High resolution ultrasound in subclinical diabetic neuropathy: A potential screening tool.

INTRODUCTION: Detection of subclinical neuropathy can aid in triage, timely intervention and dedicated care to reduce disease progression and morbidity. High resolution sonography has emerged as a promising technique for evaluation of peripheral nerves. The aim of the present study was to assess the utility of high resolution sonography in screening diabetic patients for subclinical neuropathy. METHODS: A total of 70 adult patients with type 2 diabetes mellitus and 30 controls were enrolled; those with clinical features of neuropathy constituted the diabetic polyneuropathy group and those without symptoms/normal nerve conduction the non-diabetic polyneuropathy group. After institutional ethical committee approval and informed consent, high resolution sonography was performed by two musculoskeletal radiologists. Nerves studied were median (elbow and wrist), ulnar (cubital tunnel and Guyon's canal), common peroneal (fibular head) and posterior tibial nerve (medial malleolus).The size (cross sectional area), shape, echogenicity and morphology of nerve were assessed and compared between the groups. RESULTS: The mean cross sectional area of all nerves was significantly higher both in diabetic polyneuropathy and non-diabetic polyneuropathy group compared to controls (p value < .001). Common peroneal nerve cross sectional area of 4.5 mm2 had the highest sensitivity (93%) and specificity (86%) for detecting nerve changes in the non-diabetic polyneuropathy group. The nerves were more rounded, hypoechoic and had an altered morphology in both study groups. CONCLUSION: Presence of sonographic nerve changes in asymptomatic diabetics depicted that morphological alterations in nerves precede clinical symptoms. High resolution sonography detected nerve changes with a good accuracy, and thus, can be a potential screening tool for detection of subclinical diabetic polyneuropathy.

Congenital Myopathies: A Clinicopathological Study of 10 Cases in a Tertiary Care Hospital of North India.

Objective: Congenital myopathies (CMs) are rare neuromuscular disorders. Through this article, authors want to present a clinicopathological study of 10 cases of CM. Materials and Methods: The study included patients with histopathologically confirmed CM attending the neurology services at the Institute of Human Behavior and Allied Sciences for 2 years. After collecting the demographic data, all patients were subjected to comprehensive workup including a detailed neurological examination and investigations, including muscle biopsy from representative involved muscle. Results: Ten patients diagnosed with CM. The most common CM type was congenital fiber-type disproportion (CFTD) seen in four cases followed by centronuclear myopathy in two cases and one each in desmin-related myopathy, central core disease, nemaline myopathy, CM with type II fiber hypoplasia. Clinically, they have variable features. Conclusion: This study from India highlights the importance of specific clinical features to look for when suspecting a CM coupled with specific features in histopathology. However, studies with longer duration are needed to find out the true prevalence and various spectra of CMs.

Neurological Associations of COVID-19-Do We Know Enough: A Tertiary Care Hospital Based Study.

The neurotrophic potential of SARS-CoV-2 virus is manifesting as various neurological disorders in the present pandemic. Nervous system involvement can be due to the direct action of the virus on the brain tissue or due to an indirect action through the activation of immune-mediated mechanisms. This study will discuss the detailed systematically evaluated clinical profile and relevant investigations and outcome of 14 laboratory confirmed SARS-CoV-2 positive patients presenting with neurological signs and symptoms. The patients were further categorized into confirmed, probable, and possible neurological associations. The probable association was found in meningoencephalitis (n = 4), stroke (n = 2), Guillain-Barré syndrome (n = 1), and anosmia (n = 1). The other six patients had coexisting neurological diseases with SARS-CoV-2. One patient with a large artery stroke succumbed to the illness due to respiratory complication. Memory impairment as a sequela is present during follow up of one encephalitis patient. Presently the early recognition and diagnosis of neurological manifestations remains a challenge for clinicians as the SARS-CoV-2 related neurological manifestations are in evolution. A long-term correlation study of clinical profile, radiological and laboratory investigations, along with neuropathological studies is needed to further understand the pathophysiology behind the SARS-CoV-2 neurological manifestations. Further understanding will facilitate timely recognition, therapeutic intervention, and possible prevention of long-term sequalae.

Saving the brain initiative - Developing an effective hub-and-spoke model to improve the acute stroke management pathways in urban India.

