Clinical profile and etiological spectrum of acute symptomatic seizures in the elderly populace

Aim: The current study aimed to analyze the etiology and the clinical spectrum of acute symptomatic seizures (ASS) and the predictors of in-hospital mortality in the elderly population. Materials and Methods: We evaluated 94 elderly (?60 years of age) hospitalized patients with ASS for clinical profile, etiologies, and predictors of in?hospital mortality. Results: Mean age of onset of ASS was 67.63 ± 11.48 years. The main seizure type was focal seizure in 62 (59.7%) cases, followed by tonic?clonic seizures in 30 (31.9%) cases. The most common aetiologies in ASS were stroke in 61.7%, followed by infective cause in 30.9% of cases. In?hospital mortality in the ASS in the elderly was 21 (22.3%) in our series, and stroke was the most common cause of mortality. Conclusion: Stroke was the most common etiology of ASS in the elderly and was also related to mortality. It is necessary for us to analyze the causes of ASS in the elderly, to reduce in hospital mortality.

A study of prevalence of migraine in stroke patients and its association with ischemic versus hemorrhagic stroke: a cross sectional study

Background: Migraine is characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction. Up to one third of patients also have neurological aura symptoms. It has been suggested that migraine can be a risk factor for stroke. Migraine affects three times the number of women than men. The incidence of stroke in men is two times that of women. It is shown in several studies that women aged 35 to 45 years old are at increased risk of ischemic stroke who had migraine with or without aura.Methods: The present cross sectional study was conducted in 350 consecutive patients of stroke who were attended OPD and admitted in wards of the Department of Medicine, M.G.M. Medical College and MY Hospital, Indore, MP, India, during period from December 2017 to December 2018.Results: The highest percentage of respondents i.e. 68% belonged to male group followed by 32% of respondents who were females. The highest percentage of respondents i.e. 66.6% had ischemic stroke while, 33.4% had hemorrhagic stroke. The highest percentage of respondents i.e. 90.9% had no Migraine while, 9.1% had Migraine. The highest percentage of respondents i.e. 31.2% had weekly reoccurrence, followed by forth nightly (25%) and lowest was 3.1% of daily recurrence. The association of type of stroke with sex group of patient’s history of headache which found to be significant (p ?0.05). The association of type of stroke with sex group of patient’s history of various cerebro-vascular risk factors which found to be significant (p<0.05). Patients having hemorrhagic and ischemic stroke also had HTN in 47% and 12.4% patients respectively.Conclusions: In this study it is concluded that migraine can be established as a risk factor for ischemic stroke. Early diagnosis and treatment with available medication can be helpful in prevention or decreasing risk for developing stroke.

A study of effect of low dose atorvastatin therapy on high sensitivity C-reactive protein in patients with modifiable and non-modifiable cardiovascular risk factors in central India

Background: Anti-inflammatory effects of statins have generated maximum interest, as has been demonstrated in a number of studies showing rapid decrease in CRP levels in patients of acute coronary syndromes. This CRP lowering property of statins has also translated into clinical benefits as suggested by reduction in rate of recurrent angina, recurrent myocardial infarction, and mortality.Methods: This prospective, open, and controlled study was conducted on 160 indoor and outdoor patients, for total duration of two years (2005-2006), in GMC Bhopal, MP, India.Results: In all the four groups, baseline serum hs-CRP was statistically significant (p value <0.01) higher than normal hs-CRP level. Mean reduction (%) in hs-CRP after 3 months of statin therapy was 83.6% in group A and 62.4% in group C which is highly significant (p value <0.001). In group B also, 26% hs-CRP reduction was noticed which is statistically significant (p value <0.01). Baseline hs-CRP was statistically significant high (p value <0.01) in hypertensive patients. Percentages reduction in group A (87%) and group C (66%) was statistically significant (p value <0.01). Baseline hs-CRP was statistically significant higher (p value <0.01) than normal population. After 3 months of statin therapy percentage reduction in group A and group C was statistically significant (p value <0.01). Conclusions: Low dose atorvastatin can significantly reduce CRP level in patients with risk factors for cardiovascular disease. Early initiation of low dose atorvastatin can reduce this inflammatory marker in both ACS and high risk for ACS patients and can prevent major adverse cardiac events.

