Epidermoid cyst of the brain: A common cystic lesion in rare location

Epidermoid cysts are common benign tumors comprising around 1% and 2% of all intracranial tumors. Their usual locations include the parasellar region and cerebellopontine angle, and less commonly, the Sylvian fissure, suprasellar region, cerebral, and cerebellar hemispheres. Epidermoid cysts located in the brain stem are rare. These epidermoid cysts are similar to epidermoids arising in the skin which contain cheesy and flaky-white soft pultaceous material. Epidermoid cysts are very slow-growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from the remnants of epidermal elements during the closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the 3rd and 5th weeks of embryonic life. The ideal treatment of choice is the removal of cystic components with the complete resection of the capsule. We are presenting an interesting case of an epidermoid cyst in the frontal lobe in a 42-year-old male along with radiological investigations.

Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 Infection During the First and Second Waves of the Pandemic

Objectives To compare the clinical profle and short-term outcome of children admitted with acute SARS-CoV-2 infection during the frst and second waves of the Coronavirus Disease (COVID-19). Methods This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confrmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay. Results One thousand and twenty-four children were recruited, 592 of the frst wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR=3.38) and neurological manifestations (OR=4.61). There was a higher requirement of intensive care (OR=4.2) and invasive mechanical ventilation (OR=4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the diference was not statistically signifcant. Children with neurological comorbidities (OR=8.73), malnutrition (OR=3.01), and preterm babies (OR=6.8) were associated with severe COVID. Conclusion The clinical profle of the second wave of COVID-19 in children was diferent from the frst wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a signifcant increase in the incidence of severe infections requiring ICU care was observed.

Schwannoma in the nasal cavity: A benign nerve sheath tumor at an odd location

Schwannomas are neurogenic tumors arising from the Schwann cells present in the neural sheath of the myelinated nerves. These are benign tumors that can arise anywhere in the body. Schwannomas are rarely seen in the nose and paranasal sinuses representing <4% of all head-and-neck schwannomas. Surgical excision is the treatment of choice in these cases. Nasal polyps are common nasal cavity lesions which are usually inflammatory polyps. Schwannoma of the nasal cavity usually presented with headache, unilateral nasal obstruction due to mass obliterating the nasal cavity, and epistaxis. Here, we report the case of a 47-year-old female who presented with a mass in the left nasal cavity causing the nasal blockage.

Musician-Advantage on Listening Effort for Speech in Noise Perception: A Dual-Task Paradigm Measure

Background and Objectives@#Speech in noise (SIN) perception is essential for effective day-to-day communication, as everyday conversations seldom transpire in silent environments. Numerous studies have documented how musical training can aid in SIN discrimination through various neural-pathways, such as experience-dependent plasticity and overlapping processes between music and speech perception. However, empirical evidence regarding the impact of musical training on SIN perception remains inconclusive. This study aimed to investigate whether musicians trained in South Indian classical “Carnatic” style of music exhibited a distinct advantage over their non-musician counterparts in SIN perception. The study also attempted to explore whether the listening effort (LE) associated in this process was different across musicians and non-musicians, an area that has received limited attention. @*Subjects and Methods@#A quasi-experimental design was employed, involving two groups comprising 25 musicians and 35 non-musicians, aged 18-35 years, with normal hearing. In phase 1, participants’ musical abilities were assessed using the Mini-Profile of Music Perception Skills (Mini-PROMS). In phase 2, SIN abilities were tested using the Tamil phonemically balanced words and Tamil Matrix Sentence Test at -5 dB, 0 dB, and +5 dB SNR. Phase 3 tested LE using a dual-task paradigm including auditory and visual stimuli as primary and secondary tasks. @*Results@#Fractional logit and linear regression models demonstrated that musicians outperformed non-musicians in the Mini-PROMS assessment. Musicians also fared better than non-musicians in SIN and LE at 0 dB SNR for words and +5 dB SNR for sentences. @*Conclusions@#The findings of this study provided limited evidence to support the claim that musical training improves speech perception in noisy environments or reduces the associated listening effort.