OBJECTIVES: We aimed to develop and evaluate a hub-and-spoke model in the East Delhi by assessing knowledge and creating awareness through sensitization programs in target communities and among general physicians (GPs) along with implementation of a standard stroke management protocol (SMP) at our institute in order to extend the benefit of thrombolytic therapy. METHODS: We carried out a prospective interventional study using sensitization program comprising 1046 community participants and 101 GPs under "Saving the Brain Initiative" project. Network included one hub and six nearby spoke hospitals. The pre-awareness and post-awareness data along with clinical outcome of thrombolysis collected over 2012-2017 was analyzed. RESULTS: We observed lack of awareness in communities and among GPs regarding stroke symptomatology and treatment options. There was 17.3% increase in patients with stroke post-awareness programs. Door-to-door time improved as 49.3% of patients reached hospital within <2 h of onset as compared to 32.2% in pre-awareness period. 89.4% patients had good outcome and were discharged with improved NIHSS. In the post-awareness period, the rate of thrombolysis increased by 4.0%. CONCLUSIONS: Sensitization of primary physicians, paramedical and medical staff along with community dwellers and implementation of SMP through hub-and-stroke model is instrumental in improving the rate of thrombolysis and its outcome.

Moyamoya Disease Presenting as Alternating Hemiparesis with Relapsing Remitting Hemichorea: An Unusual Manifestation.

CASE: Moyamoya disease (MMD) is a neurological disease involving internal carotid artery (ICA) leading to its occlusion. Among the children, the disease presents as ischemic strokes, whereas in adults, it presents as hemorrhagic strokes. Movement disorder among the MMD is very rare with varied presentation. This article reports a case of 16-year-old girl presented with a history of alternating hemiparesis with recurrent hemichorea with self-remitting tendency. Magnetic resonance angiography brain showed marked-to-complete attenuation of supraclinoid ICA with multiple tortuous collateral vessels replacing the circle of Willis. CONCLUSION: MMD should be kept in the differential diagnosis of children presenting with alternating focal neurological deficit with recurrent movement disorder as movement disorder could be the initial presentation. MMD may present as waxing and waning features of the chorea and neurological deficit.

An insight into death wish among patients with amyotrophic lateral sclerosis in India using "Wish-to-Die Questionnaire".

AIMS: In amyotrophic lateral sclerosis (ALS), death wish is expressed in a varying proportion of patients in different countries. In this first study from India, influence of belief system of religion/spirituality and attitude towards death, widely prevalent in the country, in decision making, was evaluated. MATERIAL AND METHODS: Twenty ALS patients were assessed using 'Wish-to-Die Questionnaire' (WDQ) developed to reflect seven domains, namely religion/spirituality, belief in karma, meaning of life, hope, family support, financial support and death wish. Functional impairment, depression, hopelessness and suicidal ideation were assessed by ALS Functional Rating Scale, Beck's Depression Inventory, Beck Hopelessness Scale and The Scale of Suicidal Ideation, respectively. RESULTS: On WDQ, all the 20 patients had belief in religion/spirituality, had hope and family support. Nineteen patients (95%) believed in karma, 16 (80%) still found life meaningful and 15 (75%) had financial support. Six patients (30%) had mild to moderate depression; hopelessness was present in 6 (30%) and suicidal ideation was present in one (5%). The 5 (25%) patients who expressed death wish did not significantly differ from others in 6 domains (religion/spirituality, belief in karma, meaning of life, hope, family support, financial support) of WDQ. The main reason in 3 patients who expressed death wish was lack of financial support. The fourth patient could not find meaning of life after the onset of illness, and the fifth wished to end his life since he had satisfactorily fulfilled all his responsibilities. CONCLUSION: Smaller proportion of patients of ALS expressed death wish in India compared to the Western countries. This may be attributed to belief in religion/spirituality and karma, having meaning of life and family support. As this is the first report from India, useful information may be obtained if similar studies are done on a larger sample.

Subacute sclerosing panencephalitis presenting as acute disseminated encephalomyelitis and pseudotumour cerebri.

Subacute sclerosing panencephalitis (SSPE) is a chronic progressive encephalitis of childhood and young adults due to persistent measles virus infection. The usual age of onset is between 5 and 15 years. There are wide varieties of presentations of SSPE described in the literatures. Variable clinical presentations may lead to diagnostic dilemma and unnecessary investigations especially in developing countries, where the measles is quite endemic and vaccination status is not up to the mark because of poor literacy and socioeconomic status. Good clinical correlations, neuroimaging findings, EEG and cerebrospinal fluid (CSF) marker for SSPE yield the clue to diagnosis. This case illustrates a 13-year-old boy presented with short history of intellectual decline, headache, papilloedema, cranial nerve palsy, myoclonus with suggestive neuroimaging mimicking acute disseminated encephalomyelitis (ADEM) and pseudotumour cerebri. Subsequently he was diagnosed to be a case of SSPE on the basis of CSF and serum measles antibody titer.

Chin fasciculations in Madras motor neuron disease: a new clinical feature.

