Drug Repositioning: A Monetary Stratagem to Discover a New Application of Drugs.

Drug repurposing, also referred to as drug repositioning or drug reprofiling, is a scientific approach to the detection of any new application for an already approved or investigational drug. It is a useful policy for the invention and development of new pharmacological or therapeutic applications of different drugs. The strategy has been known to offer numerous advantages over developing a completely novel drug for certain problems. Drug repurposing has numerous methodologies that can be categorized as target-oriented, drug-oriented, and problem-oriented. The choice of the methodology of drug repurposing relies on the accessible information about the drug molecule and like pharmacokinetic, pharmacological, physicochemical, and toxicological profile of the drug. In addition, molecular docking studies and other computer-aided methods have been known to show application in drug repurposing. The variation in dosage for original target diseases and novel diseases presents a challenge for researchers of drug repurposing in present times. The present review critically discusses the drugs repurposed for cancer, covid-19, Alzheimer's, and other diseases, strategies, and challenges of drug repurposing. Moreover, regulatory perspectives related to different countries like the United States (US), Europe, and India have been delineated in the present review.

Cerebrospinal Fluid Flow Parameters in Normal Subjects above 40 Years of Age.

Background Cerebrospinal fluid (CSF) flow is altered in many conditions like normal pressure hydrocephalus (NPH), aqueduct stenosis, or Chiari malformation. It is very important to know the normal CSF flow parameters for properly diagnosing these conditions. No data on CSF flow parameters of the Indian population are available. Hence, this study was undertaken to generate normative CSF flow parameters in the Indian population. Aim Our aim was to estimate normal CSF flow parameters across the cerebral aqueduct in Indian subjects over 40 years of age. Settings and Design This observational study was done in the tertiary care institute on subjects undergoing magnetic resonance imaging (MRI) for indications like headache and having normal MRI. Methods Phase-contrast quantitative flow sequence was done in 100 subjects perpendicular to the cerebral aqueduct on 3.0T MRI (Discovery 750w with GEM suit, GE, Milwaukee, WI, United States) using a dedicated 32-channel head coil with 10 cm/s velocity encoding. The region of interest was kept at the cerebral aqueduct in cross-section. The inbuilt software calculated flow-time and velocity-time graphs and calculated peak systolic velocity (PSV), peak diastolic velocity (PDV), systolic flow (SF), and diastolic flow (DF). Stroke volume (SV) was calculated by averaging systolic and DFs. p -Value < 0.05 was considered significant. Results Mean age was 53.72 ± 10.53 (40-78) years with 41 males and 59 females. PSV, PDV, SF, DF, and SV all showed a significant linear correlation with age with p -values of 0.001, 0.004, 0.009, <0.001, and <0.001, respectively. Only PDV ( p = 0.035) and DF ( p = 0.045) varied significantly with sex, values being higher in males. Conclusion All five CSF flow parameters studied vary positively with age, and this variation is linear. Normal decadal median values calculated for these parameters can act as baseline values for the local population and help in defining conditions like NPH.

Global Trends of Cosmeceutical in Nanotechnology: A Review.

Nanotechnology suggests different innovative solutions to augment the worth of cosmetic products through the targeted delivery of content that manifests scientific innovation in research and development. Different nanosystems, like liposomes, niosomes, microemulsions, solid lipid nanoparticles, nanoform lipid carriers, nanoemulsions, and nanospheres, are employed in cosmetics. These nanosystems exhibit various innovative cosmetic functions, including site-specific targeting, controlled content release, more stability, improved skin penetration and enhanced entrapment efficiency of loaded compounds. Thus, cosmeceuticals are assumed as the highest-progressing fragment of the personal care industries that have progressed drastically over the years. In recent decades, cosmetic science has widened the origin of its application in different fields. Nanosystems in cosmetics are beneficial in treating different conditions like hyperpigmentation, wrinkles, dandruff, photoaging and hair damage. This review highlights the different nanosystems used in cosmetics for the targeted delivery of loaded content and commercially available formulations. Moreover, this review article has delineated different patented nanocosmetic formulation nanosystems and future aspects of nanocarriers in cosmetics.

Timing of Surgery for Ruptured Arteriovenous Malformations with Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.

