Primary Rosai-Dorfman disease of the central nervous system: A clinical, histological, and molecular appraisal.

Rosai-Dorfman disease (RDD) is characterized by clonal proliferation of S-100 positive histiocytes and variable emperipolesis. It commonly affects cervical lymph nodes. Central nervous system (CNS) involvement is extremely rare. We attempted to evaluate the Cyclin D1 expression and frequency of KRAS and BRAF mutations in the RDD involving the CNS. All patients with histopathologically diagnosed RDD involving CNS were recruited from 2011 to 2022. All cases were subjected to immunohistochemistry for CD68, CD163, S100, CD1a, GFAP, CD207, EMA, ALK, BRAFV600E, IgG4, IgG, and CyclinD1. The real-time polymerase chain reaction (RT-PCR) for hotspot mutation analysis of KRAS (exons 2, 3, and 4) and BRAF (V600E) was conducted on formalin-fixed paraffin-embedded tissue using a commercial kit (EntroGen). A total of seven cases were included. The median age was 31 years, with six men and one woman. It showed spinal cord (n = 4) and intracranial (n = 3) involvement. Histologically, all cases showed histiocyte-rich inflammation with evidence of emperipolesis. These histiocytes were positive for S100, CD68, CD163, and Cyclin D1, whereas negative for CD1a, CD207, and EMA. BRAF V600E was expressed in a single case. None of the control cases (demyelination and infarction) with histiocytic infiltrate showed Cyclin D1 expression. Four RDD cases showed increased IgG4-positive plasma cells (>10/HPF) and IgG4/IgG ratio (>40%). BRAF V600E mutation was detected in one case (14.28%), while none showed KRAS mutation. RDD involving CNS is extremely rare and diagnostically challenging. Nuclear Cyclin D1 expression along with S-100 positivity in the tumor cells is a strong diagnostic clue. BRAF and KRAS mutations are rare in CNS RDD.

Pediatric primary intracranial angiosarcoma with epithelioid differentiation: a surgeon's dilemma.

Angiosarcoma is a rare form of soft tissue sarcoma originating from endothelial tissue, accounting for < 1% of all sarcomas. Primary epithelioid angiosarcomas of the central nervous system (CNS) are even more elusive, with only four reports described in the literature. In this article, we describe the first case in pediatric population, with a brief literature review regarding this entity. A 13-year-old girl presented to emergency services with raised intracranial pressure. MRI demonstrated a heterogenous lesion in the temporal lobe. She underwent emergency craniotomy and subtotal excision of the tumor. Eventually the patient developed multiple infarcts and succumbed post operatively. Pre-operative diagnosis on radiology is difficult considering the rarity of this entity and heterogeneity in radiological appearance. One needs to have a high degree of suspicion to consider angiosarcoma as a radiological differential. Overall prognosis remains poor. Early adjuvant treatment may improve overall survival.

Phytoremediation of radioactive elements, possibilities and challenges: special focus on agricultural aspects.

The radioactive contamination has been reported frequently from agricultural lands and ground water. The main reason behind the radioactive pollution is unprotected mining of radioactive elements, unsafe discard of nuclear industrial waste, military applications, dumping of medically used radioisotopes, globally situated (>400) nuclear power plants and use of phosphate fertilizers in farming. Radionuclides are well known potent carcinogens that may cause the various types of cancers to human and animals due to the long exposure to radioactive contaminated sites. To get rid of from the radioactive pollution there is a need of practically successful and cost effective bioremediation technologies that should able to decontaminate the effected lands and water to benefit the mankind. Microbial and phytoremediation are well studied methods for decreasing or gradually eliminating the radioactive contaminants. In this review, we discussed the different strategies of microbial and phytoremediation of radionuclides and recent advancements, that can play the major role in bioremediation of soil and water.