Comparative Study of Bilastine and Fexofenadine in Control of Intermittent Allergic Rhinitis

Background: Allergic rhinitis (AR) impacts 10-30% of the world affecting the quality of life of many. Hence, the requirement of a treatment targeted at delivering maximum symptom control and has minimum to no side effects. Objectives: Comparison of efficacy of Bilastine and Fexofenadine in patients suffering from intermittent allergic rhinitis with the help of Total Nasal Symptom Scoring(TNSS) and assessment of side effects- sedation and cardiac toxicity. Methodology: 60 subjects diagnosed with intermittent allergic rhinitis (IAR) were recruited and divided into groups of 30 each. One group was started on Bilastine 20mg OD and the other on Fexofenadine 120mg OD. TNSS was calculated based on symptom severity at presentation, on 10th day and 30th of antihistamine therapy. AEC values and ECG changes were compared for both groups at day 0, day 30. Measurement of sedation was done at day 10, day 30. Intergroup comparison and intragroup assessment of TNSS and its variables, sedative effects and ECG changes at day 0 and day 30 were done using Un-paired and Paired T-test. Results: Patients showed reduction in symptoms of AR with both drugs. TNSS and Rhinorrhoea showed significant improvement in Fexofenadine group as compared to Bilastine. AEC values showed significant reduction in both groups. Statistically significant ECG changes were seen after 30 days of Fexofenadine therapy but were clinically insignificant. No sedative effects were noted with both drugs. Conclusion: Both Bilastine and Fexofenadine were found to be effective in reducing symptoms in patients with IAR. Fexofenadine was more effective than Bilastine in overall symptom control and specifically in controlling rhinorrhoea after one month of therapy. Both the drugs had no sedative effects or cardiac toxicity.

Risk Factors of First Episode Simple Febrile Seizures in Children Aged 6 Month to 5 Year: A Case Control Study

Objective: To study the risk factors of first episode simple febrile seizures in children. Methods: This case control study was conducted at the pediatric department of our tertiary care hospital. Cases were children of age group 6 months to 5 years presenting with first simple febrile seizures (n=214), and Controls were children of same age group presenting with short febrile illness but without any seizures (n=214). Blood investigations were done to diagnose iron deficiency, which was diagnosed by adopting cut off of hemoglobin value <11 g/dL, serum ferritin < 12 ng/mL and red cell distribution width >15%. Other risk factors studied included age, gender, socioeconomic status, prematurity, family history of febrile seizure and epilepsy in first degree relatives, consanguinity, neonatal hospital admissions, day care attendance (for >1 mo), under nutrition, and immunization status of the child. Univariate analysis for crude odds ratio and multivariate analysis (logistic regression) was performed to study the adjusted odds ratio and independent risk factors. Results: The significant risk factors for first episode simple febrile seizure were iron deficiency [OR (95% CI) 5.78 (3.56-9.38); P=0.001], family history of febrile seizure [OR 4.31 (2.37- 7.83), P<0.001] or epilepsy [OR 4.25(2.21-8.19), P<0.001] in first degree relatives, day care attendance for >1 month [OR 4.81 (2.41-9.59), P<0.001], and prematurity at birth [OR 5.18 (2.48-10.84), P<0.001]. Conclusion: Iron deficiency, family history of febrile seizure and epilepsy in first degree relatives, day care attendance and premature birth are the risk factors for first episode simple febrile seizures in children.

Impact of Metal and Metal Oxide Nanoparticles on Male Reproductive System: A Comprehensive Review

Technological advancements and increased use of chemically hazardous materials have become a concern for human health. Environmental pollutants such as engineered metal and metal oxide nanoparticles (M&MONPs) are reported to contribute to significant health-related problems, particularly reproductive health. Reduction in male individuals' reproductive potential is one of the important causes of concern. Literature suggests that exposure to M&MONPs considerably impacts alteration in male reproductive parameters. Therefore, it is required to analyze and understand their effects on male reproductive toxicity. Oxidative stress and changes in redox equilibrium are the significant factors via M&MONPs induce changes in sperm parameters or the reproductive system. Act as endocrine disruptors and interfere with the secretion and function of reproductive hormones such as testosterone and LH, affecting spermatogenesis. Likewise, M&MONPs accumulate in organs as they can pass through the blood-testis barrier, affect Sertoli and Leydig cells, and cause reproductive dysfunction. In this review, we have analyzed the effects of M&MONPs on the male reproductive system and the underlying mechanism of action

Mammary analogue secretory carcinoma of the parotid: An arduous maze to solve

Mammary analogue secretory carcinoma (MASC) is an unusual and rare salivary gland malignancy that recapitulates the genetic and microscopic features of secretory carcinoma of the breast (SCB) which is an equally rare entity. MASC and SCB express S-100 protein, vimentin, mammaglobin, and harbor a t (12; 15) (p13; q25) translocation which leads to ETV6-NTRK3 fusion product. The morphology of MASC is not specific and can overlap with many salivary gland tumors. S100 and mammaglobin抯 strong positivity confirm the diagnosis of MASC. The morphology along with immunohistochemical findings provides important clues for diagnosis. Recent advances in molecular pathology help in investigating both differential diagnosis and prognosis in salivary gland oncology. Molecular testing is recommended to arrive at a diagnosis of MASC. We report a case of MASC of the parotid gland in a 47-year-old male patient with his immunohistochemical profile.

