Neck swelling due to skull base (pseudo)meningocele protruding through a congenital skull base bone defect: a case report.

BACKGROUND: Meningocele is defined as a protrusion of the meninges through an opening in the skull or spinal column, forming a bulge or sac filled with cerebrospinal fluid. A pseudomeningocele is defined as a cerebrospinal fluid (CSF) collection formed due to escape of CSF through a dural defect with trapping of CSF into the surrounding soft tissues. We herby report rare occurrence of a large (pseudo)meningocele in a young patient with congenital skull base defect presenting as upper lateral neck swelling. CASE PRESENTATION: We present the case of a 17-year-old boy who had painless progressive swelling right side of the upper neck without any history of meningitis or CSF leak. He had a history of undergoing cranioplasty using steel plates for nontraumatic boggy swelling right parieto-occipital region at the age of 5 years at another hospital. Clinical examination showed painless swelling right side of the upper neck, with positive cough impulse and transillumination. CT head with cisternography showed a large right skull base defect through which a large pseudomeningocele was herniating, thus producing upper neck swelling and compressing oral cavity. The neck swelling and intraoral bulge reduced in size after the coperitoneal shunt. CONCLUSION: Differential diagnosis of (pseudo)meningocele should be considered while evaluating a painless progressive upper neck swelling having cough impulse and transillumination in a young patient.

A Compressive Review on Source, Toxicity and Biological Activity of Flavonoid.

Flavonoids are biologically active chemicals in various fruits, plants, vegetables, and leaves, which have promising uses in medicinal science. The health properties of these natural chemicals are widely accepted, and efforts are underway to extract the specific components referred to as flavonoids. Flavonoids demonstrate a diverse range of bio-activities, anticancer, antioxidant activity, anti-cholinesterase activity, antiinflammatory activity, antimalarial activity, antidiabetic activity, neurodegenerative disease, cardiovascular effect, hepatoprotective effects, and antiviral and antimicrobial activity. This study aims to examine the prevailing trends in flavonoid investigation studies, elucidate the activity of flavonoids, examine their various functions and uses, assess the potential of flavonoids as preventive medications for chronic diseases, and outline future research opportunities in this field. This review explores the diverse functions of flavonoids in preventing and managing various diseases.

A Prospective Study on Perfusion MRI Changes in Intracranial Meningiomas Following Gamma Knife Therapy.

BACKGROUND: Radiosurgery plays an important role as a treatment modality for intracranial meningiomas. Perfusion MR imaging can be performed by using arterial spin-labeling (ASL) which is a relatively new and advanced technique. OBJECTIVES: To assess the changes in perfusion parameters on ASL perfusion MRI in intracranial meningioma after radiosurgery and correlate with histopathological grade of meningioma. MATERIALS AND METHODS: In this Prospective study done at the our institute over a period of 20 months (Jan 2016-Aug 2017), patients with intracranial meningiomas had perfusion MRI with ASL sequence on GE Optima 450W®, 1.5T MRI (GE Medical Systems) prior to GKT and at 6 months after GKT were included in the study. RESULTS: Twenty-seven patients were included in this study. Mean cerebral blood flow (CBF) was higher in angiomatous meningiomas. Though mean values of average CBF, maximum, minimum, and SD derived from the ASL MR perfusion were relatively higher in post GKT group as compared to those obtained in pre-GKT but it was not clinically significant. Mean baseline volume of whole cohort was 5.71 cm3 and decreased significantly post GKT in a follow up of 6 months to 5.59 cm3 (P value 0.0018). On comparing volumes of primary and secondary group, volumes were not found be significantly decreased in primary group (P value = 0.1361), 0.1361), but significantly reduced in secondary group (7.13 vs 7.034 cm3) (P value of = 0.0038). CONCLUSION: Our preliminary observations support ASL as a sensitive MRI sequence for the evaluation of meningioma perfusion patterns.

