Neurotuberculosis: A mystery seeking it's answers in pulmonary tuberculosis.

Neurotuberculosis remains a mystery and presents a formidable challenge in diagnosis and management. While pulmonary tuberculosis has a well understood pathophysiology and well researched management strategies, CNS tuberculosis still has plenty of unanswered questions. The purpose of this review is to highlight the debatable issues in the current understanding of the clinical, diagnostic, and therapeutic aspects of Neurotuberculosis.

COVID-19 infection among health care workers: A hospital based study from Indian state of Meghalaya.

Background: COVID-19 can infect any individual, but the group most susceptible is the Health Care Workers (HCWs) who are directly involved in COVID-19 patient care. Despite adhering to the recommended personal prospective equipment, a disproportionately large number of cases of COVID-19 were reported among the HCWs. Aims and Objectives: To study the burden of COVID-19 infection among the HCWs and to study the probable factors associated with increased risk of COVID-19 infection among HCWs. Materials and Methods: A hospital-based prospective cross-sectional study was conducted at a tertiary care teaching institute in the state of Meghalaya, India for the period between 1st May 2020 and 30th June 2021 and included only laboratory-confirmed COVID-19 cases. Data collected included: A) Demographic data - age, gender, category of HCW, B) History of exposure, place of posting, C) Clinical presentation and disease category. Results and Observations: A total of 144 cases were included in the study. The mean age of affected HCWs was 33.83 ± 1.408 years and male to female ratio was 0.47:1. The commonest age group affected was 18 to 30 years of age (45.14%). The majority of the HCWs were Nursing Officers (staff) (52.78%) followed by Resident Doctors (18.06%). Out of all cases, 135 (93.75%) were either asymptomatic or had mildly symptoms. In 96 (66.67%) HCWs, there was high-risk contact with a known case of COVID-19. High-risk contact outside the COVID-19 designated area of the hospital was noted in 53 (36.81%) cases; however, only 22 (15.27%) patients had a history of working in the COVID-19 designated area at the workplace. Conclusion: The most common group that got infected was the nursing staff followed by the resident doctors, with more than ninety percent of the cases having either mild symptoms or were asymptomatic. The risk of contracting COVID-19 infection was higher in non-COVID-19 as compared to COVID-19 designated areas of the hospital.

Clinical spectrum of myasthenia gravis: An institute experience over 8 years from North East India.

Background: Myasthenia gravis (MG) is a neuromuscular junction disorder usually associated with a thymic lesion. Aims and Objective: To study the clinical, serological, and thymic pathology in patient of MG from this corner of the country. Material and Method: A retrospective study involving all myasthenia patients presenting to neurology and cardio-thoracic department from the year 2013 to 2020. The clinical findings, Osserman grade of severity, antibodies profile, computed scanning thorax findings and histopathology of the thymic lesion were noted and collected as data. Results: Thirty patients of MG were included with mean age of onset being 39.10 ± 15.77 years which included 22 females and eight males. Four patients had only ocular findings while 26 patients had generalized myasthenia with three patients of respiratory failure. Ach receptor antibodies were positive in 27 patients and negative in two patients. Anti-MUSK was positive in one out of five patients. Abnormal findings in CT thorax seen in 20 patients which included enlarged thymic gland in 11 patients, thymic hyperplasia in two patients, thymoma in four patients, and anterior mediastinal mass in three patients. Thymectomy was done in eighteen patients with thymoma as the most common histopathological findings seen in eight patients, follicular hyperplasia in five patients; other was thymic hyperplasia, thymic cyst, normal thymus gland, and features of sarcoidosis in one patient. Conclusion: MG is a treatable autoimmune disorder with a variety of clinical, radiological, and histopathological findings.

Clinical and Demographic Profile of COVID-19 Patients: A Tertiary Level Hospital-Based Study From Northeast India.

Background and objective The coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India. Materials and methods This was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. Results The study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratory-confirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death. Conclusion The COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.

Levetiracetam Use During Pregnancy in Women With Active Epilepsy: A Hospital-Based, Retrospective Study from a Tertiary Care Hospital in North Eastern INDIA.

BACKGROUND AND PURPOSE: Epilepsy during pregnancy is a therapeutic challenge. Since the 1990s, the number of licensed antiepileptic drugs has substantially increased, but safety data on managing epilepsy during conception, pregnancy, and postpartum period use of newer generation antiepileptic drugs and birth defects are limited. We analyzed efficacy and safety of levetiracetam during pregnancy in northeast Indian women with active epilepsy (WWAE) which is being presented here. DESIGN: Hospital based retrospective study. PATIENTS AND METHODS: A retrospective analysis was conducted based on clinical records at a tertiary care teaching hospital and referral center in Northeast India between June 2008 through June 2018 without any personal identifying information. The Obstetric data from pregnancy register was supplemented with detailed neurologic data retrieved from medical records. RESULTS: Of 103 women with active epilepsy, 47 (45.6%) received levetiracetam as monotherapy and 56 (54.4%) as polytherapy. During pregnancy, the seizure frequency was unchanged, or the change was better in the majority (61.1%) of the patients. With one twin pregnancy, there were 96 live births, 5 spontaneous abortions, 2 induced abortions, 1 stillbirth. However, the rate of small for gestational age was higher in WWAE, Apgar score at 5 min was lower in infants of WWAE, and the need for care in the neonatal ward and neonatal intensive care was higher. Seven of 103 exposed pregnancies had a major congenital malformation (6.79%), all 7 were exposed to other antiepileptic drugs. Generalized epilepsy accounted for 57.2%. CONCLUSION: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of women with active epilepsy with proper antenatal and neurologic care. Levetiracetam taken in monotherapy can be considered as safer alternative for women with epilepsy of childbearing age. Long-term follow-up of neuropsychological and cognitive development of the children of WWAE is still needed.

Digital gangrene in spinal tuberculosis.

Though tuberculosis is commonly seen in India, uncommon manifestations like peripheral gangrene is also a possibility. Here we present a case of spinal tuberculosis, with peripheral gangrene.