Traumatic brain injury is a very heterogeneous entity that emerges over time. The neuromonitoring is critical for the prevention of secondary alterations, such as ischemia and hypoxia, which appear days after a primary injury. Neurosurgeons must understand that the phenomena are secondary to the primary lesion. Advances in multimodal neuromonitoring techniques have allowed evaluation of brain metabolism as well as other physiological parameters, including intracranial pressure, cerebral perfusion pressure, cerebral blood flow, brain temperature, blood pressure, and partial pressure of oxygen in brain tissue.

Background: Caregiver burden and expressed emotion have been studied in patients with schizophrenia but literature is less regarding these in bipolar affective disorder (BPAD). No study could be found which compared the caregiver burden and expressed emotion in these two patient groups. Hence, the study is conducted to investigate and compare the caregiver burden and expressed emotion in caregivers of patients with schizophrenia and BPAD. Materials and Methods: Data were collected from outpatient department of psychiatry, Institute of Mental Health and Hospital, Agra regarding sociodemographic characteristics (e.g., age, gender, domicile), followed by burden assessment schedule, family emotional involvement and criticism scale, positive and negative syndrome scale, Young mania rating scale, and hamilton depression rating scale (HDRS) from patients of schizophrenia and BPAD and their caregivers. Descriptive statistics such as mean and standard deviation (SD) and unpaired t test were applied for continuous data and chi square for categorical data. Spearman correlation was used to find correlation. Results: No statistically significant difference between the sociodemographic variable of either patient of schizophrenia and bipolar disorder or their caregivers was observed. Significantly higher total burden (P = 0.01) with mean value of 82.8 (SD = 8.8) in caregivers of patients with schizophrenia compared to BPAD with mean value of 76.7 (SD = 12.3) was noted. Emotional over-involvement was significantly more in patients with BPAD compared to patients with schizophrenia (P = 0.0007). Spearman correlation shows positive correlation among age of caregivers, education, and burden of care in both the groups (P < 0.05 in both groups). Conclusion: The presence of significant amount of burden of care and expressed emotion point out to the need for psychosocial support to the family members for mitigation of the burden and reduction in the expressed emotion, which in turn could reduce the relapse rates and facilitate the caregivers to effectively cope and manage the ill family member.

Background and Objectives: The purpose of this study was to study the histogenesis and neuroanatomy of the human fetal ileum and ileocecal junction at various gestational ages (15, 18, 20, 28, and 32 weeks) using neuron-specific enolase (NSE) as a neuronal marker and S-100 as a glial marker for the enteric nervous system. Materials and Methods: For this study, five aborted normal fetuses were obtained from the fetal repository of Department of Anatomy. The ileocecal part of the small intestine of these fetuses was dissected, processed, and sectioned and stained with hematoxylin and eosin and cresyl violet. Immunohistochemistry was performed using antibodies to NSE and S-100 and observed under a BX61 Olympus microscope using a DP71 camera. Results: The myenteric and submucosal plexuses of terminal ileum and ileocecal junction show immunoreactivity for both NSE and S-100 by 20 weeks. The development of myenteric plexus is more advanced than submucosal plexus. The immature neurons at 15 weeks progressively mature with distinct cell processes at 32 weeks. The mature ileocecal junction is composed of two outer circular muscle layers and a single inner longitudinal muscle layer. At 32 weeks, ileocecal valve was visualized. Interpretation and Conclusions: Our study provides the morphological evidence of the immunoreactivity in the ganglion plexus and the development of ileum and ileocecal junction at different developmental stages. It also substantiates the concept of ileocecal junction being an intussusception of ileum into the cecum.

