Trapped Fourth Ventricle in Recurrent Acoustic Schwannoma - A Rarity

Fourth ventricular dilatation is usually seen along with tri-ventriculomegaly in patients with communicating hydrocephalus. Isolated fourth ventricular dilatation is uncommon, especially as a sequelae following infective or post hemorrhagic communicating hydrocephalus. Communicating hydrocephalus is reported in vestibular schwannoma with an incidence of 3.7 to 23.5%, but 4th ventricular dilatation following its treatment has not been reported in the literature. We report a novel case of isolated fourth ventricular obstruction following surgery for recurrent vestibular schwannoma and ventriculoperitoneal shunt placement for communicating hydrocephalus. Management strategies range from endoscopic procedures to ventricular shunt placement. We describe the surgical technique for the placement of a fourth ventricular shunt with the use of a Y connector.

Em pacientes com hidrocefalia comunicante, a dilatação do quarto ventrículo é normalmente vista acompanhada de triventriculomegalia. A dilatação do quarto ventrículo isolado é incomum, especialmente como uma sequela subsequente à hidrocefalia comunicante infecciosa ou hemorrágica. Hidrocefalia comunicante é relatada em schwannoma vestibular com incidência de 3,7 a 23,5%, mas a dilatação do quarto ventrículo subsequente ao tratamento não foi encontrada na literatura. Relatamos caso de obstrução do quarto ventrículo isolado subsequente a cirurgia para schwannoma vestibular recorrente e shunt ventriculoperitoneal para hidrocefalia comunicante. As estratégias de manejo variam de procedimentos endoscópicos a shunt ventricular. Descrevemos técnica cirúrgica para alocação de shunt do quarto ventrículo com o uso de conector Y.

Prevalence of diabetes mellitus in rural population of district Sonepat, India.

Background: Both rural and urban areas in India are currently experiencing a great spurt in lifestyle diseases such as diabetes mellitus, hypertension and ischaemic heart disease. The shift in epidemiology from communicable diseases to non-communicable diseases indicates that the rural population is also at a high-risk for developing diabetes mellitus. Aims & Objective: The overall objective of present study was to estimate the prevalence of diabetes mellitus in rural population of district Sonepat, Haryana state. Material and Methods: The study was planned to estimate the prevalence of diabetes mellitus in various age groups by analysing the hospital record based data. Blood for glucose estimation was collected in a fluoride vacutainer and glucose was estimated by kit based GOD –POD method. Fasting plasma glucose ≥ 126 mg/dl and or 2 hour postprandial glucose ≥ 200 mg/dl were taken as the diagnostic criteria for diagnosis. Results: Gender specific prevalence for diabetes was 19.36% and 16.98% for male and female respectively. Maximum prevalence of diabetes 41.96% was found in the age group of 46-60 yrs. In this age group Mean fasting plasma glucose among males was 149.36 ± 19.51 and among female it was 147.43 ± 18.19. Mean 2 hour postprandial plasma glucose was 259.94 ± 51.36 & 259.65 ± 51.39 in male and female respectively. Conclusion: Rural population remains exposed to high level of blood sugar for long time due to lack of screening facility of diabetes at PHC level, and this increases the chance of developing various complication of diabetes mellitus.

Malignant Arrhythmia with Benign Tumour: Fibrolipoma of the Left Ventricle

We report a case of young male referred for evaluation of recent onset recurrent syncope. Inhospital electrocardiogram revealed an episode of ventricular flutter which reverted spontaneously to sinus rhythm. Transthoracic echocardiogram showed hyperechoic mass in the left ventricle. For further tissue characterization a cardiac magnetic resonance imaging was done which revealed a left ventricular mass with predominant fat content. The tumor was surgically resected. Histopathological examination confirmed the diagnosis of cardiac fibrolipoma. The patient recovered and is currently asymptomatic.

Predictors of health behaviours among people with recently diagnosed Type 2 diabetes.

