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.
  20 6,554 110
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%.
  17 4,023 333
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.
  15 2,331 45
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.
  11 1,278 68
ORIGINAL ARTICLES
Understanding non-compliance with WHO-multidrug therapy among leprosy patients in Assam, India
Sumit Kar, Ranabir Pal, Dharamvir Ranajan Bharati
January-June 2010, 1(1):9-13
DOI:10.4103/0976-3147.63093  PMID:21799610
Objectives: The study was undertaken to assess the adherence to World Health Organization (WHO)-multidrug therapy (MDT) and its successful completion by the leprosy patients and the extent of such defaulting, its correlates and reasons. Design: Retrograde cohort analysis was conducted during the first quarter of 2007 from the cases registered for WHO-MDT treatment during 2002 to 2005 in Kamrup district of Assam, India. Results: A total of 254 leprosy cases reflected the treatment seeking behavior of registered cases during the study period. Majority of the cases were from urban areas and defaulter rate higher in urban areas. The study group consisted of 60.63% males and 39.37% females.. Both the compliance and default was higher in the age group of 16 to 30 years. Majority of defaulters (32.28%) had passed the high school leaving certificate examination had per capita monthly income between Rs 500 - 749 (30.71%) and belonged to social class IV (33.86%) and V (30.71%). Significant statistical association was found between gender, literacy status, per capita income per month and socioeconomic status with treatment outcome. On analysis for the reasons of defaulting treatment; majority (33.07%) defaulted treatment due to loss of occupational hours when they come for receiving drugs at health center, 25.98% defaulted due to adverse reactions of drugs and 18.11% feared social stigma among major causes. Conclusions: The causes of defaulting treatment were related to gender, educational status, income as well as social class, or some combination of these. Recommendations, on strategic interventions to obviate the cause for noncompliance, were presented.
  9 2,336 215
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.
  8 2,259 34
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 2,913 254
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.
  7 4,038 267
Spectrum of surgical trauma and associated head injuries at a university hospital in eastern Nepal
A Bajracharya, A Agrawal, BR Yam, CS Agrawal, Owen Lewis
January-June 2010, 1(1):2-8
DOI:10.4103/0976-3147.63092  PMID:21799609
Background: Trauma is one of the common surgical emergencies presenting at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal, a tertiary referral center catering to the needs of the population of Eastern Nepal and nearby districts of India. Objective: The objective of this study is to analyze the magnitude, epidemiological, clinical profile and outcome of trauma at B P Koirala Institute of Health Sciences. Materials and Methods: This descriptive case series study includes all patients with history of trauma coming to BPKIHS emergency and referred to the surgery department. We noted the detailed clinical history and examination, demographics, mechanism of injury, nature of injury, time of reporting in emergency, treatment offered (operative or non operative management) and analyzed details of operative procedure (i.e. laparotomy, thoracotomy, craniotomy etc.), average length of hospital stay, morbidity and outcome (according to Glasgow outcome scale). Collected data were analyzed using EpiInfo 2000 statistical software. Results: There were 1848 patients eligible to be included in the study. The mean age of the patients was 28.9 ± 19.3 years. Majority of the patients (38%) belonged to the age group of 21 - 40 years and the male to female ratio was 2.7:1. Most of the trauma victims were students (30%) followed by laborers (27%) and farmers (22%) respectively. The commonest causes of injury were fall from height (39%), road traffic accident (38%) and physical assault (18%); 78% of the patients were managed conservatively and 22% underwent operative management. Postoperative complications were seen in 18%. Wound infection 7.5%, neurological deficit including cerebrospinal fluid (CSF) otrorrhea was seen in 2.2% patients. Good recovery was seen in 84%, moderate disability in 5.2% patients and severe disability in 1.4% patients. The mortally was 6.3% and most of the deaths were related to traumatic brain injuries. Conclusions: In Nepal, trauma-related injury contributes significantly to morbidity and mortality and is the third leading cause of death. There are very few studies on trauma from this country and hence this study will help in understanding the etiology and outcome particularly in the Eastern region of Nepal.
  7 3,611 300
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.
  7 2,836 58
CASE REPORT
Pediatric brainstem oligodendroglioma
Sandeep Mohindra, Amey Savardekar, Amanjit Bal
January-April 2012, 3(1):52-54
DOI:10.4103/0976-3147.91940  PMID:22346193
The authors present the first report of pediatric brainstem oligodendroglioma, infiltrating midbrain, and medulla oblongata. The report details clinical features, radiological findings, and surgical steps. As this entity is exceedingly uncommon, the overall epidemiology, prognosis, and long-term outcome remain far from established.
