Investigating dysautonomia of Bradbury Eggleston syndrome: A case report

This is a report of 65 years old man with recurrent episodes of dizziness while standing from supine position and history of constipation and nocturia since last 6 months. Patient disclosed no significant past history other than treated pulmonary tuberculosis 5 years back. The general mental state and vital parameters were within normal limits. Autonomic function tests and heart rate variability analysis measured autonomic reactivity and tone respectively. The tests revealed that autonomic dysfunction include severe sympathetic and mild parasympathetic involvement. After exclusion of other possible causes of orthostatic hypertension, diagnosis of pure autonomic failure also known as Bradbury Eggleston syndrome was established. Treatment with fludrocortisones and non-pharmacological interventions improved orthostatic tolerance.

Bipartite graph modeling of Alzheimer’s disease and its early automated discrimination through region-based level set algorithm and support vector machine in magnetic resonance brain images

This paper offers a bird’s eye perception of how bipartite graph modeling could help to comprehend the progression of Alzheimer Disease (AD). We will also discuss the role of the various software tools available in the literature to identify the bipartite structure in AD affected patient brain networks and a general procedure to generate a graph from the AD brain network. Further, as AD is a minacious disorder that leads to the progressive decline of memory and physical ability we resort to Computer-Aided Diagnosis. It has a vital part in the preliminary estimation and finding of AD. We propose an approach to become aware of AD particularly in its beginning phase by analyzing the measurable variations in the hippocampus, grey matter, cerebrospinal fluid and white matter of the brain from Magnetic resonance images. Hence an appropriate segmentation and categorization methods are projected to detect the presence of AD. The trials were carried out on Magnetic resonance images to distinguish from the section of interest. The effectiveness of the CAD system was experimentally evaluated from the images considered from publicly available databases. Obtained findings recommend that the established CAD system has boundless prospective and great guarantee for the prognosis of AD.

The knowledge and attitude of medicine students towards stem cells application and donation in neurologic disorders: A study at Guilan University of Medical Sciences, Iran

Background. Medical students have a significant role in improving new perspective about stem cell application in treatment of incurable diseases; such as degenerative neurologic disorders. Methods. In this descriptive cross-sectional study conducted in 2019-2020, 424 medical students at Guilan University of Medical Sciences responded to a questionnaire. The questionnaire was included the questions about knowledge of medical students about application of stem cells in neurologic disorders and stem cells donation and their attitude as well. Exclusion criteria were reluctance to participate in study and less than 20% response to questionnaire. The convenience sampling method was used. Inclusion criteria were being a medical student and willingness to participate in the project. Data were analyzed using SPSS 20 by Pearson correlation, independent student t, one-way ANOVA, U-Mann-Whitney. Results. 49.5% and 43.2% of participants had very low and low knowledge about using the stem cell. The higher score of knowledge was related to higher education periods. 70.3% of medical students had moderate attitude toward using stem cell. Only 17% of them had known the state agencies and private centers of donation. 70.5% had moderate knowledge and 55.2% had moderate attitude toward the stem cell donation. There was a correlation between the knowledge and attitude toward its donation (p = 0.004, r = 0.14). Knowledge about stem cells donation had correlation with the knowledge about its application (p = 0.001, r = 0.161). Conclusion. Although the majority of medical students have very low knowledge about stem cell application in treatment of neurologic disorders, but their attitude toward using stem cell was moderate.

Neuromuscular exercises: A new perspective in knee osteoarthritis

Background. Knee osteoarthritis (OA) is the most prevalent arthropathy across the world. It presents with swelling, pain, decreased range of motion (ROM) and instability. Patients also complain of thigh muscle weakness and lower limb weakness resulting in poor joint shielding and joint overload. Owing to these presenting features patients are prone to increased risk of morbidity and are forced to live with functional impairment. Exercises are one of the vital intervention programme used in knee OA. Exercises lead to improvement in physical function, strengthening of the muscles and reduction in pain. Neuromuscular exercises have effects on functional performance, biomechanics and activation pattern of surrounding musculatures of the patient. Therefore, neuromuscular exercises may prove to be beneficial in enhancing the efficacy of exercise training programmes in such patients due to functional instability and disturbed neuromuscular function. Purpose. This article intends to review the effect and role of neuromuscular exercises in the management of knee osteoarthritis. Method. Comprehensive computerized search was performed on Google Scholar, Pubmed and Cochrane. Conclusion. By evaluating various articles on neuromuscular exercises in knee osteoarthritis the present review suggest that neuromuscular exercises are helpful in the treatment of knee osteoarthritis.