Prospective and retrospective study of weekly intermittent hormone (estrogen and progesterone) replacement therapy in hysterectomised women

Background: Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in morbidity and mortality, but estrogen use in this population is low because of risk of side effects. Weekly intermittent therapy is a more patient friendly approach with reduced pill burden increasing compliance and adherence as well as reducing side effects. Therefore, authors wanted to study the effect of weekly intermittent fixed dose estrogen and progesterone (ultra-low dose) supplements in hysterectomised surgically menopaused women.Methods: The present study was prospective and retrospective study. For retrospective study authors records of 100 hysterectomised women up to 45years of age with severe post-menopausal symptoms treated in authors Medicine Department of Hospital with once weekly MALA-D tablets were studied. For prospective study, all consecutive hysterectomised patients with severe post-menopausal symptoms attending medicine OPD were given once weekly MALA-D which contains ethinylestradiol 0.03mg and levonorgestrel 0.15mg tablets and followed up monthly with outcomes measured by Modified Kuppermann Index, visual analogue scale, and women’s health questionnaires.Results: Present retrospective study showed moderate degree of postmenopausal symptoms as indicated by Modified Kuppermann index of 19.57. Prospective study showed significant improvement in postmenopausal symptoms with weekly intermittent hormone replacement therapy as indicated by outcomes measured by Modified Kupperman index and Visual analogue scale. Women’s health questionnaire also showed statistically significant improvement in 6 out of 8 dimensions.Conclusions: Authors concluded that weekly estrogen progesterone hormone replacement therapy with mala-D tablet (ultra-low dose therapy) was 100% effective in relieving vasomotor symptoms and it is very effective in improving psychosomatic symptoms, urinary symptoms and quality of life with no obvious side effects and greater adherence.

Classification Of Epilepsies And Epileptic Syndromes Using International League Against Epilepsy 2010: A Hospital Based Study From Rural Population Of North India.

Objectives: To determine the distribution of various epilepsies and epileptic syndromes in the people with epilepsy (PWE) in view of limited published data from rural population of India. Material and Methods: A cross sectional, hospital based study was conducted among 500 PWE. The diagnosis of epilepsy and epileptic syndromes was established under the guidelines of the International League Against Epilepsy 2010. Results: Among 500 PWE 340 (68 %) were male. Mean age was 27.19±17.5 years. Age ranged from 8 months to 93 years. Structural –metabolic (53.2 %) etiology was the most common underlying causes followed by electroclinical syndrome in 26.4 % and 6.4% had a distinctive constellation. Central nervous system (CNS) infections were noted in 16.2%, epilepsy with generalized tonic- clonic seizures in 15% and pre- /perinatal insults in 12.2 % of PWE. Conclusion: Overall the most frequent etiologies of epilepsy in present study were central nervous system (CNS) infections, epilepsy with generalized tonic- clonic seizures and pre-/perinatal insults. Genuine hard work must be done to prevent the occurrence of epilepsy with prevention and successful treatment of infections along with up gradation of the pre/ perinatal care

Achara Rasayana-a Behavioral Therapy In Ayurveda To Promote Health And Happiness

Rasayana Tantra is one of the eight major divisions of Astang Ayurveda. In Ayurveda, one of the major methods of presentation of positive health has been described i.e. Rasayana. There are many activities that promote health and happiness by engendering positive emotions and experiences, which in turn promote the production of Ojas. These activities are included in Achara Rasayana . Ayurveda strongly emphasizes prevention, promotion, cure and rehabilitation. For this, it advocates to follow the principles of health, observation of principles – Dincharya (daily regimen), Ritucharya (Seasonal regimen), Ratricharya (Night routine), Sadvritta and Achar Rasayan (Ethical and Moral activities), Aahar (Food), Nidra (Sleep) and Brahmacharya (Regulated Action). Achara Rasayana is described in various texts. It means good conduct. It signifies the physical and mental conducts of a man and it has been designated as an Rasayana – a vitalizer agent for entire span of life. This is a measure having no involvement of drugs and if it is sincerely taken into practice, it may replenish and maintain total life process free from ailments. A careful analysis of qualities of Achara Rasayana reveal that most of them are related with Mana, Dhi, Dhriti along with good conduct and these results in maximum benefit. The principles of Achar Rasayana are more relevant today than ever. It goes into the heart of the issue we are trying to overcome in order to be well and healthy. Environmental toxicity and the food chain we are accustomed to have threatened our lives. The integral connection between nature and man is an understatement.

Neurocysticercosis with initial clinical presentation of acute cysticercal meningitis coexisting with anterior chamber intraocular cysticercosis: a case report from a rural institute in India.

Acute cysticercal meningitis coexisting with intraocular cysticercosis is an extremely infrequent clinical presentation of neurocysticercosis. We report a 26 year old male, who presented with signs and symptoms of acute eosinophilic cysticercal meningitis with intraocular cysticercosis in the anterior chamber of left eye. Diagnosis was confirmed with demonstration of cerebrospinal fluid (CSF) eosinophilia, cysticercus specific IgG antibodies by CSF ELISA, sterile bacterial, mycobacterial and fungal CSF cultures, cystic lesions containing characteristic scolices consistent with neurocysticercosis on neuroimaging and histopathological demonstration of cysticercus cellulosae larva viscoexpressed from the eye. The importance of having high index of clinical suspicion highlighted along with need of examining cerebrospinal fluid with Wright-Giemsa stain so as not to miss cerebrospinal fluid eosinophilia and diagnosis of this extremely under-reported clinical entity, when there is concurrent presence of brain and other extracerebral lesions consistent with cysticercosis.

