Tuberculous meningitis masquerading as acute ischemic stroke in young adult

Tubercular meningitis (TBM) constitute 5% of all cases of extra pulmonary tuberculosis but a presentation leading to an ischemic stroke in a young adult is a rare clinical entity. In a case of TB vasculopathy, vasculitis, venous thrombosis and aneurysm may be the underlying events leading to a stroke. Stroke in TBM is seen in the tubercular zone which encompasses internal capsule, thalamus and caudate nucleus. Inflammatory mediators like TNF alpha, Interferon gamma and vascular endothelial growth factor have been implicated in the pathogenesis of arteritis. Imaging modalities like MRI show lesions which are usually bilateral in the territory of the perforating vessels. We report a case of 24 year old Asian male who presented with complaints of headache, projectile vomiting and altered sensorium. On examination his Glasgow Coma Scale (GCS) was 10/15, with left oculomotor and left facial nerve palsy, and hypotonia of all 4 limbs with bilateral plantar reflexes being mute. Contrast MRI of brain showed acute infarct, meningeal enhancement and basal exudates. He was started on Anti-tubercular therapy and steroids, but had a poor clinical outcome, due to his late presentation.

Efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients

Background: Acute Myocardial Infarction is one of the leading causes of mortality and morbidity. Now there are a number of drugs for Thrombolysis but still Streptokinase is used in many of the centers because of the ease of availability and less cost. ST segment elevation resolution following thrombolysis is simple, non-invasive, accessible tool for the assessment of coronary reperfusion. Objective of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, with respect to resolution of ST-elevation on treatment with streptokinase and also to predict short term outcome during hospital stay in terms of adverse events and mortality.Methods: 60 Acute STEMI patients who had received thrombolytic therapy with streptokinase were studied in three groups namely Category A, Category B and Category C based on ST segment resolution after administration of thrombolytic therapy.Results: Of 60 patients, 9 patients (15%) had <30% ST resolution (no STR), 26 patients (43.3%) had 30-70% ST resolution (partial STR), 25 patients (41.7%) had >70% ST resolution (complete STR).Conclusions: In the present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI is 41.7%. Patients with no resolution of ST segment 90 minutes following thrombolysis associated with more frequent adverse events and increased mortality compare to partial and complete resolution group.

Height is a risk factor for development of peripheral insensate neuropathy

Background: Peripheral insensate neuropathy is one of the most common and forms of peripheral neuropathy. It is a preeminent cause for disability, foot ulcers, deformity and amputations in individuals who are at risk.Methods: A study was conducted in Mahatma Gandhi Medical College & Research Institute, Pondicherry, India in the year 2017-18, which included examination of 760 people of more than 30 years of age by random sampling method who was attending the outpatient clinic. The Semmes Weinstein monofilament was adopted to ascertain the presence of peripheral insensate neuropathy.Results: In present study, the prevalence of peripheral insensate neuropathy was 3.2%. As the height increased, the prevalence of peripheral insensate neuropathy increased, regardless of other independent risk factors like diabetes, hypertension, etc. The risk of the peripheral insensate neuropathy increases at a height of >171.5cm in males and at a height of >164.5cm in females.Conclusions: The authors confirm that body height is a significant and independent risk factor for peripheral insensate neuropathy, regardless of co-morbidities. Height as a guide, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy.

Effect of Titanium dioxide nanoparticles on the flexural strength of polymethylmethacrylate: An in vitro study.

Context: To improve the flexural strength of polymethylmethacrylate (PMMA). Aim: To evaluate whether the incorporation of titanium dioxide nanoparticles in polymethylmethacrylate (PMMA) increases the flexural strength and to compare the different concentrations of titanium dioxide nanoparticles and its relation to flexural strength. Settings and Design: Study was conducted in Sri Ramachandra University utilizing 40 specimens manufactured from clear heat polymerizing acrylic resin. Materials and Methods: Forty specimens of clear heat polymerizing acrylic resin of dimensions 65 × 10 × 3 mm as per ISO 1,567 standardization were fabricated and were grouped into A (CONTROL) with no titanium dioxide (TiO2) nanoparticles, B with 0.5 gms of TiO2 nanoparticles, C with 1 gm of TiO2 nanoparticles and D with 2.5 gms of TiO2 nanoparticles added.The concentrations of titanium dioxide in each group were 1 wt%, 2 wt% and 5 wt%. Universal testing machine INSTRON was used to load at the center of the specimen with a cross head speed of 1.50 mm/min and a span length of 40.00 mm. Statistical Analysis Used: ANOVA and multiple comparisons are carried out using the independent t‑test. Results: The ANOVA result shows that there is a significant difference between the groups with respect to the mean flexural strength. Highest mean flexural strength is observed in Group D, while the lowest is seen in Group A. Independent t‑test revealed that there was a statistical significance between Group A and Group D (0.041) and between Group B and Group D (0.028). Conclusions: The results concluded that polymethylmethacrylate reinforced with different concentrations of titanium dioxide nanoparticles showed superior flexural strength than those of normal PMMA.