Mental health problems raise the odds of cognitive impairment in COVID-19 survivors.

Background: COVID-19 survivors around the globe are suffering from mental health issues. While mental health problems can be an early warning sign of dementia, they may also increase the chances of developing the disease. In this study, we examined the mental health of COVID-19 survivors and mapped its associations with cognitive and demographic variables. Method: COVID-19 survivors listed in the databases of three tertiary care hospitals in Kolkata were contacted sequentially. 376 willing patients were interviewed over the telephone. 99 COVID-19 patients and 31 matched controls participated in the in-person interviews that were arranged for a more detailed investigation. The participants were administered standardized tests that are widely used for the assessment of cognitive functioning and mental health status. Result: 64.89% of COVID-19 survivors reported a deterioration in physical functioning. 44.95% reported a decline in mental health, whereas 41.49% reported a drop in cognitive performance. Detailed investigations revealed that they had an increased risk of having depression, anxiety, and poor sleep quality by 91%, 68%, and 140%, respectively. 6.1% of the patients had mild cognitive impairment, and 4% had dementia. COVID-19 patients who had depression and anxiety were 8.6 and 19.4 times more likely to have cognitive decline, respectively. Compared to the matched controls, COVID-19 patients had greater depression (p<.001), anxiety (p<.001), stress (p =.003), and insomnia (p <.001). They also scored significantly lower on Addenbrooke's Cognitive Examination-III (p =.009) and Picture Naming Test (p =.005) and took significantly longer to complete Trail Making Test-A (p =.002). Conclusion: COVID-19 survivors in this study had major mental health issues even one year after contracting the virus. They had significant cognitive deficits that might progress into dementia. Strict monitoring and systematic treatment plans should be implemented as soon as possible.

A case of area postrema variant of neuromyelitis optica spectrum disorder following SARS-CoV-2 infection.

Neuromyelitis optica spectrum disorder (NMOSD) is a disabling autoimmune astrocytopathic channelopathy, characterized by the presence of pathogenic antibodies to aquaporin-4 (AQP-4) water channels. Several viral infections including HIV, influenza virus, varicella zoster virus, and Epstein Barr virus, among others, have been alleged to trigger NMOSD in both immunocompetent and immunocompromised individuals. Neurological manifestations of coronavirus infectious disease of 2019 (COVID-19) have been ever evolving and the spectrum of neuraxial involvement is broadening. Albeit it may affect any area of the neural axis, the involvement of the spinal cord is rare compared to that of the brain and of the peripheral nervous system. Cases with acute longitudinally extensive transverse myelitis (LETM) have been recently reported in SARS-CoV-2 infection but did not fulfill the international consensus diagnostic criteria for NMOSD. AQP-4-antibody-seropositive NMOSD following SARS-CoV-2 infection had not yet been reported. We herein report a novel case of a previously healthy man who presented with a clinical picture of bouts of vomiting and hiccoughs (area postrema syndrome), which rapidly evolved to acute LETM, all following SARS-CoV-2 infection. He was finally diagnosed to be a case of seropositive NMOSD which presented as area postrema syndrome. The response to immunomodulatory drugs was excellent.

Hypermanganesemia Induced Chorea and Cognitive Decline in a Tea Seller.

Background: Manganese associated neurotoxicity and neurodegeneration is quite rare yet established neurological disorder. This neurotoxic element has predilection for depositing in basal ganglia structures, manifesting mainly as parkinsonian and dystonic movement disorders with behavioral abnormalities. Case report: We report a 40-year-old man who presented with a subacute onset bilateral, asymmetric hyperkinetic movement disorder (predominantly left sided chorea) with multi-domain cognitive impairment, dysarthria, and generalized rigidity. Clinical history and examination yielded multiple differential diagnoses including deposition and metabolic disorders, autoimmune and paraneoplastic encephalitis involving basal ganglia, and neurodegenerative disorders with chorea and cognitive impairment. However, magnetic resonance imaging was suggestive of paramagnetic substance deposition, which came out to be manganese after laboratory investigations. History, clinical examinations, and investigation results pointed towards a diagnosis of acquired hypermanganesemia due to over-ingestion of manganese containing substance (i.e., black tea). He was treated symptomatically and with chelation therapy (calcium disodium edetate). At the sixth month of follow-up, complete resolution of chorea, dysarthria and partial amelioration of rigidity were observed. His cognitive decline and behavioral abnormalities improved. Discussion: This is probably the first reported case of acquired hypermanganesemia that presented as a combination of asymmetric chorea and cognitive dysfunction with atypical imaging characteristics. The clinical picture mimicked that of Huntington's disease. We highlight the potential deleterious effects of an apparently "benign" non-alcoholic beverage (i.e., black tea) on cerebral metabolism.

