Treatment algorithm for post sternotomy wound infection - our experience.

INTRODUCTION: Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are a known phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop a treatment algorithm for superficial and deep sternotomy wound infections. MATERIAL AND METHODS: Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections. RESULTS: Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up. CONCLUSION: Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Prevalence and correlates of malnutrition among elderly in an urban area in Coimbatore.

BACKGROUND: Different studies in India have shown that more than 50% of elderly population of India are suffering from malnutrition and more than 90% have less than recommended intake. OBJECTIVES: The aim of this study is to estimate the prevalence and correlates of malnutrition among elderly aged 60 years and above in an urban area in Coimbatore using Mini Nutritional Assessment (MNA). METHODS: A cross-sectional study was conducted on 154 households and 190 elderly were interviewed. Nutritional status was assessed using the MNA questionnaire. RESULTS: Mean (standard deviation) age of the total population (n = 190) was 71.09 (7.93) years and 30% was male. In this population, 37 (19.47%) was malnourished (MNA <17.0) and 47 (24.73%) were at risk for malnutrition (MNA 17.0-23.5). No significant association was observed between smoking, current alcohol consumption, higher medication use, higher comorbidity, and use of walk aid with malnutrition. Among the social factors studied, lower socioeconomic status compared to higher socioeconomic status (adjusted odds ratio [OR] =5.031, P < 0.001), single/widowed/divorced compared to married (adjusted OR = 3.323, P < 0.05), and no pension compared to those having pension (adjusted OR = 3.239, P < 0.05) were significantly associated with malnutrition. CONCLUSION: The prevalence of malnutrition observed in the aged people is unacceptably high. The increasing total number of lifestyle, somatic, functional, and social factors was associated with lower MNA scores. The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with sociodemographic, somatic, and functional status. Hence, we recommend that the treatment of malnutrition should be multifactorial, and the treatment team should be multidisciplinary. Further research is needed to develop appropriate guidelines for nutritional screening and interventional programs among geriatric population.

Antimicrobial activity of lemongrass oil against Salmonella enterica on organic leafy greens.

AIMS: We investigated the antimicrobial effectiveness of lemongrass essential oil on organic leafy greens, romaine and iceberg lettuces and mature and baby spinach, inoculated with Salmonella Newport. The influences of exposure times and abuse temperatures on bacterial survival were also investigated. METHODS AND RESULTS: Leaf samples were washed, inoculated with Salm. Newport (6-log CFUml(-1) ) and dried. Inoculated leaves were immersed in solutions containing 0·1, 0·3 or 0·5% lemongrass oil in phosphate-buffered saline for 1 or 2min and then individually incubated at 4 or 8°C. Samples were taken at day 0, 1 and 3 for the enumeration of survivors. Compared to the PBS control, romaine and iceberg lettuces, and mature and baby spinach samples showed between 0·6-1·5-log, 0·5-4·3-log, 0·5-2·5-log and 0·5-2·2-logCFUg(-1) reductions in Salm. Newport by day 3, respectively. CONCLUSIONS: The antimicrobial activity of lemongrass oil against Salm. Newport was concentration and time dependent. The antimicrobial activity increased with exposure time; iceberg samples treated for 2min generally showed greater reductions (P<0·05) than those treated for 1min (c.1-log reduction difference for 0·3 and 0·5% treatments). Few samples showed a difference between refrigeration and abuse temperatures. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the potential of lemongrass oil solutions to inactivate Salm. Newport on organic leafy greens.

A study on contraceptive prevalence rate and factors influencing it in a rural area of Coimbatore, South India.