14-3-3 protein and its isoforms: A common diagnostic marker for Alzheimer's disease, Parkinson's disease and glaucomatous neurodegeneration.

There is a molecular coupling between neurodegenerative diseases, including glaucomatous neurodegeneration (GN), Alzheimer's disease (AD), and Parkinson's disease (PD). Many cells in the eye and the brain have the right amount of 14-3-3 proteins (14-3-3s) and their isoforms, such as ß, ε, γ, η, θ, π, and γ. These cells include keratocytes, endothelial cells, corneal epithelial cells, and primary conjunctival epithelial cells. 14-3-3s regulate autophagy and mitophagy, help break down built-up proteins, and connect to other proteins to safeguard against neurodegeneration in AD, PD, GN, and glioblastoma. By interacting with these proteins, 14-3-3s stop Bad and Bax proteins from entering mitochondria and make Bcl-2 less effective. These interactions inhibit neuronal apoptosis. They play many important roles in managing the breakdown of lysosomal proteins, tau, and Aß, which is why the 14-3-3s could be used as therapeutic targets in AD. Furthermore, researchers have discovered 14-3-3s in Lewy bodies, which are associated with various proteins like LRRK2, ASN, and Parkin, all of which play a role in developing Parkinson's disease (PD). The 14-3-3s influence the premature aging and natural wrinkles of human skin. Studies have shown that lowering 14-3-3s in the brain can lead to an increase in cell-death proteins like BAX and ERK, which in turn causes excitotoxicity-induced neurodegeneration. This review aimed to clarify the role of 14-3-3s in the neuropathology of AD, PD, and GN, as well as potential diagnostic markers for improving neuronal survival and repair.

Advances in Drug Discovery and Design Using Computer-Aided Molecular Modeling.

Computer-aided molecular modeling is a rapidly emerging technology that is being used to accelerate the discovery and design of new drug therapies. It involves the use of computer algorithms and 3D structures of molecules to predict interactions between molecules and their behavior in the body. This has drastically improved the speed and accuracy of drug discovery and design. Additionally, computer-aided molecular modeling has the potential to reduce costs, increase the quality of data, and identify promising targets for drug development. Through the use of sophisticated methods, such as virtual screening, molecular docking, pharmacophore modeling, and quantitative structure-activity relationships, scientists can achieve higher levels of efficacy and safety for new drugs. Moreover, it can be used to understand the activity of known drugs and simplify the process of formulating, optimizing, and predicting the pharmacokinetics of new and existing drugs. In conclusion, computer-aided molecular modeling is an effective tool to rapidly progress drug discovery and design by predicting the interactions between molecules and anticipating the behavior of new drugs in the body.

Therapeutic Potential of Ascorbic Acid in the Management of Alzheimer's Disease: An Update.

BACKGROUND: Ascorbic acid is a potent natural antioxidant that protects against oxidative stress and performs various bodily functions. It is commonly found in fruits and vegetables. OBJECTIVE: The manuscript has been written to provide valuable insights into ascorbic acid in managing Alzheimer's disease. METHODS: The data has been gathered from web sources, including PubMed, Science Direct, Publons, Web of Science, and Scopus from 2000-2022 using AA, ascorbic acid, Alzheimer's diseases, memory, dementia, and antioxidant Keywords. RESULTS: In the present manuscript, we have summarized the impact of ascorbic acid and its possible mechanism in Alzheimer's disease by, outlining the information currently available on the behavioral and biochemical effects of ascorbic acid in animal models of Alzheimer's disease as well as its usage as a therapeutic agent to slow down the progression of Alzheimer disease in human beings. Oxidative stress plays a significant role in the advancement of AD. AA is a wellknown antioxidant that primarily reduces oxidative stress and produces protein aggregates, which may help decrease cognitive deficits in Alzheimer's disease. The current paper analyses of ascorbic acid revealed that deficiency of ascorbic acid adversely affects the central nervous system and leads to cognitive defects. However, the results of clinical studies are conflicting, but some of the studies suggested that supplementation of ascorbic acid improved cognitive deficits and decreased disease progression. CONCLUSION: Based on clinical and preclinical studies, it is observed that ascorbic acid supplementation improves cognitive deficits and protects the neurons from oxidative stress injury.

