Dr. Ram Manohar Lohia Institute of Medical Sciences

Background Encephalocele represent a group of disorders which is characterised by extracranial herniation of the leptomeninges, brain, and CSF through a structural defect in the cranium. They are usually associated with other intracranial anomalies which may impact the neurological development. Aim This study aimed to assess the predictors of neurological development of patients undergone surgical excision of occipital encephalocele. Methods All patients with occipital encephaloceles operated over the last decade (2012–2022). The sac size, presence of hydrocephalous, and associated anomalies were noted. The biopsy of these patients were reviewed and categorised as those which contains mature neural tissue and those without. The neurological outcomes were assessed by social, language, cognitive, and motor milestone and has been stratified into no delay, mild (1 of 4), moderate (2 or 3 of 4), and severe development delay (4 of 4). Results Total of 35 patients were included with median age of 10 months (IQR = 5–20 months). Fifteen (42.9%) patients had sac size of ≥ 5 cm, and 23 (65.7%) patients had mature neural tissues on biopsy. The median follow-up period was 6.4 years (IQR = 4.38–10.65) years. Seventeen (49.6%) patients had moderate to severe developmental delay. The sac size of ≥ 5 cm (AOR = 33.5; 95%CI = 3.35–334.8) (p = 0.003) and presence of mature neural content in the sac (AOR = 13.32; 95%CI = 1.1–160.36) (p = 0.041) were associated with significant neurodevelopmental delay. Conclusion The presence of a large sac of ≥ 5 cm and the presence of mature neural tissues on histopathological specimen of patients with encephalocele point towards the possibility of poor neurological development.

Elizabethkingia spp . is a rare catalase and oxidase positive nonfermenting, Gram-negative Bacillus that has traditionally been linked to an array of illnesses in immunocompromised individuals. This case series reports seven cases of Elizabethkingia meningoseptica infections from a tertiary care teaching hospital. The subjects ranged in age from 23 to 75 years. Associated risk factors included a recent history of surgery, diabetes mellitus, renal failure, use of mechanical ventilation, and presence of an indwelling central line. All seven cases acquired infection in the intensive care unit, and the isolates were resistant to penicillin, third- and fourth-generation cephalosporins, and aminoglycosides and showed varied susceptibility to piperacillin–tazobactam, carbapenems, and fluoroquinolones.

Clear cell myomelanocytic tumor (CCMMT) of the falciform ligament/ligamentum teres is a rare hepatic tumor, a variant of the perivascular epithelioid cell tumor (PEComa) family. CCMMT is the rarest variant of hepatic PEComas. Only a few cases of CCMMT have been reported in the English literature. Because of its rarity, less is known about its biological behavior. We present a case of a 31-year-old female who complained of abdominal pain, bilious vomiting, and abdominal fullness over two months. The radiological impression was of focal nodular hyperplasia. The histological examination of the resection specimen revealed a well-circumscribed tumor arranged in fascicles, sheets, and a whorling pattern. The tumor cells were spindle to epithelioid shaped with abundant clear to pale eosinophilic cytoplasm. The tumor cells expressed both myoid (smooth muscle actin) and melanocytic (MelanA and HMB45) markers, while they were negative for hepatocytic and vascular markers. Thus, based on histology and immunohistochemistry, a diagnosis of CCMMT was made. This case presents the diagnostic challenges of CCMMT and discusses the differential diagnosis with a literature review. Keywords: Immunohistochemistry; Liver Neoplasms; Perivascular Epithelioid Cell Neoplasms

Paraganglioma are rare tumor derived from either parasympathetic or sympathetic paraganglia. These tumors have wide spectrum of clinical presentation, and variable anatomic distribution, however their location in the neck and skull base is common but a sporadic location is rare. We are presenting a case of 32 yr female with history of severe systemic hypertension with mid occipital soft tissue swelling. Her radio-imaging study revealed an extra-dural mass lesion with minimal bony erosion. Peroperative course was associated with catastrophic bleeding. On further workup this is found to be a case of sporadic extradural sympathetic paraganglioma, which is not reported in the existing literature.

