The Perplexity Surrounding Chiari Malformations - Are We Any Wiser Now?

Chiari malformations are a diverse group of abnormalities of the brain, craniovertebral junction, and the spine. Chiari 0, I, and 1.5 malformations, likely a spectrum of the same malformation with increasing severity, are due to the inadequacy of the para-axial mesoderm, which leads to insufficient development of occipital somites. Chiari II malformation is possibly due to nonclosure of the caudal end of the neuropore, with similar pathogenesis in the rostral end, which causes a Chiari III malformation. There have been significant developments in the understanding of this complex entity owing to insights into the pathogenesis and advancements in imaging modalities and neurosurgical techniques. This article aims to review the different types and pathophysiology of the Chiari malformations, along with a description of the various associated abnormalities. We also highlight the role of ante- and postnatal imaging, with a focus on the newer techniques in the presurgical evaluation, with a brief mention of the surgical procedures and the associated postsurgical complications.

First report of the genus Longipalpus Montrouzier, 1861 (Coleoptera: Cerambycidae: Cerambycinae) from India with the description of a new species.

Longipalpus palodensis sp. nov. (Cerambycidae: Cerambycinae: Obriini) is described and illustrated from India. Life history information is also provided. This is the first report of the genus from India.

A new species of Miccolamia Bates, 1884 (Coleoptera: Cerambycidae) from south India.

A new species, Miccolamia (Miccolamia) ferruginea sp. nov. from south India is described and illustrated. A key to the known species of Indian Miccolamia is provided. This is the first report of the genus from southern India.

Cerebrospinal fluid rhinorrhea and otorrhea: A multimodality imaging approach.

Cerebrospinal fluid (CSF) leaks are extracranial egress of CSF into the adjacent paranasal sinus or tympanomastoid cavity due to an osteodural defect involving skull base. It can be due to a multitude of causes including accidental or iatrogenic trauma, congenital malformations and spontaneous leaks. Accurate localization of the site of the leak, underlying causes and appropriate therapy is necessary to avoid associated complications. In this paper relevant anatomy, clinical diagnosis, imaging modalities and associated findings are discussed along with a brief mention about management.

A new species of Notomulciber (Micromulciber) Aurivillius, 1913, from the southern Western Ghats of India (Coleoptera: Cerambycidae: Lamiinae: Homonoeini).

Notomulciber (Micromulciber) viraktamathi sp. nov. is described and illustrated from the southern Western Ghats, a hotspot of biodiversity in India. Ecological notes, differential diagnosis of the new species from its close relatives and a key to the species of Notomulciber from India are provided.

The effectiveness of eHealth interventions on physical activity and measures of obesity among working-age women: a systematic review and meta-analysis.

Physical inactivity and obesity are modifiable risk factors for cardiovascular disease, particularly in women. eHealth interventions may increase physical activity and improve obesity-related outcomes among women. The objective of this study was to review the evidence of the effectiveness of eHealth interventions to increase moderate-to-vigorous physical activity among working-age women. The secondary objective was to examine their effectiveness on improving obesity-related outcomes. A comprehensive search strategy was developed for eight electronic databases; through July 2016. All studies consisting of >80% women of working-age (18-65 years) in high income countries were included. Multiple unblinded reviewers determined study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Risk of Bias Tool and data quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using a random-effects model. Sixty studies were included in the review of which 20 were in the meta-analysis. The meta-analysis demonstrated eHealth interventions improved moderate-to-vigorous physical activity (standard mean difference = 1.13, 95% confidence interval: 0.58, 1.68, P < 0.0001); an increase of ~25 min week-1 . No changes were observed in obesity-related outcomes; waist circumference (P = 0.06), body mass (P = 0.05) and body mass index (P = 0.35). eHealth interventions are effective at increasing min week-1 of moderate-to-vigorous physical activity among working-age women from high income countries.

Proton Pump Inhibitors: More Indigestion than Relief?

