cells. In addition, it could be an interesting finding with respect to the antioxidant properties of RA as a chelating agent for the neurodegenerative therapeutics.
  7 1,471 101
REVIEW ARTICLE
Psychiatric aspects of Parkinson's disease
Sandeep Grover, Mansi Somaiya, Santhosh Kumar, Ajit Avasthi
January-March 2015, 6(1):65-76
DOI:10.4103/0976-3147.143197  PMID:25552854
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.
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ORIGINAL ARTICLES
Evaluation of outcome and prognostic factors in patients of glioblastoma multiforme: A single institution experience
Narendra Kumar, Pankaj Kumar, Shabab Lalit Angurana, Divya Khosla, Kanchan Kumar Mukherjee, Rupali Aggarwal, Ritesh Kumar, Anjan Bera, Suresh Chander Sharma
August 2013, 4(5):46-55
DOI:10.4103/0976-3147.116455  PMID:24174800
Aims: We present retrospective analysis of patients of glioblastoma multiforme (GBM) and discuss clinical characteristics, various treatment protocols, survival outcomes, and prognostic factors influencing survival. Materials and Methods: From January 2002 to June 2009, 439 patients of GBM were registered in our department. The median age of patients was 50 years, 66.1% were males, and 75% underwent complete or near-total excision. We evaluated those 360 patients who received radiotherapy (RT). Radiotherapy schedule was selected depending upon pre-RT Karnofsky Performance Status (KPS). Patients with KPS < 70 (Group I, n = 48) were planned for RT dose of 30-35 Gy in 10-15 fractions, and patients with KPS ≥ 70 (Group II, n = 312) were planned for 60 Gy in 30 fractions. In group I, six patients and in group II, 89 patients received some form of chemotherapy (lomustine or temozolomide). Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences, version 12.0. Overall survival (OS) was calculated using Kaplan-Meier method, and prognostic factors were determined by log rank test. The Cox proportional hazards model was used for multivariate analysis. Results: The median follow-up was 7.53 months. The median and 2-year survival rates were 6.33 months and 2.24% for group I and 7.97 months and 8.21% for group II patients, respectively ( P = 0.001). In multivariate analysis, site of tumor (central vs. others; P = 0.006), location of tumor (parietal lobe vs. others; P = 0.003), RT dose (<60 Gy vs. 60 Gy; P = 0.0001), and use of some form of chemotherapy ( P = 0.0001) were independent prognostic factors for survival. Conclusions: In patients with GBM, OS and prognosis remains dismal. Whenever possible, we should use concurrent and/or adjuvant chemotherapy to maximize the benefits of post-operative radiotherapy. Patients with poor performance status may be considered for hypofractionated RT schedules, which have similar median survival rates as conventional RT.
  6 1,410 130
Prognostic significance of age in traumatic brain injury
SS Dhandapani, D Manju, BS Sharma, AK Mahapatra
May-August 2012, 3(2):131-135
DOI:10.4103/0976-3147.98208  PMID:22865961
Background: Age is a strong prognostic factor following traumatic brain injury (TBI), with discrepancies defining the critical prognostic age threshold. This study was undertaken to determine the impact of various age thresholds on outcome after TBI. Materials and Methods : The ages of patients admitted with TBI were prospectively studied in relation to mode of injury, Glasgow coma score (GCS), CT category and surgical intervention. Mortality was assessed at 1 month, and neurological outcome was assessed at 6 months. Appropriate statistical analyzes (details in article) were performed. Results: Of the total 244 patients enrolled, 144 patients had severe, 38 patients had moderate and 62 patients had mild TBI, respectively. Age had significant association with grade of injury, CT category and surgical intervention (P < 0.01). Mortality at 1 month was significantly associated with increasing age with patients dead at 1 month being 15% for age < 18, 44% for age between 18 and 59 years, and 52% in the age group > 59 years respectively (P < 0.001). Unfavorable outcome showed significant association with an increase in age, every decade (P < 0.001). In multivariate analysis, there was stepwise increase in the odds of unfavorable outcome across age groups centered on 40 years, independent of confounding factors. The adjusted odds ratios for unfavorable outcome with regard to age thresholds 30, 40 and 50 years were 11.3, 53.3 and 1171, respectively (P < 0.005). Moreover, there was significant association of unfavorable outcome with age > 40 years in all subgroups, based on GCS and surgical intervention (P < 0.05). Conclusions : In patients with TBI, age demonstrates independent association with unfavorable outcome at 6 months, in stepwise manner centered on a threshold of 40 years.
  6 1,469 98
The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis
Kadriye Yasar, Filiz Pehlivanoglu, Gulten Cicek, Gonul Sengoz
January-April 2012, 3(1):17-20
DOI:10.4103/0976-3147.91925  PMID:22346185
Objective: In this study, the evaluation of the clinical, laboratory and radiological findings belonging to 55 cases that were hospitalized in our clinic to be followed-up and were diagnosed with tuberculous, brucellar and pyogenic spondylodiscitis (SD) was aimed. Materials and Methods: The cases with SD were evaluated retrospectively. Hematological, serological, biochemical laboratory tests and imaging technics were used for diagnosis. Results: Of 55 cases aged ranging between 25 to 79, 33 (59%) were female. The cases with tuberculous SD (TBSD), brucellar SD (BSD) and pyogenic SD (PSD) were found in 24 (43%), 12 (21%) and in 19 (34%) patients.Erytrocyte sedimentation rate, increased C-reactive protein, and leucocytosis were present in 51 (91%), 22 (39%) and 8 (14%) cases. The number of the cases with history of previous surgery or trauma was 14 (25%). Diagnosis of TBSD was established by acid fast bacilli positiveness and Löwenstein Jensen culture positiveness, in two and seven patients, respectively. While all 12 cases with BSD had positive standard tube aglutination test, only 3 (25%) had hemoculture positivity. In PSDs, diagnosis was confirmed with culture positivity in 9 of 19 cases.Of the cases in our study, 89% responded to medical treatment while three required surgery and three died (5.5% and 5.5%, respectively). Conclusion: SD may develop secondary to infections or following spinal surgical procedures and traumas. Also, the importance of endemicity should be kept in mind, beside the helpful diagnostic findings while treatment regulation.
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