Recommended Resting-State fMRI Acquisition and Preprocessing Steps for Preoperative Mapping of Language and Motor and Visual Areas in Adult and Pediatric Patients with Brain Tumors and Epilepsy.

Resting-state (rs) fMRI has been shown to be useful for preoperative mapping of functional areas in patients with brain tumors and epilepsy. However, its lack of standardization limits its widespread use and hinders multicenter collaboration. The American Society of Functional Neuroradiology, American Society of Pediatric Neuroradiology, and the American Society of Neuroradiology Functional and Diffusion MR Imaging Study Group recommend specific rs-fMRI acquisition approaches and preprocessing steps that will further support rs-fMRI for future clinical use. A task force with expertise in fMRI from multiple institutions provided recommendations on the rs-fMRI steps needed for mapping of language, motor, and visual areas in adult and pediatric patients with brain tumor and epilepsy. These were based on an extensive literature review and expert consensus.Following rs-fMRI acquisition parameters are recommended: minimum 6-minute acquisition time; scan with eyes open with fixation; obtain rs-fMRI before both task-based fMRI and contrast administration; temporal resolution of ≤2 seconds; scanner field strength of 3T or higher. The following rs-fMRI preprocessing steps and parameters are recommended: motion correction (seed-based correlation analysis [SBC], independent component analysis [ICA]); despiking (SBC); volume censoring (SBC, ICA); nuisance regression of CSF and white matter signals (SBC); head motion regression (SBC, ICA); bandpass filtering (SBC, ICA); and spatial smoothing with a kernel size that is twice the effective voxel size (SBC, ICA).The consensus recommendations put forth for rs-fMRI acquisition and preprocessing steps will aid in standardization of practice and guide rs-fMRI program development across institutions. Standardized rs-fMRI protocols and processing pipelines are essential for multicenter trials and to implement rs-fMRI as part of standard clinical practice.

Comprehensive Update and Review of Clinical and Imaging Features of SMART Syndrome.

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a delayed complication of cranial irradiation, with subacute onset of stroke-like symptoms including seizures, visual disturbance, speech impairment, unilateral hemianopsia, facial droop, and aphasia, often associated with migraine-type headache. The diagnostic criteria were initially proposed in 2006. However, the diagnosis of SMART syndrome is challenging because clinical symptoms and imaging features of SMART syndrome are indeterminate and overlap with tumor recurrence and other neurologic diseases, which may result in inappropriate clinical management and unnecessary invasive diagnostic procedures. Recently, various imaging features and treatment recommendations for SMART syndrome have been reported. Radiologists and clinicians should be familiar with updates on clinical and imaging features of this delayed radiation complication because recognition of this entity can facilitate proper clinical work-up and management. This review provides current updates and a comprehensive overview of the clinical and imaging features of SMART syndrome.

Human C1q Tumor Necrosis Factor 8 (CTRP8) defines a novel tryptase+ mast cell subpopulation in the prostate cancer microenvironment.

The adipokine C1q Tumor Necrosis Factor 8 (CTRP8) is the least known member of the 15 CTRP proteins and a ligand of the relaxin receptor RXFP1. We previously demonstrated the ability of the CTRP8-RXFP1 interaction to promote motility, matrix invasion, and drug resistance. The lack of specific tools to detect CTRP8 protein severely limits our knowledge on CTRP8 biological functions in normal and tumor tissues. Here, we have generated and characterized the first specific antiserum to human CTRP8 which identified CTRP8 as a novel marker of tryptase+ mast cells (MCT) in normal human tissues and in the prostate cancer (PC) microenvironment. Using human PC tissue microarrays composed of neoplastic and corresponding tumor-adjacent prostate tissues, we have identified a significantly higher number of CTRP8+ MCT in the peritumor versus intratumor compartment of PC tissues of Gleason scores 6 and 7. Higher numbers of CTRP8+ MCT correlated with the clinical parameter of biochemical recurrence. We showed that the human MC line ROSAKIT WT expressed RXFP1 transcripts and responded to CTRP8 treatment with a small but significant increase in cell proliferation. Like the cognate RXFP1 ligand RLN-2 and the small molecule RXFP1 agonist ML-290, CTRP8 reduced degranulation of ROSAKIT WT MC stimulated by the Ca2+-ionophore A14187. In conclusion, this is the first report to identify the RXFP1 agonist CTRP8 as a novel marker of MCT and autocrine/paracrine oncogenic factor within the PC microenvironment.

