Clinical outcomes following surgical management of brain abscess in a tertiary care centre: retrospective analysis of 56 cases

Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.

Microneurosurgical aspects in the management of posterior cranial fossa epidermoids: experience of 24 cases

Background: There is considerable debate in the surgical management of epidermoid cyst, whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis, and surgical strategy and extent of resection in the management of posterior cranial fossa epidermoid cyst.Methods: A retrospective review of 24 patients diagnosed with posterior cranial fossa epidermoid tumors surgically treated at the institution between January 2010 and July 2019.Results: A total of 24 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 13 were in the Cerebellopontine angle region, eight were in the fourth ventricle, and three in lateral cerebellar convexity. The mean duration from onset of symptoms to surgery was 1.6 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively, most of them being the CPA epidermoids. Total removal was achieved in 16 patients, near-total resection in 6 patients, and subtotal removal in 2 patients. Three patients developed recurrence radiologically of them only one patient became symptomatic. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white material in all cases. Complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient.Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection of lesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.

Critical Evaluation Of Complications Of Neck Dissection

BACKGROUND: Radical neck dissection is a reliable method of treating patients with head and neck cancer; it carries substantial morbidity and complications. This surgery has become a routine in many oncological centres but knowledge of possible complications and their management is a must for treating surgeons METHODS: In this study 60 patients undergoing neck dissection as elective or therapeutic, comprehensive or selective, as a sole procedure or combined with other surgery, with or without other modalities of treatment were selected and managed and all the complications were critically analysed. RESULTS: A total of 26 complications (43.3%) occurred in this study. There were 7 cases of thoracic duct injury (11.6%), 5 cases of post operative chyle leak (8.3%) and 2 cases of RLN injury (3.3%) and 1 case of injury to main trunk of facial nerve (1.6%), 2 patients had temporary paresis of marginal mandibular nerve (3.3%). Post operatively marginal necrosis of skin flap was present in 8 patients (13.3%) and 1 patient had facial and glottic oedema (1.6%). CONCLUSION: Despite the best planning, complications can still occur but their impact can be minimised by a vigilant and proactive emphasis in the entire peri-operative period.

Epidemiological analysis of central nervous system tumors in pediatric patients from a tertiary care centre in India

Background: Tumors of the nervous system are the second most common childhood cancer after leukemia. The diagnosis of CNS tumors is challenging due to non-specific symptoms in children which mimic other less serious illness.Methods: This was a retrospective analysis of case records of patients from 0-18 years of age, who were diagnosed with CNS tumors for a period of 7 years.Results: Out of total 64 patients included in this study, 32 were females and 24 were males. The mean age was 13.2 years. The most common clinical presentation in patients with brain tumors was headache (92.3%) followed by visual symptoms in the form of blurring or loss of vision (42.3%) and swaying while walking (32.6%). The overall mean symptom interval for all patients was 274.8 days (approx. 9 months) ranging from 7-1820 days. In the present study out of total 64 patients, 54 were brain tumors (35 supratentorial and 19 infratentorial) and 10 were spinal tumors. The most common tumor location was cerebellum (21.8%) followed by cerebral cortex, spine and sellar area. Based on histopathology the most common tumor type in our study was astrocytoma. There was no significant correlation of symptom interval with age and gender but was significantly associated with location and tumor grade.Conclusions: Early referral to centers with appropriate facilities will help, as many pediatric CNS tumors are low grade with better survival.

Research orientation in Ayurveda educational institutions: Challenges and the way forward

This paper examines the scenario of research orientation in Ayurveda educational institutions of India.We demonstrate through the data obtained by searching the SCOPUS that the actual research outputby these institutions is not very significant in terms of number of publications. While a lack of researchexpertise and infrastructure is one contributing factor to this status, a lack of questioning attitude is morecrucial one. Mushrooming of new colleges, laxity in regulations, corruption, lack of atmosphere forethical and quality research make the problem more complex. We show, with the help of SCOPUS Data,that the recent trend of establishing stand-alone institutions of Ayurveda may not help in invigoratingresearch activities since the research contributions from such institutions have always been very poor.Instead, we suggest that existing stand-alone institutions of Ayurveda be merged with other establishedCentral/State universities or other Medical colleges. The data demonstrates that the research output hasbeen always significant when an institution has many experts working in different streams of sciencewithin, than when the institutions have only Ayurveda experts. We also take up the question of designingthe clinical trials that are suitable for Ayurveda and propose an algorithm that may be considered forresearch in educational institutions, at least at doctoral level. We further enlist a set of recommendationsthat could potentially change the scenario. Evidence-informed policy making, inducting clinicians intothe education system, making the curricula more attractive by including recent advances, introducingefficient faculty training programs, and rigorous implementation of the existing regulations - are some ofthe key recommendations we have made.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hanu Basti– An Innovative Procedure In Hanu Sandhigata Roga