Bioactive extract of mycelia biomass of Ganoderma lucidum protects doxorubicin induced cardiomyopathy

Cardiotoxicity induced by anticancer drug; doxorubicin (DOX) is a limiting factor for its prolonged use in chemotherapy. No effective drug is currently available to prevent DOX induced cardiomyopathy. Ganoderma lucidum is highly valued medicinal mushroom used in traditional medicine. Mycelia biomasses are considered as alternate sources of mushroom bioactive compounds. We examined the effect of bioactive extract of G. lucidum mycelia biomass (GLME) to prevent cardiotoxicity induced by DOX in rats using a cumulative dose 18 mg/kg body wt. GLME was administered to animals at doses of 250 and 500 mg/kg body wt. once daily for five days prior to DOX administration and continued for three more days. Animals were sacrificed 24 h after the last dose of drug. Activities of creatine kinase (CK), lactate dehydrogenase (LDH), endogenous antioxidant status, oxidative stress markers, electrocardiograph (ECG) and haematological parameters were evaluated. DOX administration drastically elevated CK, LDH, myocardial peroxidation and oxidative stress and significantly lowered endogenous antioxidant activity. GLME administration attenuated elevated levels of CK, LDH and oxidative stress and also ameliorated alterations in haematological and ECG parameters. Results revealed that bioactive extract of G. lucidum mycelia imparted significant protection against DOX induced cardiomyopathy suggesting the potential therapeutic significance of G. lucidum mycelia bioactives to alleviate DOX induced cardiomyopathy.

Short term outcomes with dual chamber versus single chamber pacing for atrioventricular block - A crossover trial

A total of 42 patients were studied for primary outcomes of quality of life and 6MWD between VVIR and DDD modes. At end of 2 months after device implantation, randomization was done and the device was programmed to VVIR or DDD modes. At the end of 2 months in this mode QOL and functional was assessed and the patient was switched to other mode. The same protocol was followed at the end of 2 months. We found no difference in functional capacity and quality of life between the two pacing modes. None of the patients developed pacemaker syndrome and there was no preference for any of the modes.

Postoperative outcomes in patients undergoing elective general surgery after recovery from Covid-19 at a tertiary care centre: A one-year case series

BACKGROUND Planned elective surgery had to be postponed for a large number of patients who tested positive for Covid-19 in the preoperative period. We aimed to assess the postoperative outcomes of patients who were operated on for elective indications, following recovery from Covid-19 infection. METHODS We did a retrospective study of patients who underwent elective general surgery between 1 April 2020 and 31 March 2021, following recovery from Covid-19. The 30-day postoperative morbidity and mortality were analysed. The data relevant for the study were retrieved from the hospital’s electronic medical records. RESULTS Of the 109 patients included, 54.1% were women and the median (range) age was 49 (16–76) years; 53.2% of operations were performed for benign indications and the rest were for malignancies. Eighty-five (78%) patients underwent surgery following recovery from an asymptomatic Covid-19 infection and 23 (21.1%) patients following recovery from mild Covid-19 infection; 73.3% of the operations were performed following a planned delay of 2– 5 weeks from the diagnosis of Covid-19. The 30-day major postoperative morbidity (Clavien–Dindo grade ?3) was 6.4%, the postoperative pulmonary morbidity was 0.9%, and there was no 30-day mortality. CONCLUSIONS Elective general surgical procedures can be done safely in patients who have recovered from asymptomatic and mild Covid-19 infection, following a minimum wait period of 2 weeks.

The outcome of partial pulpotomy in traumatized permanent anterior teeth – A systematic review and meta-analysis

Background: Partial pulpotomy is a procedural intervention that can maintain the vitality of pulp during the management of traumatized permanent teeth with pulpal involvement. Aim: To evaluate whether partial pulpotomy can be considered a reliable conservative treatment option for treating traumatized permanent anterior teeth with pulpal involvement. Methodology: A computerized systematic search was performed in PubMed, Science Direct, Cochrane, and LILACS databases from 1980 to May 2021. Five studies were included in the final analysis. Quality assessment, Meta?analysis, and Publication bias of the studies were evaluated. This systematic review was registered in PROSPERO (ID – CRD42021262031). Result: The comprehensive Meta?Analysis Software was used. The test of the heterogeneity was analysed using Cochran’s Q statistics. The Q value was 7.186 (df = 6) with a P value of 0.3 and I2 as 16.5%. The studies were considered homogenous, and the fixed?effect model showed an overall point estimate of 0.89 with a 95% confidence interval (0.86–0.91). The Begg and Egger funnel plot indicated that there was no publication bias in the included studies. Conclusion: Evidence indicates that partial pulpotomy may be considered a reliable definitive treatment option in asymptomatic traumatized permanent anterior teeth with exposed pulp rather than total pulpotomy.