Intravenous methylcobalamin effectively ameliorated painful diabetic neuropathy: A randomized double-blind placebo controlled trial

Objective. Painful diabetic neuropathy (PDN) is a prevalent debilitating consequence of diabetes mellitus with lack of satisfactory therapeutic options. Methylcobalamin (MeCbl) is one of vitamin B12 analogs with known neurotrophic effects. We aimed to determine if MeCbl can relieve PDN. Materials and methods. This was a randomized (1:1) double-blind placebo-controlled trial involving PDN patients. Treatment and control group received daily 12.5 mg oral amitriptyline bid with either 500 µg of intravenous MeCbl or saline injection given on alternating days, respectively, for a 9-consecutive day period. PDN was assessed with douleur neuropathique 4 (DN4) questionnaire. Numeric pain rating scale (NPRS) was used to monitor pain intensity and treatment response. All investigators and patients were kept blinded throughout the study period. Outcomes. 42 patients, 21 on each arm had completed the study. The NPRS reduction can already be observed as early as day 2 post-intervention. Both the treatment and control group demonstrated sustained reduction of NPRS by almost one point per each time point of evaluation in the first three days (p<0.001). NPRS reduction remained until the end of the study period. The treatment group had a significantly lower NPRS score by 1.29 than that of the control group during the entire study period (95% CI -1.84 – -0.75; p < 0.001). Treatment group experienced significantly higher NPRS reduction when compared with control (4.19±1.54 vs. 2.1± 0.83; 95% CI 1.32-2.87; p < 0.001), i.e. 62.6% from baseline. Conclusions. MeCbl significantly and safely relieved PDN in a relatively rapid onset.

The contribution of susceptibility-weighted imaging (SWI) in the central nervous system superficial siderosis’ evaluation in 3 Tesla magnetic resonance imaging (MRI)

Objective. The aim of this study is to evaluate the magnetic resonance imaging (MRI) findings of central neural system (CNS) superficial siderosis cases and the diagnostic contribution of the susceptibility-weighted imaging (SWI) sequence to conventional imaging. Method. TSE T2-weighted and SWI-MRI of 26 patients diagnosed as CNS-superficial siderosis (CNS-SS) were retrospectively evaluated with 3-Tesla MRI. The localization and type of involvement of SS were reviewed. Results. The CNS-SS were divided into two categories as central amyloid angiopathy-SS (CAA-SS) and non central amyloid angiopathy-SS (non-CAA-SS). In non-CAA cases, the involvement was typical (classic) in 5 cases and atypical in 9 cases. In 12 of these cases (85.7%), SS findings were observed on both turbo spine echo (TSE) T2 images and SWI imaging, while in 2 cases (14.3%) SS was detected only on SWI images. In 7 of the CAA-SS cases, involvement was focal type SS (58.33%), while 5 cases had diffuse type SS (41.67%) involvement. In the vast majority of cases (n = 10) of this type of SS, involvement was detected only in SWI images, while siderosis was not detected in TSE T2 images. In addition, occult cerebral vascular malformation accompanying SS, which can be observed only in the SWI sequence, was found in a total of 4 cases. In the cross-matching statistical analysis performed between CAA-SS and non-CAA-SS groups and subgroups, SWI was found to be significantly superior to T2 in detecting SS in the CAA-SS group (p:0,007). Conclusions. SWI imaging was superior in detecting SS and detecting cerebral occult vascular malformation in CAA-SS cases. Although the detectability of SS by SWI was high in other groups, no statistically significant difference was found. Under these circumstances, we think that it will be beneficial to add SWI imaging to the routine imaging protocol in cases with suspected CNS-SS.

