Mini International Neuropsychiatry Interview Kid or Child Posttraumatic Stress Disorder Symptom Scale 5I for Posttraumatic Stress Disorder among Adolescent Girls Infected with COVID-19

Background: Posttraumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally life threatening or horrifying events. People suffering from PTSD are vulnerable for both physical and mental health. Objectives: To find out sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and to plot receiver operating characteristic curve taking Mini International Neuropsychiatry Interview-Kid (MINIKID) as the gold standard and Child PTSD Symptom Scale 5I (CPSS-5I) as the newer diagnostic tool for diagnosing PTSD. Materials and Methods: The cross?sectional study was carried out for a period of 6 months from January 2021 to June 2021 at R. L. Jalappa Hospital and Research Center, Kolar, Karnataka through telephonic interviews. All the data entered in Microsoft office Excel sheet, analyzed using the SPSSv22 (IBM Corp). Results: Sensitivity of the CPSS?5I was 56% and specificity was 96% compared with MINIKID. 83% and 85%, respectively, was PPV and NPV of the CPSS?5I compared with MINIKID. Area under the curve is 83.9% with P < 0.001 (72.5–95.2) indicating CPSS?5I is 84% sensitive proving to be a very good diagnostic tool for diagnosing PTSD. Furthermore, scores of 9.5 or 10.5 from CPSS?5I can be used as cutoff in diagnosing PTSD using CPSS 51. Conclusion: CPSS-5I is extremely well designed, helpful and functional tool used in diagnosing PTSD. With the current study showing CPSS-5I can be used in post-COVID PTSD diagnosis, it also provides cutoff which can be helpful in mass screening.

The Role of Tumour Budding as a Prognostic Factor in Primary Invasive Ductal Carcinoma of Breast.

Background: Tumor budding is considered as an essential step in invasion and as a poor prognostic factor in carcinoma.It is used as the main prognostic factor in colon cancer but it is now gaining popularity in other tumor types. Objectives of the study was to determine tumor budding and categorize it into low grade and high grade in primary invasive breast cancer patients and to determine the association of tumor budding with clinicopathological characteristics. An attempt was also made to compare cytokeratin expression in intra- tumoral and budding sites. Method: It was an observational-analytical study including 50 cases of surgically resected modified radical mastectomy specimens diagnosed as invasive breast carcinoma in the tertiary care hospital from October 2018 to March 2020. Tumor buds were counted in H&E and IHC stained sections in 10 high power fields. IHC marker used was pan cytokeratin. Cases were classified into low tumor budding and high tumor budding. Correlation of tumor budding was done with all the established clinicopathological characteristics. Cytokeratin expression was compared in tumor proper and budding sites. Results: Among the 50 casesof invasive breast carcinoma, 24 cases showed high tumor budding (>4/10HPF) and 26 cases showed low tumor budding (?4/10HPF). High tumor budding was seen with larger size of the tumor, higher primary tumor staging, higher lymph node staging, presence of lymphovascular invasion, lymph node involvement and presence of necrosis with a significant correlation. Also cytokeratin expression was similar in tumor proper and budding sites in 92% of the cases. Interpretation & Conclusion: Tumor budding showed significant correlation with tumor size, primary tumor staging, lymph node staging, lymph node involvement, lymphovascular invasion and tumor necrosis. Thus it can be considered as a significant prognostic factor in the invasive breast carcinoma and can be incorporated in the reporting protocol for breast cancer.

National pathology day – Commemorating a legend Dr. VR Khanolkar

The large-scale celebration of National Pathology Day on the birth anniversary of Dr. VR Khanolkar would help pathologists to showcase their role in patient care, medical education, and research, change the image of pathology, and bring this specialty to the forefront.