This interventional study was designed to evaluate the effectiveness of Buzz Session teaching in large groups and assess undergraduate medical students' perceptions of the Buzz Session teaching method. The study involved 100 first-year MBBS students divided into two groups, i.e., Buzz session (Group I) and didactic lecture(Group II). The topic "Physiology of the Cerebellum" was taught to group I through a Buzz session and to Group II through a didactic lecture. After a week, group-I received a didactic lecture on the topic "Anterolateral pathway in the spinal cord," whereas group II was taught by a Buzz session. After the training sessions, students in both groups were evaluated for each topic using the MCQ exam immediately and again at 15 days. All students were provided feedback on a 5-point Likert scale for Buzz session. According to students' perceptions, Buzz session boosted communication skills and confidence levels by 94.8% and 96.3%, respectively. 93.7% of students felt that the Buzz session helped them retain more information and 94.1% thought they made the classroom environment more lively. More Buzz sessions were desired by 94.8% of the participants. There was no significant difference in the marks gained for the acquired topics using the teaching methods (p> 0.05). After the Buzz session, the marks score was significantly higher on the test than on the didactic lecture at 15 days of instruction (p<0.05). The study concluded that students enjoyed Buzz session teaching method. The Buzz session increased short-term retention.

Japanese Encephalitis remains a significant global health concern, contributing to millions of deaths annually worldwide. Microglial cells, as key innate immune cells within the central nervous system (CNS), exhibit intricate cellular structures and possess molecular phenotypic plasticity, playing pivotal roles in immune responses during CNS viral infections. Particularly under viral inflammatory conditions, microglial cells orchestrate innate and adaptive immune responses to mitigate viral invasion and dampen inflammatory reactions. This review article comprehensively summarizes the pathophysiology of viral invasion into the CNS and the cellular interactions involved, elucidating the roles of various immune mediators, including pro-inflammatory cytokines, in neuroinflammation. Leveraging this knowledge, strategies for modulating inflam-matory responses and attenuating hyperactivation of glial cells to mitigate viral replication within the brain are discussed. Furthermore, current chemotherapeutic and antiviral drugs are examined, elucidating their mechanisms of action against viral replication. This review aims to provide insights into therapeutic interventions for Japanese Encephalitis and related viral infections, ultimately contributing to improved outcomes for affected individuals.

Background Employment is associated with a host of benefits including better self esteem, quality of life and financial independence. Maintenance dialysis is a major barrier to employment in patients with ESRD. This observational cross-sectional study was conducted to determine the proportion of patients suffering from ESRD on maintenance dialysis who were employed and various factors associated with loss of employment. Methods Patients suffering from ESRD, aged 18 to 65 years, who were on maintenance dialysis for ≥ 3 months were included. Their clinical and demographic characteristics, employment status before dialysis and change in employment after initiating dialysis was recorded and various factors associated with change in employment were analyzed. Results We observed that 39 (15.6%) out of 225 study subjects were employed on maintenance dialysis, whereas 155 (68.9%) patients were employed before initiating dialysis. Patients who lost employment were significantly younger and a higher proportion were on HD. Being on maintenance PD, residing in a nuclear family and at a shorter distance from the dialysis centre, self financing of treatment and professional employment category were associated with a greater likelihood of retaining employment after initiating dialysis. Conclusion This study revealed that only a small proportion of patients on maintenance dialysis are employed and a large number of patients lose employment after initiating dialysis. Nuclear family, PD as dialysis modality, professional category job before initiating dialysis, self-financing of treatment and living closer to dialysis centres was associated with retaining employment on maintenance dialysis.

