A novel scheme for the validation of an automated classification method for epileptic spikes by comparison with multiple observers

Objective

To validate the application of an automated neuronal spike classification algorithm, Wave_clus (WC), on interictal epileptiform discharges (IED) obtained from human intracranial EEG (icEEG) data.

Effectiveness of Human Amnion as a Graft Material in Lower Anterior Ridge Vestibuloplasty: A Clinical Study

Objective  

The aim of this study is to evaluate the clinical use of amnion as a biodegradable graft material for lower anterior ridge vestibuloplasty.     

Modified Presurgical Nasoalveolar Molding in the Infants with Complete Unilateral Cleft Lip and Palate: A Stepwise Approach

Presurgical orthopedics in one or the other form has been an important part of the multidisciplinary approach towards the better cleft care. Presurgical nasoalveolar molding (PNAM) was described as a modified approach to the conventional form of orthopedics. PNAM not only reduces the severity of the alveolar defect before surgery, it also reduces the nasal deformity bringing it near to the normal. Nonsurgical nasal correction forms an important adjunct to the primary nasal repair at the time of primary lip repair. However, acceptance of nasoalveolar molding in Indian set-up has not been wide spread due to various reasons such as lack of the resources and inability of the parents to comply with the frequent adjustment schedule. At the Nitte Meenakshi Institute of Craniofacial surgery at the Nitte University, Mangalore, authors have developed a modification of the PNAM appliance previously described in the literature. The key modification is done at the time of fabrication of the occlusal prosthesis. This modification has made the overall procedure simpler and at the same time helped to reduce the recall visits by half of the originally required. This article describes the fabrication procedure of the modified nasal alveolar molding appliance and the modified treatment protocol in a stepwise manner.     

Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients

Background:

Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis.

Materials and Methods:

We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre´ Syndrome disability scale was used to grade the disability.

Results:

In this study, 15 (51.7%) patients had secondary causes of hypokalemic paralysis and 14 patients (42.3%) had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%), dengue infection in four patients (13.7%), distal renal tubular acidosis in three patients (10.3%), Gitelman syndrome in one patient (3.4%), and Conn''s syndrome in one patient (3.4%). Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover.

Conclusion:

In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.     

Stimulus level effects on speech-evoked obligatory cortical auditory evoked potentials in infants with normal hearing

ObjectiveTo determine stimulus level effects on speech-evoked cortical auditory evoked potentials (CAEPs) in infants for a low (/m/) and high (/t/) frequency speech sound.MethodsCAEPs were recorded for two natural speech tokens, /m/ and /t/. Participants were 16 infants aged 3–8 months with no risk factors for hearing impairment, no parental concern regarding hearing or development, and normal tympanograms and otoacoustic emissions. Infants were either tested at levels of 30, 50, and 70 dB SPL or at 40, 60, and 80 dB SPL, in counterbalanced order.ResultsInput–output functions show different effects of increasing sound level between stimuli. There were minimal changes in latency with increase in level for /t/. For /m/, there were approximately 50–60 ms latency increases at soft compared to loud levels. Amplitudes saturated at moderate–high levels (60–80 dB SPL) for both stimuli.ConclusionsInfants’ CAEP input–output functions differ for /t/ versus /m/ and differ from those previously reported for adults for other stimuli. Effects of stimulus and level on CAEPs should be considered when using CAEPs for hearing aid or cochlear implant evaluation in infants.SignificanceSpeech-evoked CAEPs provide an objective measure of central auditory processing. Possible differences in CAEP growth between infants and adults suggest developmental effects on intensity coding by the auditory cortex.     

Suicide by a transvestite or sexual asphyxia? A case report

Autoerotic asphyxial activity may at times result in unexpected death. Although the majority of deaths that occur during autoerotic asphyxial episodes are accidental, the possibility of suicide must always be entertained. In the case presented here, a 22-year-old married male was found hanging by his neck in his bedroom, which was locked from the inside. He was suspended by a 'lungi' (male wrap-around cloth) from the ceiling fan hook in his room, with his feet touching the ground. He was dressed in a brassiere, panties, and silver anklets. There was no evidence of previous perverse behaviour, and investigation disclosed no evidence of previous autoerotic sexual activity, homosexual behaviour, drug abuse or suicidal ideation.     

Clinical evaluation of 99mTc(V)-dimercapto succinic acid (DMSA) for imaging medullary carcinoma of thyroid and its metastasis

^99mTc(V)-DMSA kits developed by the Radiopharmaceutical Division, Bhabha Atomic Research Centre, have been evaluated for potential use in scanning medullary carcinoma of the thyroid and its metastases. There were 15 patients with proved medullary carcinoma and 6 patients with other differentiated thyroid carcinoma. Amongst the 15 patients with medullary carcinoma, 12(80%) showed positive localisation either in the primary or one or more metastatic sites. None of the six patients with carcinoma other than medullary showed increased concentration of ^99mTc (V)-DMSA. Of the 37 known metastatic sites in 15 patients with medullary carcinoma, 24 showed concentration of ^99mTc (V)-DMSA (64.9%). In addition, ^99mTc(V)-DMSA concentration was seen in 14 sites where no evidence of metastasis was revealed. The incidence of ^99mTc (V)-DMSA concentration in soft tissue and bone metastasis was similar.Isopharm, Radiopharmaceutical Division, BARC, Bombay-400 705, India     

Pancreas divisum: thin-section CT

Twelve patients with known pancreas divisum underwent thin-section computed tomography (CT) to determine the capability of CT to depict this pancreatic anomaly. Focal pancreatic enlargement was present in five patients. Two distinct pancreatic moieties separated by a fat cleft were noted in three patients; a fourth patient had focal atrophy in the distribution of the dorsal pancreas. The two pancreatic moieties were identified at the same craniocaudal level in all four of these patients. The dorsal duct was depicted in all 12 patients, while the short ventral duct was seen in only five of the 12 patients. Failure of the ventral and dorsal pancreatic ducts to fuse was identified in all five patients in whom both ducts were seen. CT may not enable specific diagnosis of pancreas divisum in the majority of patients. If, however, distinct pancreatic moieties or unfused ductal systems are evident, the diagnosis may be confidently suggested.