  6 1,435 22
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.
  6 3,307 60
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.
  6 2,006 77
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.
  6 1,833 29
CASE REPORTS
Unilateral variant motor innervations of flexure muscles of arm
AS Yogesh, M Joshi, VK Chimurkar, RR Marathe
January-June 2010, 1(1):51-53
DOI:10.4103/0976-3147.63107  PMID:21799624
The musculocutaneous nerve usually branches out from the lateral cord of brachial plexus. It innervates the corcobrachialis, biceps brachii and brachialis muscles and continues as the lateral cutaneous nerve of forearm without exhibiting any communication with the median nerve or any other nerve. We report unilateral variation in motor innervations of the left arm in a 58-year-old male cadaver. The musculocutaneous nerve was found to be absent. A muscular branch of the median nerve was supplying the coracobrachialis muscle. In the middle of arm, the median nerve was found to be branching out, bifurcating and supplying the long and short head of biceps. The median nerve was found to be giving a separate branch, which supplied the brachialis muscle and continued as the lateral cutaneous nerve of forearm. The right sided structures were found to be normal. Surgeons should keep such variations in mind while performing arm surgeries.
  6 2,263 158
Primary lumbosacral intradural hydatid cyst in a child
Sujeet Kumar Shukla, Vivek Sharma, Kulwant Singh, Adarsh Trivedi
July-December 2010, 1(2):109-111
DOI:10.4103/0976-3147.71727  PMID:21808516
Primary spinal hydatid cyst is very rare lesion affecting less than 1% of the total cases of the hydatid disease. In this study, we report a case of spinal hydatid in a 5-year old boy presented with a history of backache, leg pain, difficulty in walking, and bowel and bladder incontinence for 4 months. An intradural nonenhancing cystic lesion was detected using magnetic resonance imaging from L4 to sacral region, and histopathological findings were suggestive of hydatid cyst.
  6 1,698 64
LETTERS TO THE EDITOR
Shunt malfunction due to proximal migration and subcutaneous coiling of a peritoneal catheter
Amit Agarwal, Anand Kakani
July-December 2010, 1(2):120-121
DOI:10.4103/0976-3147.71731  PMID:21808520
  6 2,974 61
CASE REPORTS
Pituitary tuberculoma
S Shukla, A Trivedi, K Singh, V Sharma
January-June 2010, 1(1):30-31
DOI:10.4103/0976-3147.63099  PMID:21799616
Tuberculosis of pituitary gland is rare. We report a case of tuberculosis of pituitary gland in a 68-year-old male presented with holocranial headache of four months duration with left temporal hemianopia, with visual acuity of 6/6, without any localizing sign. Magnetic resonance imaging showed a sellar ring enhancing mass with suprasellar extension. Patient was taken up for surgery and put on antitubercular treatment and hormone replacement therapy.
  5 1,350 113
Communication between radial nerve and medial cutaneous nerve of forearm
RR Marathe, SR Mankar, M Joshi, YA Sontakke
January-June 2010, 1(1):49-50
DOI:10.4103/0976-3147.63106  PMID:21799623
Radial nerve is usually a branch of the posterior cord of the brachial plexus. It innervates triceps, anconeous, brachialis, brachioradialis, extensor carpi radialis longus muscles and gives the posterior cutaneous nerve of the arm, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of forearm; without exhibiting any communication with the medial cutaneous nerve of forearm or any other nerve. We report communication between the radial nerve and medial cutaneous nerve of forearm on the left side in a 58-year-old male cadaver. The right sided structures were found to be normal. Neurosurgeons should keep such variations in mind while performing the surgeries of axilla and upper arm.