Intramuscular pyrethroid with organophosphorus (cypermethrine 3% + quinolphos 20%) mixed poisoning, its clinical presentation and management.

Organophosphorus compounds are absorbed by any route including intramuscular injection. Pyrethroid compounds are less toxic for human but in combination with organophosphates, its toxic effect potentiates due to inhibition of its metabolism. In this case report, a 40-year-old female patient presented with acute onset of pain abdomen, recurrent vomiting, and excessive salivation followed by altered mental status, on evaluation her clinical findings were suggestive of organophosphorus poisoning. Her treatment was started with injection atropine, anti-emetics, and adequate parenteral rehydration. After regaining consciousness, the patient confessed that she had taken herself intramuscular injection of pesticide which contained 3% cypermethrine plus 20% quinolphos. It was further confirmed by a very low level of plasma cholinesterase level. Intramuscular injection acted as a depot that leads to prolong intoxication and in the due course of illness, she also developed delayed onset intermediate syndrome that was managed appropriately.

Incidence and pattern of road traffic injuries in tribal population of Jharkhand: One-year study in a tertiary care teaching hospital.

BACKGROUND AND AIM: Road traffic injuries (RTIs) are a leading cause of mortality and morbidity globally. This study aimed to assess the incidence and pattern of RTIs in the tribal population of Jharkhand. METHODS AND MATERIALS: This prospective observational study was conducted for a period of 1 year (June 2018 to May 2019) at the Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. A pretested semi-structured questionnaire was administered. A total of 1713 road traffic accident (RTA) victims belonging to tribal population were interviewed during the study period. Data were entered in a Microsoft Excel sheet and analyzed using Statistical Package for Social Sciences (SPSS) version 16. RESULTS: There were 1258 (73.4%) males and 455 (26.6%) females. The majority (31.4%) of patients belonged to the age group of 21-30 years, followed by 19.2% in the age group of 31-40 years. The majority (52.13%) of RTAs involved a two-wheeler vehicle. Head injury was the most common type of injury (40.86%), followed by lower limb injury (26.68%). Common upper limb injuries were in the humerus and radius and ulna region. The majority of lower limb injuries involved tibia and femur. Common thoracic-abdomen injuries were soft tissue injury and lung contusion. Drunk driving (alcohol influence) was seen in 34.68% of cases of RTI. CONCLUSIONS: RTA is a major public health problem which needs to accelerate the efforts of road safety preventive measures. Road safety education should be promoted.

Impact of the COVID-19 Pandemic on Neurosurgical Practice in India: Results of an Anonymized National Survey.

BACKGROUND: The COVID-19 pandemic has created an unprecedented challenge for medical professionals throughout the world to tackle the rapidly changing scenario. The objective of this survey was to analyze the change in neurosurgical practice in India following the COVID-19 outbreak and assess its impact on practising neurosurgeons. MATERIALS AND METHODS: Between May 7th and 23rd, 2020, a validated questionnaire was circulated amongst practising neurosurgeons across the country by social media and e-mails, regarding changes in the patterns of patients seen, adaptations made in their practice, effect on surgeries performed, financial burden, and impact on their personal lives. The responses were kept anonymous and were analyzed for correlations between the changes observed and independent factors such as hospital affiliations, teaching professions, and neurosurgical experience. RESULTS: Our survey showed a drastic fall in the number of neurosurgical patients seen in the outpatient department (OPD) as well as the number of surgeries performed. A drop of 76.25% was seen in OPD patients (P = 0.000) and that of 70.59% in surgeries performed (P = 0.000). There was no uniformity among the neurosurgeons in the number of COVID-19 tests being done before elective/emergency surgery and in the use of protective gear while examining patients. Private practitioners were more affected financially as compared to those in the government sector. The pandemic has affected the research work of 53.23% of all respondents, with those in the teaching profession (70.96%) more affected than those in the non-teaching profession (24.67%). CONCLUSIONS: Evidence-based policies, screening COVID-19 tests with better sensitivity, and better-quality personal protective equipment kits in adequate numbers are required to protect our medical professionals from COVID-19. Mental health issues among neurosurgeons may also be an issue, this being a high risk speciality and should be closely watched for.