Is transabdominal ultrasound scanning of cervical measurement in mid-trimester pregnancy a useful alternative to transvaginal ultrasound scan?

OBJECTIVE: The aim of this study is to assess the correlation between transabdominal and transvaginal ultrasound measurements of the cervix in pregnancy. If transabdominal ultrasound measurement of cervical length is found to provide effective information, it could be used in patient counselling and when making clinical decisions. MATERIAL AND METHODS: One hundred and twenty seven pregnant patients between 18-26 weeks of pregnancy were enrolled in this prospective study for measuring cervical length, both by transabdominal and transvaginal ultrasound scan after bladder emptying. Transabdominal and transvaginal measurements were compared and correlated. RESULTS: In patients with transvaginal ultrasound scan (TVS) cervical length ≤32 mm, TVS cervical length was found to be shorter than by transabdominal ultrasound scan (TAS). Most of these patients needed >3 cm of vertical pocket of urine in the bladder for adequate visualisation of the cervix. In patients with TVS cervical length >32 mm, the TVS measurement of the cervix was longer than the TAS measurement of the cervix. In these patients, the cervix could be seen by TAS when there was either ≤3 cm vertical pocket of urine in the bladder or an empty bladder. Statistical tests showed that there is a significant difference between TAS and TVS cervical measurements and that there is a significant association between these two measurements. CONCLUSION: Most of the patients needed variable degrees of bladder filling for adequate visualisation of the cervix. Although minimal bladder filling does not influence TAS measurements of cervical length, moderate fullness of the bladder does cause an apparent increase in TAS measurements of cervical length. If the cervical length is ≥30 mm by TAS, regardless of urine content in the bladder, the patient can be assured vis a vis their risk of preterm labour as far as cervical length is concerned. However, in patients with TAS cervical measurement <30 mm and where the bladder needed a moderate amount of urine for adequate visualisation of the cervix, TVS cervical measurement may be close to the critical value of 25 mm. These patients need to be counselled and offered TVS for better assessment of cervical length.

Predictors of insulin resistance and metabolic complications in polycystic ovarian syndrome in an eastern Indian population.

The purpose of this study was to assess the predictive values of central obesity and hyperandrogenemia in development of insulin resistance and dyslipidemia in the polycystic ovarian syndrome (PCOS) patients in our region. Differences of fasting blood glucose level, insulin resistance index HOMA-IR, lipid parameters, waist hip ratio (WHR), body mass index, LH/FSH ratio and testosterone levels between 45 PCOS cases and 35 age matched controls were obtained. Strength of association between different parameters in the case group was assayed by Pearson's correlation analysis. Dependence of insulin resistance and WHR on different predictors was assessed by multiple linear regression assay. Total cholesterol, LDL cholesterol, LH, FSH, LH/FSH ratio, WHR and insulin resistance were significantly higher in the case group (p < 0.05). Serum testosterone showed strong correlation with insulin resistance and LH/FSH ratio (r = 0.432 and 0.747, p = 0.01 and 0.001 respectively) in the PCOS patients while WHR and serum testosterone level stood out to be most significant predictors for the insulin resistance (ß = 0.361 and 0.498; p = 0.048 and 0.049 respectively). Hyperandrogenemia and central obesity were the major factors predicting development of insulin resistance and its related metabolic and cardiovascular complications in our PCOS patients. We suggest early monitoring for androgen level and WHR in these patients for predicting an ensuing insulin resistance and modulating the treatment procedure accordingly to minimise future cardiovascular risks.

Prediction of Clinical Outcome in Acute Hemorrhagic Stroke from a Single CT Scan on Admission.