Ulnar nerve morphology on magnetic resonance imaging predicts nerve recovery after surgery for cubital tunnel syndrome.

Magnetic resonance imaging (MRI) can evaluate nerve morphology in cubital tunnel syndrome (CuTS), but its value in predicting surgical outcome is unclear. The purpose of this study was to determine whether ulnar nerve morphology on MRI correlated with outcome after CuTS surgery. We reviewed 40 patients who had preoperative MRI and electrodiagnostic (EDX) examinations for CuTS and outcome evaluation 6 months and 2 years postoperatively. Using MRI, ulnar nerve cross-sectional area (UNCSA), changes in signal intensity, and any space-occupying lesion were evaluated. Other factors assessed were age, symptom duration and severity, type-2 diabetes and EDX parameters. Factors associated with unfavorable surgical outcome were identified. At 6 months postoperatively, 12 patients (30%) had excellent, 19 (47.5%) good, 8 (20%) fair and 1 (2.5%) poor results on modified Wilson-Krout criteria. On univariate analysis, unfavorable outcomes were associated with increased UNCSA, space-occupying lesion, and decreased motor nerve conduction velocity (mNCV), and on multivariate analysis with increased UNCSA 1 cm distal from the epicondyle only (model 1) or increased UNCSA 1 cm proximal from the epicondyle and decreased mNCV (model 2). At 2 years, 15 patients (37.5%) had excellent, 21 (52.5%) good, 3 (7.5%) fair and 1 (2.5%) poor results, and no factors correlated with unfavorable outcome. Increased UNCSA on MRI was associated with unfavorable outcome at 6 months but not at 2 years. This study suggests that morphologic ulnar nerve changes can predict delayed nerve recovery after surgery for CuTS.

Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study.

BACKGROUND: The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies. AIMS: The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. METHODS: Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing. RESULTS: Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 µg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] µg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] µg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] µg/mL), eberconazole (0.32 [0.251]) µg/mL and amorolfine (0.60 [0.306]) µg/mL. LIMITATIONS: Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints. CONCLUSION: T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.

Gamma-ray shielding characteristics of flexible silicone tungsten composites.

Silicone being a hybrid elastomer is well known for its excellent thermal and mechanical properties, chemical resistance, compatibility with organic and inorganic fillers, nontoxicity, and flexibility. As the reported literature on silicone tungsten composite is rare, thus, a complete possible spectrum of silicone tungsten composites series with tungsten loading of 0-88.1 %wt has been fabricated by RTV method and studied as a flexible gamma shielding material. Flexible silicone/tungsten composite formulations containing different weight percentages of tungsten powder (0, 30.1, 47.8, 59.8, 68.1, and 88.1 wt %) were developed by the room-temperature vulcanization route. Two lead collimators with diameters of 0.6 cm were used to make a narrow beam geometry for gamma rays emitted from a137Cs (gamma-ray energy of 662 keV) point source. Uncollided flux was measured with a NaI(Tl) scintillation detector enclosed in lead shielding to reduce the background radiation level. The measured mass attenuation coefficient for our composites with 88.1 wt % tungsten was 0.1035 cm2/g, which is nearly 3.5% higher than that of commercially available silicone/tungsten composites named T-Flex (nearly 0.095 cm2/g) containing the same tungsten loading. Similarly, superior half value layers (HVL) of our composites with 88.1 % wt loading of tungsten i.e 1.01 cm versus 1.27 cm for the reported T-Flex counterpart with additional advantage of insitu fabrication on complex geometries. It was also found that the effectiveness of gamma-ray shielding increases with increase in density of the composites, which is due to the increase in the weight percent of tungsten powder. Our material will have applications as shielding material for both mobile and stationary radiation sources and it can also be used as fabrication material for gloves, safety shoes, coats, etc. to protect workers in a radiation environment.