Background: Both early surgery and delayed surgery of ruptured arteriovenous malformation (AVM) with intracerebral hemorrhages have their own advantages and disadvantages. Due to lack of large case-control studies, timing of surgery for ruptured AVM excision is still a controversial topic. So, we did a systemic review and meta-analysis, including our experience of early surgery, to see which surgical strategy has a favorable outcome. Materials and Methods: We systematically searched several databases and journals to screen eligible studies. After synthesizing data, results of individual studies of early and delayed surgery were calculated as the effect size (ES) and 95% confident intervals (CIs), and the pooled ES was calculated using random-effects model. Heterogeneity and publication bias were assessed for the individual outcomes. Results: A total of nine published studies, one oral presentation, and our unpublished study were included in the analysis. Delayed surgery has better results than early surgery in terms of complete excision rate (delayed ES, 1.00; 95% CI, 0.97 1.00 vs. early ES, 0.96; 95% CI, 0.91 0.99), good functional outcome (delayed ES, 0.94; 95% CI, 0.86 0.99 vs. early ES, 0.68; 95% CI, 0.51 0.84), and mortality (delayed ES, 0.00; 95% CI, 0.00 0.01 vs. early ES, 0.04; 95% CI, 0.01 0.10). Heterogeneity was significant in the results of early surgery group, and no publication bias was found in the meta-analysis. Conclusion: Delayed surgery is superior to early surgery in achieving higher complete excision rate, good functional outcome, and reducing mortality. However, larger comparative studies are needed for subgroup analysis and for reducing the impact of various confounding factors.

Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study.

Introduction: No study has been conducted to explore soft and hard tissue changes brought by functional appliances within the temporomandibular joint (TMJ) after correction of class II division 2 (div 2) malocclusion. Hence, we planned this study to evaluate the mandibular condyle disk-fossa relationship before and after prefunctional and twin block therapy using a magnetic resonance imaging (MRI) scan. Methodology: This prospective observational study was conducted among 14 males treated with prefunctional appliances for 3-6 months, followed by 6-9 months of fixed mechanotherapy. MRI scan was evaluated for changes in the TMJ at baseline after completion of prefunctional phase and after completion of functional appliance therapy. Results: At pretreatment, there was a flat contour on the posterosuperior surface of the condyles and a notch-like projection on its anterior surface. After functional appliance therapy, slight convexity appeared on the posterosuperior surface of the condyle and the prominence of the notch was reduced. There was a statistically significant anterior shift of condyles both after prefunctional and twin block treatment. The meniscus on both sides had significantly shifted posteriorly over three stages with respect to the posterior condylar (PC) plane and Frankfort horizontal (FH) plane. The superior joint space had significantly increased with significant linear glenoid fossa displacement between pre and posttreatment stages. Conclusion: Prefunctional orthodontics induced favorable changes in TMJ soft and hard tissues of patients, but they were not sufficient to place the soft and hard tissues in their normal positions. A functional appliance phase is needed to place the TMJ in their respective normal positions. How to cite this article: Patel B, Kukreja MK, Gupta A, et al. Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study. Int J Clin Pediatr Dent 2022;15(5):479-488.

Brain Perfusion, Hippocampal Volumetric, and Diffusion-weighted Imaging Findings in Children with Prolonged Febrile Seizures and Focal Febrile Seizures.

BACKGROUND: The current study was conducted to describe the findings of brain perfusion, hippocampal volumetric, and diffusion-weighted imaging (DWI) in children aged six months to seven years with febrile status epilepticus (FSE) and focal febrile seizures (FFS) when compared with age and gender-matched controls. MATERIALS AND METHODS: This cross-sectional study was conducted among children aged six months to seven years presenting with FSE or FFS within 72 h of the seizure. Cases were subjected to magnetic resonance imaging (MRI) brain and sleep-deprived electroencephalography. Age and gender-matched children who were subjected to MRI brain for nonepileptic indications served as their control. Hippocampal volumes, T2 values, cerebral blood flow, and diffusion characteristics were compared between the cases and controls and also between those with FSE and FFS. RESULTS: A total of 31 cases (FFS = 20, FSE = 11) and 30 controls were enrolled. There was no significant difference between right and left hippocampal volumes and T2 relaxometry values between cases and controls and also between children with FSE and FFS. Similarly, the cerebral blood flow was also comparable in cases and controls. There was a single case of FSE with hippocampal malrotation; one child showed diffusion restriction in the hippocampus after prolonged (>60 min) FSE. CONCLUSION: Children with FSE and FFS had comparable hippocampal volume and brain perfusion to healthy children. However, one child with FSE had hippocampal malrotation and another had diffusion restriction. The study findings need to be interpreted in the context of small sample size, and lack of follow-up neuroimaging.