BACKGROUND: From a single CT scan in primary intracerebral hemorrhage (ICH), clinical outcome can be assessed on admission by using the CT scan parameters. AIMS: The study aims to find out how hematoma volume, location of stroke, midline shift, intraventricular extension of bleed and ventricle compression influence the clinical outcome in patients with acute ICH. MATERIALS AND METHODS: Non-contrast CT scan was done on admission in hospital for every patient with acute hemorrhagic stroke and was analyzed accordingly. Clinical assessments were done in National Institute of Health Stroke Scale (NIHSS). Chi-square test and multiple logistic regression analysis were used for statistical analysis. RESULTS: Mean hematoma volume associated with death before 30 days is 33.16 cm(3) (P < 0.0001), with survived after 30 days is 15.45 cm(3) (P < 0.0001), with NIHSS score ≥16 is 29.03 cm(3) (P < 0.0001) and with NIHSS score <16 is 13.69 cm(3) (P < 0.0001). Independent poor prognostic factors were hematoma volume > 30 cm(3) (OR = 27.857), brain stem hemorrhage (OR = 6.000), intraventricular extension of bleed from other location (OR = 7.846), presence of ventricular compression alone (OR = 2.700) and in combination with midline shift of ≥ 5 mm (OR = 2.124). CONCLUSIONS: From a single CT scan during hospital admission, mortality and morbidity in next 30 days can be predicted. A hematoma volume >30 cm(3), brain stem hematoma, intraventricular extension of bleed and ventricular compression along and with midline shift are associated with early mortality in ICH.

Familial, environmental, and occupational risk factors in development of amyotrophic lateral sclerosis.

BACKGROUND: Definite etiology of amyotrophic lateral sclerosis (ALS) is still a matter of debate. AIMS: The study was designed to evaluate the role of environmental, occupational, and familial risk factors in development of ALS. MATERIALS AND METHODS: This was a case control study of 110 cases of definite ALS with 240 age and sex matched controls. Investigations were done on the following aspects- family history, occupation, living place, source of drinking water, exposure to industrial, chemical, agricultural toxins and heavy metals, physical and electrical injury, working under magnetic field for more than 10 years in both the groups. Clinical examinations, electrophysiological, and neuroimaging studies were done in every patient. Chi square test, logistic regression analysis, and calculation of odds ratio were used to analyze the data. RESULTS: Rural livings (odds ratio = 1.99), smoking (odds ratio = 1.88), insecticides, and pesticides exposures (odds ratio = 1.61), electrical injury (odds ratio = 6.2) were detected as the associated factors in development amyotrophic lateral sclerosis. CONCLUSIONS: The study expressed the need of extensive research globally in molecular and genetic levels to detect the associated factors in etiopathogenesis of ALS for better understanding the etiology and for remedial aspects.

Plasma osmolality in acute spontanious intra-cerebral hemorrhage: Does it influence hematoma volume and clinical outcome?

BACKGROUND: Neurological deterioration in acute spontaneous intra cerebral hemorrhage (ICH) may depend on hematoma volume, electrolyte imbalances, hydration status and other physiological parameters. Plasma osmolality is a marker of hydration. This study has examined the relationship of plasma osmolality with hematoma volume and clinical outcome. MATERIALS AND METHODS: This is a prospective observational study included 75 patients with non-traumatic acute spontaneous ICH. Plasma osmolality, hematoma volume and clinical outcome in National Institute Health stroke scale (NIHSS) were measured on admission and on day 7 after treatment. Mean plasma osmolality was compared between those who died before day 7 and those who died after day 7. Plasma osmolality was also compared between patients with NIHSS score >20 and patients with NIHSS score ≤20. Paired t test, Pearson correlation coefficient and independent sample t test were done using SPSS software (version 17 for Windows). RESULT: There is no significant correlation between hematoma volume and plasma osmolality. Higher admission plasma osmolality was associated with early death [312.0 (±16.0) mOsm/kg for those who died before day 7 versus 297.0 (±14.7) mOsm/kg for those who died after day 7, P value =0.031]. Higher admission plasma osmolality was associated with very severe stroke [311.5 (±14.1) mOsm/Kg for patients with NIHSS score >20 versus 293.6 (±11.3) mOsm/kg for patients with NIHSS score ≤20, P value =0.000). CONCLUSION: High plasma osmolality is a predictor of early mortality. Hematoma volume is not influenced by plasma osmolality.

Role of familial, environmental and occupational factors in the development of Parkinson's disease.