The characteristic features of Madras motor neuron disease (MMND) are onset in the young in the first two decades, sporadic occurrence, facial and bulbar paralysis, sensorineural hearing impairment, asymmetrical weakness of limbs and pyramidal signs with a slow progression. The majority of the cases reported are from South India. MMND variant has the additional features of optic atrophy and cerebellar signs. We are reporting a 48 year old female of MMND who had persistent fasciculations of chin, with electromyographic features of fasciculations and fibrillations in mentalis muscle. Chin fasciculations, a rare clinical feature, is now described for the first time in Madras motor neuron disease adding a new feature to the clinical constellation of symptoms.

Universal cone angle of ac electrosprays due to net charge entrainment.

The half-angle of an ac cone is shown to exhibit a universal (length-scale independent) asymptotic value of 12.6 degrees at high-permittivity ratio, which is quite distinct from the 49.3 degrees of dc Taylor cones. Our theory and experiments suggest that ac entrainment of low-mobility anions, generated by field-assisted ion dissociation, sustains a net charge at the ac cone. Mutual Coulombic repulsion between these free charges compensates the singular azimuthal capillary force and elongates the cone with an axial force that does not exist in dc cones.

Evaporative self-assembly from complex DNA-colloid suspensions.

Evaporation-induced pattern formation has attracted considerable attention as a simple yet versatile method for generating self-assembled structures that have broad applications from photonic devices to biomacromolecular recognition. Previous study of evaporative self-assembly has mainly focused on single nonvolatile component systems, and the driving mechanisms have been extensively investigated. In contrast, pattern formation from evaporating multicomponent systems, despite its wide existence in nature and numerous engineering applications, has been rarely explored. In this work, we examine a DNA-colloid binary suspension as a model system to understand the evaporation-induced interfacial hydrodynamics and self-assembled morphology in multicomponent systems involving complex competing intermolecular and interfacial interactions. Direct microscopic observations show that the composition of the binary system plays a critical role in the multiple-ring formation upon evaporation: (1) suspensions with high DNA concentrations and low colloidal concentrations favor the formation of the multiple-ring pattern; (2) the size of colloidal particles added into DNA aqueous droplets can significantly disrupt smooth multiple rings to form rippled rings and curtain-like periodic patterns with a curious spoke-like structure as the size of colloidal particles increases; and (3) the enhancement of DNA-colloid interaction by oppositely charged colloidal particles results in considerably high irregularity of DNA stain ring spacing. We examine the disruption of the multiring morphology under varied conditions and attribute it to local hydrodynamics governed by colloid aggregation and sedimentation. Our results demonstrate the feasibility of fabricating periodic self-assembled hybrid structures via one-step evaporation of droplets consisting of multiple components.

Coupling between precipitation and contact-line dynamics: multiring stains and stick-slip motion.

The contact line in an evaporating drop can stay pinned to form a single ring or can shrink in a discontinuous stepwise manner and generate multiple rings. We demonstrate the latter with DNA solutions and attribute it to a pinning-depinning cycle that generates new contact lines. The new contact line recedes after depinning and is repinned at an internal precipitate ring that determines the location of the next contact line. Each precursor ring is formed when DNAs are trapped by an internal microstagnation flow and precipitation dynamics hence control this unsteady drop motion.

Rapid bioparticle concentration and detection by combining a discharge driven vortex with surface enhanced Raman scattering.

Rapid concentration and detection of bacteria in integrated chips and microfluidic devices is needed for the advancement of lab-on-a-chip devices because current detection methods require high concentrations of bacteria which render them impractical. We present a new chip-scale rapid bacteria concentration technique combined with surface-enhanced Raman scattering (SERS) to enhance the detection of low bacteria count samples. This concentration technique relies on convection by a long-range converging vortex to concentrate the bacteria into a packed mound of 200 mum in diameter within 15 min. Concentration of bioparticle samples as low as 10(4) colony forming units (CFU)ml are presented using batch volumes as large as 150 mul. Mixtures of silver nanoparticles with Saccharomyces cerevisiae, Escherichia coli F-amp, and Bacillus subtilis produce distinct and noticeably different Raman spectra, illustrating that this technique can be used as a detection and identification tool.

Polyhedra formation and transient cone ejection of a resonant microdrop forced by an ac electric field.

New deformation or fission phenomena are reported for microdrops driven by an ac electric field at their resonant frequencies. The Maxwell forces that pull out the vertices from a drop can be enhanced when the ac frequency is comparable to both the drop resonant frequency and the inverse charge relaxation time of the diffuse layer. The selected polyhedra possess symmetries that ensure a global force balance of the Maxwell forces and a linear dimension consistent with a sphere whose nth harmonic (n is up to six in the observation) coincides with the applied ac frequency. At high voltages, the resonant focusing of charges by the vibration modes produces evenly distributed and transient Taylor cones that can eject charged nanodrops.