Prospective randomized comparison of quality of regenerate in distraction osteogenesis of ring versus monolateral fixator in patients with infected nonunion of the tibia using digital radiographs and CT.

AIMS: In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia. PATIENTS AND METHODS: Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study. RESULTS: The regenerate mineralization on radiographs was comparable in both groups at two, four, six, and ten months' follow-up but the rail fixator group had statistically significant higher grades of mineralization when compared with the circular frame group at eight and 12 months' follow-up. The regenerate mineralization was also higher in the rail fixator group than in the circular frame group on CT at three and six months, although this difference was not statistically significant. CONCLUSION: Overall, the regenerate mineralization was higher in the monolateral than the circular frame group. A monolateral fixator may be preferred in patients with infected nonunion of the tibia with bone defects up to 7 cm. Cite this article: Bone Joint J 2019;101-B:1416-1422.

Cytoprotective Agents to Avoid Chemotherapy Induced Sideeffects on Normal Cells: A Review.

Anticancer agents play a vital role in the cure of patients suffering from malignancy. Though, the chemotherapeutic agents are associated with various adverse effects which produce significant toxic symptoms in the patients. But this therapy affects both the malignant and normal cells and leads to constricted therapeutic index of antimalignant drugs which adversely impacts the quality of patients' life. Due to these adversities, sufficient dose of drug is not delivered to patients leading to delay in treatment or improper treatment. Chemoprotective agents have been developed either to minimize or to mitigate the toxicity allied with chemotherapeutic agents. Without any concession in the therapeutic efficacy of anticancer drugs, they provide organ specific guard to normal tissues.

Cystic Leucoencephalopathy in NDUFV1 Mutation.

Complex I deficiency is one of the most common mitochondrial respiratory chain defect. This deficiency of oxidative phosphorylation results from mutation in nuclear and mitochondrial DNA. Mutations in NDUFV1 (Flavin binding subunit of Respiratory complex 1) results in neurological manifestations including Leigh syndrome and leucoencephalopathy. The authors report a one-year-old boy with history of regression of motor milestones following a trivial fall from the bed. His magnetic resonance imaging revealed diffuse, cystic leucoencephalopathy involving corpus callosum and periventricular white matter. Clinical features and radiological findings may resemble those of vanishing white matter disease. Next generation sequencing revealed likely compound heterozygous missense pathogenic variant in exon 8 of NDUFV1 gene [c.1156C > C/T (p.Arg386Cys)] and possibly novel splice site variation in intron 2 of NDUFV1 gene (c.155 + 1G > G/A). NDUFV1 related leucoencephalopathy must be considered among those presenting with sudden onset of motor regression with neuroimaging correlate of diffuse cystic leucodystrophy.

Combined microsurgical and endoscopic technique for removal of extensive intracranial epidermoids.

BACKGROUND: Intracranial epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around delicate neurovascular structures and often extend from one compartment to another. The purpose of this study was to determine the usefulness of endoscopic assistance in the microsurgical resection of these lesions, in which total resection is therapy of choice. METHODS: A total of 48 cases of intracranial epidermoids were treated by combined microscopic and endoscopic techniques. Initially, the tumor was removed under the microscope and after ensuring maximum excision, the endoscope was used to find out and excise any residual tumor. RESULTS: Out of these 48 cases complete excision was achieved in 44 cases and subtotal excision in four patients. Postoperative complications were seen in 17 patients, but none of the complications was attributed to the use of endoscope. Overall use of endoscope benefited 79% of cases. CONCLUSION: We recommend combined microsurgical and endoscopic approach to achieve complete/maximum resection of extensive intracranial epidermoid tumors.

MRI Brain Lesions in Eclampsia: A Series of 50 Cases Admitted to HDU of a Tertiary Care Hospital.

