Surgical management for dystonia: Efficacy of deep brain stimulation in the long term

Introduction: Dystonia is a movement disorder substantially affecting the quality of life. Botulinum Neurotoxin (BoNT) is used intramuscularly as a treatment for dystonia; however, not all dystonia patients respond to this treatment. Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD) and essential tremor, but it can help in dystonia as well. Objectives: We studied a total of 67 dystonia patients who were treated with DBS over a period of 7 years to find out the long-term efficacy of DBS in those patients. First, we calculated patient improvement in post-surgery follow-up programs using the Global Dystonia Severity scale (GDS) and Burke–Fahn–Marsden dystonia rating scale (BFMDRS). Secondly, we analyzed the scales scores to see if there was any statistical significance. Methods: In our study we analyzed patients with ages from 38 to 78 years with dystonia who underwent DBS surgery between January 2014 and December 2020 in four different centers (India, Kuwait, Egypt, and Turkey). The motor response to DBS surgery was retrospectively measured for each patient during every follow-up visit using the GDS and the BFMDRS scales. Results: Five to 7 years post-DBS, the mean reduction in the GDS score was 30 ± 1.0 and for the BFMDRS score 26 ± 1.0. The longitudinal change in scores at 12 and 24 months post-op was also significant with mean reductions in GDS and BFMDRS scores of 68 ± 1.0 and 56 ± 1.0, respectively. The p-values were <0.05 for our post-DBS dystonia patients. Conclusions: This study illustrates DBS is an established, effective treatment option for patients with different dystonias, such as generalized, cervical, and various brain pathology-induced dystonias. Although symptoms are not completely eliminated, continuous improvements are noticed throughout the post-stimulation time frame

Epidural electrical spinal cord stimulation of the thoracic segments (T2-T5) facilitates respiratory function in patients with complete spinal cord injury

Introduction: Patients with high cervical Spinal Cord Injury (SCI) usually require mechanical ventilation support. Phrenic Nerve Stimulation (PNS) both direct and indirect is the main alternative for these patients to wean off ventilator although PNS has several limitations and phrenic nerve could be also damaged after cervical spinal cord injury.Objective: In this study, we assessed if the spinal cord Epidural Electrical Stimulation (EES) at the segments T2-T5, related to intercostal muscles, can facilitate respiratory function and particularly inspired tidal volume during mechanic ventilation.Methods: Two patients with a high cervical injury were selected for this study with ethical committee permission and under review board supervision. A phrenic nerve conduction study with diaphragm electromyography (DEMG) was performed before and after trial of EES.Results: Results demonstrate that EES at T2-T5 substantially increase the inspired volume. The results of this study also demonstrate that EES at spinal segments T2-T5 can bring patients dependent from mechanical ventilation to pressure support (on CPAP), preventing Baro-trauma and other complications related to mechanical ventilation.Conclusion: These findings suggest that tested approach applied alone or in combination with the phrenic nerve stimulation could help to reduce time on mechanical ventilation and related complications

A rare cause of nodular skin lesions with fever in an immunocompetent individual

Histoplasmosis is a fungal disease caused by the dimorphic fungus Histoplasma capsulatum. It is endemic to many parts of the world but is rarely seen in India. The fungus usually affects the immunocompromised patients and is rarely reported in immunocompetent hosts. We hereby report a case of the nodular skin lesion with fever lesion that finally turned out to have cutaneous histoplasmosis, from a non-endemic region of northern India and that too in an immunocompetent

Uncommon cause of persistent hypoxia in a patient with obstructive sleep apnea

We report a case of hypothyroidism, obstructive sleep apnea (OSA) with persistent daytime hypoxemia. Cause of hypoxemia was two arteriovenous (AV) malformations in the lower lobe of the lung. We must be alert to other causes of hypoxemia in patients of OSA with persistent daytime hypoxemia

Molecular characterization of hepatitis A virus strains in a tertiary care health set up in north western India