Retrospective assessment of the validity and use of the community balance and mobility scale among individuals with subacute spinal cord injury.

STUDY DESIGN: This is a retrospective chart review. OBJECTIVES: The objective of this study was to evaluate the convergent validity, internal consistency and use of the Community Balance & Mobility Scale (CB&M) in individuals with incomplete spinal cord injury (iSCI) during inpatient rehabilitation. SETTING: This study was conducted in an SCI rehabilitation center in Canada. METHODS: Inpatient charts from January 2009 to October 2015 were screened. A chart was excluded if the inpatient was aged >65 years, did not complete a CB&M and/or had a comorbid condition. Demographics, CB&M score and injury-related characteristics were extracted. Berg Balance Scale (BBS), Six-Minute Walk Test (6 MWT) and Ten-Meter Walk Test (10 mWT) scores were obtained if completed within 1 week of the CB&M. χ2-Tests were used to identify CB&M items that were uniformly distributed, implying good discrimination between individuals. Convergent validity was assessed by correlating (Pearson's r) CB&M scores with BBS, 6 MWT and 10 mWT scores. Internal consistency (Cronbach's α) was evaluated. RESULTS: Thirty inpatients were included (23 male, 38.3±15.3 years old, three AIS C, 26 AIS D, C1-L4, 16 traumatic). BBS scores were ⩾51/56; however, CB&M scores showed a wider range (27-82/96). Unilateral Stance, Tandem Walking, Lateral Foot Scooting, Forward to Backward Walking and Descending Stairs showed uniform distributions. Scores on the CB&M correlated strongly with scores on the 6 MWT (r=0.72, P<0.001) and moderately strongly with 10 mWT and BBS scores (r=0.47-0.59, P=0.004-0.013). Cronbach's α=0.87. CONCLUSIONS: The CB&M is a valid measure in high-functioning individuals with iSCI. Prospective studies are required to further evaluate the psychometric properties of the CB&M as a measure of high-level balance for SCI.

Isolated idiopathic aortitis with an unusually thickened aortic wall: case report.

Aortitis includes a broad range of disorders involving inflammation of the aorta. While most forms of aortitis can be linked to a specific cause, patients with idiopathic aortitis (IDA), are asymptomatic and usually diagnosed after surgical removal. The specific pathophysiology is not well understood, but can be strongly associated with tobacco smoking, young age at presentation, and family history of aortic aneurysm. Wall thickening is the most common physical characteristic of aortitis, and the inflammation can affect any layer of the aorta. The normal wall thickness of the aorta is less than 4 mm and can be as thick as 9 mm. Few studies document a correlation between wall thickness and the severity of aortitis. This paper presents a unique case of severe aortic aneurysm associated with an abnormal thickening of the ascending aorta.

Outcome of Twin Deliveries at a Tertiary Care Centre of Eastern Nepal.