Brain banking in India: Relevance in current day practice

Biobanks are set to become the norm. The explosion of new and powerful technologies like genomics and other multiomics has catapulted research from individual laboratories to multi-institutional and international partners. Today, with increasing life span, and the rising incidence of brain diseases, Brain Banks have become an invaluable source for unravelling the pathogenesis of several brain disorders, and develop effective therapies. The article briefly reviews the evolution of brain banking, rise of global networks, with a brief overview of steps involved from donor recruitment, protocols of processing, storage, annotation, and tissue distribution. The ethics of biobanking is one of the most controversial issues in bioethics, the key issues being consent, confidentiality, and commercialisation. Regulatory authorities in different countries and in India, the Indian Council of Medical Research has taken a lead to formulate new ethical guidelines for research involving human participants protecting rights, and well-being of research participants. Although brain banks have been established in the 1960s, in India, the first Brain Bank was established in 1995 at the National Institute of Mental Health and Neurosciences, Bengaluru. Now a network with two more Brain banks is being established in the country. The challenges and benefits of establishing the first Brain Bank as a National Research Facility in India is shared. For optimising available resources and promote brain banking, it is essential for medical professionals, and the public to perceive the crucial advantage in conversion of biological waste into invaluable resources for neuroscience. This will be the greatest “gift of hope” that we can offer for the future generations to overcome hitherto untreatable disorders such as dementias.

Traumatic avulsion of the eyeball: a case report

Ocular trauma is very common, but globe avulsion along with optic nerve avulsion is a rare clinical event. Blunt trauma during a road traffic accident can cause rupture or avulsion of the globe and the outcome can range from complete recovery on repositioning to visual loss because of globe perforation or optic nerve injury. Here, authors report a case of a 20-year-old male who presented with history of a road traffic accident causing severe facial injuries. The physical examination revealed oedema and ecchymoses over the right side of the face with avulsion of the right eyeball anteriorly outside the orbit along with avulsion of the optic nerve. The visual acuity in the injured eye was no perception of light and the direct pupillary response was absent. Computed tomography revealed fracture of the roof and lateral wall of the right orbit. As the eye was not salvageable, enucleation surgery was done. Insertion of an ocular prosthesis for rehabilitation was planned. The presentation, investigations, surgery and follow-ups are described.

Histogenesis Of Human Foetal Thymus

Introduction: The thymus is a primary lymphoid organ. It is a bilobed structure divided into lobules by theconnective tissue septa. Each lobule consists of a cortex and medulla. Most of the studies regarding early foetalhistology of this organ are animal based. The present study has been undertaken to highlight some featuresregarding histogenesis of human foetal thymus.Materials and Methods: In the present study, 30 normal human stillborn/aborted foetuses were studied. Theobtained foetuses were fixed in 10% formalin. After proper fixation they were subjected to dissection. Theobtained specimens were processed by standard paraffin block making procedure. Sections were taken andstained with haematoxylin & eosin. The stained sections were examined under light microscopy using 10x and40x optical magnifications and photographs taken.Results: At 12th week, capsule was thin and cortico-medullary differentiation not much prominent. Epithelialcells and lymphocytes were present. Hassall’s corpuscles were very small and immature. Distinct lobulation wasseen at 18th week with well differentiated cortex and medulla. The gland became more distinct from 21stweekonwards with increased number of Hassall’s corpuscles of various types. 29 week onwards the thymus glandrevealed an adult histological picture.Conclusion: All structural changes viz cortico-medullary differentiation, lobulation and maturity of Hassall’scorpuscles occurred within the first 18 weeks of gestation.

