Etiopathology, Clinical and Imaging Characteristics of Border Zone Strokes.

Introduction: A border zone infarct (BI) is defined as an infarction that is localized to watersheds or border zones in the brain. BI is further classified into cortical border zone infarct (CBZ) and internal border zone infarct (IBZ). This study was conducted to explore the clinical and radiological characteristics of BI. Materials and Method: The study was conducted on eligible 400 acute ischemic stroke patients out of which 52 BI patients (diagnosed by the radiologist on DWI MRI images), patients >18 yrs of age were selected and divided into two groups of IBZ and CBZ infarct patients. The degree of intracranial and extracranial stenosis and characteristics on clinical presentation were assessed. The data were collected and analyzed using SPSS version 20.0 software at significance level p-value <0.05. Results: 25% and 75% of CBZ and IBZ patients, respectively, had history of presyncope or syncope before stroke. On vascular evaluation, 3.9% and 51.9% were in MCA and ICA stenosis group, respectively. Evidence of cardio embolism was found in 17.3% of patients. 53.3% of CBZ and 53.8% of IBZ patients were in ICA stenosis group, and 6.7% of CBZ and 7.7% of IBZ patients were in MCA stenosis group, with a statistically insignificant relation (p-value >0.05). Conclusion: Association of BI with events causing hypotension or hypovolemia is well-established in our study, association of BI with large vessel atherosclerosis is common, and its contribution to CBZ and IBZ seems to be equal.

Does the presence of full-coverage crown interfere with removal of obturation material: A cone-beam computed tomography image segmentation volumetric analysis.

Aim: The aim of this study was to assess and compare the influence of the presence of full-coverage crown on the obturation material removal efficiency of different retreatment file systems. Materials and Methods: Sixty extracted, human, maxillary premolars were accessed, instrumented, and obturated with gutta-percha and AH Plus sealer. The samples were scanned with cone-beam computed tomography and volume of obturating material was measured using ITK-SNAP volumetric software. Samples were divided (n = 30) into with and without all metal full-coverage crown groups. Each group was then subdivided into three subgroups (n = 10) based on retreatment file used (ProTaper URS, HyFlex Remover, and NeoEndo). The volume of remnants of obturating material was remeasured by image segmentation using ITK-SNAP volumetric software. One-way analysis of variance, followed by the Tukey's post hoc test, was used for data analysis, with a significance level of 5%. Results: A significant difference in percentage remnant of obturating material after retreatment file was observed on overall comparison between with (29.84%) and without crown (21.79%) groups (P < 0.05). Each file system removed significantly more obturating material in without crown samples than with crown samples (P < 0.05). The percentage remnant of obturating material after retreatment file use was as follows: ProTaper URS > NeoEndo retreatment file > HyFlex Remover. All file systems showed significantly different (P < 0.05) efficiency in removal of obturating material. Conclusions: None of the retreatment file systems were able to remove obturating material completely. The presence of full-coverage crown negatively impacted the efficiency of retreatment files for the removal of obturating material. HyFlex Remover performed better than NeoEndo which was better than ProTaper URS.

Overview of Early Cases of Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Centre in North India.

INTRODUCTION: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. MATERIALS AND METHODS: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March-4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. RESULTS: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32%, 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. Inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. CONCLUSION: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease.

Clinical Profile of Covid-19 Infected Patients Admitted in a Tertiary Care Hospital in North India.

BACKGROUND: The novel coronavirus (Covid-19) continues to wreck havoc across China, European countries, USA and now seems to gain a strong foothold in India. The aim of this report is to describe the clinical profiles of these Covid-19 infected patients admitted in Sawai Mansingh Hospital(S.M.S), Jaipur ranging from their age, sex, travel history, clinical symptoms, laboratory evaluation, radiological characteristics, treatment provided along with common side effects and the final outcome. The described cases are one of the earliest cases of Covid-19 in the Indian subcontinent. METHODS: Epidemiological, clinical, laboratory, and radiological characteristics and treatment and outcomes data were obtained with data collection forms from electronic medical records and history given by 21 Covid-19 infected patients admitted in S.M.S., Jaipur. Patients were tested for Covid-19 by real-time reverse transcription polymerase chain reaction (RT-PCR) assay of 2019-nCoVRNA. RESULTS AND DISCUSSION: During the course of this study 21 Covid-19 positive patients were admitted in S.M.S Hospital, Jaipur. Male patients constituted 66.66% of total patients and majority of the patients (80.90%) were below 60 years of age. Most of the patients (71.40%) were either foreigners or had a history of foreign travel suggesting that these cases were not community acquired except for 4 cases from textile producing district Bhilwara (known as Manchester of India), an epicenter of North India. Approximately 33.33% patients were completely asymptomatic and of those who were symptomatic cough was the most common symptom (85.71%) followed by fever (78.57%), myalgia (64.28%), headache (28.57%) and dyspnea (28.57%). Three patients (14.28 %) had underlying co morbidity in the form of hypertension, diabetes mellitus, hypothyroidism, chronic kidney disease or coronary artery disease. 11 patients (52.38%) had lymphopenia in their hemogram during the course of admission. 3 patients (14.28%) had leucocytosis and 4 patients (19.04%) presented with thrombocytopenia. All 4 patients in the severe category had raised FDP, D-Dimer levels and they needed oxygen support. These patients had deranged liver functions and had elevated pro-calcitonin levels, serum ferritin levels and LDH levels. 1 out of the these 4 cases went into ARDS during the course of treatment. 10 patients yielded negative results for Covid-19. The mean duration from admission to getting 1st Covid-19 sample negative was 8.3 days. 18 patients (85.71%) are still under treatment. CONCLUSION: Clinical investigations in initial Covid-19 patients in the Indian subcontinent reveal lymphopenia as predominant finding in hemogram. Patients with older age and associated comorbid conditions (COPD and diabetes) seem to have greater risk for lung injury thereby requiring oxygen support during the course of disease and these patients also had greater derangement in their biochemical profile.

