Optic nerve sheath diameter as a non-invasive indicator of intracranial hypertension in traumatic brain injury: correlation with CT head and prognostic implications

Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD correlating with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006) in patients with negative findings on CT. ROC curve with average cut off of 6 mm correlated with positive CT findings with sensitivity of 80%, specificity of 70% and negative predictive value of 87% was found. Conclusions: Ultrasound-guided ONSD monitoring shows promise for diagnosing intracranial hypertension in traumatic brain injury. Correlations with CT, GCS, and outcomes emphasize its clinical relevance, warranting further validatio.

Internet Addiction and Sleep Quality Among Medical Students of Delhi: A New Age Epidemic

Background: Recently there is an explosive growth of internet usage among youth worldwide. Internet addiction is defined as psychological dependence on the Internet leading to inability to control one’s use of the Internet. Objective: To study the prevalence of internet addiction and quality of sleep among medical students of Delhi and to find out the factors associated with internet addiction. Methods: A cross-sectional study, using stratified random sampling method was conducted among un-dergraduate students of VMMC & Safdarjung hospital Delhi. Young’s internet addiction test and Pitts-burgh sleep quality index was administered. Results: Mean age of study participant was 20.3 ± 2.3 SD years. Internet addiction was found in more than half of the study participant. Poor sleep quality was also found in more than half (57.2%) of them. On analysing internet addiction with associated factors, it was observed that gender, monthly data usage, source of internet use, phone use while eating, ever notice by teacher in class while using phone, month-ly expenditure and quality of sleep were statistically significantly (p < .001) associated. Conclusion: This study implies that internet addiction was high among medical student. More than half of the study participants was suffering from poor sleep quality.

Radiation therapy outcomes in muscle invasive urinary bladder cancer: A single institution experience.

INTRODUCTION: To audit the survival outcomes and loco‑regional control in muscle invasive urinary bladder cancer patients treated with external beam radiation therapy (RT). MATERIALS AND METHODS: From November 2008 through December 2011, 50 consecutively diagnosed muscle invasive urinary bladder carcinoma (T2‑4a N0‑2, M0) patients were included in this retrospective study. All these patients received external beam RT to a median dose of 60 Gy (range 30‑66 Gy), and were not suitable for radical surgery due to patients’ preference or medical comorbidities. A stepwise procedure using proportional hazard regression was used to identify prognostic factors with respect to survival. RESULTS: Completion trans‑urethral resection of bladder tumor was done in 38 (76%) patients of the cohort and 47 (94%) had transitional cell carcinoma on histopathology. Clinical stage T2 was diagnosed in 40 (80%) patients. The median follow‑up for the entire cohort was 14 ± 8.9 months (range 1‑36 months). In conclusion, 24 patients (48%) were free of disease, 5 patients (10%) had residual disease, and 13 patients (26%) had died of disease. Two‑year and 3 year overall survival of intact bladder for the entire cohort was 58% and 43.6%, respectively. Cox regression modeling strongly suggested clinical stage (P = 0.01) and RT dose (P = 0.001) as being predictors for overall survival. CONCLUSION: RT shows reliable outcomes and excellent compliance in this advanced disease. Prescribing a higher RT dose could potentially correlate to better intact bladder control rates while maintaining good quality of life in selected patients.

Experiences of identification and differentiation as functions of leprosy, personality and age.

It is a study of sociogenic need satisfactions that determines the homeostasis of 'being' by remaining contingent conditions of perpetuation or debasement of the social 'self'. The paper has a focus on identification satisfaction and differentiation experience of patients of the highly stigmatized leprosy. The study proceeds with an 'Experimental Group--Control-Group' randomized design. Experimental Groups are two, viz., those of Lepromatous and Non-lepromatous patients. 'Control Group' consists of 'disease-free' normal people. The three independent variables are disease types, age, personality factors. The dependent variables are two, viz., score of identification satisfaction and differentiation experience, measured by standardized tools. Each dependent variable has four '3 X 3 X 2' factorial experiments to test 56 'Null Hypotheses'. The sample consists of 360 elements for each one of the eight experiments. Leprosy elements are drawn from the Central JALMA Institute for Leprosy and the 'Kushta Seva Sadan' (Agra). The 'F' test is run for statistical verification of 'Null hypotheses'. Results show presence of 'role-reversion' and 'role negation' of age and personality factors. The disease possesses 'anti-roles'. It does not allow age and personality factors to promote identification satisfaction and to demote differentiation and experience. The disease actively promotes differentiation and demotes identification through its own 'alien system'. The senescents are the greatest sufferers. 'Social Stigma' works a 'social thanatos' and exposes senescents to substantial 'self-erosion'.