Absence of Glia Maturation Factor Protects from Axonal Injury and Motor Behavioral Impairments after Traumatic Brain Injury

Traumatic brain injury (TBI) causes disability and death, accelerating the progression towards Alzheimer’s disease and Parkinson’s disease (PD). TBI causes serious motor and cognitive impairments, as seen in PD that arise during the period of the initial insult. However, this has been understudied relative to TBI induced neuroinflammation, motor and cognitive decline that progress towards PD. Neuronal ubiquitin-C-terminal hydrolase- L1 (UCHL1) is a thiol protease that breaks down ubiquitinated proteins and its level represents the severity of TBI. Previously, we demonstrated the molecular action of glia maturation factor (GMF); a proinflammatory protein in mediating neuroinflammation and neuronal loss. Here, we show that the weight drop method induced TBI neuropathology using behavioral tests, western blotting, and immunofluorescence techniques on sections from wild type (WT) and GMF-deficient (GMF-KO) mice. Results reveal a significant improvement in substantia nigral tyrosine hydroxylase and dopamine transporter expression with motor behavioral performance in GMF-KO mice following TBI. In addition, a significant reduction in neuroinflammation was manifested, as shown by activation of nuclear factor-kB, reduced levels of inducible nitric oxide synthase, and cyclooxygenase- 2 expressions. Likewise, neurotrophins including brain-derived neurotrophic factor and glial-derived neurotrophic factor were significantly improved in GMF-KO mice than WT 72 h post-TBI. Consistently, we found that TBI enhances GFAP and UCHL-1 expression and reduces the number of dopaminergic TH-positive neurons in WT compared to GMF-KO mice 72 h post-TBI. Interestingly, we observed a reduction of THpositive tanycytes in the median eminence of WT than GMF-KO mice. Overall, we found that absence of GMF significantly reversed these neuropathological events and improved behavioral outcome. This study provides evidence that PD-associated pathology progression can be initiated upon induction of TBI.

Current status of treatment of latent tuberculosis infection in India

In view of the high burden of latency of tuberculosis (TB) in India, tackling latent TB in the right way is a menace. All latent TB’s infection (LTBI) are treated in countries having low burden such as the United States. However, this approach cannot be implemented in high burden countries like India until concrete evidence or consensus by experts on this subject is made. There are very specific risk groups where these patients are to be treated as far as current evidence-based medicine is concerned. Hence, the need to develop a document was felt, through which the treatment of LTBI becomes homogeneous by each and every physician who is practicing and treating TB. The last attempt to review the topic was made in 2015, after which there have been many changes and update in this subject.

Rosuvastatin plus fenofibrate in diabetic dyslipidemia: a hospital record based study

Background: Cardiovascular diseases (CVD) are the leading cause of death throughout world population each and every year. Focus on dyslipidemia management is urgently required in India to halt the rising tide of CVD. The purpose of diabetic dyslipidemia study is a record based one, to find out the effect of Rosuvastatin plus Fenofibrate, in adult Type 2 diabetes with dyslipidemia, with high TGL/HDL ratio in Lipid profiles, in a tertiary care hospital in the Union territory of Puducherry.Methods: There were 101 patients hospital records were analysed in which male were 45 and females were 56. The various biochemical parameters like serum Total Cholesterol, HDL, LDL, TGL, Non-HDL, TCL/HDL Ratio and TGL/HDL ratio reports were collected before and after 12-weeks of Rosuvastatin 10 mg with Fenofibrate 145 mg combination, for the treatment period once daily for their lipid-lowering therapy.Results: The combination therapies of Rosuvastatin plus Fenofibrate were safe and feasible to achieve more TG goal and proved that has predominately decreased the elevated lipid profiles from the medical resources of our record based study. The use of combination medications of rosuvastatin (10mg) plus Fenofibrate (145mg) is often needed to effectively treat the lipid triad, by the potency of rosuvastatin to lower LDL-C and Fenofibrates effectiveness in lowering TG in treating mixed diabetic dyslipidemia.Conclusions: After Rosuvastatin (10mg) plus Fenofibrate (145mg), the lipid profile data proved that the importance of TGL/HDL ratio apart from the TCL/HDL ratio, for good lipid control in diabetic dyslipidemic patients.

A Sensitive Ultra-Fast Bioanalytical Method for the Quantification of Rabeprazole in Human Plasma.

