Neurological Recovery Pattern in Cervical Spondylotic Myelopathy after Anterior Surgery: A Prospective Study with Literature Review

STUDY DESIGN: Prospective clinical study. PURPOSE: The present study aimed to examine the neurological recovery pattern in cervical spondylotic myelopathy (CSM) after anterior cervical decompression and compare it with the existing reports in the literature. OVERVIEW OF LITERATURE: Neurological recovery and regression of myelopathy symptoms is an important factor that determines the outcomes of surgical decompression. The present findings contribute to the literature on the pattern of neurological recovery and patient prognosis with respect to the resolution of myelopathy symptoms after surgery. METHODS: This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total of 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively followed up for 1 year and were evaluated for their neurological recovery pattern. The postoperative outcome was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. The recovery rate was calculated using Hirabayashi's method. The JOA score was assessed before the operation and postoperatively at 1 week, 2 weeks, 1 month, 3 months, 4 months, 6 months, and 1 year. RESULTS: The postoperative mJOA score was 0 in the 1st month, 12.90±3.57 in the 3rd month, 13.50±3.55 in the 4th month, 14.63±3.62 in the 6th month, and 14.9±3.24 at the final follow-up of 1 year. The average recovery rate during the 1st month follow-up was 0%, and that during the 3rd month follow-up was 12.91% with a range of 0%–50%. The average recovery rate during the 4th month was 32.5%, with a range of 0%–60%, while that during the 6th month was 72.83%, with a range of 0%–100%. The average recovery rate during the final follow-up of 1 year was 54.3%. CONCLUSIONS: Neurological recovery after surgical decompression starts from the 3rd postoperative month and progresses until the 6th postoperative month; thereafter, it gradually plateaus over the subsequent 6 months until it steadies. Symptom duration is an important factor that requires consideration while determining postoperative neurological recovery.

Enseñanza de salud pública durante la formación médica en la India / Undergraduate teaching of public health in medical colleges of India

Introducción: La Salud Pública, Medicina Comunitaria o Medicina Preventiva y Social, como se la conoce habitualmente en las facultades de medicina de India, es una materia importante en términos de su relevancia para la salud. Objetivo: En este estudio se intenta ofrecer una visión general de la enseñanza de Medicina Comunitaria en el nivel de programa de las facultades de medicina de India. Resultados: En la actualidad existen 299 facultades médicas en India, de las cuales egresan unos 28.000 graduados al año. Se enseña Medicina Comunitaria en todas las facultades. Hemos citado ejemplos de enseñanza innovadora y de métodos de evaluación que han sido empleados en algunas facultades de medicina en el país, así como hemos intentado aprender lecciones de los casos discutidos. Discusión y conclusiones: Se observa que los programas fuertemente basados en la experiencia comunitaria, el abordaje multidisciplinario, la participación activa de la población, la provisión de servicios de atención médica, la permanencia en el lugar de los estudiantes y los métodos de enseñanza epidemiológica por medio de situaciones de la vida real, lo que los hace interesantes y relevantes para los alumnos, son algunos de los métodos esenciales para un entrenamiento exitoso en Salud Pública de los estudiantes de pregrado. Por lo tanto, la enseñanza basada en la comunidad debería enfatizarse de manera destacada.

Toxic epidermal necrolysis due to Dapsone treatment in a patient with Hansen's disease: a case report

Dapsone is a sulfone antimicrobial and is used widely as an antileprotic medication. The commonly encountered cutaneous adverse drug reactions [ADR] due to dapsone are exfoliative dermatitis, toxic 'erythema, erythema multiforme, morbilliform and scarlatiniform eruptions, urticaria, erythema nodusum and toxic epidermal necrolysis [TEN]. We hereby report a case of toxic epidermal necrolysis caused due to dapsone. The causality, severity and preventability assessments were carried out. The patient was treated with systemic hydrocortisone, antibiotics and other symptomatic drugs. The reaction was severe and the patient expired on the second day of hospital admission in spite of the treatment. Since TEN is a life threatening cutaneous ADR and dapsone is a commonly used drug, this reaction needs monitoring

Transient acantholytic dermatosis [Grover's disease] - a case report

Transient acantholytic dermatosis was described by Grover. Its definite cause and pathogenesis is unknown. A 22-year-old man presented to our out-patient department with multiple itchy vesicles and pustules on the neck and chest. The biopsy was done and histopathology findings revealed focal acantholytic dyskeratosis. Case was diagnosed as Grover's disease. Patient was given vitamin A 50000 IU per day and later dapsone was added. Patient was advised to avoid sunlight and heat. This is the first case of biopsy confirmed Grover's disease from Nepal

Re-Engineering the liver with natural biomaterials

The extensive regenerative capacity of hepatocytes and the key roles of the liver in metabolic processes have generated interest in the liver as an appropriate target for cell and gene therapy. If cells were considered as natural biomaterials, then liver cell transplantation would fall within the general field of bioengineering. While unmodified hepatocytes engraft in the liver and ectopic sites, biological modifications and optimization of bioengineered systems would facilitate engraftment and survival of transplanted cells, especially in ectopic locations. Acute liver failure, chronic liver disease and metabolic deficiency states are among the conditions that can potentially be treated by cell transplantation. In acute liver failure, cell transplantation into the liver, along with the creation of an extrahepatic reservoir of cells might be required because engraftment and proliferation of transplanted cells in the liver needs time. In other situations, gradual liver repopulation alone might well be effective without additional manipulations.