Osteoarthritis, a form of arthritis is characterised by chronic degeneration of various hard and soft tissues around the joint. It can also affect the Temperomandibular joint and called as TMJ osteoarthritis. The non dental causes of oral pain closely related to Temperomandibular disorder. It affects both sexes with higher prevalance in women. Hanubasti a form of Bahya Sneha and Sveda, designed on the principle of Shirobasti. Here the word innovative is used because the SOP (standard operating procedure) of Hanubasti is unique and new. We have standardized the procedure and want to conduct large trial of the same. In this article, an attempt is made to describe the methods, indications and precautions of Hanubasti procedure based on the clinical experience and evidence based medicine (EBM).

Biofilm production and multidrug resistant bacterial isolates in ventilator associated pneumonia

Context: Ventilator-associated pneumonia is the second most common complication among all types of nosocomial infections. Mechanical ventilation predisposes to formation of a biofilm which worsens the prognosis because of increased multidrug resistant isolates implicated in formation of biofilm. Aim of the Study: The study was conducted to find out the relationship between duration of mechanical ventilation, biofilm formation, and antibiotic resistance among VAPpathogens. Study Design and Methods: A descriptive analytical study of 150 clinically suspected VAPpatients was done. Patients were divided into Group I and II based on intubation duration for 1–5 days and more than 6 days, respectively. Endotracheal aspirate was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ? 106 CFU/ mLfor quantitative cultures were considered significant. Biofilm production was detected by tissue culture plate method. Multivariate analysis was done to find out the association of the various factors. Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacterbaumannii. Among Gram negative bacteria 66.8% were ?-lactamase producers. In biofilm production by tissue culture method, Group I patients, 72.4% of the isolates showed either strong / moderate biofilm formation and in Group II patients, 92.3% of the isolates showed either strong / moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAPoccurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested. Conclusion: Bacterial aetiology, prolonged intubation, biofilm formation, and drug resistance have ramification on outcome of VAP. Hence removal of ET tube in regular intervals should be considered with a proper choice of antimicrobial treatment or using ETtube coated with drugs/ biomaterials that discourage biofilm formation may be explored.

GC-MS Compositional Analysis of Essential Oil of Leaf and Fruit Rind of Citrus maxima (Burm.) Merr. from Coastal Karnataka, India.

Essential oils derived from plants by hydro distillation possess several medicinal properties. Citrus maxima (Burm.) Merr. fruit is nutritive, cardiotonic, refrigerant, in stomach troubles, puerperal sepsis and insanity; while leaves are useful in epilepsy, chorea, convulsive cough and stomach pain due to indigestion. Gas chromatography coupled with mass spectroscopy (GCMS) has been used for detection and identification of volatile components from the hydro-distillate from leaf and rind of Citrus maxima (Burm.) Merr. of Rutaceae. Yield of oil was more in rind (0.12%) compared to leaf (0.07%). Forty two and thirty four compounds were detected from leaf and fruit respectively, among which citronellol (28.26%) was the major component in the leaves while D-limonene (89.04%) in the rind. Volatile compounds responsible for various medicinal properties are identified from hydro-distillate of Citrus maxima (Burm.) Merr. from Dakshina Kannada using GC-MS.

A Comparative Study of Temporalis Fascia versus Tragal Peri-chondrium as Graft in Repair of Tympanic Membrane Perforation

The perforations of the tympanic membrane may be of traumatic origin or due to chronic suppurative otitis media. If the perforations fail to heal conservatively, they require surgical closure. Autologous graft materials have stood the test of time in repairing tympanic membrane perforations. In our tertiary care institution, we conducted a prospective randomised control trial on 20 subjects to evaluate the comparative efficacy of temporalis fascia and tragal perichondrium as grafting material in underlay tympanoplasty. In this study, surgical success was evaluated in terms of intact drum membrane and minimal complications during the follow-up period. Temporalis fascia achieved a graft uptake of 90% and a satisfactory hearing improvement in 76% of the patients with minimal postoperative complications. Tragal perichondrium achieved a success rate of 80% graft uptake and 75% hearing gain. The rates are comparable with no statistical significance of difference between them.

Analysis of Virechana karma with Danti avaleha: A retrospective study.