Proton pump inhibitors (PPIs) are widely prescribed to treat a number of gastrointestinal (GI) disorders due to excessive acid production. While effective and safe, adverse renal effects have been increasingly described in epidemiological literature. The most well-documented adverse renal outcome is acute interstitial nephritis; however, association with overall acute kidney injury has also been recently reported. Recently, two observational studies have linked PPI use with chronic kidney disease. Finally, hypomagnesemia is another reported complication and is thought to be resulting from GI loss of magnesium. This study will critically review literature on the effect of PPIs on the kidney.

Assessment of maternal risk indicators for the development of caries in their children: A comparative, cross-sectional study.

INTRODUCTION: Certain factors in mothers could be risk indicators for certain diseases in their children. Hence, this study was undertaken to assess maternal risk indicators for the development of early childhood caries in their children. METHODOLOGY: A comparative, cross-sectional study was designed among 180 mother-child pairs attending various Anganwadi centers. Demographic, dietary, oral hygiene practices and other necessary information were collected from mothers using a structured questionnaire. Caries status and amount of plaque were recorded through clinical examination. Nonstimulated saliva from mothers was cultured for mutans streptococci (MS). Data were analyzed using SPSS version 17. Chi-square, Student's t-test, and logistic regression were used. A P ≤ 0.05 was considered statistically significant. RESULTS: In the study group, 73.3% of mothers had caries as compared to only 53.3% mothers in control group. While mean DMFT and mean DMFS of mothers in the study group was 3.78 ± 3.91 and 8.37 ± 12.2, respectively, the same for the mothers in the control group was 2.66 ± 3.01 and 5.8 ± 5.3. Sixty (66.7%) out of ninety mothers in the study group had a high MS count as compared to only 40 (44.4%) mothers in control group (P = 0.003). CONCLUSION: The present study showed that high salivary MS count and decay in mothers could be important risk indicators for the development of caries in their children.

Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?

BACKGROUND AND PURPOSE: Tumefactive demyelinating lesions with atypical features can mimic high-grade gliomas on conventional imaging sequences. The aim of this study was to assess the role of conventional imaging, DTI metrics (p:q tensor decomposition), and DSC perfusion in differentiating tumefactive demyelinating lesions and high-grade gliomas. MATERIALS AND METHODS: Fourteen patients with tumefactive demyelinating lesions and 21 patients with high-grade gliomas underwent brain MR imaging with conventional, DTI, and DSC perfusion imaging. Imaging sequences were assessed for differentiation of the lesions. DTI metrics in the enhancing areas and perilesional hyperintensity were obtained by ROI analysis, and the relative CBV values in enhancing areas were calculated on DSC perfusion imaging. RESULTS: Conventional imaging sequences had a sensitivity of 80.9% and specificity of 57.1% in differentiating high-grade gliomas (P = .049) from tumefactive demyelinating lesions. DTI metrics (p:q tensor decomposition) and DSC perfusion demonstrated a statistically significant difference in the mean values of ADC, the isotropic component of the diffusion tensor, the anisotropic component of the diffusion tensor, the total magnitude of the diffusion tensor, and rCBV among enhancing portions in tumefactive demyelinating lesions and high-grade gliomas (P ≤ .02), with the highest specificity for ADC, the anisotropic component of the diffusion tensor, and relative CBV (92.9%). Mean fractional anisotropy values showed no significant statistical difference between tumefactive demyelinating lesions and high-grade gliomas. The combination of DTI and DSC parameters improved the diagnostic accuracy (area under the curve = 0.901). Addition of a heterogeneous enhancement pattern to DTI and DSC parameters improved it further (area under the curve = 0.966). The sensitivity increased from 71.4% to 85.7% after the addition of the enhancement pattern. CONCLUSIONS: DTI and DSC perfusion add profoundly to conventional imaging in differentiating tumefactive demyelinating lesions and high-grade gliomas. The combination of DTI metrics and DSC perfusion markedly improved diagnostic accuracy.

Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants.

OBJECTIVE: This study aims to systematically review available evidence from prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants of moderate-to-vigorous intensity physical activity (MVPA) among working-age women. METHODS: Six databases were searched to identify all prospective cohort studies that reported on intrapersonal (e.g. self-efficacy and socioeconomic status [SES]), social (e.g. crime, area SES and social support) and/or physical (e.g. weather, work and recreation) environmental determinants of MVPA in working-age (mean 18-65 years) women. A qualitative synthesis including harvest plots was completed. PROSPERO: CRD42014009750 RESULTS: Searching identified 17,387 potential articles; 97 were used in the analysis. The majority (n = 87 studies) reported on ≥1 intrapersonal determinant. Very few (n = 34) examined factors in the social or physical environments, and none looked at social policy. Positive and consistent influencers included higher self-efficacy (n = 18/23), self-rated health (n = 8/13) and intentions (n = 10/11) and perceived behavioural control (n = 5/7) to be physically active. Having children in the household was negatively related to MVPA (n = 9/15). CONCLUSIONS: Physical activity intervention studies should consider a woman's level of self-efficacy and perceived behavioural control to be physically active. Additional studies are needed on the impact of children in the household, having a spouse/partner and using group goal setting. More evidence is needed to evaluate the impact of environmental factors.

Quantification of Dental Health Care Waste Generated among Private Dental Practices in Bengaluru City.

BACKGROUND: Bengaluru, in India has more than 1148 practicing dentists for a population of 8.42 million. The amount and type of dental health care waste (DHCW) generated by the dental practitioners has to be assessed prior to chalking out and implementation of an effective DCHW management plan. Currently, there is no evidence available regarding the quantity, type, and method of disposal adopted by these practitioners. Hence, this study was conducted with the objective of estimating the quantity of DHCW by the private dental practitioners in Bengaluru city. MATERIALS AND METHODS: The sample size was estimated to be 110. The sampling frame was constituted from the registered dental practitioners in Bengaluru with the Department of Health and Family Welfare, Govt. of Karnataka. Sampling strategy employed included a probability proportional sampling strategy for the four zones in Bengaluru followed by a simple random sampling of clinics from each zone. Standardized weight method was followed to estimate the quantity of different category of waste. Three data collectors who were trained and calibrated collected the information regarding the type and quantity of waste generated, the nature of practice and years of establishment. RESULTS: Total quantity of waste generated was 0.161 kg/clinic/day with 0.130 kg and 0.026 kg of infectious and recyclables, respectively. The projected data for the actual number of private practices in Bengaluru city showed alarming figures of 41,535 kg and 8307 kg of infectious and recyclable waste being generated every year. Data also showed poor management practices of lead foil and plaster of paris and alarming figures projected annual quantity. CONCLUSION: The data demonstrated large quantities of hazardous waste generation and poor segregation practices of the practitioners. This warrants the immediate need for collective, voluntary measures to be initiated for appropriate and effective management of DHCW.

Nephroprotective activity of Bilvadi agada in gentamicin induced nephrotoxicity in male Wistar rats.