Cross sectional study of depression, anxiety and quality of life in glaucoma patients at a tertiary centre in North Kerala

Purpose: To determine the magnitude and direction of association of anxiety and depression and the quality of life (QoL) in persons with glaucoma. Methods: This prospective cross?sectional study in conducted in a tertiary eye center in north Kerala included glaucoma patients and normal subjects aged 40–80 years. The Patient Health Questionnaire?9 (PHQ?9), the Generalized Anxiety Disorder?7 (GAD?7), Glaucoma Quality of Life (GQOL), and glaucoma evaluation were performed for all participants. One?way analysis of variance was used for statistical analysis. Results: The study included 148 subjects with glaucoma and 150 subjects without glaucoma. The prevalence of depression (35.81%) and anxiety (25.0%) was significantly higher in glaucoma patients. In a multivariate regression model, PHQ?9 (adjusted OR: 2.39, 95% CI: 1.31–4.38, P < 0.001), GAD?7 (adjusted OR: 2.06, 95% CI: 1.01–4.19, P = 0.01) and GQOL (coefficient: 6.92, 95% CI: 4.52–9.31, P = < 0.001) was significantly associated with glaucoma. The GAD?7 score was significantly higher (P = 0.02) in PACG compared to POAG in moderate and severe anxiety. ADL scores (one?way ANOVA, P = 0.001) and GQOL scores (one?way ANOVA, P < 0.001) were significantly associated with vision impairment and blindness. Conclusion: Depression and anxiety are common in glaucoma patients, indicating the need for screening protocols using PHQ and GAD scales to identify persons at risk. The lack of ophthalmic risk factors associated with depression and anxiety emphasizes the importance of psychological evaluation and combined management with a psychiatrist in glaucoma management.

Primary DLBCL of testis: Presenting as a case of testicular mass

Primary testicular non-Hodgkin’s lymphoma (NHL) is a rare, clinically aggressive form of extranodal lymphoma and constitutes 1% of all NHL and 5% of all testicular neoplasms. The vast majority of primary testicular lymphomas (PTLs) are diffuse large B-cell lymphoma (DLBCL); however, Burkitt’s lymphoma, anaplastic lymphoma, or Hodgkin’s lymphoma may primarily involve the testis but it is less common. High inguinal orchiectomy, along with chemotherapy with or without radiotherapy, is the current treatment of choice for these tumors. Here, we present the case of primary testicular NHL in a 72-year-old male.

Association between serum netrin-1, netrin-4 and risk of the acute coronary syndrome in patients with type 2 diabetes mellitus-A pilot study

The present study was done to assess the diagnostic utility of serum netrin-1 and netrin-4 for recognising the acute coronary syndrome (ACS) in type 2 diabetes mellitus (T2DM) patients. Forty-two T2DM patients with ACS (Cases) and forty-two T2DM patients without ACS (Controls) were compared. Cases had lower serum netrin-1 and netrin-4 levels than controls and were negatively associated with creatinine kinase-total, creatinine kinase-MB, troponin-T and H-FABP. ROC analysis showed that netrin-1 and netrin-4 had good sensitivity and specificity for ACS prediction in T2DM patients. Serum netrin-1 and netrin-4 levels might be considered complementary markers for ACS diagnosis in T2DM patients.