Introduction The intertwined nature of obesity and diabetes, termed diabesity, is a significant health concern. Aspirin has been recognized for its potential in mitigating inflammation-related health issues, a key concern in managing diabesity. However, the optimal aspirin dosage and its impact on specific inflammatory markers, viz. high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6, over time remain a subject of ongoing research. Objective This study investigated the effects of different doses of aspirin (150mg and 300mg) on the levels of hs-CRP and IL-6 over a period of 6 months. Methods This cross-sectional observational quasi-experiment study involved 125 confirmed type-2 diabetes mellitus (T2DM) patients with obesity aged ≥40 years. Blood samples were collected for analyzing hs-CRP and IL-6 levels. Demographics and clinical characteristics, such as BMI, waist-hip ratio, blood parameters, fasting blood sugar (FBS), and hs-CRP, were analyzed. Results At baseline, both the 150 mg and 300 mg aspirin dose groups had similar median levels of hs-CRP. After two months, there was no significant difference (p=0.150). However, by six months, the 150mg dose group had a significantly higher median hs-CRP than the 300 mg dose group (p=0.003). The 150 mg dose group had a significantly higher median level of IL-6 levels at baseline (median; 40.0) compared to the 300 mg dose group (median; 2.27, p<0.0001). After two months, the levels of IL-6 in both groups were similar (median; 2.27 and 2.23 respectively, p<0.0001). By the end of six months, the groups had no significant difference (median; 0.53 and 2.22 respectively, p=0.128). Conclusion The dose of aspirin may significantly impact the levels of hs-CRP and IL-6 over time, with the effects being more pronounced after six months of treatment. These findings suggest that aspirin, a commonly used and cost-effective medication, could potentially be leveraged in a more targeted manner to manage inflammation (CRP and IL-6 levels) in individuals with diabesity.

: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age group. The intricate nature of PCOS development is highlighted by fluctuations in various sex hormones, such as luteinizing hormone(LH), follicle-stimulating hormone and prolactin. This study aims to assess the lipid profile levels, vital metals and sex hormones in the serum of patients with PCOS and contrast these findings with normal controls. The study analyzed health metrics between 57 women with PCOS and 57 normal controls. The lipid profile was assessed using Beckman Coulter AU480. Sex hormones were estimated using Roche Diagnostics Cobas 6000. Inductively coupled plasma mass spectrometry (ICPMS) was used to measure the essential trace metals, including magnesium (Mg), copper (Cu) Selenium (Se) and zinc (Zn). : The PCOS patients exhibited significantly elevated levels of LH (9.52 vs 3.48, p<0.0001), FSH (9.91 vs. 6.12, p<0.0001) and prolactin (24.71 vs. 16.41, p=0.03) mIU/ml. The correlation study showed a significant positive correlation between AMH and Se levels (R=0.27, p=0.045) and between LH and HDL (R=0.76, p=0.030). : In patients with PCOS, LH, FSH, and prolactin levels were found to be increased. A correlation was observed between Se and AMH, and a relationship was noted between LH and HDL. Selenium appears to have a significant influence on the ovarian reserve.

In this era of globalisation and pandemics, automation in clinical laboratories is in huge demand as it enhances the workflow process. Laboratory automation is one field which does not remain untouched and when it comes to automation in diagnosis of chronic diseases like tuberculosis it augments the long list of tests which are in current use. Mycobacterium spp. specially Mtb is one slow growing bacterium which requires a long waiting time till the diagnosis can be made and this could result in high mortality as is evident from large number of people who die due to tuberculosis. The automation in mycobacteriology tends to fasten this process and help in reduction of a large economic burden on developing countries where these diseases are endemic. Various automated methods have been introduced, when it comes to detecting Mycobacterium spp., covering spectrum from microscopy to molecular methods. This chapter addresses the need for automation in detecting Mycobacterium spp. along with various technologies which have brought a revolution in field of diagnosis and cure.

The technology which process microbiology samples without human assistance and better ergonomics is termed as automation. We are experiencing a new revolution of artificial intelligence via automation. Globally, researchers and microbiologists are upgrading their laboratories from conventional methods to total laboratory automation considering the increased awareness about impact of infectious diseases, rising sample load and lack of expertise of skilled manpower resources. This chapter discusses various purposes and defined objectives of automation.

The automation in microbiology has been introduced some 30 years back. Major advances in technology over few decades led to the introduction of automated devices for sample inoculation, transportation to smart incubators, followed by its digital reading. The automation in aerobic bacteriology began first with the launch of first generation automated specimen processors, which took place more than 20 years ago. The various automated sample inoculation instruments now available are the Innova (BD), the InoqulA (BD Kiestra), the Previ-Isola (bio- Mérieux), the WASP (Copan) and the BD Phoenix AP (BD). Quite a number of automated aerobic bacterial ID and AST systems are also available in market. FDA cleared automated systems for phenotypic identification of bacteria includes: Vitek −2 (Biomerieux), MALDI-TOF MS (Biomerieux), MicroScan (Siemens Healthcare Diagnostics), Phoenix (BD Diagnostics) and Aris 2X (Sensititre, Thermo Fisher). For complete colony counting, two types of automatic colony counters are available, first are the digital counters which are not automatic in complete sense. It is dependent on the technician to identify and probe the colony. Another one is the semi- automatic or automatic counters. These are equipped with hardware to capture high quality images. Automation in blood culture system was one of the very early automations to be seen in the field of microbiology. Automated blood culture system was first developed in 1970. Currently three automated microbial detection systems have been approved for use in the detection of bacteremia, namely the BacT/Alert 3D (bioMerieux), BD Bactec Plus (BD) and VersaTREK (TREK diagnostics system). Studies have shown that automated systems have been successful in increasing the sample screening rates by around 19% for positive stool specimens, detection of MRSA, VRE and ESBL producing microorganisms has increased by around 2%, 5% and 5% respectively in various clinical specimens. Studies are also needed to assess the financial, operational and clinical impact of automation in microbiology.