BACKGROUND: Twins, compared to singletons, have higher perinatal mortality and morbidity. The aim of this study was to describe the twinning rate, epidemiological variables and hospital outcome of twin deliveries and to find out ways of better management of twins in our part. METHODS: A retrospective evaluation of the outcome of 92 twin pregnancies during one year study period (1st January 2014 to 31st December 2014) was conducted at BPKIHS. Twins delivered within the institution were included but cases less than 28 weeks gestation were excluded. Maternal and neonatal data were retrieved and analysed. RESULTS: The twinning rate was 9.2/1000 (92/10,031). The mean birth weight was 1636.30 ±339.21 grams and mean gestational age 34.31±2.67 weeks(28 - 40 weeks). One hundred eighty-two babies (98.9%) were low birth weight (LBW) while 32.1% were small for gestational age (SGA). There was mild, moderate and severe growth discordance in 63 (68.5%)22 (23.9%)and 7 (7.6%) respectively. Three (3.26%) of 92 pairs had twin-to-twin transfusion syndrome. The hospital mortality rate was 10.87% (20/184) and 69 (37.5%) babies had complications. The clinical causes of death were hyaline membrane disease in 7 (3.3%), severe birth asphyxia in 5 (2.7%), congenital malformations in 3(1.6%) and sepsis in 3 (1.6%) babies. CONCLUSIONS: Twin deliveries are common in this hospital and have poor hospital outcome with more complications and mortality. Hence there is a need for further studies with long term follow-ups to plan for better management of twins in our part.

Chemical composition and antibacterial activity of essential oil of Nepeta graciliflora Benth. (Lamiaceae).

The chemical composition of the essential oil obtained from aerial parts of Nepeta graciliflora was analysed, for the first time, by GC-FID and GC-MS. A total of 27 compounds were identified, constituting over 91.44% of oil composition. The oil was strongly characterised by sesquiterpenes (86.72%), with ß-sesquiphellandrene (28.75%), caryophyllene oxide (12.15%), α-bisabolol (8.97%), α-bergamotene (8.51%), ß-bisabolene (6.33%) and ß-Caryophyllene (5.34%) as the main constituents. The in vitro activity of the essential oil was determined against four micro-organisms in comparison with chloramphenicol by the agar well diffusion and broth dilution method. The oil exhibited good activity against all tested organisms.

Recurrence Risk of Febrile Seizures in Children.

BACKGROUND: Identifying children with febrile seizure who are at risk for recurrence is important so that special attention can be given to them. The objective of this study was to identify the risk factors for recurrence of febrile seizures in children. METHODS: This prospective hospital based study was conducted from July 2013 to August 2014 'among children of 6 months to 6 years of age at Bishweshwar Prasad Koirala Institute of Health Sciences (BPKIHS), Nepal. Children meeting the selection criteria were enrolled in study. Clinical, investigation, treatment and outcome parameters were analyzed. RESULTS: A total of 92 children with febrile seizure were enrolled in study. Males accounted for 70% and females 30%. Simple febrile seizure was present in 48% and complex febrile seizures were seen in 52%. Recurrence of seizure was seen in one third of cases. Loss of consciousness was most common post-ictal phenomenon followed by confusion and lethargy. Upper respiratory infection was the most common precipitating factor. Generalized Tonic Clonic Seizure was the most common seizure type present in 79% of cases. Significant risk factors for recurrence occurred in males (p=0.088), age less than 1 year (p=0.003). Most of the recurrence occurred within one year of first seizure. CONCLUSIONS: Febrile Seizure is common in males. Almost one third of children with febrile seizure are at risk for recurrence. The significant risk factors for recurrences are male gender and age <1year.

Composition and antioxidant activity of Senecio nudicaulis Wall. ex DC. (Asteraceae): a medicinal plant growing wild in Himachal Pradesh, India.

The composition of essential oil isolated from Senecio nudicaulis Wall. ex DC. growing wild in Himachal Pradesh, India, was analysed, for the first time, by capillary gas chromatography (GC) and GC-mass spectrometry. A total of 30 components representing 95.3% of the total oil were identified. The essential oil was characterised by a high content of oxygenated sesquiterpenes (54.97%) with caryophyllene oxide (24.99%) as the major component. Other significant constituents were humulene epoxide-II (21.25%), α-humulene (18.75%), ß-caryophyllene (9.67%), epi-α-cadinol (2.90%), epi-α-muurolol (2.03%), ß-cedrene (1.76%), longiborneol (1.76%), 1-tridecene (1.16%) and citronellol (1.13%). The oil was screened for antioxidant activity using DPPH, ABTS and nitric oxide-scavenging assay. The oil was found to exhibit significant antioxidant activity by scavenging DPPH, ABTS and nitric oxide radicals with IC50 values of 10.61 ± 0.14 µg mL(- 1), 11.85 ± 0.28 µg mL(- 1) and 11.29 ± 0.42 µg mL(- 1), respectively.