Virechana (therapeutic purgation) is a common procedure that is widely practiced among the panchakarma treatments (pentad treatments). Various Virechaka dravyas (purgative drugs) have been described for Virechana. Even after critical analysis of Virechaka dravyas in the literature, still there is difficulty in the fixation of dose. Hence, the retrospective analysis of varied outcomes of Virechana with Danti (Baliospermum montanum) avaleha (linctus) is discussed in this paper. The study included twenty‑seven case reports of patients who were administered Virechana with Danti avaleha. These case reports are of patients suffering from various ailments such as irregular menstrual cycles, polycystic ovarian syndrome, primary and secondary infertility, and psoriasis. Danti avaleha was administered at dose of 10 g and 5 g in the Krura (~strong) and Madhyama (~moderate/normal) Koshta (~GI tract) patients, respectively. Among seven Krura koshta patients, three of them resulted with Pravara (excellent) Shuddhi and other four resulted with Madhyama (medium) Shuddhi. In twenty Madhyama koshta patients, sixteen of them resulted with avara (minimum) Shuddhi and remaining four patients resulted with Madhyama shuddhi. Complications like Udara shoola (spasmodic pain of abdomen) and Vamana (emesis) were observed during Virechana. Majority of the patients suffered with Udara shoola were of Madhyama koshta. Vamana was seen in both Krura and Madhyama koshta patients. Irrespective of the type of Shuddhi and complications, all the patients resulted with Samyak Kaphaantiki Virikta lakshana (signs of perfect purgation with end expulsion of Kapha). The study concluded that the Krura koshta patients were tolerable for dose of 10 g and are expected to attain Pravara Shuddhi. Whereas Madhyama koshta patients were intolerable even to mild dose of 5 g, producing Avara shuddhi.

Study of various congenital anomalies in fetal and neonatal autopsy.

Background: The study of dead is to save the livings. The growing awareness that still births and infant mortalities are unable to reduction has led to a wide spread desire for more information regarding the cause of these deaths. Congenital malformations have become important cause of fetal and neonatal (perinatal) mortality in developed countries and would very soon be increasingly important determinants of fetal and neonatal mortality in developing countries like India. In spite of antenatal diagnostic modality still the fetal autopsy plays the vital role in the conformation as well as identification of congenital anomalies and also for the counseling of the parents, to prevent the fetal congenital anomalies in further pregnancies. This study was undertaken with the purpose of finding out cause of death during the perinatal period at government maternity hospital and pediatric department S.V.R.R.G.G.H. & S.V. medical college Tirupati, and to study the clinical and pathological findings (Gross & microscopic) in fetal and neonatal death. Methods: The present study of congenital anomalies in fetal and neonatal deaths was done at S.V. medical college, Tirupati, over a time period of 2 years from September 2008 to 2010 August. Consent for autopsy in requested compassionately, respectfully and fully informed. The present study included dead fetus and neonates with gestational age above 20 weeks of intra uterine life and within 7 days of post natal life. All fetuses of gestational age <20 weeks and all neonates above 7 days of age were excluded from the study. The study also obtained clearance from the ethical committee of the institution. Autopsy was performed by standard technique adopted by Edith L. Potter. External and internal findings followed by histopathological examination, and autopsy findings were compared with available ultrasound findings. Results: A total of 46 Autopsies performed, 40 (87%) were fetal deaths, 6 (13%) were early neonatal deaths. In a total of 46 fetuses, there were 13 male and 33 female babies. On external examination of 46 fetal and Neonatal (perinatal) deaths, 8 (17.39%) babies showed congenital malformation. On internal examination of the 46 fetal and Neonatal (perinatal) deaths, 4 babies showed internal congenital anomalies. A total of 46 anatomical and histopathologic examinations were done among fetal and neonatal (perinatal) deaths. Out of 13 autopsies on male babies, 2 had congenital malformation and 33 autopsies on female babies, 7 had congenital malformations. Congenital anomalies were commonest in the birth weight group of 1000-1500 grams accounting for 9 cases. Malformations of central nervous system (33.33%) were most common followed by musculoskeletal system (16.66%), genitourinary and respiratory system (8.33%) respectively. Conclusion: Most number of perinatal deaths occurred in low birth weight and preterm babies. Study of malformations greatly helpful in genetic counseling and prenatal diagnosis in successive pregnancies.

Evaluation of micronutrient (zinc, copper and iron) levels in periodontitis patients with and without diabetes mellitus type 2: A biochemical study.