A Case of Post Encephalitic Optic Neuritis: Clinical Spectrum, Differential Diagnosis and Management.

PURPOSE: Most cases of optic neuritis are idiopathic or are associated with multiple sclerosis. We present a case in which a young female developed post-infectious left optic neuritis following herpes simplex encephalitis (HSE). CASE REPORT: A 24-year-old female presented with a severe headache, fever, and malaise of a one-week duration. Viral encephalitis was diagnosed and treated; intravenous acyclovir (750 mg every 8 h) was administered for 14 days. The patient improved clinically and was prescribed oral valacyclovir (1,000 mg, three times daily) for an additional 3 months as an outpatient. The patient presented again four weeks after the initial admission with left periocular pain and other typical manifestations of optic neuritis. We diagnosed post-infectious left optic neuritis following viral encephalitis. Corticosteroid therapy with 250 mg intravenous methylprednisolone every 6 hours was initiated and the patient showed rapid significant recovery. CONCLUSION: This case report highlights the patient's clinical course and includes a brief history of the systemic effects of HSE, as well as the pathophysiology, management, and differential diagnosis of post-encephalitic optic neuritis. We suggest that clinicians should routinely perform an ophthalmologic examination during the follow-up visits of such patients.

A case report on total pancreatic lipomatosis: An unusual entity.

Total pancreatic lipomatosis (PL) is an unusual entity of pathologic significance and speculative origin. It refers to complete replacement of pancreatic parenchyma by fat cells. Fat replacement may vary from mild fatty infiltration to massive replacement of the pancreas by adipose tissue, resulting in malabsorption syndrome due to pancreatic insufficiency. We present a case of a 60-year-old elderly woman with atypical abdominal complaints, diabetes mellitus, weight loss, and steatorrhea. Abdominal computed tomograms were diagnostic of PL. Magnetic resonance imaging verified this impression. The patient improved clinically after the 8-week trial of high-dose oral pancreatic enzyme replacement therapy. There is a marked reduction of steatorrhea and weight gain. This case report focuses on pathophysiology, diagnosis, and treatment guidelines of PL.

Design of HIV Coreceptor Derived Peptides That Inhibit Viral Entry at Submicromolar Concentrations.

HIV/AIDS continues to pose an enormous burden on global health. Current HIV therapeutics include inhibitors that target the enzymes HIV protease, reverse transcriptase, and integrase, along with viral entry inhibitors that block the initial steps of HIV infection by preventing membrane fusion or virus-coreceptor interactions. With regard to the latter, peptides derived from the HIV coreceptor CCR5 were previously shown to modestly inhibit entry of CCR5-tropic HIV strains, with a peptide containing residues 178-191 of the second extracellular loop (peptide 2C) showing the strongest inhibition. Here we use an iterative approach of amino acid scanning at positions shown to be important for binding the HIV envelope, and recombining favorable substitutions to greatly improve the potency of 2C. The most potent candidate peptides gain neutralization breadth and inhibit CXCR4 and CXCR4/CCR5-using viruses, rather than CCR5-tropic strains only. We found that gains in potency in the absence of toxicity were highly dependent on amino acid position and residue type. Using virion capture assays we show that 2C and the new peptides inhibit capture of CD4-bound HIV-1 particles by antibodies whose epitopes are located in or around variable loop 3 (V3) on gp120. Analysis of antibody binding data indicates that interactions between CCR5 ECL2-derived peptides and gp120 are localized around the base and stem of V3 more than the tip. In the absence of a high-resolution structure of gp120 bound to coreceptor CCR5, these findings may facilitate structural studies of CCR5 surrogates, design of peptidomimetics with increased potency, or use as functional probes for further study of HIV-1 gp120-coreceptor interactions.

Deep Orbital Dermoid Cyst Bulging into the Superior Orbital Fissure: Clinical Presentation and Management.

PURPOSE: To present a case of deep orbital dermoid cyst with emphasis on clinical presentation, imaging spectrum, differential diagnosis and management. CASE REPORT: A 28-year-old female was referred to our hospital with chief complaint of drooping of right eyelid and progressive headache. Ocular motility, visual acuity and fundus examination were normal. computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well-defined, intraosseous deep orbital dermoid cyst (5.9 mm × 12.5 mm) located near the apex of right orbit, extending from greater wing of sphenoid into the superior orbital fissure. Due to occulomotor nerve (superior and inferior divisions) compression which passes through the superior orbital fissure, ipsilateral headache and ptosis occurred. Complete surgical excision of cyst was performed using noninvasive extracranial lateral orbitotomy approach. After removal of the cyst, curette and cutting drill were used to thoroughly remove any residual cystic content. Histopathological analysis confirmed the diagnosis. The healing was uneventful postoperatively. CONCLUSION: CT and MRI are easy, reliable, safe and effective imaging methods for establishing the diagnosis of orbital dermoid cyst. Size, location and manifestations are the most important determinants of the disease management. Complete surgical excision without rupture of the cyst is the treatment of choice.