INTRODUCTION: India is the first country to implement National Family Program in 1952. Acceptance of contraceptive methods is influenced by various factors at the individual, family, and community level with their roots in the socioeconomic and cultural milieu of Indian society. This study was carried to find the contraceptive prevalence rate among eligible couples as well as to find the factors influencing it in a rural area of Coimbatore. METHODOLOGY: The study was carried out using the data extracted from the family health survey conducted by trained field staff for the purpose of furnishing details regarding people residing in the field practice area of Rural Health Training Centre (RHTC), Vedapatti located in Coimbatore district after obtaining Institutional Human Ethical clearance. All eligible couples were included for the study. Contraceptive prevalence is expressed in percentage with 95% Confidence interval. Univariate analysis (Chi-square test) was done to find the association between contraceptive acceptance and independent variables. Strength of association is determined by odds ratio with 95% Confidence Interval (CI). P < 0.05 was considered statistically significant. RESULTS: Contraceptive Prevalence Rate among eligible couples was found to be 75% (95% CI: 73.6-76.4). Most commonly used method among the study participants was tubectomy (81.6%), followed by condoms (11.4%), intrauterine devices (6.3%), and oral contraceptive pills (0.7%). Higher age of the women, religion, educational status of the women, socioeconomic status, working status of the women, number of living children, age at the time of marriage, and age at the time of first child birth were found to have statistical significant association with higher usage of contraception. CONCLUSION: The contraceptive prevalence rate was found to be higher in this study population and multiple factors were influencing the contraception usage among the eligible couples.

Prevalence and correlates of anemia among women in the reproductive age (15-49 years) in a rural area of Tamil Nadu: An exploratory study.

BACKGROUND: Anemia is a major public health problem among reproductive-aged women in India. Despite many programs implemented for decades to fight anemia, still the prevalence of anemia is high because its associated factors vary among different regions. This exploratory study was carried out to find the prevalence of anemia and factors influencing it among nonpregnant reproductive-aged women (15-49 years) in a rural area of Coimbatore. MATERIALS AND METHODS: The study was conducted in the field practice area of Rural Health Training Centre, PSG IMSR, Coimbatore, during March 2016 to August 2016. Participants were recruited by two-staged random sampling method and 426 participants were enrolled. A predesigned semi-structured questionnaire was used to collect the data pertaining to the factors influencing the prevalence of anemia, and their hemoglobin level was measured using a hemoglobin photometer. The data were analyzed using SPSS-24. (IBM Corporation, SPSS Inc., Chicago, IL, USA) Univariate analysis was done using Chi-square test and the strength of association was estimated by odds ratio. Those factors which were found to be significant by univariate analysis were further subjected to multivariate logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS: The prevalence of anemia was estimated as 64.8% (95% confidence interval: 60%-69%). Significant predictors for anemia among the study participants were less frequent intake of green leafy vegetables (adjusted odds ratio [AOR] = 3.65, confidence interval [CI]: 2.17-6.12), low socioeconomic status (AOR = 3.36, CI: 1.93-5.84), illiteracy (AOR = 3.09, CI: 1.09-5.24), birth spacing <2 years (AOR = 2.49, CI: 1.19-5.25), excessive menstrual bleeding (AOR = 2.27, CI: 1.09-4.76), and inadequate knowledge regarding anemia (AOR = 2.03, CI: 1.19-3.44). CONCLUSION: Anemia is still prevalent in high magnitude in reproductive-aged women, and measures to prevent and control it are not optimum. Hence, its multifactorial determinants have to be addressed to alleviate its burden.

Wilson's disease: (31)P and (1)H MR spectroscopy and clinical correlation.

