Spontaneous Subdural Empyema: A Case Report.

Subdural empyema is the collection of purulent material between the dura mater and arachnoid. Subdural empyema most often occurs due to the direct extension of local infection. But spontaneous subdural empyema is a rare entity. In literature, not many cases of spontaneous subdural empyema by Escherichia coli are reported. Here we report a case of spontaneous subdural empyema along with a review of literature who was previously treated on the suspicion of encephalitis with urinary tract infection and then brought to our hospital.

Binary Simulated Normal Distribution Optimizer for feature selection: Theory and application in COVID-19 datasets.

Classification accuracy achieved by a machine learning technique depends on the feature set used in the learning process. However, it is often found that all the features extracted by some means for a particular task do not contribute to the classification process. Feature selection (FS) is an imperative and challenging pre-processing technique that helps to discard the unnecessary and irrelevant features while reducing the computational time and space requirement and increasing the classification accuracy. Generalized Normal Distribution Optimizer (GNDO), a recently proposed meta-heuristic algorithm, can be used to solve any optimization problem. In this paper, a hybrid version of GNDO with Simulated Annealing (SA) called Binary Simulated Normal Distribution Optimizer (BSNDO) is proposed which uses SA as a local search to achieve higher classification accuracy. The proposed method is evaluated on 18 well-known UCI datasets and compared with its predecessor as well as some popular FS methods. Moreover, this method is tested on high dimensional microarray datasets to prove its worth in real-life datasets. On top of that, it is also applied to a COVID-19 dataset for classification purposes. The obtained results prove the usefulness of BSNDO as a FS method. The source code of this work is publicly available at https://github.com/ahmed-shameem/Feature_selection.

Vitamin K deficiency-related late-onset haemorrhagic disease of a newborn with acute subdural haemorrhage: long-term outcome.

Newborn infants who for any reason have not received vitamin K supplementation are at risk of major haemorrhagic complications including intracranial bleeding, due to vitamin K deficiency bleeding (VKDB). We describe a 5-month-old exclusively breastfed infant who presented with subdural haemorrhage following a fall from the mother's lap and was found to have VKDB. The patient was lost to follow-up and was brought back at 8 years of age with global developmental delay, epilepsy and hemiparesis. Computed tomography scan showed left-sided encephalomalacia. Healthcare providers and the public should be aware of this preventable, acquired coagulopathy and its potential sequelae, and encourage the uptake of vitamin K at birth.

Congenital spinal dysraphism with infected sacrococcygeal sinus tract: need for improved awareness amongst clinicians.

Spinal dysraphism (SD) includes a group of developmental anomalies resulting from failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. There are two types of SD, open and closed. Close SD, also known as spina bifida occulta, can present with diagnostic challenges in resource limited settings where awareness regarding the condition and specialist radiological investigations, including Magnetic Resonance Imaging (MRI), may not be easily available. Undiagnosed cases can potentially lead to long term morbidities. We report the case of a 13-year old boy with closed SD presenting with recurrent infections of the sacrococcygeal sinus tract which were treated with oral antibiotics for what was considered to be localized infection. Following neurosurgical assessment and spinal MRI a diagnosis of SD was made. He underwent surgical excision of the sinus tract and closure of the defect with good outcome. The case emphasizes the need for awareness regarding SD in children who have sinus tracts in the intergluteal fold with symptoms of recurrent discharge and infection.

Rare cause for a common presentation: isolated pulmonary valve endocarditis yet another mimicker.

Isolated pulmonary valve endocarditis (PVE) is a rare condition. Known risk factors in previous case reports were intravenous drug abuse and congenital heart disease. Epidemiology of PVE has been changing. It is now being reported specially following invasive healthcare-related procedures even in patients with structurally normal heart. Vast majority of patients present with respiratory symptoms and diagnosis of endocarditis may be challenging unless there is high index of suspicion. Various microorganisms had been isolated as aetiological agents; however, Enterococcus faecalis is being increasingly isolated. PVE mostly managed conservatively with intravenous antibiotics with option for surgical intervention in specific situations. We present a patient with isolated PVE due to E. faecalis following colonoscopy and polypectomy with predisposing risk factor of alcohol excess, mimicking clinically as pneumonia and radiologically as a neoplastic lesion.

Traumatic Cerrebral Fungus: Experience From an Institution in North East India.

BACKGROUND: Traumatic brain fungus is manifestation of neglected head injury. Although rare it is not uncommon. The patients are usually intact with good Glasgow coma (GCS) score inspite of complex injuries and exposed brain parenchyma but morbidity and mortality is very high with time if no proper and timely management is offered. There is very less study on traumatic brain fungus with no defined management protocols. So an attempt was made to explain in details the surgical strategies and other management techniques in patients with traumatic brain fungus. AIMS: To study and evaluate the pattern of causation, clinical presentations, modalities of management of traumatic brain fungus and outcome after treatment. METHODS: All patients with fungus cerebri, admitted to our centre from January 2012 to December 2015 were studied prospectively. All the patients were examined clinically and triaged urgently for surgery. CT head was done in all patients to look for any brain parenchymal injury. All patients were managed surgically. Outcome was assessed as per the Glassgow Outcome Score. RESULTS: Total 10 patients were included in the study. 8 were men and 2 women. The patients' ages ranged from 3-48 years (mean 31.6 years). The interval between initial injury and protrusion ranged from 3 days to 6 days (mean 4.1 days). Mean GCS at the time of presentation was 13.2.60% of the patients (n = 6) sustained moderate head injury. (GCS-9-13). Size of the fungus ranged from 5cm×3cm to 8cm×10cm. CONCLUSION: Early and proper local wound treatment prevents fungus formation. Pre-emptive antibiotics, AEDs and cerebral decongestants are recommended. Loose water-tight duroplasty prevents CSF leak. But mortality and morbidity can be reduced significantly if brain fungus is managed properly by applying basic surgical principles and antibiotic protocols combined with newer surgical modalities.

