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Hydrocephalus secondary to tuberculous meningitis (TBM) is a challenging condition to treat. Though ventriculo-peritoneal (VP) shunt is an accepted modality of treatment for hydrocephalus in TBM, there is a high rate of complications associated with the same. The study was planned to evaluate various factors associated with shunt malfunction in patients undergoing VP shunt surgery for hydrocephalus due to TBM. A retrospective review of all the patients undergoing VP shunt and shunt revision for TBM between 2004 and 2008 was performed. 449 VP shunt surgeries were performed in 432 patients for hydrocephalus due to TBM. Among these 70 shunt revisions were performed in 53 patients. Shunt malfunction rate in our series was 16.2%. High cerebrospinal fluid (CSF) protein concentration (>200 mg/dL) was associated with 5 times increased incidence of shunt malfunction. Patients with hyponatremia (Na+ <130 mEq/dL) prior to surgery had a 3 times increased incidence of shunt malfunction (P < 0.05). Other factors such as duration of symptoms, presence of neurological deficits, Evan’s index, third ventricular diameter, thickness of exudates, presence of infarcts, anemia, CSF cellularity and CSF glucose concentration were not associated with increased incidence of shunt malfunction. Analysis showed that shunt viability was longest in patients with normal serum sodium levels and CSF protein concentration less than 200 mg/dL and shortest in patients with low serum sodium and CSF protein concentration more than 200 mg/dL. Patients with pre-operative hyponatremia and high CSF protein concentration have a higher incidence of shunt malfunction and need to be followed-up closely.

Objective:The objective was to analyze the demography, clinical presentation, and management of spinal intradural schwannomas in pediatric population.Materials and Methods:This retrospective study includes 21 pediatric patients (under 18 years of age) who underwent surgery for spinal intradural schwannomas from January 1998 to April 2008. The medical records were reviewed retrospectively and the information regarding clinical presentation, tumor location, operative findings, and postoperative status and functional outcome were analyzed.Results:A total of 21 patients (14 females and 7 males) were operated for spinal schwannomas. Six patients had associated neurofibromatosis (five were NF I and one was NF II) at presentation. The most common presenting symptom was progressive myelopathy (86%). The tumor location was either cervical or dorsal in 18 cases. All patients underwent surgery. Gross total excision was achieved in 20 cases. The median follow-up was 38 months. All the patients had neurological improvement in both power and bladder symptoms.Conclusion:Pediatric spinal neurofibromas/schwannomas are an uncommon but completely treatable group of tumors. Complete surgical excision gives excellent outcome.

Actinomycosis is an indolent, slowly progressive infection caused by Actinomyces species. Of human actinomycosis, the spinal form is rare and actinomycosis-related spinal neurological deficit is uncommon. We report two cases with cervical and dorsal actinomycosis and one of them with spinal neurological deficit.

INTRODUCTION Guntur district, which forms part of the AP state capital region, tops the list of HIV positive cases in the state. The district also had the dubious distinction of being the "HIV capital" in undivided Andhra Pradesh in the last two years. A proportion of the many patients who have advanced AIDS in Guntur diagnosed lately present for the first time requiring admission to hospital. AIM The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted in Tertiary Health Centre in Guntur, Andhra Pradesh. MATERIAL AND METHODS This was an observational, analytic, prospective cohort study using a sample of all patients consecutively admitted in tertiary health centre from March 2015 to September 2015. Patients were divided into two groups, ART Group and non-ART Group. ART Group includes all the patients who were started immediately on Anti-retroviral Therapy (ART) before their discharge. Non-ART Group contains patients who did not received ART or who were terminally ill to start ART. Prevalence of opportunistic infections, morbidity and mortality outcomes of the two groups before discharge were determined. RESULTS Among the cohort of 203 PLHIV enrolled during the study period, only 85(42%) were initiated on ART immediately. In all patients, tuberculosis (67;35%) was the most common opportunistic infection followed by extra pulmonary tuberculosis (63; 31%) and Pneumocystis pneumonia (35;19%). The mean baseline CD4 cell count was 84 cells/uL for the non-ART group and 55 cells/uL for the ART group (p <0.01). The median duration from time of initial admission to ART initiation was 14 days. The median duration of stay from initial admission to discharge from hospital was 13 days in the NON ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group (p =0.001). Immune reconstitution inflammatory syndrome was diagnosed in three patients (4%) among the admissions, but caused no deaths. CONCLUSIONS Average CD4 count is lower in patients admitted with AIDS defining illness. Tuberculosis co-infection contributes the largest burden of disease and was diagnosed in two thirds of all admissions. Starting ART as soon as it can be tolerated (within 2 weeks) after anti-tuberculosis therapy will be of great benefit in reducing mortality. Most patients stayed for a median of four days after the ART initiation. This was crucial to monitor and treat anticipated adverse events and drug toxicities from combined opportunistic infection treatment and ART. KEYWORDS People living with HIV (PLHIV), Human immunodeficiency virus (HIV), Acquired immunodeficiency syndrome (AIDS), Antiretroviral therapy (ART). Opportunistic infections (OI), Antituberculosis treatment (ATT).

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The vast majority of HIV-positive children worldwide acquire the infection through vertical transmission. The transmission of HIV from a HIV-positive mother to her child during pregnancy, labor, delivery, or breastfeeding is called Mother-To-Child Transmission. Awareness and attitude towards HIV and the prevention of MTCT in antenatal women is important in reducing the incidence of HIV in children. The study was conducted to evaluate the cognizance of HIV/AIDS and to study the influence of sociodemographic factors on the knowledge of vertical transmission of HIV among pregnant women. The data was collected using a well-structured and interviewer administered questionnaire. The study showed the overall low level of knowledge among pregnant women on HIV/AIDS especially regarding it' MTCT. From the study, education proved to be the major weapon that can improve the knowledge among pregnant women. Our study even shows that there is less effort of health providers towards educating the antenatal women regarding HIV. Even spouse testing for HIV is low. There is a need to increase the cognizance of HIV and MTCT among pregnant women who were less educated and belonging to lower socio economic status.