Objective The purpose of the study is to establish the prevalence of stroke as well as the clinical and radiological correlates of stroke in children with tuberculous meningitis (TBM). Methods and Materials A prospective observational study was conducted at the Pediatric Department, King George’s Medical University (KGMU), Lucknow, Uttar Pradesh, India. Using a computed tomography (CT) scan/brain magnetic resonance imaging (MRI), patients were divided into stroke and non-stroke groups. Demographic characteristics, clinical presentations, cerebrospinal fluid examination, basal meningeal enhancement, hydrocephalus, tuberculoma, and clinical outcome were compared between the two groups. Results Seventy-eight TBM patients, aged between 6 months and 14 years, were included. Out of 78 enrolled patients, 3 (3.8%) had definite TBM, 73 (91%) had probable TBM, and 4 (5.1%) had possible TBM (LCS). As per the Medical Research Council (MRC) staging, 13% had Stage 1 TBM, 26% had stage 2, and 61% had stage 3 TBM. Out of 78 patients with chest X-ray findings, 42 (53%) had findings suggestive of tuberculosis (TB), which included 33 (42%) with hilar lymphadenopathy and 9 (11%) with a miliary pattern. On neuroimaging, hydrocephalous was seen in 62.8% of cases, basal meningeal enhancement in 64.1%, tuberculoma in 6.4% of cases, and infarction in 53.8% of cases. There was no statistically significant association found between the staging of TBM and the presence of infarction as the majority of cases involved were in stage 3 of the disease (61.5%). TBM patients with stroke had poor clinical outcomes. Conclusion Age, altered sensorium, focal neurological deficits, vomiting, and basal meningeal enhancement can predict the occurrence of stroke in young adults with TBM.

The association between serum interleukin-6 (IL-6) and highly sensitive C - reactive protein (hsCRP) as predictors of the risk factors for Myocardial Infarction. The study included a total of 50 patients with Myocardial Infarction, aged between 25 to 74 years. The levels of hsCRP were measured using the immunoturbidimetry method, while Interleukin 6 was estimated using the sandwich ELISA method. Statistical analysis was conducted using SPSS version 21.0, with p values calculated using Quartile ratio, ANOVA unpaired t-test, and Kaplan-Meier Curve Method. A p-value of less than 0.05 was considered statistically significant. All participants underwent a questionnaire, physical examination, medical history assessment, and laboratory tests. The results of the study showed that there was a significant correlation between IL-6 and hsCRP levels in the Quartile groups, as well as with lipid profiles. The Kaplan-Meier method also demonstrated a significant association between IL-6 and hsCRP levels in participants. The comparison of biomarkers further supported these findings. Thus, data shows that elevated levels of hsCRP and IL-6 could serve as valuable diagnostic markers for predicting Acute Myocardial Infarction. Our study strongly suggests that IL-6 could be a powerful marker in evaluating the Myocardial Infarction.