A highly sensitive ultra-fast LC-MS/MS based bioanalytical method for the measurement of Rabeprazole in human plasma was developed and validated using 13C-D3-Rabeprazole as internal standard. Rabeprazole is a sulfabenzimidazole class of compounds, setting chromatography for these classes of compounds is always a challenge. Rabeprazole was extracted from human plasma samples by liquid-liquid extraction (LLE) and separated on a short reverse phase Ascentis® Express C18, 50 mm × 4.6 mm, 2.7 μm column by isocratic elution with 40% 10 mM ammonium acetate solution and 60% acetonitrile at a flow rate of 0.700 mL/min. Rabeprazole and its labeled internal standard were detected by multiple reaction monitoring (MRM) mode using electro spray ionization (ESI). All the validation parameters as per current guidelines like specificity, selectivity, accuracy, precision, recovery, matrix factor, haemolysis effect and stability are assessed in human plasma. Rabeprazole was found to be linear over a range of 0.1 ng/mL to 150 ng/mL in human plasma. LLOQ of0.1 ng/mL is sensitive enough for application to different clinical studies. The intra- and inter-day precision was less than 10% and accuracy was within -3.33 to 10.00%. Recovery (70%) was consistent across the linear dynamic range of the method. The validated method is a simple, accurate, precise and robust to measure Rabeprazole in human plasma and could be used for application to any format of clinical studies.

Comparison of def index with Nyvad's new caries diagnostic criteria among three to six years old children in a school at Bangalore city

Background: Dental caries is a multifactorial disease with varying clinical picture and its diagnostic criteria is complicated, when initial lesion is considered. Hence, there is a need for an index which measures cavitated, non-cavitated, and initial lesion in dental caries. So, the purpose of this study was to compare the of def index with Nyvad's new diagnostic criteria. Materials and Methods: A total of 249 school children in the age group of three to six years were selected for the study from Sajjan Rao School at Bangalore city. Children teeth were cleaned and dried with cotton rolls and chip blower. The dental caries examinations were conducted under standardized conditions using plane mouth mirrors and explorers with the help of artificial illumination. The diagnostic criteria used were deft and d, e, and f component of Nyvad's new caries diagnostic criteria. Mann Whitney 'U' test was used to compare the two indexes at five percent significant level. Results: The mean value for deft was 2.48 and the mean for d, e, and f component of Nyvad's new caries diagnostic criteria was 3.18 which shows statistically significant difference with P value of <0.05. Conclusion: The result obtained by Nyvad's new caries diagnostic criteria produces values much higher than those with def caries index system. Hence, Nyvad's new caries diagnostic criteria can be used to diagnose dental caries at the initial stages, which in turn will reflect exact prevalence of caries.

Dysferlinopathy: Spectrum of pathological changes in skeletal muscle tissue.

Background: Dysferlinopathy is an autosomal recessive-limb girdle muscular dystrophy (AR-LGMD) caused due to the defect in gene encoding dysferlin, a sarcolemmal protein. Awareness of the variants and their relative frequency is essential for accurate diagnosis. Aim: To study the spectrum of morphologic changes in immunohistochemically proven cases of dysferlinopathies, to correlate the findings with clinical phenotype and durations of illness and determine the frequency. Materials and Methods: Dysferlinopathies seen over a period of 2 years at a tertiary neurological center were analyzed. Results: Clinically, majority had Miyoshi phenotype (46.6%) with distal involvement and LGMD phenotype (40%) with proximal muscle involvement. In addition, a proximo-distal and tibial muscle phenotype was encountered. Morphologically, rimmed vacuoles were noted in the Miyoshi phenotype. The presence of ragged red fibers, lobulated fibers and inflammation had no preference to a particular phenotype. Significant atrophy and lobulated fibers were noted in patients with longer duration of illness. Conclusions: Dysferlinopathy was the second most common identifiable cause (21%) of LGMD next to sarcoglycanopathies (27%).