A multicentre UK study of GVHD following DLI: rates of GVHD are high but mortality from GVHD is infrequent.

DLIs are frequently used following haematopoietic SCT (HSCT) in patients with risk of relapse but data on GVHD following DLI are scarce. We report on 68 patients who received DLI following HSCT. Most patients developed GVHD following DLI (71%), which was acute in 22 patients (32%) almost half of whom had grade III-IV acute GVHD (aGVHD). Thirty patients (44%) developed cGVHD which followed aGVHD in four patients and was graded severe in nine patients. Corticosteroids were the most common first-line therapy for both acute and chronic GVHD. A wide range of second/third-line agents included cyclosporin, mycophenolate, tacrolimus, imatinib, infliximab and ECP. Relapse of initial malignancy occurred in 37%. Relapse was significantly less frequent in those receiving pre-emptive DLI. Relapse rates were also lower in those with GVHD (31%) than those without GVHD (50%), but this did not reach statistical significance. At 55 months post DLI, 34% of patients had died most commonly from relapse and 22% had on-going GVHD. Although GVHD was an important cause of morbidity post DLI (71%), only 6% died from GVHD. Although most patients develop GVHD post DLI and may require consecutive therapies, mortality from GVHD is infrequent. DLI remains an important option for relapse post transplant and manipulation of the GVT effect needs to be optimised to induce remission without morbidity from GVHD.

Surface electronic structure calculations using the MBJLDA potential: application to Si(111)2 × 1.

The Si(111)2 × 1 surface has been widely studied via a range of different experimental and theoretical techniques, and found to adopt a π-bonded chain configuration. To determine an accurate electronic structure for this system, however, it has been found necessary to use sophisticated and very computationally expensive methods such as GW or hybrid functionals. In this article, we show that the MBJLDA approach, originally proposed by Tran and Blaha for bulk materials (Tran and Blaha, Phys. Rev. Lett. 2009, 102, 226401), yields results which are comparable to GW, and generally superior to those obtained from hybrid functional density functional theory calculations. The MBJLDA method is also substantially more computationally efficient. A procedure and justification for the application of the MBJLDA approach to surfaces in general is also provided.

A prospective evaluation of posterior capsule opacification in eyes with diabetes mellitus: a case-control study.

AIM: To compare the development of posterior capsule opacification (PCO) between eyes with and without diabetes mellitus after single-piece hydrophobic acrylic intraocular lens implantation 4 years postoperatively. METHODS: In this prospective, observational case-control study carried out at Iladevi Cataract and IOL Research Centre, Ahmedabad, India, 75 consecutive eyes with diabetes mellitus (cases) were compared with 75 age-matched eyes with age-related cataract (controls). A detailed, preoperative and posterior segment evaluation was carried out in eyes with diabetes mellitus to detect the presence or absence of diabetic retinopathy (DR). The Mann-Whitney U-test was applied to compare the differences in the development of PCO between the two groups. RESULTS: There was no difference in median PCO between cases and controls at 1 month (2.0 vs 1.50, P<0.068), but cases had a higher median PCO at 12 months (2.95 vs 1.30, P<0.001). At 4 years, there was no significant difference in median PCO between cases and controls (3.75 vs 2.25, P=0.273). The duration of diabetes increased the incidence of PCO at 4 years (P=0.02). Severity of DR had no influence on the progress of PCO at 4 years (P=0.69). CONCLUSION: Diabetes mellitus did not increase the incidence of PCO at 4 years. The duration of diabetes increased the risk of PCO. The severity of retinopathy did not influence the development of PCO.