Pediatric cholesteatomas (PC) have multifactorial aetiology, spread aggressively and there are high chances of residual/ recurrent disease after treatment. The surgical technique to manage this entity has been debatable. This study was done to (i) enumerate the presentation of PC and the surgical techniques adopted (ii) analyse the outcomes viz., residual/ recurrence rates and hearing results. A cross sectional record based study was done on 618 cases of PC operated between 1983 and 2015, at a centre dedicated to otology and lateral skull base surgery. The data which was maintained on the basis of clinical and peri- operative findings was analysed. Otorrhea (59.2%) and hearing loss (54.2%) were the common symptoms. The surgeries done were: canal wall up (CWU) (44.3%), canal wall down (CWD) (41.1%), modified bondy’s mastoidectomy (5.7%), radical mastoidectomy (4.9%), trans canal excision (1.8%) and subtotal petrosectomy (2.3%). The residual and recurrence rates were 12.6% and 7.9% respectively. A significant difference between the pre and post operative hearing was observed. The mean improvement in air bone gap was 7.7db. Residual/ recurrent disease were higher in CWU as compared to CWD group. The surgery should be individualised so that the patient remains disease free.

Background The most frequent lesion in the blood vessels feeding the myocardium is vascular stenosis, a condition that develops slowly but can prove to be deadly in a long run. Non-invasive biomarkers could play a significant role in timely diagnosis, detection and management for vascular stenosis events associated with cardiovascular disorders. Aims The study aimed to investigate high sensitivity troponin I (hs-TnI), cardiac troponin I (c-TnI) and high sensitivity C-reactive protein (hs-CRP) that may be used solely or in combination in detecting the extent of vascular stenosis in CVD patients. Methodology 274 patients with dyspnea/orthopnea complaints visiting the cardiologists were enrolled in this study. Angiographic study was conducted on the enrolled patients to examine the extent of stenosis in the five prominent vessels (LDA, LCX, PDA/PLV, RCA, and OM) connected to the myocardium. Samples from all the cases suspected to be having coronary artery stenosis were collected, and subjected to biochemical evaluation of certain cardiac inflammatory biomarkers (c-TnI, hsTn-I and hs-CRP) to check their sensitivity with the level of vascular stenosis. The extent of mild and culprit stenosis was detected during angiographic examination and the same was reported in the form significant (≥50% stenosis in the vessels) and non-significant (<50% stenosis in the vessels) Carotid Stenosis. Ethical Clearance for the study was provided by Dr. Ram Manohar Lohia Institute of Medical Sciences Institutional Ethical Committee. Informed consent was obtained from all the participants enrolled in the study. Results We observed that 85% of the total population enrolled in this study was suffering from hypertension followed by 62.40% detected with sporadic episodes of chest pain. Most of the subjects (42% of the total population) had stenosis in their LAD followed by 38% who had stenosis in their RCA. Almost 23% patients were reported to have stenosis in their LCX followed by OM (18% patients), PDA/PLV (13%) and only 10% patients had blockage problem in their diagonal. 24% of the subjects were found to have stenosis in a single vessel and hence were categorized in the Single Vessel Disease (SVD) group while 76% were having stenosis in two or more than two arteries (Multiple Vessel Disease). hs-TnI level was found to be correlated with the levels of stenosis and was higher in the MVD group as compared to the SVD group. Conclusion hs-TnI could be used as a novel marker as it shows prominence in detecting the level of stenosis quite earlier as compared to c-TnI which gets detected only after a long duration in the CVD patients admitted for angiography. hs- CRP gets readily detected as inflammation marker in these patients and hence could be used in combination with hs-TnI to detect the risk of developing coronary artery disease.

Introduction Parkinson's disease (PKD) is neurodegenerative disorder marked by tremors, bradykinesia, muscle rigidity and reduction in precise hand movements which could lead to improper oral hygiene and Periodontal disease. Current systematic review aims to review existing literature and provide assessment of periodontal health in PKD patients through a meta‐analysis Methods Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines and registered in PROSPERO—CRD42023451700. Databases were searched for studies having sufficient data on periodontal health in patients with PKD compared to healthy controls and reporting outcomes in terms of various periodontal parameters of probing depth (PD), plaque index (PI), clinical attachment level (CAL), presence of bleeding on probing and gingivitis. Quality assessment of included was evaluated using Newcastle Ottawa Scale (NOS). Results Eleven studies fulfilled the eligibility criteria, of which ten studies were suitable for meta‐analysis. Pooled estimate through the SMD showed that all periodontal parameters were altered and significantly deteriorated in PKD compared to controls but this group differences were statistically insignificant ( p > 0.05). Publication bias through the funnel plot showed symmetric distribution with absence of systematic heterogeneity. Conclusion Parkinson's disease could be a possible factor in deterioration of periodontal health.