Different remediation technologies based on physical (precipitation, extraction and membrane separation technologies) and chemical (chemical extraction and leaching, hydrolysis, etc.) methods to remediate the radioactive compounds from soils and water are being developed and evaluated. Most of these technologies are cost intensive and only applicable to little contaminated sites. On the other hand phytoremediation and microbial bioremediation are scientifically proven for applying at large scale and economical. Phytoremediation is one of the bioengineering treatments in which terrestrial and aquatic plants have been successfully used for cleaning the radioactive pollutants from diverse environments. Present review article is a updating the recent developments came in the different bioremediation methods. Moreover aim of this manuscript is also emerging the research gaps and identified the future research frontiers to unlock the complexity of phyto and microbial remediation advancements. Although several plants and numerous bacteria and fungi have been identified as the potential radioactive accumulator but their complete mechanism of bioremediation is still unknown. Present article will help the researchers to understand the process of bioremediation of radionuclides in more depths and will aware about the requirements of the coming future.HighlightsPhyto and microbial bioremediation of radioactive elements, possibilities and challenges.Causes of radioactive contamination in soil and water.Nanophytoremediation is an advanced technology of phytoremediation.Drawbacks of phytoremediation.

Seasonal variation and Incidence of rupture of intracranial aneurysm : A prospective study and Literature review.

OBJECTIVES: Some studies have found an association of incidence of aneurysmal Sub arachnoid hemorrhage (aSAH) seasonal variations and weather patterns but others have refuted this. With conflicting reports in the literature, we tried to find out whether climatic conditions influence the incidence of aSAH. PATIENTS AND METHODS: This was a prospective single centre study involving patients with aSAH operated in a tertiary care hospital over one calendar year. Meteorological parameters like temperature, barometric pressure, humidity and sunshine hours were noted for 2 consecutive days prior to the ictus and on the day of ictus. RESULTS: 392 patients of aSAH who underwent clipping were enrolled. There was no significant difference in the incidence of aSAH across various seasons (p > 0.05). Pre ictus fall in temperature lead to a surge in number of cases. 241 patients (61.5%) reported were from geographical areas which had experienced a fall in temperature over preceding 2 days, with a mean fall in temperature of 1.1(SD 2.1) degree celsius (p less then 0.05). The incidence of aSAH patients in low sunshine hour seasons (1.13 patients/day) was significantly more than that in higher sunshine hour seasons (0.9 patients/day) (p less than 0.05 ). CONCLUSIONS: Seasonal variation had no direct bearing on the incidence of aSAH. Pre ictus fall in temperature lead to a rise in number of cases. Also, higher incidence of aneurysmal subarachnoid haemorrhage was seen in lower sunshine hour seasons.

Non-invasive assessment of cerebral microvascular changes for predicting postoperative cerebral hyperperfusion after surgical revascularisation for moyamoya disease: an arterial spin labelling MRI study.

PURPOSE: Cerebral hyperperfusion syndrome (CHPS) can result after anastomotic surgery as the reperfusion is established in chronically ischemic cerebral territories in patients of moyamoya disease (MMD). In this study, we have evaluated the feasibility of arterial spin labelling (ASL) perfusion MRI to predict cerebral hyperperfusion syndrome based on changes of cerebral blood flow (CBF) after revascularisation surgery in patients of MMD. METHODS: Our prospective study included 25 patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass with or without dural/muscle synangiosis. ASL MRI was performed before and 1-7 days after surgery. On the side planned for operation, 5-mm ROI circle was drawn on the predetermined regions in frontal lobe, temporal lobe, parietal lobe and basal ganglia in proximal and distal territories of MCA to calculate ipsilateral CBF values (CBFi). An attempt was made to select the same location on contralateral side (non-operative) (CBFc) for each measurement for calculation of hemispheric normalised CBF (nCBFh) ratios. To adjust for inter individual variation among MR imagers and CBF, additional regions of interest were drawn within the cerebellum (CBFcbl) for cerebellar CBF normalised ratios (nCBFCbl). RESULTS: Of the 25 patients (26 operated hemispheres), 5 patients showed significant immediate postoperative symptoms suggestive of CHPS. Based on our findings, sensitivity and specificity of ASL perfusion to detect CHPS were evaluated. ASL was found to have 47-100% sensitivity and 45-88% specificity to detect CHPS. We have tried to calculate the prevalence of CHPS in postoperative patients of moyamoya disease, which in our study ranged from 6.83 to 40.70%. CONCLUSION: Based on our results, we concluded that ASL perfusion is an appropriate alternative to standard nuclear medicine studies to monitor the changes in perfusion after STA-MCA bypass surgery in moyamoya patients. ASL MR perfusion can be used to identify changes in cerebral blood flow (CBF) for early detection of cerebral hyperperfusion syndrome in patients with otherwise normal conventional MRI sequences with very high sensitivity but moderate specificity.

Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads.

BACKGROUND: Although head injury (HI) from low- and middle-income countries (LMIC) heavily contributes to the global disease burden, studies are disproportionately less from this part of the world. Knowing the different epidemiological characteristics from high-income nations can target appropriate prevention strategies. This study aims to provide a comprehensive overview of the clinico-epidemiological data of HI patients, focusing on the existing challenges with possible solutions from a developing nation's perspective. METHODS: This is a prospective, registry-based, observational study of HI in an Indian tertiary trauma-care center over 4 years. Various clinico-epidemiological parameters, risk factors, and imaging spectrum were analyzed in a multivariate model to identify the challenges faced by LMIC and discuss pragmatic solutions. RESULTS: The study included a large-volume cohort of 14,888 patients. Notably, half of these patients belonged to mild HI, despite most were referred (90.3%) cases. Only one-third (30.8%) had severe HI. Less than a third reached us within 6 h of injury. Road traffic accidents (RTA) accounted for most injuries (61.1%), especially in the young (70.9%). Higher age, males, RTA, helmet non-usage, drunken driving, systemic injuries, and specific imaging features had an independent association with injury severity. CONCLUSIONS: The study represents the much-needed, large-volume, epidemiological profile of HI from an LMIC, highlighting the suboptimal utilization of peripheral healthcare systems. Strengthening and integrating these facilities with the tertiary centers in a hub and enhanced spoke model, task sharing design, and efficient back-referrals promise effective neurotrauma care while avoiding overburden in the tertiary centers. Better implementation of road safety laws also has the potential to reduce the burden of HI.

COVID-19: changing patterns among neurosurgical patients from North India, efficacy of repeat testing, and inpatient prevalence.

OBJECTIVE: COVID-19 has affected surgical practice globally. Treating neurosurgical patients with the restrictions imposed by the pandemic is challenging in institutions with shared patient areas. The present study was performed to assess the changing patterns of neurosurgical cases, the efficacy of repeated testing before surgery, and the prevalence of COVID-19 in asymptomatic neurosurgical inpatients. METHODS: Cases of non-trauma-related neurosurgical patients treated at the Postgraduate Institute of Medical Education and Research (PGIMER) before and during the COVID-19 pandemic were reviewed. During the pandemic, all patients underwent a nasopharyngeal swab reverse transcription-polymerase chain reaction test to detect COVID-19 at admission. Patients who needed immediate intervention were surgically treated following a single COVID-19 test, while stable patients who initially tested negative for COVID-19 were subjected to repeated testing at least 5 days after the first test and within 48 hours prior to the planned surgery. The COVID-19 positivity rate was compared with the local period prevalence. The number of patients who tested positive at the second test, following a negative first test, was used to determine the probable number of people who could have become infected during the surgical procedure without second testing. RESULTS: Of the total 1769 non-trauma-related neurosurgical patients included in this study, a mean of 337.2 patients underwent surgery per month before COVID-19, while a mean of 184.2 patients (54.6% of pre-COVID-19 capacity) underwent surgery per month during the pandemic period, when COVID-19 cases were on the rise in India. There was a significant increase in the proportion of patients undergoing surgery for a ruptured aneurysm, stroke, hydrocephalus, and cerebellar tumors, while the number of patients seeking surgery for chronic benign diseases declined. At the first COVID-19 test, 4 patients (0.48%) tested were found to have the disease, a proportion 3.7 times greater than that found in the local community. An additional 5 patients tested positive at the time of the second COVID-19 test, resulting in an overall inpatient period prevalence of 1%, in contrast to a 0.2% national cumulative caseload. It is possible that COVID-19 was prevented in approximately 67.4 people every month by using double testing. CONCLUSIONS: COVID-19 has changed the pattern of neurosurgical procedures, with acute cases dominating the practice. Despite the fact that the pandemic has not yet reached its peak in India, COVID-19 has been detected 3.7 times more often in asymptomatic neurosurgical inpatients than in the local community, even with single testing. Double testing displays an incremental value by disclosing COVID-19 overall in 1 in 100 inpatients and thus averting its spread through neurosurgical services.