Active and passive case detection strategies for the control of leishmaniasis in Bangladesh.

SETTING: Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis. OBJECTIVE: To determine 1) the numbers of patients diagnosed with visceral leishmaniasis (VL) and post-kala azar dermal leishmaniasis (PKDL) using an active case detection (ACD) strategy in Fulbaria and a passive case detection (PCD) strategy in Trishal, and 2) the time taken from symptoms to diagnosis in the ACD subdistrict. DESIGN: A cross-sectional descriptive study of patients diagnosed from May 2010 to December 2011. The ACD strategy involved community education and outreach workers targeting households of index patients using symptom-based screening and rK-39 tests for suspected cases. RESULTS: In the ACD subdistrict (Fulbaria) and PCD sub-district (Trishal), respectively 1088 and 756 residents were diagnosed with VL and 1145 and 37 with PKDL. In the ACD subdistrict, the median time to diagnosis for patients directly referred by outreach workers or self-referred was similar, at 60 days for VL and respectively 345 and 360 days for PKDL. CONCLUSION: An ACD strategy at the subdistrict level resulted in an increased yield of VL and a much higher yield of PKDL. As PKDL acts as a reservoir for infection, a strategy of ACD and treatment can contribute to the regional elimination of leishmaniasis in the Indian sub-continent.

Contexte : Deux sous-districts du Bangladesh, Fulbaria et Trishai, où la leishmaniose est hyper-endémique.Objectif : Déterminer 1) le nombre de patients ayant eu un diagnostic de leishmaniose viscérale (VL) et de leishmaniose dermique post-kala azar (PKDL) grâce à une stratégie de détection active des cas (ACD) à Fulbaria et à une stratégie de détection passive (PCD) à Trishai, et 2) le temps écoulé entre les symptômes et le diagnostic dans le sous-district à ACD.Schéma : Etude descriptive transversale des patients diagnostiqués entre mai 2010 et décembre 2011. La stratégie ACD comportait une éducation des communautés et des stratégies avancées ciblant les foyers des patients index grâce à un dépistage basé sur les symptômes et au test rK-39 pour les patients suspects.Résultats : Dans les districts de stratégie ACD (Fulbaria) et le sous-district de stratégie PCD (Trishai), 1088 et 756 patients respectivement ont eu un diagnostic de VL et 1145 et 37 respectivement ont eu un diagnostic de PKDL. Dans ce sous-district, le délai médian de diagnostic était de 60 jours pour tous les patients atteints de VL, qu'ils soient référés par du personnel des stratégies avancées ou viennent d'eux-mêmes. Il était respectivement de 345 et 360 jours pour la PKDL.Conclusion : Une stratégie ACD au niveau d'un sous-district permet de dépister un nombre accru de VL et encore plus de PKDL. Comme la PKDL constitue un réservoir d'infection, la stratégie d'ACD et le traitement des cas dépistés peuvent contribuer à l'élimination régionale de la leishmaniose du sous-continent indien.

