Spinal cord injury: scenario in an Indian state.

STUDY DESIGN: Prospective observational study. OBJECTIVES: To find out the epidemiology and demographic factors associated with patients of traumatic spinal cord injury (SCI). SETTING: Sawai Man Singh Medical College and Hospital, Jaipur, India. METHODS: Consecutive SCI cases admitted from January 2000 to December 2008 were evaluated on a preformed proforma for demographic factors, epidemiological data and neurological status. RESULTS: In 2716 cases of SCI, 1400 were cervical and 1316 thoracolumbar, with male to female ratio of 4.2:1 and 71% in the age group of 20-49 years. Around 79% patients were from rural background. About 23.3% were farmers while 22.9% were laborers. Among the causes of injury, 53% patients had a fall from height and 28% suffered from road traffic accidents. Fall of heavy object over head and back (10.7%), fall with heavy object over head (3.0%) and fall following electric shock (4.0%) were uncommon causes. Complete paralysis was found in 20.5% cervical and 23.3% in thoracic injuries. Extremity and rib fractures (10.6%) and head injuries (7.2%) were common associated injuries. About 55% cases were initially attended at non-specialized centers. Proper bladder and bowel management in early phase was lacking. CONCLUSION: Epidemiological factors of SCI in Indian scenario are different from western countries with major cause being fall. The low socio-economic status and younger age group had a major financial, social and psychological impact as majority of the patients were the primary earning members of the family. Therefore, measures should be taken to reduce the incidence of SCI.

Role of intracellular calcium in the spermicidal action of 2',4'-dichlorobenzamil, a novel contact spermicide.

The Na+-Ca2+ exchanger and Ca2+-ATPase pumps reported to be present on the sperm membrane are responsible for maintaining the intracellular Ca2+ concentration that is involved in regulation of sperm function. We have investigated the role of intracellular Ca2+ in the presence of 2',4'-dichlorobenzamil hydrochloride (benzamil), a Na+-Ca2+ exchange inhibitor, on human sperm motility. The mechanism of the complementary spermicidal action produced by a combination of benzamil and propranolol on human spermatozoa has been investigated also. When administered alone benzamil and propranolol produced a dose- and time-dependent decrease in motility of sperm in ejaculated semen and spermatozoa separated from semen. A combination of benzamil and propranolol exhibited a complementary spermicidal action, thereby resulting in dose reduction of both drugs for obtaining total immotility within 1 min of administration. An increase in the intracellular Ca2+ level was found to contribute to the spermicidal activity. Inhibition of the Na+-Ca2+ exchange system on sperm membrane by benzamil and membrane stabilization by propranolol resulted in accumulation of Ca2+ inside the sperm cells. When the two drugs were used in combination the time required for the total loss of motility of spermatozoa was significantly reduced due to a similar mechanism of action of both drugs.

Effect of 2',4'-dichlorobenzamil hydrochloride, a Na(+)-Ca(2+) exchange inhibitor, on human spermatozoa.

The present study is aimed to investigate the contact spermicidal efficacy of 2',4'-dichlorobenzamil hydrochloride (DBZ), a Na(+)-Ca(2+) exchange inhibitor, on ejaculated human spermatozoa. The drug produced a dose- and time-dependent spermicidal action on human spermatozoa. A concentration of 4 mM produced total loss of sperm viability within 1 min of addition to total semen. On the other hand, a similar action on spermatozoa separated from semen was noted at 0.5 mM concentration. The loss of spermatozoal viability was accompanied with an increase in intracellular Ca(2+). Sperm revival testing with glucose suggested a spermicidal rather than a spermiostatic action.

Periorbital vasculitis complicating Kawasaki syndrome in an infant.

Periorbital vasculitis is a previously unreported complication of Kawasaki syndrome (KS). We describe an infant with severe KS refractory to initial management with salicylate and intravenous immunoglobulin (IVIG). Retreatment with IVIG and high-dose pulsed steroids was required for persistent fever and inflammatory manifestations. Despite aggressive medical therapy, a large left coronary artery aneurysm developed. After apparent complete KS remission, acute periorbital vasculitis developed in the left upper eyelid and orbit, requiring operative intervention for diagnosis and high-dose pulsed steroids for therapy. The significance of this previously unreported ophthalmic complication of KS is reviewed, along with a discussion of the role of steroids in KS manifestations refractory to IVIG.

Vestibular decruitment, hyperactivity, and rebound caloric nystagmus.

OBJECTIVE: This study examined the collective sensitivities of decruitment, hyperactivity, and rebound caloric nystagmus (RCN) for lesions of the brain stem/cerebellum against the current gold standard of imaging, the contrast enhanced magnetic resonance imaging (MRI). STUDY DESIGN: This is a retrospective study of patients who underwent a vestibular evaluation and a contrast-enhanced MRI scan. SETTING: The study was performed at a tertiary referral center. PATIENTS: The patients included in this study were evaluated for investigation of a variety of reported problems, including vertigo/dysequilibrium, headache, hearing loss, and tinnitus. Their age range was 13 to 79 years. INTERVENTION: Every patient underwent a vestibular evaluation, which included the Torok monothermal caloric test and an MRI scan. MAIN OUTCOME MEASURES: The results of this caloric test include vestibular decruitment, hyperactivity, and rebound caloric nystagmus. The sensitivity and specificity of these results for MRI confirmed brain stem/cerebellar lesions were determined. RESULTS: The overall sensitivity of the measures of this caloric test was 90%. The overall specificity was 25%. CONCLUSIONS: As a screening test for brain stem cerebellar lesions, the Torok monothermal caloric test performs well in terms of its sensitivity. The specificity is low, and this probably because MRI looks at morphology rather than function.