Objective: To correlate the Magnetic Resonance Imaging findings and clinical presentation in patients of eclampsia. Materials and methods: This one year prospective study was conducted in the HDU of Department of Obstetrics and Gynecology, PT.B.D.Sharma, PGIMS, Rohtak .A total of 50 women with eclampsia (both antepartum and postpartum) were divided into two groups: a) study group patients with abnormal MRI b) control group: b) control group: patients with normal MRI.Comparison was done using chi-square test and unpaired student 't' test. Results: MRI revealed abnormal findings in 24% of women, commonest diagnosis being CVT without infarct (10%) followed by infarct (8%), PRES (4%) and HLE (2%).Totally 66% (n = 33) of the women presented with postpartum eclampsia while 34% (n = 17) had antepartum eclampsia.96%(n = 48) were unbooked cases. Unconsciousness, altered sensorium, headache, blurring of vision, seizures, GCS < 3 correlated well with MRI findings (p = 0.000, p = 0.027, p = 0.001, p = 0.007, p = 0.005, p = 0.000 respectively) whereas fundoscopic changes did not (p = 0.520). The mean uric acid and serum creatinine levels was higher (0.41 ± 0.11 mmol/ L vs 0.26 ± 0.10 mmol/ L and 80 ± 18 µmol/ L vs 71 ± 9 µmol/ L) in the study group and this was statistically significant (p = 0.003, p = 0.04 respectively).There was no statistically significant difference between blood pressure values of cases with or without MR imaging evidence of brain lesions. There was no maternal mortality among 50 cases. The sensitivity, specificity, positive predictive value and negative predictive value of neurological findings for abnormal MRI in patients with eclampsia was found to be 91.7%, 73.7%, 52.4%, 96.6% respectively. Conclusion: Unconsciousness, altered sensorium, headache, blurring of vision,seizures, GCS < 3, elevated uric acid and serum creatinine levels in the follow-up of pregnant patients with preeclampsia/eclampsia should be a warning for possible brain lesions whereas booking status, mean BP, fundoscopy, platelet, hemoglobin, liver enzymes were not significantly associated with positive MRI findings in patients of eclampsia.

rCBV- and ADC-based Grading of Meningiomas With Glimpse Into Emerging Molecular Diagnostics.

INTRODUCTION: This study was conducted to grade meningiomas based on relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC) to help surgeons plan the approach and extent of operation as well as decide on the need of any adjuvant radio/chemo therapy. The current and evolving genomic, proteomic, and spectroscopic technologies are also discussed which can supplement the current radiologic methods and procedures in grading meningiomas. METHODS: A total of 35 patients with meningioma prospectively underwent basic MR sequences (T1W, T2W, T2W/FLAIR) in axial, sagittal and coronal planes followed by Diffusion Weighted (DW) imaging having b value of 1000 (minimum ADC values used for analysis). Then, gadobenate dimeglumine/meglumine gadoterate was administered (0.1 mmol/kg at a rate of 4 mL/s) followed by saline flush (20 mL at a rate of 4 mL/s). Next, T2*W/FFE dynamic images were acquired; dynamics showing maximum fall in intensity was used for creating rCBV and relative Cerebral Blood Flow (rCBF) maps and calculating rCBV. RESULTS: Both maximum rCBV and minimum ADC within the tumor were not significant for differentiating benign from malignant meningiomas. A cut-off maximum rCBV of 2.5 mL/100 g in peritumoral edema was 75% sensitive, 84.6% specific, and 83.3% accurate in differentiating benign from malignant meningiomas. CONCLUSION: Benign and malignant meningiomas can be differentiated based on maximum rCBV in peritumoral edema but ADC values within the tumor are insignificant in differentiating benign and malignant tumors. rCBV values within tumor, however, may be helpful in subtyping meningiomas, especially transitional and meningothelial meningiomas.

Concurrent Acute Glomerulonephritis and Retropharyngeal Abscess in 10 Year Boy: A Case Report.