Context: Periodontal tissue destruction is caused by an inappropriate host response to microorganisms. Diabetes is a metabolic disease and most of its complications are due to hyperglycemia. Periodontitis is considered as its sixth complication. Micronutrients such as zinc, copper and iron are essential for human health. There is accumulating evidence that the metabolism of several trace elements is altered in diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progress of this disease and its complication. An association between micronutrients and periodontitis has also been suggested by preliminary studies. However, till date there is a lack of relevant clinical data. Aim: This study was designed to estimate and compare the serum levels of zinc, copper and iron in diabetes mellitus type 2 patients and healthy individuals with and without periodontitis. Setting and Design: Single centre case-control study. Subjects and Materials: This study included 150 subjects, 50 in each group. Group 1 comprised of 50 subject with diabetes mellitus type 2 and periodontitis. Group 2 comprised of 50 subjects with chronic periodontitis and Group 3 comprised of 50 control subjects. Atomic absorption spectrophotometry method was used to measure clinical level of zinc and copper in serum. Estimation of serum iron levels was done by bathophenanthroline method. Statistical analysis: The results obtained were tabulated and subjected to statistical analysis by analysis of variance and Tukey multiple comparison tests using statistical software SPSS version 17. Results: The results showed that the serum levels of zinc decreased and serum levels of iron and copper increased in diabetes patients with periodontitis compared to healthy individuals with and without periodontitis. Conclusion: Imbalance of Zinc, copper and iron levels in the serum can predispose an individual to the risk of developing periodontitis.

Feeding Obturator - A Presurgical Prosthetic Aid For Infants With Cleft Lip And Palate - Clinical Report.

Cleft lip and palate is a congenital deformity that may be associated with various craniofacial problems and crumbles the overall development of the child. Early surgical treatment is imperative but may need to be postponed until certain age and weight gain of the infant. The present article is a case report of an infant with cleft lip and palate for whom a feeding obturator was the treatment of choice. It describes various problems associated with cleft lip and palate, available treatment modalities; and advantages of the feeding obturator.

Disseminated blastomycosis in a child with a brief review of the Indian literature.

Disseminated blastomycosis is rare in India, particularly in the pediatric population. We discuss the clinical picture, progress and outcome of disseminated blastomycosis in a 4-year-old child. We also present a brief review of the literature focussing on the scenario of blastomycosis in India.

The Effect of Chemical (Glutraldehyde ) And Microwave Sterilization on Flexural Strength Autopolymerizing (PMMA ) Resings.

This Study evaluated the effect of disinfection methods on the Flexural Properties of Auto Polymerizing Resin. (Tooth Colored and Repair Resin). Specimens were exposed to microwaves for 15 min and 2 % Glutaraldehyde for 10 hours. Specimens stored in Water for 12 hours were used as control. For each procedure 10 specimens were used. The result indicated that changes in Flexural Strength observed were of no significance for both Tooth Colored and Repair Resin. The Microwave method is useful alternative to immersion disinfection having advantage of less time consumption.

The effect of posture on esophageal ph in endoscopy normal reflux disease (ENRD) cases.

Purpose of the study Endoscopy Normal Reflux Disease (ENRD) is a common presentation of reflux disease. These patients are symptomatic but do not have abnormal endoscopy findings. They may have pathological intraesophageal reflux. Lifestyle modifications are the mainstay of management of these patients. Posture plays an important role in their management. It was felt that exact quantification of reflux pattern with different postures in ENRD cases should be studied to include it as a part of management of these cases. Basic Procedures Fifteen male patients were studied. 24 h ambulatory pH metry was done for all patients. Half an hour recording was studied for various postures: supine, supine with 30° head end elevated, upright, right and left lateral recumbent position. The data of pH metry for half an hour of each of these postures was studied. Results and Interpretation All fifteen patients were ENRD cases and were upright refluxers. None of them had an abnormal supine reflux pattern. The percentage time of reflux and the reflux episode duration was significantly low in supine (P<0.05) and supine with 30° head end elevated (P<0.005). Conclusion In our study of 15 upright refluxers, supine with 30° head end elevated and supine position were the postures associated with least reflux. Posture can help reduce the reflux significantly and can be used as an effective means in management.

Congenital extraskeletal Ewing's sarcoma of chest wall - A rare case report.

Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.

Large congenital melanocytic nevus with metastatic melanoma with a probable primary in the lung.

Large congenital melanocytic nevi (>20 cm in greatest diameter) are very rare and are seen in approximately 1 in 20,000 newborns. The major risk these patients face is the development of neurocutaneous melanosis or malignant melanoma. We report a rare case of large congenital melanocytic nevus with metastatic melanoma in a 40-year-old woman. In this case, though the primary was not established with certainty, on the basis of clinical course and radiological evaluation of various organs, we presume that the primary could be in the lung.

Cemento - Ossifying Fibroma- A Case Report.

Mandibular resection and reconstruction was done with rib graft on right side for a boy suffering from cemento-ossifying fibroma. The defect secondary to surgical ablation of mandible have far reaching consequences like speech, respiration, mastication, deglutition and cosmetics and growth disturbances. Restoring these functions is a challenging task. However, fairly regular crop of complications do occur during these surgical reconstructions. This article reports a rare case of an 11years old boy diagnosed as cement ossifying fibroma who underwent mandibular reconstruction with rib graft and the details of the follow up of the case for 6 months.