Fall: The accidental injury in geriatric population.

The term 'accident' is often used to describe a multitude of disparate events from falls and road accidents to suicides and violence. A 'fatal accident' for this purpose is defined as one in which death occurs within 30 days. Falls, road accidents and burns are major categories of accidents which lead to the highest rates of mortality among Geriatric Population. In most of the studies cited 'elderly people' are defined as those aged 60 or over and falls are the accidents with the highest mortality rates, particularly in the age group 85 or over. In 2006, with approximately 76.6 million (above 7.7% of total population) India alone accounted for one-seventh of world’s elderly. Their population has been steadily growing. It is projected to rise to about 12.4 % in 2026, doubling from 76.6 million in 2006 to 173.1 million in 2026. The major area of concern is their health with multiple medical and psychological problems. Falls are one of the major problems in the elderly and are considered one of the “Geriatric Giants” (immobility, instability, incontinence and impaired intellect/memory).

Biological warfare, bioterrorism and biodefence.

Biological warfare is the intentional use of micro-organisms and toxins to produce disease and death in humans, livestock and crops, their attraction in war, and for use in terrorist attacks is attributed to various unique features. Biological weapons (BWs) can be disseminated by aerosol sprays, explosives or food and water contamination. Bws can strike suddenly without any warning and inflict considerable mortality and morbidity that can continue for a long period, such attacks may create high level of panic, environment contamination and extreme pressures on emergency health services. Bioterrorism is the use of bws in terrorism. Current concerns regarding the use of bws result from the increasing number of countries that are engaged in the proliferation of such weapons and their acquisition by terrorist organizations. The need of the hour is to develop biodefence by full international cooperation and to educate the likely target populations about precautions and protective measures to be taken in such attacks.

Polyneuropathy with osteosclerotic myeloma--POEMS syndrome.

A 55-years-old male, who presented with insidious onset gradually progressive sensorimotor polyneuropathy, POEMS-syndrome was diagnosed based on polyneuropathy, splenomegaly, hypothyroidism, the presence of IgG-monoclonal serum protein with osteosclerotic lesions and hyperpigmention of skin. Biopsy of the osteosclerotic lesion from the right superior pubic rami was consistent with plasmocytoma. Electrophysiological studies revealed demyelinating sensorimotor neuropathy and biopsy from sural nerve showed demyelinating neuropathy with secondary axonopathy. The patient showed improvement with radiotherapy. This is a rare systemic disease from the clinical spectrum of plasma cell dyscrasias with polyneuropathy. The importance of POEMS syndrome in the differential diagnosis of polyneuropathies has been emphasized.

Bilateral internuclear ophthalmoplegia following head injury.

A 40-year-old female after a closed head injury presented with bilateral internuclear ophthalmoplegia. Attempted convergence was abnormal and MRI revealed the focal hemorrhage in the medial longitudinal fasciculus region by showing bright signal in the a pontomesencephalic region in the midline on both T1 and T2 weighted images. The patient regained normal ocular mobility after six months of the injury. The medial longitudinal fasciculus, which is believed to be lesioned in cases of internuclear ophthalmoplegia, is an unusual and rare finding, particularly in patients victims of head injury without further neurological signs. Isolated internuclear ophthalmoplegia should be considered in the differential diagnosis when one encounters an adduction deficit in a patient suffering head injury.

Transitory alexia without agraphia: a disconnection syndrome due to neurocysticercosis.

We describe a 65-year-old male who presented with acute onset inability to read, without any difficulty in writing. A clinical diagnosis of alexia without agraphia was made and the patient was subjected to routine investigations including contrast MRI. MRI showed a ring-enhancing lesion in left occipital area, suggestive of neurocysticercosis supported by quantitative enzyme-linked immunosorbant assay from purified cell fraction of taenia solium cysticerci (PCF-ELISA). Patient was treated with albendazole and prednisolone for one week. The clinical manifestation as well as the radiological finding resolved after treatment.

Early white matter changes in Wilson disease.

We describe a 12 years old male who presented with one year history of cognitive decline with extrapyramidal features. Wilson disease was diagnosed on basis of biochemical studies and MRI. MRI showed increased signal intensity on T2 weighted images in basal ganglia and supratentorial with infratentorial gray and white matter. Our patient developed white matter changes early in course of disease.