Postinfectious Glomerulonephritis (PIGN) usually follows 1-2 weeks after respiratory tract infection and 4-6 weeks after skin infection. Acute Glomerulonephritis (AGN) is uncommon with simultaneous severe throat infections. We describe a 10-year-old boy who was presented with high grade fever, dysphagia and tender swelling over left side of neck. Examination also revealed enlarged multiple cervical lymph nodes on the same side of neck. Magnetic Resonance Imaging (MRI) of soft tissue of neck revealed evidence of retropharyngeal abscess. The next day, he subsequently developed haematuria and oliguria with borderline raised blood pressure. His corresponding blood urea and serum antistreptolysin O (ASO) levels were raised with low C3 levels. He had a remarkable improvement on injectable broad spectrum antibiotics with complete resolution of fever and neck symptoms. At eight weeks follow up, complete resolution of microscopic haematuria with normal C3 levels was observed. The present case highlights a 10-year-old young boy with retropharyngeal abscess presenting with clinical and laboratory evidence of Poststreptococcal Glomerulonephritis (PSGN).

Trigeminal schwannoma.

Schwannoma is a benign tumor of the nerve sheath arising from the perineural schwann cells. The nerves most commonly involved in schwannomas of the head and neck are the vagus and the cervical sympathetic chain. Trigeminal schwannomas are rare tumours. A 17 year old male patient with a chief complaint of swelling on face was diagnosed as suffering from bening tumor extending from cranial base (from foramen ovale) to the parapharengeal space. Mandibular access osteotomy was done to expose the tumor. Surgical excision of the tumor was done along with the preservation of the nerve. Schwannomas can occur along the pathway of any somatic or sympathetic nerve. Superficial schwannomas require simple exposure and excision but the one which are deep and large, may require complex access osteotomies. Careful surgery is required to preserve the nerve function. Once completely excised, the prognosis is excellent.

Growing skull fractures: guidelines for early diagnosis and surgical management.

BACKGROUND: Growing skull fracture (GSF) is a rare complication of pediatric head trauma and causes delayed onset neurological deficits and cranial defect. GSF usually develops following linear fracture with underlying dural tear resulting in herniation of the brain. Early diagnosis and treatment are essential to avoid complications. However, there are no clear-cut guidelines for the early diagnosis of GSF. The present study was conducted to identify the criteria for the early diagnosis of GSF. MATERIAL AND METHODS: From 2010 to 2015, all pediatric patients of head trauma with linear fracture were evaluated. Patients of age <5 years with cephalhematoma, bone diastasis of 4 mm or more with underlying brain contusion were subjected to contrast brain MRI to find out the dural tear and herniation of the brain matter. Patients with contrast MRI showing dural tear and herniation of the brain matter were considered high risk for the development of GSF and treated surgically within 1 month of trauma. Patients with contrast brain MRI not showing dural tear and herniation of the brain matter were regularly followed for any signs of GSF. RESULTS: A total of 20 patients were evaluated, out of which 16 showed dural defects with herniation of the brain matter and were subjected to duraplasty. Four patients in which MRI did not show dural tear and herniation of the brain matter were regularly followed-up and have not shown any sign of GSF later on follow-up. CONCLUSION: Early diagnosis of GSF can be made based on the four criteria, i.e., (1) age <5 year with cephalhematoma, (2) bone diastasis 4 mm or more (3) underlying brain contusion (4) contrast MRI showing dural tear and herniation of the brain matter. Dural tear with herniation of the brain matter is the main etiopathogenic factor for the development of GSF. Early diagnosis and treatment of GSF can yield a good outcome.

Spinal dorsal dermal sinus tract: An experience of 21 cases.

BACKGROUND: Spinal dorsal dermal sinus is a rare entity, which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection. The present study was undertaken to know the clinical profile of these patients, to study associated anomalies and to assess the results of surgical intervention. METHODS: Medical records of 21 patients treated for spinal dorsal dermal sinus from September 2007 to December 2013 were reviewed. RESULTS: We had 21 patients with male: female ratio of 13:8. Only 2 patients were below 1-year of age, and most cases (15) were between 2 and 15 years (mean age = 8.2 years). Lumbar region (11 cases) was most frequently involved, followed by thoracic (4 cases), lumbosacral, and cervical region in 3 patients each. All of our patients presented with neurological deficits. Three patients were admitted with acute meningitis with acute onset paraplegia and had intraspinal abscess. The motor, sensory, and autonomic deficits were seen in 14, 6, and 8 patients, respectively. Scoliosis and congenital talipes equinovarus were the common associated anomalies. All patients underwent surgical exploration and repair of dysraphic state and excision of the sinus. Overall, 20 patients improved or neurological status stabilized and only 1 patient deteriorated. Postoperative wound infection was seen in 2 cases. CONCLUSIONS: All patients with spinal dorsal dermal sinuses should be offered aggressive surgical treatment in the form of total excision of sinus tract and correction of spinal malformation, as soon as diagnosed.