Decompressive craniectomy in pediatric non-traumatic intracranial hypertension: a single center experience.

Purpose: To study the clinical profile and predictors of outcome in children undergoing decompressive craniectomy (DC) for non-traumatic intracranial hypertension (ICH).Materials and methods: Mixed observational study of children, aged 1 month-12 years, who underwent DC for non-traumatic ICH in a tertiary care pediatric intensive care unit from 2012 to 2017. Data on clinical profile and outcome were retrieved retrospectively and survivors were assessed prospectively. The primary outcome was neurological outcome using Glasgow Outcome Scale-Extended (GOS-E) at minimum 6 months' post-discharge. GOS-E of 1-4 were classified as a poor and 5-8 as a good outcome.Results: Thirty children, median (IQR) age of 6.5 (2, 50) months, underwent DC; of which 26 (86.7%) were boys. Altered sensorium (n = 26, 86.7%), seizures (n = 25, 83.3%), pallor (n = 19, 63.3%) and anisocoria (n = 14, 46.7%) were common signs and symptoms. Median (IQR) Glasgow Coma Scale at admission was 9 (6,11). Commonest etiology was intracranial bleed (n = 24; 80%). Median (IQR) time to DC was 24 (24,72) h. Eight (26.7%) children died; 2 during PICU stay and 6 during follow-up. Neurological sequelae at discharge (n = 28) were seizures (n = 25; 89.2%) and hemiparesis (n = 16; 57.1%). Twenty-one children were followed-up at median (IQR) duration of 12 (6,54) months. Good neurological outcome was seen in 14/29 (48.2%) and hemiparesis in 10/21 (47.6%) patients. On regression analysis, anisocoria at admission was an independent predictor of poor outcome [OR 7.33; 95%CI: 1.38-38.87; p = 0.019].Conclusions: DC is beneficial in children with non-traumatic ICH due to a focal pathology and midline shift. Evidence on indications and timing of DC in NTC is still evolving.

Revisiting the land use assumptions in forest carbon projects through a case from India.

Forest carbon projects are based on the premise of stable land use over long durations generally ranging from 20 to 100 years. This narrative is based on two assumptions- first, that project will be able to offset the opportunity cost of land and labour through carbon and other benefits and second assumption being that social, economic, political and biophysical factors will remain largely stable and not affect the land use significantly. This research critically evaluates these assumptions with the help of empirical evidence from a project in Haryana in India. The analysis suggests that various socioeconomic factors such as the development context of the region, changes in crop, wage and carbon prices have increased the opportunity cost of land manifold. Similarly, factors such as increased uncertainty over resource rights and biophysical factors have adversely affected the land use choices and project viability. Around 50% of the participants have changed the land use affecting the project viability. The opportunity cost of participation has been unevenly high for marginal and poor participants, who are worst affected. Hence, it can be argued that these universal land use assumptions of forest carbon projects are questionable. These findings have implications for the role and design of forest carbon projects in the broad context of climate mitigation. The land use change and forestry options through market based forest carbon projects might not offer as big a mitigation opportunity as is generally projected in the literature due to changing opportunity costs of land, complex property rights and other factors. Hence it might require recalibration of the role of these projects in the mitigation strategies at local,national and global levels. Similarly, the forest carbon projects need to be designed based on a comprehensive assessment of land use, which considers not only a dynamic and differential opportunity cost across various stakeholders, but also other sociocultural and political factors, which can impact the land use and sustainability of the project.

Non traumatic vertebral lesions: incremental utility of PET-CT over MRI and FNAC in a suggested diagnostic algorithm.