INTRODUCTION: Proton ((1)H) magnetic resonance spectroscopy (MRS) changes are noted in Wilson's disease (WD). However, there are no studies regarding membrane phospholipid abnormality using (31)P MRS in these patients. We aimed to analyze the striatal spectroscopic abnormalities using (31)P and (1)H MRS in WD. METHODS: Forty patients of WD (treated, 29; untreated,11) and 30 controls underwent routine MR image sequences and in vivo 2-D (31)P and (1)H MRS of basal ganglia using an image-selected technique on a 1.5-T MRI scanner. Statistical analysis was done using Student's t test. RESULTS: The mean durations of illness and treatment were 6.2 ± 7.4 and 4.8 ± 5.9 years, respectively. MRI images were abnormal in all the patients. (1)H MRS revealed statistically significant reduction of N-acetyl aspartate (NAA)/choline (Cho) and NAA/creatine ratios in striatum ((1)H MRS) of treated patients compared to controls. The mean values of phosphomonoesters (PME) (p < 0.0001), phosphodiesters (PDE) (p < 0.0001), and total phosphorus (TPh) (p < 0.0001) were elevated in patients compared to controls. Statistically significant elevated levels of ratio of PME/PDE (p = 0.05) observed in the striatum were noted in treated patients as compared to controls in the (31)P MRS study. The duration of illness correlated well with increased PME/PDE [p < 0.001], PME/TPh [p < 0.05], and PDE/TPh [p < 0.05] and decreased NAA/Cho [p < 0.05] ratios. There was correlation of MRI score and reduced NAA/Cho ratio with disease severity. The PME/PDE ratio (right) was elevated in the treated group [p < 0.001] compared to untreated group. CONCLUSIONS: There is reduced breakdown and/or increased synthesis of membrane phospholipids and increased neuronal damage in basal ganglia in patients with WD.

Bilateral vertebral artery dissection caused by atlantoaxial dislocation.

UNLABELLED: Craniovertebral anomalies are rare causes of vertebral artery dissection. Therefore, appropriate evaluation is necessary in vertebrobasilar strokes, specially in the young. This is particularly true for patients with vertebral stroke without risk factors. RESULTS: Here we report a 24-year-old male presenting with posterior circulation infarcts. The patient had no obvious vascular risk factors. However, digital subtraction angiography showed chronic dissection of both vertebral arteries with partial recanalization. Further evaluation with computed tomogram of neck revealed atlantoaxial dislocation. This is a rare case in which atlantoaxial dislocation has resulted in bilateral vertebral artery dissection and stroke in young.

Usefulness of salivary sialic acid as a tumor marker in tobacco chewers with oral cancer.

AIM: This study aims to assess the usefulness of salivary sialic acid (SA) as a tumor marker in the detection of oral squamous cell carcinoma (OSCC) among tobacco chewers. MATERIALS AND METHODS: After the approval of study protocol by the Institutional Ethics Committee and informed voluntary consent, salivary samples were collected from 96 participants in each group of tobacco chewers with OSCC, tobacco chewers without precancerous or cancerous lesion, and healthy controls. Salivary protein-bound SA (PBSA) and salivary-free SA (FSA) were measured by Yao et al.'s method of acid ninhydrin reaction, and the data were subjected to appropriate statistical analysis. RESULTS: The salivary PBSA and FSA levels in the Groups 1, 2, and 3 participants were 31.17 ± 7.6 mg/dL and 63.45 ± 9.8 mg/dL, 25.45 ± 16.61 mg/dL and 33.18 ± 11.38 mg/dL, and 22.73 ± 3.01 mg/dL and 21.62 ± 8.86 mg/dL, respectively. Salivary FSA levels were significantly increased among the tobacco chewers with OSCC patients (Group 1) and tobacco chewers with no premalignant lesions of the oral cavity (Group 2) compared to the healthy controls (Group 3) with P < 0.05 being statistically significant. Salivary FSA levels were significantly increased in Group 1 as compared with Group 2. The salivary PBSA was high among Group 1 as compared to the control Group 3; there was however no significant difference in the levels of salivary PBSA between Group 1 and Group 2. There was no significant difference in the PBSA levels between OSCC patients of Group 1 and the tobacco chewers without precancerous or cancerous lesion in the oral cavity of Group 2. CONCLUSION: Salivary PBSA and FSA are significantly raised in both tobacco chewers with OSCC and in tobacco chewers with no precancerous or cancerous lesions in the oral cavity. SA should therefore be used cautiously while considering it as a marker for the early detection of oral cancer. Tobacco can be a crucial confounding factor when SA is used as a biomarker in OSCC since their levels are elevated to some extent even in tobacco chewers without any clinically obvious precancerous or cancerous lesions in the oral cavity.