Marco de referencia: Los subdistritos de Fulbaria y Trishal en Bangladesh, donde es hiper-endémica la leishmaniasis.Objetivo: Determinar: 1) el número de pacientes con diagnóstico de leishmaniasis visceral (VL) y de leishmaniasis cutánea pos kala azar (PKDL) mediante una estrategia de detección activa de casos (ACD) en Fulbaria y una detección pasiva (PCD) en Trishal; y 2) y el lapso entre la aparición de los síntomas y el diagnóstico en el subdistrito que aplicó la estrategia ACD.Método: Se llevó a cabo un estudio transversal descriptivo de los pacientes en quienes se estableció el diagnóstico de leishmaniasis entre mayo del 2010 y diciembre del 2011. Como parte de la estrategia ACD se impartió educación a la comunidad y participaron trabajadores extrainstitucionales que contactaban a los hogares de los casos iniciales y practicaban una detección basada en los síntomas y la prueba rK-39 de diagnóstico rápido en los casos de presunción diagnóstica.Resultados: En el subdistrito de Fulbaria la estrategia ACD permitió el reconocimiento de 1088 residentes con VL y 1145 con PKDL; en el subdistrito de Trishal se detectaron mediante la estrategia PCD 756 y 37 casos, respectivamente. La mediana del lapso necesario hasta establecer el diagnóstico de VL en los pacientes remitidos directamente por los trabajadores periféricos fue análoga a la mediana del lapso en los que se presentaron por su propia iniciativa y correspondió a 60 días en casos de VL; en los pacientes con PKDL la mediana del lapso fue 360 días en los pacientes remitidos por los trabajadores periféricos y 360 en los pacientes que acudieron por su propia cuenta.Conclusión: Una estrategia ACD a escala del subdistrito ofrece un mayor rendimiento diagnóstico de la VL y un incremento aun mayor del diagnóstico de PKDL. Dado que la PKDL representa un reservorio de la infección, una estrategia ACD y tratamiento puede contribuir a la eliminación regional de la leishmaniasis en el subcontinente indio.

Case based learning: a method for better understanding of biochemistry in medical students.

INTRODUCTION: Health professionals need to develop analytic and diagnostic thinking skills and not just a mere accumulation of large amount of facts. Hence, Case Based Learning (CBL) has been used in the medical curriculum for this reason, so that the students are exposed to the real medical problems, which helps them in develop analysing abilities. This also helps them in interpreting and solving the problems and in the course of doing this, they develop interest. In addition to didactic lectures, CBL was used as a learning method. METHODS: This study was conducted in the Department of Biochemistry, S.B.K.S.M.I and R.C, Sumandeep Vidyapeeth ,Piparia, Gujarat, India. A group of 100 students were selected and they were divided into two groups as the control group and the study group. A total of 50 students were introduced to case based learning, which formed the study group and 50 students who attended didactic lectures formed the control group. RESULTS: A very significant improvement (p<0.0001) was observed among the students after the CBL sessions and they were also motivated by these sessions. A 4 point Likert scale questionnaire which contained 8 questions was administered to the students, to know their perception on the usefulness of the CBL. 98% of the students reported that they found the CBL sessions to be an interesting method of gaining knowledge. 84% of them felt that they exposed them to an experience of logical application of the knowledge which was gained in cracking cases, which would be of great help in the future also. CONCLUSION: Case Based Learning (CBL) was used and it is effective in the medical curriculum for a better understanding of Biochemistry among the medical students.

Post-kala-azar dermal leishmaniasis with mucosal involvement: an unusual case presentation including successful treatment with miltefosine.

Post-kala-azar dermal leishmaniasis (PKDL) is a dermatologic manifestation that usually occurs after visceral leishmaniasis (VL) caused by Leishmania donovani. It is characterized by hypopigmented patches, a macular or maculopapular rash and nodular skin lesions on the body surface. Involvement of the mucosae is very rare and unusual in PKDL. We report a case of PKDL that presented with polymorphic skin lesions, along with involvement of peri-oral mucosa and tongue from an endemic area for kala-azar in Bangladesh. In the absence of a definite past history of kala-azar, a clinical suspicion for PKDL was confirmed by positive rapid serological tests against two recombinant (rK39 and rK28) leishmanial antigens, demonstration of Leishmania donovani (LD) body in the slit skin smear, and isolation of promastigotes by culture from a nodular lesion. The patient was treated with oral Miltefosine for three consecutive months and showed significant clinical improvement as demonstrated by a negative slit skin smear at two months after initiation of therapy. We report this case as an unusual presentation of mucosal involvement in PKDL and subsequent treatment success with Miltefosine.