OBJECTIVE: To prospectively compare positron emission tomography-computed tomography (PET-CT) with conventional magnetic resonance imaging (MRI) and FNAC for diagnosis of non- traumatic vertebral lesions fracture in countries like India where tuberculosis is endemic. METHODS: Fifty four patients with non-traumatic spontaneous vertebral lesions were prospectively studied. All patients underwent CEMRI focusing on the spinal lesions, whole-body PET-CT and FNAC.Results were then analysed and compared with final diagnosis obtained either by FNAC or clinical follow up. RESULTS: Out of total 54 patients, FNAC from the spinal lesion could establish diagnosis in 36 patients (26 TB, 1 Fungal and 9 tumors). Of the remaining 18 patients, diagnosis could be established in 7 utilizing FNAC from other sites as dictated by PET-CT. In the remanining11 patients, the diagnosis and management was decided on the concordance of MRI and PET-CT. CONCLUSION: All three investigations have their own advantages and pitfalls and they complement each other in reaching the final diagnosis. MRI has a better pick up rate (than PET-CT) for inflammatory lesions. PET-CT on the other hand has better sensitivity for malignant vertebral disease. Diagnosis was established if FNAC was conclusive. In cases where FNAC was inconclusive, an additional 38.9% patients' diagnosis could be established by FNAC from other sites of involvement as dictated by PET-CT. This was an incremental utility of PET-CT. When even this fails, there were two possible scenarios-MRI and PET-CT in concordance with each other. In such a scenario, the combined report of MRI and PET-CT was relied upon. The last sub group (where MRI and PET-CT were discordant and FNAC was inconclusive) still remains achilles' heel. Wide bore biopsy may help in establishing diagnosis in such group.

Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services?

Background and Purpose- Though reports suggest decreasing fatality rates of subarachnoid hemorrhage with time, trends in outcome are not reported much especially from developing countries. This study was to analyze changes in outcome across 2 decades and elucidate probable factors. Methods- Prospective databases during 1996 to 2015 were reviewed for neurological outcome at 3 months in relation to demographics, Hunt and Hess grade, Fisher grade, and definitive treatment; and compared between 2 decades, contrasted by establishment of intensive care unit with continuous monitoring and other advancements. Univariate and multivariate analyses were performed. Results- Of the total 2039 patients, 1035 were managed in the former and 1004 in the recent decades. Compared with the former decade, there is delayed age at presentation (46 versus 49 years, P<0.001), poorer Fisher grades (81% versus 87%, P<0.001), and more patients with Hunt and Hess grade 2 (24% versus 39%, P<0.001) in the recent decade. While all patients in databases of the former decade had undergone clipping, 6% in the recent decade underwent coiling. 11% in the recent decade could not undergo definitive treatment. Despite this, there was significantly higher overall favorable outcome (50% versus 60%; odds ratio, 1.5; P<0.001) in recent decade. Favorable outcome of surgical clipping per se improved significantly from 50% to 67% (odds ratio 2.0; P<0.001). Though the improvement was across subgroups, it was more marked among Hunt and Hess grade 3 and Fisher grades 3 and 4. In multivariate analyses, both overall outcome (adjusted odds ratio, 1.7; 95% CI, 1.4-2.1; P<0.001) and surgical outcome (adjusted odds ratio, 1.8; 95% CI, 1.5-2.2; P<0.001) were significantly better in recent decade, independent of known prognostic factors. Conclusions- This is probably the first report to show independent improvement in outcome of subarachnoid hemorrhage with betterment in neurosurgical services from developing country. Dedicated intensive care unit care and focused management protocols could be the likely causes for improvement. Resource-constrained institutions may target patients in Hunt and Hess grade 3 and Fisher grades 3 and 4 for optimal intensive care unit utilization.

Embryonal tumor with multilayered rosettes: Diagnosis on intra-operative squash smear.

We describe a rare example of infratentorial primitive neuroectodermal tumor categorized as embryonal tumor with multilayered rosettes diagnosed on intra-operative squash smear and frozen section and discuss its key diagnostic features, pitfalls and differentials. Correct interpretation at the time of frozen section is crucial as it helps in deciding the further course of surgery. To the best of our knowledge, this is the first such report in the literature.

Comparative evaluation of H&H and WFNS grading scales with modified H&H (sans systemic disease): A study on 1000 patients with subarachnoid hemorrhage.