  5 1,452 99
ORIGINAL ARTICLES
Licit and illicit substance use by adolescent students in eastern India: Prevalence and associated risk factors
Dechenla Tsering, Ranabir Pal, Aparajita Dasgupta
July-December 2010, 1(2):76-81
DOI:10.4103/0976-3147.71721  PMID:21808508
Background: Use of tobacco, alcohol, and other substances is a worldwide problem and affects many adolescents. Objective: (1) To find out the magnitude of licit and illicit substance use among students; and (2) to find out the association between socioeconomic and demographic characteristics of the students and habits of use. Materials and Methods: This was a population-based cross-sectional study conducted during June 2003 to May 2004. In a multistage random sampling among all the districts and schools in West Bengal, India, 416 high school students from two schools were selected. The main outcome measures were substance use, namely, tobacco, alcohol, and cannabinoids. From the schools, all the students in the classes VIII, IX, and X were taken as the study population and were administered a pretested close-ended anonymous self-administered questionnaire relating to pattern, frequency, and correlates of substance use. Results: The ultimate response rate was 87.02% and 416 students could be covered in our study. The overall prevalence rates among rural and urban students were 6.14% and 0.6% for illicit drug use, 8.60% and 11.04% for tobacco, and 7.37% and 5.23% for alcohol consumption, respectively. Both licit and illicit substance use was associated more with male students. Current and regular use were mostly restricted to tobacco, and the use of a substance by family members had a significant impact on its use by their children. "Enjoyment" and "Curiosity" were found to have the major influence in their decision to use a substance. Conclusions: Early identification of the magnitude and the factors related to substance use can improve scopes for planning and preventive approaches for this vulnerable group before the problems get serious after which interventions become difficult.
  5 2,966 185
Inpatient occupational therapists hand-splinting practice for clients with stroke: A cross-sectional survey from Ireland
Cormican Adrienne, Chockalingam Manigandan
July-December 2011, 2(2):141-149
DOI:10.4103/0976-3147.83579  PMID:21897676
Introduction: Hand splinting after stroke is a common practice despite inadequate evidence. This warrants a better understanding of the therapists' splinting practice, to develop clinically meaningful treatment options. Aims: The study examined the nature and prevalence of the factors associated with therapists' hand splinting practice and their perceived splinting efficacy. Settings and Design: A cross-sectional national survey of hand-splinting practice among inpatient occupational therapists (OTs) in Ireland. Materials and Methods: Sixty-two therapists participated in this national survey.Statistical analysis used: A number of factors were analyzed to explore their relationship with therapists' perception of splint efficacy using Spearman's rank order correlation. Results: 53(85.5%) out of 62 survey respondents prescribed splints to their clients at the time of taking the survey. To reduce spasticity, to correct contractures and thus increase range of motion (ROM) were the commonly used splinting goals. These were the goals that were significantly associated with the therapists' splinting efficacy too. Conclusions: Hand-splint prescription following stroke was found to be a common practice among OTs who perceive splints to be quite effective. A custom-made, volar forearm-based wrist-hand splint is the preferred splint among therapists to achieve a number of clinical aims such as improving ROM, stretching soft tissue contractures and reducing spasticity in the upper extremity. A wide variety of splinting regimens is currently practiced, reflecting the lack of a universally accepted and comprehensive practice guideline to regulate therapy. Methodologically valid clinical trials evaluating the efficacy of therapist-preferred splints in achieving their favored outcomes are needed. Development of common, universally accepted therapeutic guidelines based on comprehensive scientific review of such studies is thus needed.
  5 6,083 73
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.
  5 2,880 30
The effect of right or left handedness on caries experience and oral hygiene
Binali Çakur, Mehmet Yildiz, Senol Dane, Yahya Orçun Zorba
January-June 2011, 2(1):40-42
DOI:10.4103/0976-3147.80093  PMID:21716828
Background: There is an indisputable relationship between tooth decay and oral hygiene. Caries can only be prevented by keeping tooth decay at bay. In several prophylactic methods, brushing is the most important. Brushing efficiency is directly related to an individuals' manual dexterity. Objective: To investigate whether there were differences in oral hygiene and caries prevalence between right- and left-handers. Materials and Methods: Forty-six elementary school students were included in the study. The subjects were 30 males and 16 females, ranging in age from 11 to 13 years. Handedness was ascertained by using the Edinburgh Handedness Scale. All students were examined intraorally. During this examination, the necessary values to determine oral hygiene status and to determine caries prevalence were recorded. Results: It was observed that subjects who used their right hands were in a better position in terms of oral hygiene than those using the left (P < 0.01). In terms of caries prevalence, however, averages for right-handed individuals were lower than those for left-handed subjects, although the difference was not statistically significant. Conclusions: It can be stated that the right-handed individuals have better oral hygiene and the lower incidence of caries because of their better manual dexterity and brush efficiency. So, dentists should consider better manual dexterity and brush efficiency in right-handed individuals before treatment planning. However, future well-designed neurologic studies involving larger numbers of subjects will be necessary to confirm the findings of this study and to understand more about the effects of handedness on oral hygiene performance.
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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.
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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.
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