Background: Effectiveness of intermittent short course chemotherapy for tuberculous meningitis (TBM) has not been well studied. This is particularly relevant for pediatric population where it is associated with a higher mortality and morbidity. Pediatricians are therefore reluctant to accept directly observed treatment, short course (DOTS) strategy for TBM. Aim: To evaluate the early outcome of intermittent DOTS for children with TBM registered under the Revised National TB Control Program (RNTCP) program. Materials and Methods: Children less than or 12 years of age admitted with TBM and receiving chemotherapy under the RNTCP program were recruited in this prospective observational study. We included only those children diagnosed at a tertiary care hospital between May 2008 to March 2009. Diagnostic algorithm and treatment schedule were followed as per the RNTCP guidelines. Treatment outcome and followup status were recorded up to 8 weeks from the time of starting chemotherapy. Results: A total of 30 children (10 months to 12 years of age) with TBM were included in the study. After 8 weeks of treatment, 40% (n=12) children died; all these were diagnosed with stage 3 TBM on admission. Out of the 18 survivors, nearly 50% had significant neurological morbidity (hypertonia 2, cranial neuropathy 6, visual deficit 2, optic atrophy 2, monoplegia 2, hemiplegia 5). Conclusion: The RNTCP regimen for treating TBM in children is associated with a high early mortality and significant neurological morbidity after 8 weeks of therapy under program conditions in India. There is a need to compare it with regimes of daily therapy.

Objective: Examine the effect of race and gender variation on the burden of stroke and associated risk factors among hospital-discharged patients. Materials and Methods: We examined Tennessee Hospital Discharge Database from 1997 to 2008 for patients (older than 20 years) discharged with a diagnosis of stroke. The number of stroke patients was 17,149 in 1997; 19,020 in 2003; and 17,010 in 2008. We also extracted data on cardiovascular risk factors for each patient. Age-adjusted prevalence of hospitalization for stroke per 100K for non-Hispanic white and black patient groups was developed per Center of Disease Control (CDC) procedures of at-risk population. Race- and gender-specific prevalence of stroke and associated cardiovascular risk factors among hospitalized patients were examined using multivariate logistic models. To examine consistency, we compared the two groups at three different points: 1997, 2003, and 2008 regarding the prevalence of stroke and their associated risk factors. Results: Our analyses revealed three major trends: (1) Age-adjusted stroke rate declined by 13.8% over a 12-year period (from 466.8 per 100,000 in 1997 to 402.2 per 100,000 in 2008). This decline occurred for both black and white patients. However, the white stroke rate declined by 19.8% (from 401.9 in 1997 to 322.2 in 2008), compared with only 13.7% among blacks (from 599.2 in 1997 to 517.3 in 2008). Additionally, throughout the 12-year period, although no significant gender differences were observed, the stroke rates among blacks remained consistently higher compared with whites (black:white rate ratios of 1.60 in 1997, 1.40 in 2003, and 1.60 in 2008). Logistic regression analysis revealed the four risk factors that consistently predicted stroke for both black and white patients in 1997, 2003, and 2008, namely, hypertension (HTN), diabetes mellitus (DM), high cholesterol, and cardiac arrhythmia. Conclusion : Aggressive management of two cardiovascular risk factors (HTN and DM) may subsequently reduce stroke health disparity and the burden of stroke hospitalization among blacks.

Preterm birth is the leading cause of perinatal morbidity and mortality. It is of great clinical importance to find markers that could help in identifying women with threatened pre-term labor who have the highest risk of pre-term delivery and who might benefit from timely admission. The objective of the present study was to evaluate the use of cervical phosphorylated insulin-like growth factor-binding protein 1 (phIGFBP-1) in the prediction of pre-term delivery and to assess its association with cervical length measured by trans vaginal sonography (TVS), as a predictive diagnostic test. We enrolled 100 women between 20 and 35 weeks of gestation. Fifty subjects who had presented with symptoms of pre-term labor were recruited as Group A and another 50 with risk factors for pre-term birth but with no symptoms at the time of presentation as Group B. All the participants were subjected to cervical length measurement and rapid bed side test to detect phIGFBP-1 in cervicovaginal secretions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both tests were calculated and compared in terms of period of gestation at delivery and time lapse between test and delivery. Qualitative data were analyzed by using Chi-square test and Fisher's exact test, whereas quantitative data were analyzed by using unpaired Student's t test and Mann-Whitney test. P value < 0.05 was considered significant. In the symptomatic group, sensitivity, specificity, PPV, and NPV of phIGFBP-1 in predicting delivery within 48 h, 7 days, 14 days, and preterm delivery (≤37 weeks) was 100%, 100%, 100%, and 76% (sensitivity), 52.6%, 60.6%, 62.5%, and 56% (specificity), 40%, 56.7%, 60%, and 63% (PPV) 100%, 100%, 100%, and 70% (NPV), respectively. Sensitivity, specificity, PPV, and NPV of cervical length in predicting pre-term delivery in symptomatic group was 20%, 96%, 83.3%, and 54.5%, respectively. In the asymptomatic group, sensitivity, specificity, PPV, and NPV of phIGFBP-1 in predicting pre-term delivery was 0%, 87.5%, 0%, and 77.8% and that of cervical length was 0%, 95%, 0%, and 79.2%, respectively. The results of the present study suggest that phIGFBP-1 has high NPV for prediction of pre-term labor. Pre-term birth is very unlikely if the results of both tests, that is, phIGFBP-1 and cervical measurements are negative and therefore it could be of value in reduction of maternal morbidity by preventing unnecessary interventions.