The comparative studies on grading in subarachnoid hemorrhage (SAH) had several limitations such as the unclear grading of Glasgow Coma Scale 15 with neurological deficits in World Federation of Neurosurgical Societies (WFNS), and the inclusion of systemic disease in Hunt and Hess (H&H) scales. Their differential incremental impacts and optimum cut-off values for unfavourable outcome are unsettled. This is a prospective comparison of prognostic impacts of grading schemes to address these issues. SAH patients were assessed using WFNS, H&H (including systemic disease), modified H&H (sans systemic disease) and followed up with Glasgow Outcome Score (GOS) at 3 months. Their performance characteristics were analysed as incremental ordinal variables and different grading scale dichotomies using rank-order correlation, sensitivity, specificity, positive predictive value, negative predictive value, Youden's J and multivariate analyses. A total of 1016 patients were studied. As univariate incremental variable, H&H sans systemic disease had the best negative rank-order correlation coefficient (-0.453) with respect to lower GOS (p < 0.001). As univariate dichotomized category, WFNS grades 3-5 had the best performance index of 0.39 to suggest unfavourable GOS with a specificity of 89% and sensitivity of 51%. In multivariate incremental analysis, H&H sans systemic disease had the greatest adjusted incremental impact of 0.72 (95% confidence interval (CI) 0.54-0.91) against a lower GOS as compared to 0.6 (95% CI 0.45-0.74) and 0.55 (95% CI 0.42-0.68) for H&H and WFNS grades, respectively. In multivariate categorical analysis, H&H grades 4-5 sans systemic disease had the greatest impact on unfavourable GOS with an adjusted odds ratio of 6.06 (95% CI 3.94-9.32). To conclude, H&H grading sans systemic disease had the greatest impact on unfavourable GOS. Though systemic disease is an important prognostic factor, it should be considered distinctly from grading. Appropriate cut-off values suggesting unfavourable outcome for H&H and WFNS were 4-5 and 3-5, respectively, indicating the importance of neurological deficits in addition to level of consciousness.

Proposed solution for dorsal internal carotid artery aneurysms: Suggestion of a novel new clip design.

Dorsal internal carotid artery (ICA) aneurysms are notorious for their high morbidity and mortality. They have an extremely fragile wall and have a high chance of rupture and clip slippage during the intraoperative and postoperative period. Strategies proposed to mitigate these problems encompass including part of the normal ICA wall in addition to neck of aneurysm in clip blades, as well as the use of encircling materials (silicon, cellulose, Weck's clip) over a clip. The Achilles' heel of the problem is to take an appropriate thickness of the normal ICA in clip blades. Too less or too much of this can spell disaster. This is easier said than done during an actual surgical procedure. So, in this difficult situation, is there any better method of clipping? We propose a fenestrated clip in which the clip blades are placed just at the beginning of fenestration and at right angles to the clip. This occludes the aneurysm taking part of the normal ICA wall in the clip blades. The fenestration hugs the ICA and prevents clip slippage. This has been explained with appropriate figures in the two and three-dimensional format. There cannot be a single stop solution for a complex disease like dorsal ICA aneurysm. The present proposed design is an attempt to provide a better clipping chance in these difficult aneurysms. Future work on this design can prove its usefulness.

The missing falx: a potential surgical pitfall during interhemispheric transcallosal approach.

One of the standard surgical approaches to lateral ventricular tumors involves interhemispheric dissection along the falx cerebri. The falx cerebri thus provides an important landmark in guiding the surgeon to the midline. Unrecognized absence of falx may lead to surgical complications. A child with tuberous sclerosis presented with refractory epilepsy and a lateral ventricular tumor. The tumor was excised by an interhemispheric trans-callosal approach. The midline falx cerebri was absent anteriorly, rendering the identification of midline difficult. The embryology of a deficient falx and its surgical implications are discussed in this short report.

Multiplex PCR as a novel method in the diagnosis of spinal tuberculosis-a pilot study.

BACKGROUND: Establishment of a reliable and rapid diagnosis is of paramount importance in spinal tuberculosis. The available gadgetry of investigations, such as AFB smear, culture of Mycobacterium tuberculosis, and Uniplex PCR, suffers from a lack of adequate sensitivity and/or a lack of rapidity. Therefore, many times a diagnosis is made either very late in the disease process or sometimes empirical therapy has to be started because a definite diagnosis could not be made. All of these are not ideal situations for a clinician. The present study was done with the aim to establish a rapid and reliable diagnosis of M. tuberculosis infection. This was established by identifying M. tuberculosis genes. METHODS: The study was done on nine consecutive patients who presented with non-traumatic spontaneous vertebral compression collapse. CT-guided aspirate from the involved vertebra was subjected to Multiplex PCR (MPCR) using three primers: IS6110, protein b, and MPB 64. The aspirate was also subjected to smear and culture. The results of MPCR were compared with the final diagnosis. RESULTS: Seven out of nine patients had a final diagnosis of tuberculosis. MPCR was positive in six of these seven patients, thus showing sensitivity of 85.7% and specificity of 100%. Results of MPCR were obtained within 24 h. CONCLUSIONS: MPCR using IS6110, protein b, and MPB64 primers has a high sensitivity and specificity in rapid diagnosis of spinal tuberculosis. To the best of our knowledge, this has not been attempted before in spinal tuberculosis. This is particularly useful for paucibacillary infections like spinal tuberculosis. However, further studies using large sample sizes are needed to confirm the practical applicability of this technique.

