NIPAH Virus Encephalitis: Unveiling the Epidemiology, Risk Factors, and Clinical Outcomes - A Systematic Review and Meta-Analysis.

Objective: This study assessed Nipah virus (NiV) encephalitis epidemiology, clinical outcomes, and risk variables to inform treatment and prevention. Methodology: In a PubMed systematic search, 929 citations were found. After screening and eligibility, 22 studies were included. This study obtained age, gender, geographic regions, diagnostic methods, data collection methods, and bias risk. The case fatality rate (CFR) and NiV infection risk variables were evaluated by meta-analysis. Results: Southeast Asia, especially Bangladesh and Malaysia, had the most NiV cases. The major diagnostic method was blood and cerebrospinal fluid IgM and IgG antibody tests, and males predominated. Proxy respondents and matched controls were utilized for risk factor analyses when patients could not answer. The pooled CFR for NiV encephalitis was 61.0%, indicating severity. Risk factors included pigs, nighttime bats near homes, tree climbing, and male gender. Conclusion: Southeast Asian public health is plagued by NiV encephalitis. The high CFR calls for better diagnosis, treatment, and prevention. NiV's multiple risk factors must be understood for targeted therapy. Future research should fill knowledge gaps and improve NiV infection prevention.

Cardiac Autonomic Neuropathy in Newly Diagnosed Patients With Type 2 Diabetes Mellitus.

INTRODUCTION: Cardiac autonomic neuropathy (CAN) is a debilitating complication in diabetes mellitus, leading to life-threatening arrhythmias and various impairments. Its prevalence varies widely, and early detection and management are crucial. This study investigates the prevalence of CAN in newly diagnosed type 2 diabetes mellitus patients in Central India, comparing them to a control group. METHODOLOGY: This case-control study included 35 newly diagnosed type 2 diabetes mellitus patients and 35 age-matched healthy controls from the general population. Cardiac autonomic function testing (AFT) was done by heart rate variability (HRV), the deep breathing test (DBT), the cold pressor test (CPT), and the lying-to-standing test (LST). Parameters were recorded and analyzed using statistical tests. RESULTS: Patients with type 2 diabetes mellitus had significantly higher weight, BMI, fasting blood sugar, post-prandial blood sugar, urine albumin-creatinine ratios, and systolic and diastolic blood pressure than controls. Abnormalities in HRV and E: I ratio during the DBT and CPT were more prevalent in these patients. Parasympathetic dysfunction (delta HR) and a lower E: I ratio were also significantly high in this group. Also, LST results suggested a greater likelihood of orthostatic symptoms in the patients' group. CONCLUSION: This study highlights the importance of AFT in diagnosing early CAN in newly diagnosed patients. Early diagnosis and management of diabetic CAN are essential to prevent complications.

Profile of Cardiovascular Autonomic Dysfunctions in Breast Cancer Patients.

Background Patients on breast cancer chemotherapy frequently present with signs and symptoms of autonomic dysfunction. Cardiac autonomic dysfunction (CAD) is a significant cause of morbidity and mortality, affecting the quality of life with progressive advancing disease. It is associated with the short survival of breast cancer patients. Therefore, thoroughly assessing cardiovascular autonomic functions is crucial to monitor these patients' disease prognosis and chemotherapy side effects. The present study evaluated baseline heart rate variability (HRV) and Ewing's battery of cardiac autonomic reactivity tests in breast cancer patients on chemotherapy to evaluate CAD. Methodology This is a case-control study. Autonomic reactivity tests were performed in the autonomic function laboratory, Department of Physiology, All India Institute of Medical Sciences, Raipur. HRV was recorded using a lead II electrocardiogram (ECG) in two groups, namely, controls (n = 25 healthy female volunteers) and cases (n = 25 histologically proven stage I-III breast cancer patients, age 30-65 years, received three cycles of chemotherapy). Results Patients on chemotherapy had significantly lower reactivity for the time domain (all parameters) and frequency domain (absolute total power) of HRV compared to age-matched healthy controls. Autonomic reactivity showed significant loss in the patient group. Conclusions The sympathetic and parasympathetic parameters showed a significant loss of autonomic functions in the patient group compared to the healthy controls. This may be because of the chemotherapeutic drugs taken by the patients or cancer as the disease per se. As autonomic dysfunction is highly prevalent in patients with cancer and is associated with multiple symptoms, it is essential to study it in the cancer population.

Cardiac Autonomic Neuropathy (Can) in Newly Diagnosed Type 2 Diabetes Mellitus Patients.

Autonomic dysfunction associated with Type 2 Diabetes Mellitus is a well known entity, of which cardiac autonomic neuropathy deserves a special mention due to its propensity to cause major cardiac events in a seemingly asymptomatic individual. The incidence of Cardiac autonomic neuropathy among newly diagnosed Diabetes patients is less studied, with most of the current studies done in Western populace who have a different metabolic milieu compared to Indians. This study aims to find the prevalence of cardiac autonomic neuropathy in the Central Indian population, presenting to our center who are diagnosed to be having Diabetes Mellitus within one year. MATERIAL: 35 patients, of the age group (18-45 years), who were diagnosed to have Type 2 Diabetes Mellitus within the last one year were taken, after excluding any other chronic illness, like CKD, CLD, CVA, etc. and after getting consent. 35 healthy age and sex-matched controls were included in the study. Cardiac Autonomic Testing was done for all of them, using the measurement of Heart Rate Variability (HRV), Deep Breathing Test (DBT), Cold Pressor Test (CPT), and Lying to Standing Test (LST). The experimental data was analyzed using Labchart Software for autonomic dysfunction. OBSERVATION: On preliminary analysis, around 40% of the patients enrolled in the study had cardiac autonomic dysfunction, predominantly parasympathetic dysfunction, compared to the controls. There was no significant age-wise difference in cardiac autonomic dysfunction. There was also no statistically significant correlation with the HbA1c of the patient at presentation and their cardiac autonomic dysfunction. CONCLUSION: There is significant cardiac autonomic dysfunction among newly diagnosed Diabetes patients. This reaffirms the fact that early screening and diagnosis of this disease is paramount to prevent significant morbidity and mortality associated with the complications of the disease.