BACKGROUND: Despite intensive research during the past several decades, the cause of Parkinson's disease remains unknown. Infections, toxins, lifestyle and hereditary factors have all been supposed to play a role in the genesis of Parkinson's disease. The final mechanisms of neuronal injury and death are probably similar, where both genetic and environmental factors are important, and these two factors interact along the etiopathogenic pathway. OBJECTIVE: The purpose of the present study is to evaluate the role of familial, environmental and occupational factors in the development of Parkinson's disease. METHODS: We evaluated 345 cases of idiopathic Parkinson's disease (215 males, 130 females; mean age 62 ± 2 years) and 370 controls (220 males, 150 females; mean age 62 ± 3 years) between January 2003 and January 2008 with regard to the following aspects in detail: place of living, family history of Parkinson's disease and tremor, source of drinking water, exposure to insecticides, pesticides, herbicides and industrial toxins, acute poisoning, CNS infections and head injury. The duration of exposure to the risk factors and the history of Parkinson's disease among the cases were investigated after obtaining written informed consent from cases and controls. RESULTS AND CONCLUSIONS: Family history of Parkinson's disease and familial tremor (p = 0.035), exposure to insecticides and pesticides (p = 0.049), well water use for drinking purposes (p = 0.03), Japanese B encephalitis (p = 0.04) and acute organophosphate poisoning (p = 0.046) were associated with the development of Parkinson's disease in this region of India. Further research is needed at the epidemiological, genetic and molecular levels for a better understanding of the etiopathogenesis of Parkinson's disease as well as remedial aspects.

Hydatid cyst in rectus abdominis muscle in a child: An unusual occurrence.

Hydatid cysts usually involve the liver; extrahepatic localization is reported in 11% of all cases of abdominal hydatid disease. Cyst at unusual localization includes kidney, heart, spleen, pancreas and brain. Isolated involvement of muscle is also rare in children. Here is a case of hydatid cyst in a female child involving the rectus abdominis muscle, which is a very rare presentation. There were no cysts in any other location. Serological tests were negative for cystic echinococcosis. The patient was operated on and the cyst was completely excised. The pathologic examination confirmed the diagnosis of hydatid cyst.

Lissencephaly--not an uncommon cause of intractable seizure in children: report of 3 cases.

Lissencephaly or azyria, a rare disorder characterised by the absence of cerebral convolutions and poorly formed sylvlan fissures giving the appearance of a foetal brain with smooth cerebral surface, thickened cortical mantle and microscopic appearance ofincomplete neuronal migration. It is to consider lissencephaly in the diagnosis of developmental delay with seizure disorder as many patients may be diagnosed as cerebral palsy. Several lissencephaly syndrome have been described, Here three cases of lissencephaly with developmental delay and Intractable seizures are reported.

Discontinuation of secondary preventive treatment of stroke: an unexplored scenario in India.

OBJECTIVE: This prospective study will evaluate the socioeconomic factors responsible for the discontinuation of secondary preventive treatment of stroke in India and its outcome. DESIGNS METHODS: A total of 1212 stroke patients (male=708, mean age 58 ± 2 years; female=504, mean age 56 ± 2 years; intra-cerebral haemorrhage=496; ischaemic=716) were enrolled in the stroke clinic for secondary preventive treatment from 1st January 2006 to 1st January 2008 and were followed up at 4-6-week intervals. Among them, 512 patients were grouped as being below the poverty line. Discontinuation of treatment for more than 2 weeks by a patient placed that patient in a group labelled discontinued. Outcomes of discontinuation of secondary preventive treatment were evaluated with respect to (1) control of risk factors, (2) recurrence of stroke, and (3) mortality rate. Reasons for the discontinuation were comparatively analysed with respect to awareness, education, economy, distance, and daily cost of treatment, types of stroke and disability status. RESULTS AND ANALYSIS: During the study period of 2 years, the following was observed: 420 patients (34.65%) discontinued secondary preventive treatment; 112 patients (9.24%) dropped out; 680 patients (56.10%) continued. Chi-square and null hypothesis procedures were applied for statistical analysis. Distance, economy, poor awareness on stroke, low educational level, types of stroke, cost of treatment and disability status all were significant factors in the discontinuation of treatment. The discontinued group had poor control of risk factors, higher recurrence of both types of stroke and higher mortality. CONCLUSIONS: Discontinuation of secondary preventive treatment due to diverse socioeconomic factors results in greater recurrence and disabilities among stroke survivors, and these findings should be reported to national and international planning authorities to strengthen preventive measures to achieve better outcomes and reductions of the stroke burden globally.

Menkes kinky hair disease: A case report.

An eight month old male infant with protein energy malnutrition was admitted in the hospital with the history of repeated attacks of convulsion since four months of age. He was also suffering from frequent attacks of cough and cold since 6 months of age which was marked prior to admission. The infant had fair complexion, sparse fuzzy wooly hair with marked trunkal hypotonia. He had also mental retardation. Serum copper and ceruloplasmin levels were low, MRI showed prominent extraaxial spaces with gliosis, MR angiography revealed tortuosity of cerebral vessels. Microscopic examination of hair revealed pili torti. The patient was diagnosed as Menkes disease and treated symptomatically. For lack of facilities we were not able to do genetic study.