Recent Patents, Formulation and Characterization of Nanoliposomes.

Nanoliposome has been introduced for nanoscale bilayer lipid vesicles. These are the nano version of liposomes, having cell-specific targeting, required to achieve a desired drug concentration at the target site for optimum therapeutic efficacy, possibly by minimizing the adverse effects on healthy cells and tissues. Nanoliposomes possess impending applications in the fields of nanotechnology, e.g. cancer therapy, cosmetics, diagnosis, gene delivery, agriculture and food technology. Nano liposomes can be formulated by Sonication technique, Extrusion method, Emulsification evaporation method and Lipid layer hydration method. Authors have performed detailed patent and literature survey on PubMed, PubMed Central, Spingerlink and Elsevier based reviews and research articles on nanoliposomes. An attempt has been made to highlight the various formulation methods including the patented technologies, applications and characterization of nanoliposomes.

Twist drill aspiration of pyogenic brain abscesses: our experience in 103 cases.

BACKGROUND: Intracranial abscesses remain a significant health care problem in developing countries. Though potentially curable, brain abscess remains a diagnostic and therapeutic challenge. The effective treatment of intracranial abscess remains controversial. Various surgical procedures like drainage, aspiration, and excision have been advocated for the management of brain abscess with variable results. Aspiration is a rapid and safe procedure, especially with use of stereotactic techniques, intraoperative ultrasound, or computed tomography (CT) scan guidance. However, these are not readily available everywhere. OBJECTIVE: To assess the outcome in pyogenic brain abscesses treated by twist drill aspiration (a bedside procedure) in which point of aspiration is marked with the help of three-dimensional (3D) reconstructed CT images. METHODS: From September 2007 to September 2011, a total of 103 cases of brain abscesses over 2.5 cm in size were treated by twist drill aspiration. The point of aspiration was marked with the help of 3D reconstructed CT images using fixed bony landmarks as reference, and exact measurement were taken with the help of biopsy software. RESULTS: In the present study, 103 cases of superficial brain abscesses were treated via twist drill aspiration. Out of these, 98 patients had a single abscess and five had multiple abscesses. Out of the 103 patients, 86 (83.4%) showed good recovery, 9 (8.7%) had moderate disability, 3 (2.9%) had severe disability, and 5 (4.8%) expired. CONCLUSION: Twist drill aspiration is a rapid, safe, and very effective lifesaving procedure in the underdeveloped world where stereotaxy is not readily available.

Comparison of total versus partial revision of primary ventriculoperitoneal shunt failures.

BACKGROUND: Optimal surgical management of patients presenting with primary shunt failure in the era of neuroendoscopy remains complex. The value of replacing the entire shunt system as opposed to a single shunt component has not been assessed extensively. METHODS: In a retrospective study, the records of all patients who underwent their first shunt revision due to mechanical obstruction between September 2007 and December 2011 were reviewed. Shunt revisions were classified as total (entire shunt replaced) or partial (only malfunctioning component replaced). Patients having a minimum follow-up of 1 year after primary shunt revision were included in the study. Kaplan-Meier (shunt survival curves) and log-rank analysis were used to compare failure rates between partially and totally revised shunts. RESULTS: Records of 62 patients in whom cause of primary shunt failure was obstruction (P roximal or distal) were analyzed retrospectively. At the end of follow-up period, 26 out of 28 partial revision group and 22 out of 34 total revision group had shunt failure. The median survival of the shunt in the partial revision and total revision groups was 60 and 270 days, respectively. The method (partial/total revision) related difference in shunt survival duration was statistically significant as shown by log-rank analysis (log-rank test value = 5.94 and P < 0.05). CONCLUSION: Partial revision of shunt predisposes to accelerated shunt failure as compared with total revision in cases of obstructed ventriculoperitoneal shunt.