Spectrum of magnetic resonance imaging findings in a family with giant axonal neuropathy confirmed by genetic studies.

Giant axonal neuropathy (GAN) is a disorder that affects both the peripheral and central nervous system with clinical and genetic heterogeneity. We describe the spectrum of magnetic resonance imaging (MRI), MR-spectroscopy (MRS), and diffusion changes in two siblings from India. In addition to the described MRI findings two unreported findings, hyperintensity signals of both the globus pallidus on T1-weighted images and involvement of bilateral thalamus, were observed. MRS showed elevated choline peaks and reduced N-acetylaspartate peaks as well as presence of lactate peaks. Diffusion weighted images showed restricted diffusion.

Video-assisted teaching versus traditional didactic lecture in undergraduate psychiatry teaching.

OBJECTIVES: The objectives of this study are as follows: (1) To compare video-assisted teaching versus didactic lectures using the pretest and posttest. (2) To compare the feedback on the two teaching methods using a teaching feedback form. MATERIALS AND METHODS: Two consecutive batches of 22 and 20 students, respectively, of the 3rd year medical undergraduate students posted to the department of psychiatry were included for the study. The first batch underwent video-assisted schizophrenia class and didactic lecture in bipolar disorder (BPAD). A crossover of the topics was done. The students underwent pretest and posttest for each topic using the same set of topic-specific validated multiple choice questions and also filled a prevalidated teaching feedback form for each class. RESULTS: Difference between pre- and post-test scores after all classes was significant, indicating effective gain of knowledge by both methods. Feedback analysis indicated that most students favored video-assisted teaching (total mean feedback score - 61.99) compared to the conventional method (total mean feedback score - 60.58). Increase in mean feedback scores indicates the students' preference. CONCLUSION: Both didactic and video-assisted lectures were effective in terms of knowledge gained and students' feedback. Using video assistance as a complement to lectures and not to replace the traditional methods is the way forward.

Cerebral Phaeohyphomycosis with Onychomycosis: Case Report and Review of Literature.

The term phaeohyphomycosis (PHM) means dark-pigmented fungal hyphae. Cerebral PHM (CPHM) with onychomycosis is extremely rare; very few have been reported so far. The authors report a case of CPHM with onychomycosis in a 37-year-old male from a rural background in Haryana, India, with involvement of the left frontal lobe. The mass was resected and biopsy was sent for histopathological examination. He was given antifungal drugs in the postoperative period. The patient responded very well to the treatment, and there were no signs of recurrence at the 6-month follow-up visit. The clinical features, imaging and histopathological investigations, and management of this rare entity are discussed, and the available literature is also reviewed.

Clinical, pathological and molecular findings in two siblings with giant axonal neuropathy (GAN): report from India.

BACKGROUND: Giant axonal neuropathy (GAN, MIM: 256850) is characterized by an early onset of severe peripheral neuropathy, varying central nervous system involvement and strikingly frizzly hair. Mode of inheritance is autosomal recessive. Mutations in the gigaxonin (GAN) gene on chromosome 16q24.1 are frequently observed for this disorder, but genetic heterogeneity has been demonstrated for a milder variant of GAN. Gigaxonin binds C-terminally to various microtubule associated proteins causing their ubiquitin-mediated degradation. For several gigaxonin mutations it was shown that they hamper this process resulting finally in accumulation of microtubule associated proteins which may disturb cellular functions. Here, we report a family originating in India with two patients showing typical clinical signs suggestive of GAN. METHODOLOGY: Genomic DNA was analyzed for both siblings and their parents in order to detect the molecular changes in the GAN gene. The complete coding region including flanking sequences was amplified using published primer sequences. The PCR products were sequenced on both strands after purification using an ABI 3730 (Applied Biosystems) capillary sequencer. The resulting sequences were evaluated using SeqPilot (JSI-medical systems GmbH) and were compared to the reference sequences (NT_024797, NM_022041) given in the NCBI-database. CONCLUSIONS: An AluYa5 insertion (c.1657ALUYa5ins, p.Thr553_Pro597del) in exon 11 of the GAN gene was identified homozygous in both siblings, whereas the parents were heterozygous carriers of this mutation. Here, the reported mutation is located in C-terminal part of the protein affecting the terminal kelch domain. Thus a functional important part of the protein is altered by the AluYa5 insertion and causes GAN.