BACKGROUND: Gentamicin (GM) nephrotoxicity accounts for 10-30% of the acute renal failure (ARF) among drug-induced ARF. In Ayurveda such side effects are considered as the poisonous effects of low potent poisons called gara visa. Bilvadi agada (BA), a classical formulation is indicated in gara visa and most of its ingredients have proven for their nephroprotective activity. AIM: The aim was to evaluate the effect of BA in GM-induced nephrotoxicity in male Wistar rats. MATERIALS AND METHODS: BA, GM, normal saline were procured from standard companies. SETTINGS AND DESIGNS: Eighteen male Wistar rats were randomly divided into three groups, viz. Control group which received normal saline intraperitoneal (i.p.) daily for 8 days; toxic group received GM 80 mg/kg/day i.p. for 8 days, and trial group received both GM 80 mg/kg/day i.p. and BA 216 mg/each rat weighing ~200 g orally 1 h after administration of GM. STATISTICS: All the values were expressed as mean ± standard error and data were analyzed by applying one-way analysis of variance followed by Dunnett's test for multiple comparison. RESULTS: BA treated group showed a significant change (P < 0.05) in levels of serum creatinine, urine creatinine, and urine potassium. There was no significant change (P > 0.05) seen in serum potassium, sodium, chloride, calcium and phosphorus and urine sodium, chloride in all three groups. Glomerular congestion, interstitial edema, tubular necrosis, interstitial hemorrhage was reduced in BA treated group. The results of this study indicate that BA reduces GM-induced nephrotoxicity and it may be due to anti-inflammatory, immunomodulatory, diuretic and anti-oxidant properties of drugs. Further studies are necessary to explore the exact mechanism of BA in nephroprotection.

Nephron sparing surgery for unilateral non-syndromic wilms tumor.

The initial therapy for most children with Wilms tumor is radical nephrectomy. Several centers, have explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors. The primary motivation for this approach is concern about late occurrence of renal dysfunction after unilateral nephrectomy. We report our experience with NSS for unilateral non-syndromic Wilms tumor. We reviewed the records of nine children who underwent nephron sparing surgery for unilateral, nonsyndromic Wilms tumors at our Hospital between Jan 2000 through Jan 2012. All patients received preoperative chemotherapy with two drugs (vincristine, and dactinomycin) following which patients underwent tumor resection. Subsequent renal function was assessed by estimating the glomerular filtration rate using creatinine clearance and other measures of long-term renal function assessment included blood pressure evaluation and the need for antihypertensive medications. During the study period nine children with a mean age 19.66 ± 14.37 months at diagnosis and presenting with unilateral non-syndromic Wilms tumor underwent nephron sparing surgery. In all the nine children, the renal plane of resection showed a tumor-free margin. Post-operative serum creatinine repeated at the end of 3 months revealed maintenance of good renal function in all children. Nephron sparing surgery is a safe and effective option in the management of early stage unilateral non-syndromic Wilms tumor. It is oncologically safe and does not lead to decreased local tumor control. The function of the kidney remnant remains rather well.

Prevalence of Various Orofacial Pain Symptoms and Their Overall Impact on Quality of Life in a Tertiary Care Hospital in India.

BACKGROUND: Pain is a major public health problem and is the most commonly reported symptom of oral and dental disease that has a significant impact on both individual and community. The present study was prevalence of various orofacial pain symptoms and their overall impact on the quality of life in a tertiary care hospital. MATERIALS AND METHODS: This study was carried out in the outpatient department of the Government Dental College and Research Institute, Bangalore. The severity of the chronic orofacial pain symptoms was assessed using the Chronic Pain Grade Questionnaire by Von Korff. RESULTS: The results showed that toothache (57.6 %) was the most commonly reported symptom and burning mouth sensation (6.4 %) was the least commonly reported. Majority of the patients had grade 3 level of pain-related disability (34.8 %) followed by grade 2 (26.8 %), grade 1 (22.4 %) and grade 4 levels (16 %). The mean pain intensity was reported to be more among females and maximum among patients with facial pain. CONCLUSION: The present study demonstrated that orofacial pain symptoms have a significant impact on the patients suffering from it. Therefore, proper measures should be taken for the management of the patients with these symptoms and associated conditions.

The Influence of Insulin Dependent Diabetes Mellitus on Dental Caries and Salivary Flow.