Background: Behavioural interventions shown to be an effective strategy (in terms of changing behaviour among those at risk) for targeting multiple high risk behaviours in relation Type 2 diabetes. Physical activity plays an important role in the management of Type 2 diabetes. Aims & Objective: The overall aim of study was to identify demographic and psychosocial predictors of change in self-reported physical activity and to identify targets for future interventions. Material and Methods: Participants (N = 478) of this study were all randomized into the ADDITION Plus trial and were recruited from 36 practices in East Anglia region, in U.K. Participants were people recently diagnosed with diabetes (screen detected and clinically diagnosed within the preceding 3 years were individually randomized) and were between the age group of 40-69 years, (mean age 59.2 years). The present study is an observational cohort study. For the current study self-reported data regarding physical activity measured at baseline and one year were used and all demographic (age, sex, ethnic group, age finished full time education, current working status, socioeconomic status) and psychosocial (perceived behaviour control, intention) predictors were assessed at baseline. Linear univariate and multivariable linear regression analysis was used to quantify the associations between demographic and psychosocial correlates. Results: Adjusting for baseline physical activity, only ‘current working status’ and ‘physical activity at baseline’ independently predicted physical activity at one year. No significant associations were found for any other correlates. Conclusion: Present study found very few predictors of physical activity over the year. It is critical to further investigate the change in physical activity by including other correlates related to demography, psycho-social, environmental influences such as family support, physical environment etc. Present findings outline that being employed predicted physical activity over 12 months, accordingly it may be suggested that future interventions should be planned for retired, not working and employed people.

Shifting trends of HIV epidemiology among most at risk groups (MARGs) in India.

Background:HIV/AIDS is one of the major barriers for community development. HIV epidemic in India is mainly concentrated among Most at Risk Groups (MARGs)/ High Risk Groups (HRGs) i.e. Injecting Drug Users (IDUs), Female Sex Workers (FSWs), Men who have sex with men (MSM) & Transgender and their sexual partners. National AIDS Control Programme (NACP) phase- II (year 1999-2006) & phase-III (year 2007-2012) envisaged and implemented Targeted Interventions (TIs) across country which has helped in somewhat containing the HIV epidemic among HRGs in various pockets. The implementation of Targeted Intervention programme has remained invariably different based on the response of respective State AIDS Control Societies (SACS). Objective:To analyze the shifting trends of HIV epidemiology among MARGs, identify lessons learnt and examine future aspects of public health interventions among MARGs. Materials and Methods:Present research has systematically reviewed HIV epidemiology among Most at Risk Groups (MARGs) using 16 peer reviewed research papers, HIV Sentinel Surveillance Survey (HSS) reports (years 2007 and 2008-09), National Family Health Survey (NFHS)-3 report, epidemiological studies, public health intervention reports via online database ‘PubMed’ and ‘Web of Science’ are analysed. Results:Findings of various studies defining the HIV prevalence among MARGs highlights HIV prevalence ranging between 3.0 % to 70.0% in some pockets. These findings may not be generalized considering the limited sample size used in such studies. Annual rounds of HIV Sentinel Surveillance Survey (HSS) are considered more reliable and generalizeable. The trend of HIV prevalence among MARGs based on three years moving average show a consistent fall in HIV prevalence among FSWs in erstwhile high prevalence states. Whereas the trend of HIV prevalence among MSM & Transgender show initial decrease between period 2003 to 2006 and then rise from 2006 to 2007. HIV prevalence among IDUs show decrease from 2003 to 2008 in Manipur, Nagaland, and Chennai and notable increase reported in Meghalaya, Mizoram, West Bengal, Mumbai, Kerala and Punjab. There are regional variations in HIV prevalence among MSM & Transgender and Injecting Drug Users. Conclusion:Review has outlined that despite reduction of new HIV infections (by 50% from 2000 to 2009) and reported decline in HIV prevalence among Female Sex Workers, a sustained focus on prevention is required among MARGs and their partner to contain HIV. However selection bias, non response bias, under reporting bias, surveillance bias in these studies might have also affected the results. There is felt need for more qualitative and behavioural researches to corroborate with HIV epidemiology and trends among MARGs.