Leprosy, an infectious disease, described since ancient times and endemic in India since then, has been eliminated (elimination defined as a prevalence of less than 1 case per 10,000 population) as a public health problem in December 2005. World Health Organization and National Leprosy Eradication Program (NLEP) have now focused on reducing the disease burden in the population. Data indicates that annual fresh case detection rate remains high with a high incidence of multibacillary cases. A review of present NLEP figures and those reported in a number of studies reflect a discordance and caution by dermatologists. A review of present policy, epidemiological status in the population, and our experience is presented. Data from Base Hospital, Delhi Cantonment, over the past 3 years, including patients treated as well as those on surveillance is presented. A higher incidence of paucibacillary cases was seen, with a high incidence of pure neuritic involvement (15%), reactions (24.7%), and deformities (28.37%). Tenosynovitis was observed with increasing frequency. Future challenges in containing the epidemic to reduce the disease burden in population will require regular assessment of treatment measures, especially the use of fixed drug therapy as well as rehabilitation of the affected. Dermatologists shall play a central role in any such endeavor in the management of this disease.

Despite being a recognized clinical entity for past more than 100 years, Abdominal Compartment Syndrome (ACS) continues to be an ill understood and under diagnosed condition in surgical practice. It has a high prevalence of upto 50 percent in general surgical or trauma patients receiving intensive care and is associated with twice the death rate. Concurrent medical conditions such as diabetes, ascites, heart failure and a host of others increase the vulnerability both in terms of development of ACS and a poorer outcome. It is also a major cause of death in trauma. Since ACS often clinically mimics the underlying condition, such as abdominal injury or peritonitis/ ascites from any cause, its presentation is confusing. Diagnosis is based on clinical awareness of its potential risk, simple bedside intra-abdominal pressure (IAP) measurement, repeated examination of the abdomen and a 24 × 7 vigil on vital signs. Biochemical markers are non-specific and unreliable. Treatment is very urgent and may involve achieving permissive hypotension, careful management of fluid balance, high quality intensive medical and nursing care, prevention/treatment of sepsis, abdominal drainage and if indicated, decompression surgery by laparotomy, leaving the abdomen open and protected with sterile dressings or a temporary abdominal negative pressure therapy device. Prompt, good and urgent care reduces the risk of adverse outcome.

Allergic contact dermatitis (ACD) is not uncommon in children. Prevalence of ACD was previously thought to be low in children and adolescents, but of late increased prevalence has been reported. Actual increase in the prevalence could be due to increased recognition of the disease or due to other factors such as changes in lifestyle. Various factors such as age, gender, atopy, social and cultural practices, habits of parents and caregivers, and geographical changes may influence the prevalence and pattern of ACD in children. It can significantly affect the quality of life among children. ACD can affect various sites, including hands, face, neck, axillae, trunk, anogenital region, thigh, feet, and others, depending on the site of exposure to allergen. Common allergens implicated in childhood ACD include nickel, cobalt, potassium dichromate, mercury, aluminium, skin care products, fragrances, neomycin, dyes, preservatives, rubber, and so on. Identification of the implicated allergen is vital as the patient may experience recurrent episodes of dermatitis in the absence of avoidance of allergen. Patch testing is by far the commonly used method of identification of the causative allergen. The only etiologic treatment is elimination of the contact allergen. The patients/parents should be informed about the identity of the offending agent and the possible sources of the sensitizer. Topical steroids used in the acute stage and topical calcineurin inhibitors along with oral H1-antihistamines to alleviate itching are the mainstay of treatment. In widespread and severe cases, systemic corticosteroids may be indicated for a short period of time. The prognosis of ACD is dependent on its cause and the feasibility of avoiding repeated or continued exposure to the causative allergen.