Efficacy of manual therapy interventions in management of lumbar prolapsed intervertebral disc: A pilot randomized controlled trial

Background. This pilot trial reports the initial estimates of the efficacy of manual therapy interventions in lumbar prolapsed intervertebral disc and determines the feasibility and acceptability of full powered “randomized controlled trial” on efficacy of “spinal mobilization with leg movement (SMWLM)”, high velocity low amplitude thrust (HVLA) and neural mobilization (NM) in lumbar PIVD (Prolapsed Inter-Vertebral Disc) and pilot data will be used to perform sample size calculation for full trial. Material and methods. 48 subjects diagnosed lumbar PIVD were randomly distributed into 4 groups. The primary outcomes were feasibility, assessment procedure, retention rate, adherence and acceptability to the intervention. The secondary outcomes measures were pain, disability and straight leg raise (SLR) range of motion. Results. 90 subjects were screened based on selection criteria. Out of them, 50 (55.55%) were eligible. 48(96%) subjects accepted to participate in study. Baseline data of all the groups was similar but post-intervention score were significant when compared the data between the groups. Highest mean change for visual analog scale (VAS), oswestry disability index (ODI) and SLR were found in SMWLM group. No adverse effects were reported by subjects. Results also suggest that the outcome measures were feasible and acceptable and the treatment considered as the beneficial approach. Conclusions. Present study suggests that it is feasible and acceptable to do a fully powered “randomized controlled trial (RCT)” to evaluate the efficacy of manual therapy interventions in management of lumbar PIVD. This study also reveals that manual therapy interventions are effective in management of lumbar PIVD.

A retrospective study on the clinico-demographic profile of multiple sclerosis patients in various tertiary care hospitals in Mangalore city of South India

Objectives. To study the risk factors, clinical presentations, course of the disease, investigations and management practices in MS. Materials and methods. Records of 23 patients diagnosed with MS using the McDonald diagnostic criteria were analysed. Outcomes. The mean age at diagnosis was 34.6±17.1 years. 17 (73.9%) patients were females. Early and late onset MS were present among 2 (8.7%) and 4 (17.4%) patients respectively. The most common symptom at diagnosis was paraesthesia [9 (39.1%)]. Motor symptoms and sensory symptoms at the time of diagnosis were present among 9(39.1%) patients each. 20 (87%) patients had motor system involvement, 9 (39.1%) had sensory system involvement, 12 (52.2%) had cranial nerve involvement, 4 (17.4%) had sphincter dysfunction and 2 (8.7%) had cerebellar involvement. Relapsing and remitting MS (RRMS) were present among 18 (78.3%) patients. Oligoclonal bands were present among 17 (73.9%) patients. Vitamin D levels in the blood were found deficient among 4 (80%) out of 5 patients with available reports of the same. Juxtacortical region was the most common [9 (39.1%)] site of involvement. Steroids were used for management among majority [12 (52.2%)] of the patients. Non-pharmacological methods for management constituted only physiotherapy which was advised among 13 (56.5%) patients. Improvement in treatment outcome were seen among 19 (82.6%) patients. Conclusions. Almost three fourth of the patients were females. RRMS was the most common course of the disease. Juxtacortical region was the most common site involved. Steroids were most commonly used for management. More non-pharmacological methods need to be introduced for MS management.

Serum calcitonin gene related peptide (CGRP) levels in migraine: A study on its clinical correlation and diagnostic efficacy

Migraine is a primary headache disorder marked by recurrent unilateral headache episodes. Calcitonin gene related peptide (CGRP) plays major role in migraine pathophysiology. CGRP is multifunctional, and its vasodilating activity within the central and peripheral blood vessels is one in all its primary functions. The intention is to prove serum calcitonin gene related peptide (CGRP) as an early diagnostic tool for migraine and the novelty is to correlate it with characteristics of migraine so that it helps in early initiation of treatment. Methods. 100 subjects including 90 patients with migraine and 10 with non-headache (NH) age-matched controls were prospectively recruited in our current study. The subjects were aged from 15- 50 years. The clinical assessment was made every month for the three months after the start of therapy. The subjects were compared based on the serum CGRP values. Serum CGRP concentrations were measured by using CGRP ELISA kit. Results. Out of total subjects selected, the maximum (23.3%) subjects were between age 26 and 30 years and least effected age group was 46-50 years (4.44%). Females’ predominance with 82% than males with 18%.Stress was major trigger occurring in 57% of cases. Throbbing pain with elevated CGRP levels 130.44±114.22 and p value (p = 0.01). The average CGRP levels was higher in test group 149.00±93.86 compared to control 61.30±24.37 with p value (p = 0.02). Conclusions. The serum CGRP levels were statistically more in migraine patients correlated with characteristics like throbbing type of pain, stress and inadequate sleep. Hence, the serum CGRP levels estimation can be considered as a diagnostic tool for migraine when the clinical character’s over lap or early in the course of migraine when all criteria for diagnosis are not yet fulfilled.