Role of MR imaging in the evaluation of etiology of status epilepticus.

PURPOSE: MRI helps in detecting the etiology of epilepsy, which may assist in better management. However its role in emergency situations like status epilepticus (SE) is still not clear. We analyzed the MRI findings in various subtypes of SE and tried to find out if etiological diagnosis improves by doing MRI over and above that provided by clinical evaluation, CT scan and CSF and other laboratory data. METHOD: This prospective study involved 34 patients (M:F:: 23:11, mean age: 25.8+/-17.2 years; range=1-60 years) of SE. Patients were chosen irrespective of type of SE, etiology of SE, duration of SE, or treatment received. MRI was performed using standard parameters and sequences. Details of clinical, laboratory, EEG, and CT/MRI scan data were recorded. RESULTS: While 23 patients had received some treatment prior to admission, the rest did not receive any treatment. Eight patients had past history of seizures and 3 of them had history of SE. EEG revealed background slowing (22) and epileptiform discharges (15). CT scan (n=32) observations were: normal (25), inconclusive (2), diagnostic (3). MRI improved the diagnosis in 32.4% (11/34) patients over and above that provided by clinical examination, EEG, other laboratory investigations and CT scan. Seizures could be controlled with recommended treatment in 29 patients, while in 5 (Generalized Convulsive SE: 3, Epilepsia Partialis Continua: 2), it remained uncontrolled. At discharge, all but eight scored '0' on modified Rankin Scale. CONCLUSIONS: MRI is an important diagnostic tool even in emergency situation like SE. Detection of proper etiology assists in appropriate treatment and hence improves the outcome of SE.

Reversible parkinsonism following ventriculoperitoneal shunt in a patient with obstructive hydrocephalus secondary to intraventricular neurocysticercosis.

Parkinsonism with evidence of midbrain dysfunction has been reported in a few patients with aqueductal stenosis after placement of ventriculoperitoneal (VP) shunt. The response to levodopa is variable. We report a patient with neurocysticercosis of the fourth ventricle who developed transient parkinsonism without evidence of midbrain dysfunction after placement of a VP shunt. The frequency of tremor was 5-5.5 Hz. Though the response to levodopa was initially slow, later it was significant, and after 3 months he was asymptomatic without levodopa. The exact pathophysiology of parkinsonism in our patient remained obscure.

Multichannel somato sensory evoked potential study demonstrated abnormalities in cervical cord function in brachial monomelic amyotrophy.