Gastric cancer is generally associated with a dismal outcome. One of the major reasons for this is the fact that patients often ignore the early symptoms of the disease, which masquerade benign diseases such as reflux disease and gastritis, and hence present when the cancer is advanced or metastatic. Multidisciplinary management has emerged as an important determinant of outcomes in patients with gastric cancer. Complete surgical resection remains the cornerstone if cure is to be achieved, especially in those patients with non-metastatic disease. This article provides an updated review of the multidisciplinary management of patients with resectable gastric adenocarcinoma.

Acute pancreatitis is a diffuse inflammatory process in and around the pancreas triggered by the leakage of activated pancreatic secretions. It may remain localized within the pancreatic glandular tissue or spread to involve the adjacent or remote tissue planes and organs. Since the morbidity and mortality of acute pancreatitis is closely related to the extent of intra- and extra-pancreatic complications, cross-sectional contrast-enhanced computed tomography (CECT) imaging plays a major role in assessing the complications, stratifying the severity, and thus, prognosticating the outcome. Early diagnosis of complications allows for timely institution of specific measures that can help decrease the morbidity and mortality. This kaleidoscopic retrospective presents the complications of acute pancreatitis on CECT. The essay may benefit family physicians, surgeons, gastro-intestinal (GI) surgeons and GI physicians who manage such patients in their clinical practice, besides drawing the attention of residents and fellows practicing GI radiology.

The chronicles of modern neuroscience are filled with extraordinary romanticism. The triumphant, even if turbulent, journey is punctuated by man's abstract out-of-the-box thinking, audacity, amazing flashes of brilliance, courage, inventiveness, sagacity, and serendipity. The journey began with trepanation, or cutting holes in the skull. The first skull operations were carried out by Neolithic Peruvian Indians around 10,000 bc. Down the centuries the procedure was embraced by preliterate world all over mother earth. Even today, through the ubiquitous e-space, charlatans advocate trepanation for "enhancing consciousness"! The first musings that different types of head injury produce different symptoms stand engraved in gold in the Egyptian Edwin Smith surgical papyrus (1,600 bc). That the human brain-and not the heart-is the motherboard of all cognition and emotion, and seat of sensation, movement, and mentation came to be known only when the prince of physicians, Galen of Pergamum carried out his classical squealing hog experiments in the 2nd century. Nevertheless, it was not until the work of the great neuroanatomist Ramσn y Cajal (1852-1934) and that of the founder of modern neurophysiology Lord E. D. Adrian (1889-1977), that modern neuroscience found its terra firma. The more recent era, however, has witnessed a truly remarkable technological advancement. If the works of Sir Godfrey N. Hounsfield, Allan M. Cormack and Raymond Damadian have pried open the lid on human brain and spine through true-to-life cross-sectional anatomical and functional imaging, Leksell and Larsson's gamma knife, Russel Brown's stereotactic surgery, laparoscopes, brain suites, synthetic discs and pleuripotent stem cells have opened totally new vistas in the realm of neurosurgery. Given the diktat of space, capturing all the magical moments of this evolution is willy-nilly impossible. Yet, if this story narrates the essence of how a few men-in-white faced the rigours of their times and triumphed over the challenges, the scalpel would have found its mark.

Medical research does not deal with only medical sciences; it is also dependent on other disciplines, and statistics is an integral part in its conduct. It is challenging for a medical researcher to grasp the importance of statistics and also to decide the types of statistical issues in the various phases of his/her medical research. There are inherent variations within and between the human/animal subjects used in medical research and these uncertainties can only be grasped using statistical tools. Initiating a medical research while taking into account the statistical aspects right at the planning stage is one of the best ways to conduct better evidence-based research. The validity of the results of a medical research depends not only on the methodology of conducting the study but also on the analysis of data collected. As opposed to the general perception, statistics not only deals with analysis of data but is also intricately interwoven with the methodology section of the research where sample sizes, inclusion/exclusion criteria, and others are mentioned. Although statistical softwares simplify the computational aspect of statistics, the confusing conceptual aspects make interpretation of the outputs difficult and incorrect. Seemingly simple terms such as population, sample, parameters, and variables have been explained keeping the medical researchers' perspective in mind. This first article in the series "Statistics in Medical Research" makes an attempt to facilitate the medical researcher to overcome the initial questions that challenge him/her with regard to statistics.