Vascularized Second Metatarsal Joint Transfer with Concomitant Orthognathic Surgery for Reconstruction of the Temporomandibular Joint: Our Pilot Experience.

Background: Temporomandibular joint ankylosis-associated deformity and dysfunction is a challenge to reconstruct. Alloplastic temporomandibular joints, both stock and custom-made, are used to replace the ankylotic mass with a functional joint. Still, the cost of these alloplastic joints is so expensive that it cannot be affordable to most of our population. Purpose: A primary objective of achieving at least 35 mm of mouth opening was planned. Secondarily we planned to achieve a functional occlusion with acceptable facial balance and symmetry. Method: Autologous TMJ reconstruction using vascularized second metatarsal joint transfer with concomitant orthognathic surgery. The surgery aims to achieve a significant functional rehabilitation with correction of maxillomandibular deformity in a single-stage surgery. Results: As a result of this, we present our initial experience to rehabilitate the patient with temporomandibular joint ankylosis both functionally and aesthetically by performing simultaneously joint replacement using the patient's own vascularized second metatarsal joint and concomitantly performing the orthognathic surgery. By this, we could holistically treat the patient with minimal cost and make them socially acceptable. Conclusion: We do not propose a 2nd metatarsal vascularized flap as a substitute for a custom-made total TMJ prosthesis. Still, we suggest a viable option in a selected set of patients where TMJ prosthesis cannot be afforded or has failed with a history of multiple surgeries in the same region.

Cardiovascular autonomic functions & cerebral autoregulation in patients with orthostatic hypotension.

BACKGROUND & OBJECTIVES: Patients of orthostatic hypotension may or may not have symptoms of the cerebral hypoperfusion despite fall in the blood pressure. The present study was done to quantify autonomic functions and cerebral autoregulation in patients of orthostatic hypotension with or without symptoms. METHODS: The study was conducted in 15 patients of orthostatic hypotension and 15 age, sex matched control subjects. The sympathetic reactivity was measured by diastolic blood pressure response to handgrip test (ΔDBP in HGT) and cold pressor test (ΔDBP in CPT). The parasympathetic reactivity was measured by E:I ratio during deep breathing test (DBT) and Valsalva ratio (VR) during Valsalva maneuver. The cerebral autoregulation was computed from the changes in the cerebral blood flow, cerebrovascular conductance and blood pressure measured during different time points during head-up tilt (HUT). RESULTS: The sympathetic reactivity was lower in patients as compared to controls [ΔDBP in HGT: 10 (4 - 16) vs 18 (12 - 22) mmHg, P<0.01; ΔDBP in CPT : 10 (4-12) vs 16 (10-20) mmHg, P<0.01]. The parasympathetic reactivity was also lower in patients as compared to controls. The sympathetic and parasympathetic reactivity was comparable in the symptomatic and asymptomatic patients. The maximum fall in blood pressure during HUT was comparable between symptomatic and asymptomatic patients (29.14 ± 10.94 vs 29.50 ± 6.39 mmHg), however, the percentage fall in the cerebral blood flow was significantly higher in the symptomatic (P<0.05) compared to asymptomatics. INTERPRETATION & CONCLUSIONS: Patients with orthostatic hypotension had deficits in sympathetic and parasympathetic control of cardiovascular system. Cerebral autoregulation was present in asymptomatic patients (increase in cerebrovascular conductance) during HUT while it was lost in symptomatic patients.

Pattern and prevalence of cardiovascular autonomic neuropathy in diabetics visiting a tertiary care referral center in India.

The cardiovascular autonomic neuropathy (CAN) is a known complication of long standing diabetes. In the present study, the prevalence of sympathetic and parasympathetic abnormalities in diabetic patients was evaluated on retrospective analysis of standard tests done for the assessment of CAN. Three different scoring systems were utilized for assessment of CAN namely, Ewing's crtieria, Bellavere's criteria and the criteria followed at the Autonomic Function Test laboratory. All the three criteria use different set of tests for classification. A total of 124 patients' laboratory data was analysed. The abnormality of single test ranged from 6.49% in Valsalva Maneuver to 47.41% in cold pressor test. When Bellavere's criteria was used only 53 patients had evidence of CAN while Ewing's criteria revealed that 100 patients had CAN however 69 of these patients could not be categorized. The criteria used by AFT laboratory revealed that isolated sympathetic (49 patients) and paraysmpathetic (10 patients) abnormality can be seen in CAN along with those with combined deficits (42 patients). If the Bellavere's criteria is used then patients with dominant sympathetic neuropathy are likely to be missed during testing. High prevalence of CAN in tertiary care referral centre suggests that the testing of autonomic functions in diabetics should be done routinely. It is recommended that full battery of test to evaluate both the arms of autonomic drive namely sympathetic and parasympathetic should be done and reported as such.