Chronic Renal Failure Secondary to Unrecognized Neurogenic Bladder in A Child with Myelodysplasia.

Myelodysplasia includes a group of developmental anomalies resulting from defects that occur during neural tube closure. Urological morbidity in patients with myelodysplasia is significant and if not treated appropriately in a timely manner can potentially lead to progressive renal failure, requiring dialysis or transplantation. We report the case of a 13-year old girl with neurogenic bladder who presented chronic renal failure secondary to lipomyelomeningocele with retethering of cord. She was managed with urinary indwelling catheterization until optimization of renal function and then underwent detethering of cord with excision and repair of residual lipomeningomyelocele. Her renal parameters improved gradually over weeks and then were managed on self clean intermittent catheterization. The case emphasizes the need for considering retethering of spinal cord in children with myelodysplasia where symptoms of neurogenic bladder and recurrent urinary tract infections occur.

Hemiplegia Following Mild Head Injury in a Child with Sturge-Weber Syndrome - A Diagnostic Dilemma.

Sturge-Weber syndrome (SWS) is a neurocutaneous disorder with skin, eye, and brain involvement. Hemiplegia in children with SWS after a mild head injury is known to occur in up to one-fifth of cases. A3-year male child presented with a sudden onset hemiplegia following a mild head injury. He was known to have seizure disorder and was being treated with sodium valproate. CTscan of the brain showed contusion. He was admitted for neurological observations and the patient made complete recovery with conservative treatment. MRI scan of the brain done 5 days later which showed venous malformation of choroid plexus on the left side. These changes were considered to be consistent with a preexisting cerebral lesion which coincidentally got detected at neuroimaging done after the mild head injury. There is need for good seizure control as it is likely to be associated with better neurological outcome. The case emphasizes the need for clinical correlation with findings at neuroimaging in children with SWS presenting with head injuries.

Partial Heel Pad Avulsion with Open Calcaneal Tuberosity Fracture with Tendo-achilles Rupture: A Case Report.

INTRODUCTION: The management of heel pad avulsion injuries has been challenging because of the precarious blood supply. The difficulties get compounded when it is associated with tendo-achilles rupture and calcaneal fracture. Here, it is a description of a case with the above features managed with a unique technique. CASE REPORT: A 63-year-old woman presented to casualty with injury to right ankle after a road traffic accident. On clinical and radiological examination, there was avulsion of heel pad with calcaneal tuberosity fracture and tendo-achilles rupture. It was managed with debridement of the wound, repair of tendo-achilles, and fixation of calcaneal tuberosity and heel pad. The functional outcome was assessed in terms of the ability of the patient to return to painless barefoot weight bearing. The uniqueness of this method is the combined use of suture material (Ethibond) and stainless steel (cannulated cancellous screws [CCS]), by tying the Ethibond from tendo-achilles to the head of CCS rather than bone. When the CCS were tightened, two things were achieved; one being the reduction of the fracture and the second to bring a good apposition of tendo-achilles with the calcaneum. As this method worked on tension band principle and Ethibond was used instead of stainless steel wire, if no objections, this technique can be called as "soft tension band technique." CONCLUSION: This case report illustrates a method of preserving heel pad when it is viable along with definitive treatment of associated soft tissue and bony injuries by a simple technique. This method has described the fixation of open fracture of calcaneal tuberosity with tendo-achilles rupture with heel pad avulsion in one sitting with excellent clinical results.

Painless Loss of Vision as The First Presentation of Undiagnosed Neurofibromatosis 1 in A Child.

Objective A 10 year old presented with painless loss of vision as the first manifestation of neurofibromatosis 1 (NF1). Clinical assessment detected diagnostic features of NF1 and Magnetic Resonance Imaging (MRI) scan confirmed presence of plexiform neurofibroma and bilateral optic pathway glioma (OPG). The child was managed with chemotherapy which helped in improvement of vision. Review of current literature recommends vision testing in diagnosed cases of NP1 till 7 years of age; this is aimed at detecting visual impairments resulting from a symptomatic OPG.

Intramedullary spinal neurocysticercosis treated successfully with medical therapy.

Neurocysticercosis caused by Taenia solium and is a common parasitic disease of the cental nervous system. It usually presents with seizures, headaches, progressively worsening focal neurologic symptoms, visual disturbances, loss of bladder control, etc. However, acute onset symptoms may also be seen. MRI scans can accurately diagnose spinal or cerebral lesions and is also helpful in monitoring progress while on treatment. Albendazole is currently the drug of choice along with steroids for medical management of neurocysticercosis. The case of intramedullary spinal neurocysticercosis was treated with praziquantel.

Regrowth of septal spur in split cord malformation.

Regrowth of a diastematomyelic bone septum is very rare, and only few cases have been reported in the literature. We report a 3-year-old female patient who developed recurrent fibro-osseous spur after primary excision.