Effects of Spatial Training Paradigms on Auditory Spatial Refinement in Normal-Hearing Listeners: A Comparative Study

Background and Objectives@#This study compared the effectiveness of two spatial training programs using real and virtual sound sources in refining spatial acuity skills in listeners with normal hearing. @*Subjects and Methods@#The study was conducted on two groups of 10 participants each; groups I and II underwent spatial training using real and virtual sound sources, respectively. The study was conducted in three phases: pre-training, training, and post-training phases. At the pre- and post-training phases, the spatial acuity of the participants was measured using real sound sources through the localization test, and virtual sound sources through the virtual acoustic space identification (VASI) test. The thresholds of interaural time difference (ITD) and interaural level difference (ILD) were also measured. In the training phase, Group I participants underwent localization training using loudspeakers in free field, while participants in Group II were subjected to virtual acoustic space (VAS) training using virtual sound sources from headphones. Both the training methods consisted of 5-8 sessions (20 min each) of systematically presented stimuli graded according to duration and back attenuation (for real source training) or number of VAS locations (for virtual source training). @*Results@#Results of independent t-scores comparing the spatial learning scores (pre vs. post-training) for each measure showed differences in performance between the two groups. Group II performed better than Group I on the VASI test, while the Group I out-performed Group II on the ITD. Both groups improved equally on the localization test and ILD. @*Conclusions@#Based on the present findings, we recommend the use of VAS training as it has practical implications due to its cost effectiveness, need for minimal equipment, and end user usefulness.

Fatal adult-onset diaphragmatic hernia in the context of the COVID-19 pandemic

ABSTRACT Late-presenting or "Adult-Onset" Diaphragmatic Hernia is uncommon, especially in individuals with no history of trauma. The non-traumatic diaphragmatic hernia may be a Congenital Diaphragmatic Hernia [CDH] lately manifested as a sequela to an iatrogenic intervention or prolonged infections. We aim to explore the genetic correlations in "adult-onset" CDH, with an insight into the indirect contribution of the COVID-19 pandemic towards the fatal outcome.In this report, we present a case of an adult female who died from the complications of an undiagnosed adult-onset diaphragmatic hernia, deemed completely preventable, if not for the global COVID-19 pandemic. There was no prior history of physical trauma or medical history of any relevance.Early diagnosis and rapid surgical intervention remain the keystone management for successfully treating individuals affected by this entity. The decedent in question presented with symptoms demanding hospital stay for investigations that would have aided in timely diagnosis and prevented death. However, the excessive fear of COVID-19 prevented the patient from undergoing hospitalization and follow-up, delaying the diagnosis and leading to death.

Transcatheter Interatrial Shunts for the Treatment of Heart Failure with Preserved Ejection Fraction

Abstract Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, which accounts for about 50% of patients with heart failure (HF). The morbidity and mortality associated with HFpEF is similar to HFrEF. Clinical trials to date have failed to show a benefit of medical therapy for HFpEF, which may due to lack of uniform phenotypes and heterogeneous population. In addition, medical therapy proven for HFrEF may not address the pathophysiologic basis for HFpEF. Left atrial remodeling and dysfunction is central to HFpEF and accounts for secondary pulmonary hypertension and pulmonary vascular congestion that frequently occurs with exertion. Interatrial shunts represent a novel treatment modality for HFpEF. These shunts allow for left atrial decongestion and a reduction in pulmonary venous hypertension during exercise leading to improvements in hemodynamics, functional status and quality of life. Trials to date have demonstrated safety and short-term efficacy of these devices for HFpEF. The long-term benefits are currently being evaluated in ongoing trials. If effective, the use of interatrial shunts may be a new therapeutic paradigm for the treatment of HFpEF.

Effect of Quiet and Noise on P300 Response in Individuals with Auditory Neuropathy Spectrum Disorder

Abstract Introduction Auditory neuropathy spectrum disorder (ANSD) is a clinical condition in which individuals have normal cochlear responses and abnormal neural responses. There is a lack of evidence in the literature regarding the neural discrimination skill in individuals with ANSD, especially when the signal is presented in the presence of noise. Objectives The present study was performed with the aim to investigate auditory discrimination skill, in quiet and in the presence of noise, in individuals with ANSD and to compare the findings with normal-hearing individuals. Methods A total of 30 individuals with normal hearing sensitivity and 30 individuals with ANSD in the age range of 15 to 55 years old, with the mean age of 27.86 years old, were the participants. P300 response was recorded from both groups using syllable pairs /ba/-/da/ in oddball paradigm and the syllable /da/ in repetitive paradigm in quiet and at +10 dB signal-to-noise ratio (SNR). Results There was significant prolongation in latency and reaction time, and reduction in amplitude of P300 response and sensitivity in both groups with the addition of noise. The topographic pattern analysis showed activation of the central-parietal-occipital region of the brain in individuals with ANSD, whereas activation of the central-parietal region was observed in individuals with normal hearing. The activation was more diffused in individuals with ANSD compared with that of individuals with normal hearing. Conclusion The individuals with ANSD showed a significantly more adverse effect of noise on the neural discrimination skill than the normal counterpart.