Surgical Resection for Epilepsy Following Cerebral Gunshot Wounds.

OBJECTIVE: The surgical management of epilepsy after penetrating gunshot wounds (GSWs) to the head has not been described in the modern era. Given the extensive damage to the cranium and cortex from such injuries, the safety and efficacy of surgical intervention are unclear. We report surgical strategy and outcomes after resection for medically refractory epilepsy following GSWs in 4 patients. METHODS: A prospectively compiled database of 325 patients with epilepsy was used to identify patients undergoing surgery for medically refractory epilepsy after a GSW to the brain. Seizure frequency, scalp and intracranial electroencephalography evaluation, type of resection, and seizure outcomes were compiled. RESULTS: All 4 patients underwent direct electrocorticography recordings either with implanted electrodes or intraoperatively that were used to drive surgical decision making. All patients had intracranial shrapnel fragments and large areas of encephalomalacia on imaging. Intracranial electrodes were placed in 2 patients to localize seizure onsets. Two patients underwent frontal lobe resections, and the other 2 patients underwent multilobar resections. Latency between injury and epilepsy surgery was 12 years, and mean age at surgery was 28 years. In all cases, epilepsy surgery led to a significant improvement in seizure control (Engel class I, 2 patients; II, 1 patient; and III, 1 patient). CONCLUSIONS: Epilepsy is common after penetrating head injury, and the incidence is likely to increase given the growing numbers of armed conflicts in urban centers worldwide. In selected cases, intracranial monitoring and surgical resections may be safely performed and can lead to favorable seizure outcomes.

POEMS Syndrome in a Juvenile Initially Diagnosed as Treatment Resistant Chronic Inflammatory Demyelinating Polyneuropathy.

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) is a disorder that mainly affects adults. We report a pediatric patient, initially considered to have Guillain-Barré syndrome, who continued to have progression of neuropathic disease leading to the diagnosis of chronic inflammatory demyelinating polyneuropathy. Diagnosis of POEMS was established by an abnormal bone marrow biopsy, prompted by laboratory and imaging findings, which became abnormal later in the course of the disease. POEMS syndrome is extremely rare in children, and neuropathic features in this age group have not been previously described. This case illustrates that "Guillain-Barré syndrome-like" initial presentation for POEMS, which has not been previously reported. It also emphasizes that in children with progressive acquired neuropathies that are treatment unresponsive, POEMS syndrome should be considered.

A profile of dengue cases admitted to a tertiary care hospital in Karnataka, southern India.

During the past two decades, epidemics of dengue fever have been causing concern in several South-East Asian countries, including India. A study was conducted in a tertiary care hospital situated in Southern India to determine the trends and outcome of dengue cases. There was a steady rise in number of cases from 2002 to 2007, with the largest number of cases seen in 2007. Most cases were observed in the post-monsoon season in the month of September. Out of a total of 344 cases, 285 (82.8%) patients had dengue fever, 34 (9.8%) had dengue haemorrhagic fever and 25 (7.3%) had dengue shock syndrome. Deaths were reported in nine cases, with the majority of deaths occurring in 2003. The disease control programme should emphasise on vector surveillance, integrated vector control, emergency response, early clinical diagnosis and appropriate management of the cases.

A study on treatment outcome of registered tuberculosis cases under RNTCP in Udupi Taluk, Karnataka.

Directly Observed Treatment Short Course is the internationally recommended strategy to ensure cure of tuberculosis. However, it is equally important to review the shortcomings if any of such an important strategy against tuberculosis to make it more useful. This Descriptive study carried in a Tuberculosis Unit was to find out the treatment outcome of patients registered under Revised National Tuberculosis Control Program. The data was collected from the tuberculosis register and was analyzed using SPSS 13.0 version. Study included 563 patients, 68% were males and 32.0% were females. Category I had majority of the patients 307 (54.52%); Category II had 133 (23.6%), and Category III had 116 (20.6%) patients. In Category I, 175 (57.0%) patients were cured and 13(4.2%) had treatment failure. In Category II, 61 (45.9%) were cured and 11(8.3%) had treatment failure. In Category III, 105 (90.5%) had complet treatment. Out of 236 patients who were cured, majority were under the care of government health workers 125(53%), followed by anganwadi 32(13.6%) and social workers 27(11.4%). Joint efforts of DOTS providers cured 53 (22.4%) patients. Ensuring early diagnosis and high cure rate of Tuberculosis cases is the only effective way to stop the spread of Tuberculosis.