BACKGROUND: Brachial monomelic amyotrophy (BMMA) is known to affect the central cervical cord gray matter resulting in single upper limb atrophy and weakness. SETTINGS AND DESIGN: Case series of BMMA patients who underwent somatosensory evoked potentials (SEP) studies at a tertiary referral center. AIMS: We proposed to record Multichannel Somatosensory Evoked Potentials (MCSSEP) from median and ulnar nerves with neck in neutral and neck fully flexed position in 17 patients with classical BMMA seen over three years. MATERIALS AND METHODS: Recordings were done from both median (MN) and ulnar nerves (UN). N9, P9, N13, N20 potentials were recorded and amplitudes measured. SSEPs were performed in 22 age-matched healthy men. Amplitudes of cervical response were calculated by N13/P9 ratio and compared in both positions. RESULTS: Among the controls N13 amplitude was always normal {MN: mean N13/P9 - 0.96 in neutral; 0.95 in flexed}{UN: mean N13/P9 - 0.82 in neutral; 0.83 in flexed}, and mean amplitudes did not reveal any difference in both conditions ( P> 0.05). Among 17 patients N9, P9 and N20 responses were normal in neutral position. Flexion showed no change in latency or amplitude of N9 and N20 responses ( P -0.63) whereas the N13 response was abnormal in at least one tested nerve in the affected limb (MN: P < 0.01; UN: P < 0.01). During flexion, N13 response was abnormal in 14 (82%) patients after MN stimulation and in all 17(100%) after UN stimulation {MN: mean N13/P9 - 0.62 in neutral; 0.38 in flexed}{UN: mean N13/P9 - 0.55 in neutral; 0.31 in flexed}. CONCLUSION: MCSSEP in BMMA with neck flexion caused a significant reduction of the cervical N13 response indicating segmental cervical cord dysfunction.

Are Body Image Issues Affecting Our Adolescents? A Cross-sectional Study among College Going Adolescent Girls.

BACKGROUND: Body image relates to how people think and feel about their own body. In today's society, with the growing sense of ideal body image, adolescents try to lose or gain body weight to attain that perfect body. Body image perception is still naive, and this research will try to understand these unexplored areas, where there is paucity of body image-related studies. OBJECTIVES: The objective of the study is to find out the proportion of girls dissatisfied about body image, and the association of various factors with body image dissatisfaction and to ascertain the weight control behaviors adopted by adolescent college girls. METHODOLOGY: A cross-sectional study was done among 1200 college girls in Coimbatore. A semi-structured questionnaire was used to collect data on various factors associated with body image dissatisfaction. Body mass index (BMI) of the participants was calculated. RESULTS: Body image dissatisfaction was there among 77.6% of the girls. It was found that factors such as higher BMI, sociocultural pressure to be thin and depression were all significantly associated with body image dissatisfaction. The most commonly followed weight control behaviors were eating small meals and skipping meals. Improving the appearance and body shape were the main reasons for weight control behaviors. CONCLUSION: This study establishes the fact that body image dissatisfaction is no longer a western concept and affects Indian adolescent girls to a great extent. Hence, effective interventions have to be planned to increase awareness on ideal body weight and protect our young generation from pressures of negative body image.

Intrathecal gadolinium-enhanced magnetic resonance cisternography in cerebrospinal fluid rhinorrhea: road ahead?

Accurate localization of cerebrospinal fluid (CSF) fistula in a patient with CSF rhinorrhea is challenging and often involves multiple imaging studies with associated expense and patient discomfort. Intrathecal contrast-enhanced computed tomography (CT) and unenhanced magnetic resonance (MR) cisternography using constructive interference in steady state (CISS-3D) sequences are currently being used in attempt to localize the leakage site but with varying degrees of success. Our purpose is to evaluate the utility of intrathecal gadolinium-enhanced MR cisternography (GdMRC) in patients with CSF rhinorrhea. Ten consecutive patients of CSF rhinorrhea (five spontaneous, four post-traumatic, and one post-operative) were evaluated with GdMRC. Nine of the patients underwent intrathecal contrast CT and CISS-3D examinations in addition. Each of studies was reviewed independently by three neuroradiologists blinded to results of other modalities. Surgery was planned after consensus and surgical correlation obtained in nine cases. The fistulous site was clearly demonstrated by using GdMRC in eight patients, CISS-3D in six, and intrathecal CT in three patients. The site of leakage was confirmed surgically in all the patients. One patient was found to be false negative both by intrathecal CT and GdMRC, and in one patient no fistulous site was demonstrated by any of the modalities and surgery was not offered. No adverse reaction was seen in any of the patients. GdMRC is a novel method of confirmation and localization of CSF fistula with potential for routine clinical application. Diagnosis and localization of fistulous site is better demonstrated due to its high-contrast resolution, absence of bony artifacts, and direct multi-planar imaging.