Biology of aging brain.

Normal aging of the nervous system is associated with some degree of decline in a number of cognitive functions. With the present day attempts to increase the life span, understanding the metabolic interactions and various mechanisms involved in normal neuronal aging continues to be a challenge. Loss of neurons is now recognized to be more modest than the initial estimates suggested and the loss only affected some of the specific neuroanatomical areas like hippocampus and prefrontal cortex. Individual neurons in addition show reduced size of dendritic and axonal arborization. Neurons have significant homeostatic control of the essential physiological functions like synaptic excitability, gene expression and metabolic regulation. Deviation in these normal events can have severe consequences as observed in aging and neurodegeneration. Based on experimental evidence, the evolution of aging is probably the result of altered metabolic triad: the mitochondria, reactive oxygen species and intracellular calcium homeostasis. Perturbations in the metabolic and functional state of this triad lead to a state of decreased homeostatic reserve, where the aged neurons still could maintain adequate function during normal activity. However, these neurons become vulnerable to the stress of excessive metabolic loads associated with spells of ischemia, trauma progressing to neuronal degeneration. Age-related neuronal dysfunction probably involves a host of subtle changes involving the synapses, receptors, neurotransmitters, cytological alterations, electrical transmission, leading to cognitive dysfunction. An exaggeration of it could be the clinical manifestation of dementia, with intraneuronal accumulation of protein aggregates deranging the metabolic state. This review deals with some of the structural, functional and metabolic features of aging nervous system and discusses briefly the functional consequences.

Histiocytosis Syndromes of Childhood: A report of four cases.

Histiocytosis Syndromes of Childhood (HSC) are a group of rare and diverse disorders characterized by aggressive proliferation or accumulation of cells of monocyte - macrophage system of bone marrow. The clinical spectrum of this syndrome is distinctly varied. The exact pathophysiology of HSC is yet to be determined; however, evidence suggests that one of the subtypes, Hemophagocytic Lymphohistiocytosis, is due to decreased Natural Killer cell activity, resulting in increased activation of other T cell subtypes and production of cytokines. We present four cases of HSC managed at our center between October 2008 & February 2010.

Hemorrhagic Pericarditis in a child with primary varicella infection (chickenpox).

Chickenpox (Varicella) representing the primary infection by Varicella zoster virus is a common benign and self-limited infectious disease of childhood. Although the disease can be associated with complications, they are generally mild and tend to occur in adults and immunocompromised children. Severe and life-threatening complications are extremely rare, particularly those involving the cardiovascular system. We report a malnourished 5-year-old girl with chicken pox complicated by hemorrhagic pericarditis and deep vein thrombosis leading to fatal pulmonary thromboembolism. Though varicella infection runs a benign self-limiting course, it continues to cause significant morbidity and mortality when associated with complications, particularly in malnourished children. Hence, the importance of vaccination and early recognition of complications is emphasized.

Biochemical analysis of protein stability in human brain collected at different post-mortem intervals.

BACKGROUND & OBJECTIVES: Rising prevalence of neurodegenerative disorders with a steady increase in aged-population necessitates studies of the human brain to understand their pathophysiology. As animal models are not available, medical centers have established "brain banks" to provide autopsy brain samples for such research. Frozen tissues must be of optimal quality to permit molecular and protein studies. Post-mortem interval (PMI) is an important factor affecting tissue quality although its effects on brain physiology are unclear. We undertook this study to analyze the biochemical effects of PMI on protein stability in human brains collected at autopsy and stored at the brain bank of a tertiary care neurosciences institute in south India. METHODS: Different neuroanatomical areas including frontal cortex (FC), cerebellum (CB), caudate nucleus (CD) and substantia nigra (SN) from autopsy human brains (n=9) with varying PMI (4-18 h) were analyzed for pH, protein insolubility, protein oxidation/ nitration and protein expression of glial fibrillary acidic protein (GFAP), synatophysin and neurofilament (NF). Histological changes at different PMI were also assessed. RESULTS: An increase in tissue pH was noted with increasing PMI. Although there was no significant alteration in solubility of proteins, SN showed increased protein oxidation/nitration events, GFAP and NF expression with increasing PMI. No major abnormalities in cell morphology or tissue integrity were noted. Immunohistochemistry with GFAP and NF did not show any significant increase in signal in FC at high PMI. INTERPRETATION & CONCLUSION: In post-mortem human brains, although there were no gross structural changes at the tissue level with increasing PMI, biochemical events such as oxidative and nitrosative damage of cellular proteins, tissue pH could be considered as markers of tissue quality for biochemical research. Further, SN was found to be most susceptible to PMI related changes.