Objective: To study the effect of intrauterine instillation of human chorionic gonadotropin hormone (hCG) before embryo transfer (ET) on pregnancy outcomes in women undergoing in-vitro fertilization (IVF) cycles. Materials and Methods: The study was an age and anti-mullerian hormone (AMH) level-matched case–control study. Total 80 women of age group 25 to 40 years were recruited who were undergoing IVF for mild male factor, tubal factor, or ovulatory dysfunction. Two groups were formed and age matched. Study group (n = 40) received 800 IU of hCG 5 min before ET, whereas control group (n = 40) underwent direct ET without prior instillation of hCG. The pregnancy outcomes were compared between the two groups. Result: Primary outcome was implantation rate (IR). IR was significantly higher in study (hCG) group as compared to control group (30.95% vs. 15.29%, P = 0.016). Secondary outcomes were clinical pregnancy rate and live birth rate. Study group had higher pregnancy rate as compared to control group, but the difference was not statistically significant (40% vs. 25%, P = 1.0). Live birth rate was higher in study group but not significant (35.5% vs. 22.5%, P = 0.35). Abortions were comparable in both the groups. Conclusion: Intrauterine hCG before ET significantly improves IR and resulted in better IVF outcomes.

Objective: To assess patients preference for preselected doctor attire in outpatient department (OPD) setting of a government hospital. Materials and Methods: An anonymous, predesigned, pretested, semistructured interview schedule was administered to adult (>18 years) ambulatory coherent patients. The brief questionnaire captured selected sociodemographic details of patients, department visited, and use of aprons (white coat) by attending doctor observed and desired practice. To the item—“Was your attending doctor in OPD wearing apron (white coat)?”, the possible response was yes/no. For the item—“Would you like to see your attending doctor wearing apron (white coat)?”, again the possible answer was yes/no. When a patient responded to this item as “no,” we further explored their reason for the same. The patients were shown four colored pictures each for male and female doctor in different dress. They were probed regarding their preference that they would like to see their attending doctor to be wearing. These attires were labeled as 1 = cool casual, 2 = casual, 3 = professional informal, and 4 = professional formal. Result: The mean age of 547 patients was 35.34 (±12.81) years; 322 (58.9%) were males. Out of 547 patients, nearly 395 (72.2%) wanted (desired) to see their attending doctor to be wearing apron; however, only 256 (46.8%) reported that attending doctors were actually wearing the apron in the outpatient department. Only 152 (27.7%) patients responded that it does not matter to them whether attending doctor was wearing white coat (apron) or not. Majority of patients preferred male doctor to be wearing professional formal (42.3%) and professional informal (40.9%) attire, whereas for female doctor, also majority preferred professional formal (38.7%) and professional informal (37.5%), respectively. Casuals were the least preferred attire. Conclusion: It is reiterated that majority of patients in our OPD setting preferred formal attire of attending doctor with apron, a clear and loud message for future physician in training.

Neuropathic tremors are often encountered in both hereditary as well as acquired inflammatory demyelinating neuropathies, such as IgM paraproteinemic neuropathy and chronic inflammatory demyelinating polyradiculoneuropathy and occasionally during the recovery phase of Guillain-Barré syndrome (GBS). Acute motor axonal neuropathy (AMAN) accounts for up to 30–65% the patients with GBS in East Asia and is rarely associated with a neuropathic tremor. We report a patient with AMAN, who presented with pure motor quadriplegia with bulbar symptoms and a prominent atypical resting head tremor during the acute phase of illness, which showed an excellent response to topiramate therapy.

Franceschetti Syndrome is an autosomal dominant disorder of craniofacial development with variable expressivity. It affects structures which are derivatives of the first and second brachial arches. It has a characteristic facial appearance as a result of hypoplasia of facial bones, accompanied by ear, eye and nose abnormalities and positive coloboma sign. This article describes clinical and radiographic features of this syndrome in a 22 year old male who reported to our department with the complaint of pain in his left upper back and right lower back tooth region showing incomplete clinical form of Franceschetti syndrome. Also pathogenesis, diagnosis, prevention, management are discussed.

Sturge–Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a rare congenital and dermatological disorder. It is one of the phakomatoses and is associated with unilateral port-wine stain of the face, ipsilateral glaucoma, seizures, mental retardation, and ipsilateral leptomeningeal angioma. However, different variants have been described. We describe the case of a 13-year-old female patient with bilateral SWS associated with advanced glaucoma in both the eyes and absent neurological involvement. Surgical treatment with Ahmed glaucoma valve was performed in both the eyes at an interval of 2 weeks for achieving a lower level of intraocular pressure.