Electroencephalographic and imaging profile in a subacute sclerosing panencephalitis (SSPE) cohort: a correlative study.

OBJECTIVE: There are only a few studies correlating diverse radiological and EEG features of subacute sclerosing panencephalitis (SSPE). The objective of the study was to (a) describe EEG profile and (b) correlate it with the clinical and imaging data of patients with confirmed SSPE. METHODS: This study was conducted at a University teaching hospital in south India and involved 58 patients (M:F=37:21, age: 12.3, SD 4.8 years) of SSPE. Diagnosis of SSPE was based on the characteristic clinical manifestations, and raised IgG (1:625) anti-measles antibody in cerebrospinal fluid (CSF) by ELISA in all the patients. Scalp EEGs were recorded on 16 channel machines using standard parameters and procedures. The EEG, clinical and imaging data were reviewed. RESULTS: EEGs were frequently abnormal: typical (37) and atypical (21). Diffuse slowing of background activity (BGA) was noted in 46 records being asymmetrical in six. Periodic complexes were periodic (32), quasi-periodic (21) or a-periodic (4). Periodic complexes (PC) (amplitude: 370.7, SD 171.2 microV; duration - 1.7, SD 2.0 s; inter-complex interval: 8.4, SD 9.2s) were symmetrical in 39 and asymmetrical in 19. CT (32) and MRI (23) scans were normal in 16 patients while others had white matter (15), cerebral edema (8), cerebral atrophy (8), basal ganglia (2), and thalamic (2) changes. There was an independent association of frontally dominant slowing of BGA (p=0.04) and typical PCs (p=0.03) with the diffuse cerebral edema on imaging. White matter changes correlated with slowing of BGA (p=0.04), but not with typical PC (p=0.16). CONCLUSIONS: This study provides valuable insight into the structural and clinical correlates of EEG changes in SSPE. SIGNIFICANCE: Irrespective of the incidence of occurrence of SSPE in a community, a clinician should be aware of the wide spectra of EEG findings. This study also discusses the possible underlying structural and clinical correlates.

Intermediate maple syrup urine disease: neuroimaging observations in 3 patients from South India.

Maple syrup urine disease is a disorder of branched-chain keto acid metabolism. Three children were diagnosed with the intermediate form of maple syrup urine disease during routine evaluation of mental retardation. Clinical features were characterized by mental retardation, seizures, autistic features, and movement disorder in the form of dystonia. High-performance liquid chromatography of the urine and serum revealed elevated levels of branched-chain amino acids, suggesting a diagnosis of maple syrup urine disease. Magnetic resonance imaging showed diffuse hyperintense signals in the white matter along with involvement of the thalami and globus pallidus. Magnetic resonance imaging in the intermediate form showed myelination in the posterior limb of the internal capsule, in contrast to the classic form of the disease. Knowledge about the neuroimaging findings of this rare disease will help to narrow down the differential diagnosis when evaluating children with unexplained mental retardation and seizures.

Cholesterol ester storage disease with unusual neurological manifestations in two siblings: a report from South India.

Cholesterol ester storage disease is a rare autosomal recessive storage disorder resulting from lysosomal acid lipase deficiency. Two siblings manifested with hepatosplenomegaly, ptosis, and bilateral external ophthalmoplegia. Evaluation revealed hyperlipidemia and bilateral adrenal calcifications. Leukocyte acid lipase levels were significantly low in both the patients, compared with controls, suggesting a diagnosis of cholesterol ester storage disease. Ptosis and external ophthalmoplegia have hitherto not been reported in cholesterol ester storage disease.