Corrigendum to "Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines".

[This corrects the article DOI: 10.1100/2012/807438.].

Connective Tissue Disorder-Associated Vasculitis.

Vasculitides secondary to connective tissue diseases are classified under the category of 'vasculitis associated with systemic disease' in the revised International Chapel Hill Consensus Conference (CHCC) nomenclature. These secondary vasculitides may affect any of the small, medium or large vessels and usually portend a poor prognosis. Any organ system can be involved and the presentation would vary depending upon that involvement. Treatment depends upon the type and severity of presentation. In this review, we describe secondary vasculitis associated with rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, relapsing polychondritis, systemic sclerosis, Sjogren's syndrome and idiopathic inflammatory myositis, focusing mainly on recent advances in the past 3 years.

Is intra arterial nimodipine really beneficial in vasospasm following aneurysmal subarachnoid haemorrhage?

UNLABELLED: Object/Background: Vasospasm is a common cause of mortality and morbidity following rupture of intracranial aneurysm. Hemodynamic therapy instituted in these patients in the past has been replaced by direct manipulation of the spastic vessels by angioplasty and intra-arterial infusion of vasodilators. However, no case control studies exist proving its superiority. The purpose of our study was to compare the efficacy of intra-arterial nimodipine (IAN) to that of hemodynamic therapy in patients with vasospasm following aSAH. MATERIAL AND METHODS: Fifty-three patients who developed vasospasm following aSAH were included in the study. IAN was instilled in addition to hemodynamic therapy in 39 patients and 14 patients (who refused to give consent for IAN) were continued on hemodynamic therapy alone and served as controls. The response to IAN was studied on angiogram. The clinical response was assessed in both the groups at regular intervals. IAN was repeated if necessary. The outcome (GOS) at discharge and at 3 months after discharge was compared. RESULTS: Thirty-six (92.3%) out of 39 patients showed immediate angiographic reversal of vasospasm.28 of them showed clinical response, of which only 11 had lasting response. 11(28.2%) of 39 patients who received IAN had a good outcome at discharge and 23(58.9%) had a favourable outcome at 3 months follow up. In those who received hemodynamic therapy alone, 4 out of 14(28.6%) patients had a good outcome at discharge and 8 (57.1%) a favourable outcome at 3 months. CONCLUSIONS: Angiographic reversal of vasospasm is seen in majority of the patients following IAN. However, this does not necessarily translate into a long lasting clinical response. The final outcome in patients who received hemodynamic therapy is comparable to those who received additional IAN. IAN does not appear to provide a major added advantage over the conventional hemodynamic therapy.

Centrifugal opening of dura for total extirpation of large convexity meningiomas: modifying the "classic" technique to prevent injury to the adjacent brain and veins.

BACKGROUND: Traditionally, the dura is opened along the margin of a convexity meningioma, jeopardizing the adjacent herniating brain and compressed veins in case of large meningioma. In this work, we describe a technique to open the dura centrifugally over convexity meningiomas. METHODS: Fifteen cases of large convexity meningiomas were operated on using the new technique. In our technique, the involved dura over large convexity meningiomas was opened in a centrifugal manner just short of the tumor-brain interface. The tumor was decompressed while preserving the arachnoid. The involved dura, along with the cuff of adjoining normal dura, was cut after tumor excision. RESULTS: Gross total excision could be achieved in all cases without any added deficits. There was arachnoid breach in three patients with insignificant venous injury in one. The preoperative symptoms improved in all. CONCLUSIONS: In this technique, the dura provides a natural barrier to protect the adjacent compressed brain and veins, thus avoiding handling the compressed adjacent neurovascular structures during surgery for large convexity meningioma without compromising the extent of resection.