A profile of acute poisoning at Mangalore (South India).

BACKGROUND: The aim of this study was to characterize the poisoning cases admitted to the Government Wenlock Hospital (a teaching hospital of Kasturba Medical College) Mangalore, India. STUDY DESIGN: All cases admitted to the emergency department of the hospital between January 2001 to May 2003 evaluated retrospectively. Data obtained from the hospital medical records and included the following factors: socio-demographic characteristics, agents and route of intake, and time of admission of the acutely poisoned patients. RESULTS: Of the total 33,207 patients admitted in the hospital for treatment, 325 patients were for to acute poisoning. This was 1% of all emergency admissions. Of these 70% were males and 30% females. The majority (36%) cases were from age group of 21-30 years. Most (72%) poisonings were intentional and only 27% were unintentional. The most important agents of acute poisoning were agrochemical pesticides (49%) followed by drugs (17%), and alcohols (13%). Forty-eight (15%) patients died. The poisons responsible for most of the mortality were organophosphate pesticides (65%) and aluminium phosphide (15%). In summary, the prevention and treatment of poisoning due to organophosphate and aluminium phosphide should merit high priority in the health care of the indigenous population of South India (Dakshina Kannada district).

A rare case of giant occipital meningocele with Dandy Walker Syndrome: Can it grow bigger than this?

Association of Dandy-Walker syndrome with occipital meningocele (OMC) is extremely rare and about thirty cases are reported till date in the Western literature. However, OMC is classified by Talamonti et al. into small, large, and giant categories with respective diameters were upto 5 cm in small, large with 5-9 cm, and giant with >9 cm. Usually the size of OMC progressively increases as raised intracranial pressure leads to compensatory cerebrospinal fluid escape into sac with the growth of children. Authors report an interesting case of an 18-month-old female child with extra-gigantic OMC, whose size was almost same since birth, representing the first case of its kind, who underwent successful surgical repair. Clinical presentation, radiological features, and surgical management options in literature are reviewed briefly for this rare disease association.

Localization of mandibular foramen relative to landmarks in East Indian mandibles.

CONTEXT: The position of mandibular foramen (MF) is an important anatomical landmark for effective anesthesia in dentistry for many procedures, including dental extraction from the lower jaw and putting mandibular implants. Several causes have been examined in this context, and the uncertainty in the location of the MF has been examined to be a major factor for the high failure rate of anesthesia and complications of the orthodontic procedure. AIMS: The purpose of this study was to examine and analyze the position of the MF relative to six bony landmarks on the ramus in the population of Jharkhand. SUBJECTS AND METHODS: The different parameters were measured in 30 dry adult's mandibles that were obtained from the Department of Anatomy. The data were tabulated and statistically analyzed. STATISTICAL ANALYSIS USED: Paired t-test. RESULTS: The mean distance between the MF and the respective landmarks was noted as 16.00 ± 3.50 mm for the anterior border, 10.21 ± 2.34 mm for the posterior border, 20.48 ± 3.89 mm for the superior border, 24.15 ± 4.97 mm for the inferior border, 33.46 ± 6.08 mm for the condyle, and 12.31 ± 4.88 mm for the internal oblique ridge for the right side. On the left side, these distances were 16.27 ± 3.9 for the anterior border, 10.28 ± 5.24 for the posterior border, 20.15 ± 3.8 for superior border, 24.86 ± 4.04 for inferior border 32.48 ± 4.73 for condyle, and 10.93 ± 4.06 for the inferior oblique ridge. Statistically, there was no significant difference in the distance to either side from selected 5 landmarks, the only exception being the condyle. CONCLUSIONS: Condyle and internal oblique ridge have been shown to be two new landmarks that may be used to find MF. Bilateral symmetry has been shown for all landmarks except for condyle.