Toxoplasma granuloma of brainstem: A rare case.

Toxoplasmosis is a common opportunistic infection in patients with AIDS in whom it frequently presents as intracranial space-occupying lesions. In the immunocompetent patient the most common manifestation is as asymptomatic cervical lymphadenopathy which may be associated with vague systemic manifestations such as fever or myalgia. In very rare cases people with normal immunity may present with meningoencephalitis polymyositis or myocarditis. It is very rare to encounter a brainstem granuloma due to toxoplasma infection in such patients. We report a non-immunocompromised man who presented with multiple cranial nerve palsies due to a brainstem lesion, which turned out to be a toxoplasma granuloma. He recovered completely after a four-week course of Pyrimethamine and Sulphadoxine. An extensive search of the literature failed to reveal any prior reports of a similar nature. This case is being reported because of its rarity and the complete recovery made by the patient.

Dysmyelinating neuropathy in benign form of megalencephalic leukoencephalopathy with subcortical cysts: A novel observation from south India.

A 37-year-old gentleman presented with macrocephaly since early childhood and progressive impairment of motor and cognitive functions. Magnetic resonance imaging revealed extensive white matter involvement and frontotemporal subcortical cysts. Absent ankle jerk and abnormal nerve conduction study raised a possibility of associated peripheral neuropathy. Sural nerve biopsy was suggestive of dysmyelinating neuropathy. This report serves to expand the clinical spectrum of this rare leukodystrophy.

Central nervous system cladosporiosis: An account of ten culture-proven cases.

Background: Central nervous system (CNS) cladosporiosis is a rare infection caused by Cladophialophora bantiana. It has varied presentation and poor outcome. Most of the available data in the literature are reviews of individual case reports. Objective: To describe the clinical, radiological and mycological features of 10 cases of C. bantiana managed at a single tertiary center. To analyze the various treatment options, factors associated with outcome and to review the relevant literature. Materials and Methods: This is a retrospective study of 10 patients with CNS cladosporiosis managed at National Institute of Mental Health and Neurosciences from 1979 to 2006. It is a descriptive study. The case records were reviewed for clinical presentation, radiological features, management and outcome. Only those patients in whom the fungus could be isolated on culture were included in the study. Results: The age of the patients ranged from three to 42 years. Nine patients presented with features of space-occupying lesion and one patient with chronic meningitis. There were no specific clinical or radiological features. None of patients had impaired immune status. This infection presented as two pathomorphological forms - diffuse meningoencephalitis and focal abscesses. Burr hole tapping and excision are the surgical options. Both patients with burr hole tapping required excision of abscess subsequently. Two out of seven patients with abscess expired compared to all three patients with diffuse meningoencephalitis who expired. Recurrences occurred in four of the five patients following excision of the abscess. Combination antifungal treatment had better result than monotherapy. The outcome was poor with survival of only 50%. Conclusions: Thorough microbiological examination is required to diagnose CNS infection caused by C. bantiana. The outcome is better in patients with abscess. Excision of the abscess followed by combination antifungal therapy results in better outcome. Close follow-up is required due to high risk of recurrence.