Objective. To assess whether or not there was any change in the dental caries and rate of salivary flow of patients with Insulin Dependent Diabetes Mellitus (IDDM) and the contribution of salivary flow to caries risk in IDDM. Setting. Department of Endocrinology, MS Ramaiah Hospital, Bangalore, India. Design. A comparative cross-sectional descriptive type. Materials and Methods. The sample consisted of two groups: 140 diabetic group (mean age 14.8 yr) and 140 nondiabetic group (mean age 13.7 yr). Dental caries by dmf(t) and dmf(s) indices for primary dentition and DMF(T) and DMF(S) indices was used in permanent dentition to assess the dental caries experience. Both stimulated and unstimulated salivary flow rate were assessed after collection of saliva. Results. In diabetic group 76% had carious lesion and in nondiabetic group 85.3% had carious lesion. Diabetics have lower mean DMFT, DMFS, dmft, and dmfs compared to the nondiabetic group. Diminished unstimulated and stimulated salivary flow rate in diabetic than nondiabetic group. Conclusions. The findings obtained conclude that even though there was reduced salivary flow rate in diabetic group the caries prevalence was low.

Effect of low-compression balls on wheelchair tennis match-play.

The purpose of this study was to compare court-movement variables and physiological responses to wheelchair tennis match-play when using low vs. standard compression tennis balls. Eleven wheelchair basketball players were monitored during repeated bouts of tennis (20 min) using both ball types. Graded and peak exercise tests were completed. For match-play, a data logger was used to record distance and speed. Individual linear heart rate oxygen consumption relationships were used to estimate match-play oxygen uptake. Significant main effects for ball type revealed that total distance (P<0.05), forward distance (P<0.05), and average speed (P<0.05) were higher for play using a low-compression ball. A lower percentage of total time was spent stationary (P<0.001), with significantly more time spent at speeds of 1-1.49 (P<0.05), 1.5-1.99 (P<0.05) and 2.0-2.49 (P<0.05) m ∙ sec(-1) when using the low-compression ball. Main effects for physiological variables were not significant. Greater total and forward distance, and higher average speeds are achieved using a low-compression ball. The absence of any difference in measured HR and estimated physiological responses would indicate that players move further and faster at no additional mean physiological cost. This type of ball will be useful for novice players in the early phases of skill development.

Physical activity classification utilizing SenseWear activity monitor in manual wheelchair users with spinal cord injury.

STUDY DESIGN: Validation. OBJECTIVES: The primary aim of this study was to develop and evaluate activity classification algorithms for a multisensor-based SenseWear (SW) activity monitor that can recognize wheelchair-related activities performed by manual wheelchair users (MWUs) with spinal cord injury (SCI). The secondary aim was to evaluate how the accuracy in activity classification affects the estimation of energy expenditure (EE) in MWUs with SCI. SETTING: University-based laboratory. METHODS: Forty-five MWUs with SCI wore a SW on their upper arm and participated in resting, wheelchair propulsion, arm-ergometery and deskwork activities. The investigators annotated the start and end of each activity trial while the SW collected multisensor data and a portable metabolic cart collected criterion EE. Three methods including linear discriminant analysis, quadratic discriminant analysis (QDA), and Naïve Bayes (NB) were used to develop classification algorithms for four activities based on the training data set from 36 subjects. RESULTS: The classification accuracy was 96.3% for QDA and 94.8% for NB when the classification algorithms were tested on the validation data set from nine subjects. The average EE estimation errors using the activity-specific EE prediction model were 5.3±21.5% and 4.6±22.8% when the QDA and NB classification algorithms were applied, respectively, as opposed to 4.9±20.7% when 100% classification accuracy was assumed. CONCLUSION: The high classification accuracy and low EE estimation errors suggest that the SW can be used by researchers and clinicians to classify and estimate the EE for the four activities tested in this study among MWUs with SCI.

Association between maternal - child levels of salivary Mutans Streptococci and early childhood caries.