Toxicity of a plant based mosquito repellent/killer.

The mission to make humans less attractive to mosquitoes has fuelled decades of scientific research on mosquito behaviour and control. The search for the perfect topical insect repellent/killer continues. This analysis was conducted to review and explore the scientific information on toxicity produced by the ingredients/contents of a herbal product. In this process of systemic review the following methodology was applied. By doing a MEDLINE search with key words of selected plants, plant based insect repellents/killers pertinent articles published in journals and authentic books were reviewed. The World Wide Web and the Extension Toxicity Network database (IPCS-ITOX) were also searched for toxicology data and other pertinent information. Repellents do not all share a single mode of action and surprisingly little is known about how repellents act on their target insects. Moreover, different mosquito species may react differently to the same repellent. After analysis of available data and information on the ingredient, of the product in relation to medicinal uses, acute and chronic toxicity of the selected medicinal plants, it can be concluded that the ingredients included in the herbal product can be used as active agents against mosquitoes. If the product which contains the powder of the above said plants is applied with care and safety, it is suitable fo use as a mosquito repellent/killer.

Pattern of use of personal protective equipments and measures during application of pesticides by agricultural workers in a rural area of Ahmednagar district, India.

BACKGROUND: Pesticides, despite their known toxicity, are widely used in developing countries for agricultural purposes. OBJECTIVES: To find various patterns of hardware use for spraying of insecticides, prevalent storage practice adopted by the user, types of personal protective equipments used for the handling of chemicals; to detect dangerous practices and the extent to which safety norms being followed by the users during the application/treatments, and finally their knowledge concerning the risks of pesticides. MATERIALS AND METHODS: The agriculture workers who had been involved in pesticide application for agricultural purpose were interviewed face-to-face to gain information on the following determinants of pesticide exposure: Types, treatment equipment, use of personal protection and safety measures during the application/treatments and knowledge of the risks of pesticide exposure. RESULTS: Hundred workers, aged between 21 and 60 years old, were included. Pesticides were mostly applied with manual equipment using Knapsack (70%) and only 5% farmers were using Tractor-mounted sprayer. Workers frequently performed tasks involving additional exposure to pesticides (mixing chemicals, 66%, or washing equipment, 65%). Majority of the workers/applicators used no personal protection measures or used it defectively/partially. Most of the workers/respondents (77%) did not bother for safety and health risks of pesticide exposure. CONCLUSIONS: Workers involved in pesticide application use personal protection measures very poorly and defectively. Almost half of the applicators were not following right direction with respect to wind direction while spraying, thus it increase the risk of exposure. There is a clear need to develop specific training and prevention programs for these workers. The determinants of pesticide exposure in agricultural workers described in this study should be properly assessed in epidemiological studies of the health effects of pesticides on agricultural workers at national level.

Rapid method for the determination of some organophosphorus insecticides in a small amount of serum in emergency and occupational toxicology cases.

A simple and rapid method is described for the estimation of some organophosphorus insecticides in the serum of occupationally exposed persons. The compounds are extracted with a mixture of acetone and diethyl ether (1:1 v/v) in acidic medium and the extraction residue is analyzed by gas chromatography with nitrogen phosphorus detection method. Linearity was acceptable over concentrations from 0.25 to 4.0 mug/mL. The method percentile recovery for the six different organophosphorus insecticides was 86.3% for phorate, 78.3% for dimethoate, 82.3% for malathion, 79.4% for chlorpyrifos, 80.2% for diazinon, and 68.5% for ethion at the mug/mL level. Serum samples of nine workers who had been occupationally exposed to malathion in an insecticide manufacturing factory, were analyzed and malathion was found at low levels in all the samples.