Background & objectives: Hepatitis A virus usually causes acute viral hepatitis (AVH) in the paediatric age group with a recent shift in age distribution and disease manifestations like acute liver failure (ALF). This has been attributed to mutations in 5′non-translated region (5′NTR) which affects the viral multiplication. The present study was aimed to carry out the molecular detection and phylogenetic analysis of hepatitis A virus strains circulating in north western India. Methods: Serum samples from in patients and those attending out patient department of Pediatric Gastroenterology in a tertiary care hospital in north India during 2007-2011 with clinically suspected AVH were tested for anti-hepatitis A virus (HAV) IgM antibodies. Acute phase serum samples were subjected to nested PCR targeting the 5′NTR region followed by sequencing of the representative strains. Results: A total of 1334 samples were tested, 290 (21.7%) were positive for anti-HAV IgM antibody. Of these, 78 serum samples (< 7 days old) were subjected to PCR and 47.4% (37/78) samples showed the presence of HAV RNA. Children < 15 yr of age accounted for majority (94%) of cases with highest seropositivity during rainy season. Sequencing of 15 representative strains was carried out and the circulating genotype was found to be III A. The nucleotide sequences showed high homology among the strains with a variation ranging from 0.1-1 per cent over the years. An important substitution of G to A at 324 position was shown by both AVH and ALF strains. The cumulative substitution in AVH strains Vs ALF strains as compared to GBM, Indian and prototype strain in the 200-500 region of 5′ NTR was comparable. Interpretation & conclusion: Our results showed hepatitis A still a disease of children with III A as a circulating genotype in this region. The mutations at 5′NTR region warrant further analysis as these affect the structure of internal ribosomal entry site which is important for viral replication

Measuring Poverty in Eastern India through Multi-Dimensional Poverty Index (MPI): Tool to Focus Where to Invest in Public Health

Background: The measurement of deprivations in the population provides valuable information for the analysis of inequality and poverty, based on which economic and public health policies and interventions are planned or implemented. This study intends to assess demographic, socioeconomic, water-sanitation & hygienic behavior of families in eastern India and measure poverty through Multi-Dimensional Poverty Index (MPI) with the relative contribu- tion of the indicators. Methods: A population-based door to door health survey on a population residing in 3600 households was conducted in all vil- lages in three gram panchayats in three blocks (1200 households in each GP). Results: Less than three –fourth of the households has been identi- fied as MPI poor. Nearly one-fifth has been identified as vulnera- ble to poverty. The income poverty rate was 36%, and 76% are MPI poor The article also lens out deprivation within study areas. Interpretations: Consumption or income-based indicators alone cannot be a good proxy to capture the multidimensional aspect of poverty and deprivations. Demographic, socio-economic, health and dietary indicators play a significant role in determining the  real standard of living. This study acts as evidence in defining Multi-Dimensional Poverty Index as a tool to focus where to invest in public health

Information on Recent Monkeypox Outbreak: Systematic Search and Content Analysis of YouTube Videos

Objective: To examine the availability, characteristics, content, reliability, and quality of YouTube videos on the recent monkeypox outbreak. Methods: A systematic search was carried out on YouTube using the keywords “Monkeypox” on May 31, 2022. Video-related metrics were entered into the EpiCollect5 application simultaneously while watching the videos. A total of 599 videos were taken for final analysis. On the basis of content, the videos were categorized as useful, misleading, and news updates. Standardized tools were utilized to assess the content, quality, and reliability of the useful videos. Results: Videos attracted cumulative 16,825,261 views and 591,932 likes. A total of 272 (45.4%) videos were categorized as useful, 122 (20.4%) videos as misleading, and 205 (34.2%) videos as news reports, with a 0.96 kappa coefficient of agreement between the 2 accessors. Mass media contributed to approximately 69% of the total videos. The mean Global Quality Scale, medical information and content index, and modified DISCERN scores were 2.8±0.7, 2.2±0.8, and 3.07±0.7 respectively. Conclusion: The present study found that nearly half of the selected videos on recent monkeypox outbreaks contained useful information. Health care professionals and health-related organizations should be encouraged to disseminate scientifically correct information during public health emergencies. One-fifth of the videos contained misleading information, which may be due to a lack of quality assessment and peer review processes. Hence, strict caution and strategies for proper verification procedures should be exercised before uploading any health-related video on this platform