BACKGROUND: To find out if there is an association between levels of salivary Mutans Streptococci (MS) of mothers and salivary MS and Caries experience of their Children. MATERIALS AND METHODS: A cross sectional study was designed among 180 mother-child pair attending Vanivilasa Children Hospital, Bangalore, India. Caries was diagnosed using WHO criteria. Ninety children with Early Childhood Caries (ECC) with their mothers were included in case group and 90 caries free children with their mothers were included in the control group. Whole non-stimulated saliva was collected from mothers and children and cultured for MS. Colonies were counted and compared. Data was analyzed using SPSS version 10. Chi-square test and t-test were used to find differences between groups. P value of <0.05 was considered as significant. RESULTS: Among 180 children, 80 of them had a high MS count. Among them, 60 (75%) had ECC and only 20 (25%) were caries free. This difference was significant with P < 0.001. Among 180 mothers, 100 had a high MS count. Among them, 60 (60%) belonged to case group and 40 (40%) to the control group (P = 0.003). Forty nine of the Children in case group with a high count also had mothers with high count as against only 14 in the control group (P < 0.001). CONCLUSION: Present study showed a strong association between maternal and child salivary MS levels indicating that mother's MS count could be an important risk indicator for ECC development.

Adverse events following immunisation with SA 14-14-2 Japanese encephalitis vaccine in children of Kolar in Karnataka.

Around 30 million children of 1 to 15 years have received the live attenuated SA 14-14-2 Japanese encephalitis (JE) vaccine in the campaign against JE in India from 2006 to 2007. This study aims to assess the short-term adverse events following JE vaccination as there is limited data on it in Indian children. A longitudinal study of children vaccinated in the campaign against JE in Kolar, in 2007 was undertaken. In July to August 2007, following the JE vaccination campaign in Kolar, 1640 children of 10 to 15 years were followed for four weeks. Events such as fever, pain at the injection site, cough, headache and nausea or vomiting were recorded. Surveillance was maintained on the referral hospitals for hospitalisation due to encephalitis and anaphylaxis following vaccination. The incidence of adverse events is summarised as frequencies and percentages with 95% confidence interval (CI). The analysis was performed using statistical package for social sciences (SPSS) 15.0 for Windows. The incidence of minor adverse events was 11.3% (95% CI 9.8-12.9%) for fever, 17% (15.2-18.8%) for pain at the injection site, 12.6% (11-14.2%) for cough, 2.6% (1.8-3.3%) for headache and 1.1% (0.6-1.6%) for nausea and/or vomiting. Severe adverse events were not observed. Mild adverse events following immunisation are common with SA14-14-2 JE vaccine. Hence the health personnel involved in JE control campaign should be aware of these adverse events.

Dental caries experience, tooth surface distribution and associated factors in 6- and 13- year- old school children from Davangere, India.

OBJECTIVES: The objective of the present study was to investigate the caries experience and patterns in a sample of 6- and 13- year old school children and to estimate the contributing roles of the likely risk indicators. STUDY DESIGN: Data were obtained from 400 (196, 6-year old and 204, 13-year old) school children. A questionnaire was sent to the children parents to measure socioeconomic, socio-demographic, and behavioral variables. Dental caries detection was performed according to the World Health Organization criteria (dmft and DMFT). The mean dmft/DMFT scores were analysed either as a continuous (calculating means and standard deviations) or as a categorical variable (providing proportions). We also created a multivariate logistic regression model. RESULTS: Overall caries prevalence was dmft > 0 = 26.75% (6-years old = 50.51%; 13-years old = 3.92%) and DMFT > 0 = 25.25% (6-years old = 12.75%; 13-years old = 37.25%). Multivariate analysis showed that presence of enamel defects, low socio-economic status, mothers' educational levels were significantly associated with caries prevalence in both the dentition, and caries in the primary teeth (OR = 4.87) were associated with DMFT > 0. Most commonly affected teeth were lower first molar in permanent dentition and lower second molars in primary dentition. In both the dentition occlusal surfaces were most often affected compared to other surfaces. CONCLUSIONS: This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Indian schoolchildren. Key words:Dental caries experience, socio-economic status, enamel defects, tooth surface distribution.