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Background and Purpose This study was performed to elucidate quality of life (QOL) and its determinants in adult drug refractory epilepsy (DRE) patients who were not candidates for epilepsy surgery. Methods A correlational study was performed at the center of excellence, epilepsy between July 2014 to June 2016. All consecutive DRE patients who were not candidates for epilepsy surgery were enrolled. The outcomes were QOL, assessed using the quality of life inventory in epilepsy-31 items (QOLIE-31) inventory and the correlation of QOL with epilepsy-related variables like seizure severity and frequency. We also compared current QOL with QOL during the pre-surgical evaluation to strengthen our study outcome. Results A total of 129 adult patients were enrolled over two years. The mean age was 26.5 ± 6.7 years and male: female ratio was 3: 1. The mean age at epilepsy onset was 9.6 ± 6.6 years and mean duration of epilepsy was 14.9 ± 7.5 years. There was lower seizure frequency than during pre-surgical evaluation in 37.2% of patients, while in 62.8% the seizure frequency remained the same or was higher. Nine (6.98%) patients became seizure free. In comparison to QOL status during the pre-surgical evaluation, there was statistically significant worsening of QOL in all domains ( p < 0.01). Seizure severity significantly correlated with almost all QOL domains ( p ≤ 0.01), while seizure frequency significantly correlated with only the single domain of overall QOL ( p = 0.03). Conclusions The QOL of DRE patients who were not candidates for epilepsy surgery worsened relative to the QOL during the pre-surgical evaluation period. Seizure severity significantly correlated with QOL, but seizure frequency did not.

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Background Platelet‐rich plasma (PRP) has been found to be effective in treating periorbital hyperpigmentation (POH). PRP prepared by double‐spin (DS) method and activated by calcium has been used conventionally. PRP can be prepared by single spin (SS) and activated at low temperature (novel method), but the evidence is limited. Objective To compare the novel and conventional PRP in the treatment of periorbital hyperpigmentation. Methods We selected 21 patients of POH and randomly divided the face into two halves. One‐half of the face (group A) was treated with novel PRP (SS and low‐temperature activation). The other half (group B) was treated with conventional PRP (DS and calcium activation). A total of 3 PRP injections were given at 4 weekly intervals. Patients were observed and assessed on 12th week by photography, dermoscopy, visual analog scale (VAS) score, and Dermatology life quality index (DLQI). Platelet counts and growth factors were assessed in PRP. Results Mean platelet count in novel and conventional PRP was 7.41 ± 1.76 lacs and 8.17 ± 2.23 lacs (p = 0.348). Mean photographic and dermoscopic assessment at the end of the study in group A and group B was 52.33 ± 6.468 and 53.14 ± 6.99 (p = 0.151). Change in VAS in groups A and B was 3.85 ± 1.27 and 3.90 ± 1.04 (p = 0.895). Levels of various growth factors assessed by ELISA did not differ significantly. There was significant decline in DLQI. Conclusion The novel method is not inferior to conventional method of PRP in the treatment of periorbital hyperpigmentation.

A 22-year-old man presented with a history of progressive weakness and wasting of the right hand and forearm for 12 months followed by similar symptoms in the left upper limb for the past 5 months. He also gave a history of episodes of loss of consciousness for the past 5 years with a frequency of one per 3 months. On examination, there were melanocytic naevi—one large lesion in the nape of the neck and multiple satellite lesions. On investigation, the cervical cord MRI was normal. The brain MRI and angiography showed a moyamoya pattern. Thus, this patient had congenital melanocytic naevi with Hirayama disease and moyamoya pattern. He was treated with extracranial–intracranial bypass for moyamoya disease. During 6-month follow-up, he has been stable. Although moyamoya syndrome has been associated with several systemic diseases and conditions, the coexistence of a moyamoya pattern with Hirayama disease and melanocytic naevi has not been described so far.

Background and PurposeTo identify predictors of seizure-related injury (SRI) and death in people with epilepsy (PWE) in a North Indian cohort.MethodsThis ambispective cohort study included PWE registered in an epilepsy clinic in Delhi between May 2010 and December 2011. Five hundred twenty-six patients were enrolled and followed for 25 months. Patients were categorized into two groups based on SRI/no SRI during the study period. We analyzed various factors to identify predictors of SRI and death.ResultsOf 526 patients, 355 (67.5%) reported having no SRIs and 171 (32.5%) had sustained an SRI. Among patients with SRI, 72.5% were male; 62% of those with no SRI were male. The injury type included soft tissue (60%), head trauma (20%), dental trauma (10%), orthopedic (10%), and burns (5%). On univariate analysis, factors predicting SRI occurrence were male gender, abnormal birth history (p < 0.01), abnormal mental status (p < 0.01), seizure duration (p < 0.04), daytime seizures (p < 0.05), dependence on a caregiver (p < 0.008), and uncontrolled seizures (p < 0.001), history of cluster seizures or status epilepticus (p < 0.001), occurrence of generalized tonic-clonic seizures (GTCS), and use of >3 antiepileptic drugs (p < 0.008). On multiple logistic regression analysis, male gender, uncontrolled seizures, history of cluster seizures or status epilepticus, and GTCS were significant risk factors. Sixteen deaths occurred in our cohort, and 13 fit the definition of probable sudden unexpected death in epilepsy (SUDEP). Most patients with SUDEP had an unwitnessed event (69.2%). The only significant factor in predicting death was uncontrolled seizures.ConclusionsMale gender, occurrence of GTCS, uncontrolled seizures, and history of cluster seizures or status epilepticus predicted SRI occurrence in PWE. Precautions should be taken by caregivers of patients with these risk factors, to prevent injury.

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Background Human species are facing a new crisis. The COVID19 pandemic has not only disrupted the health system of the entire world but has also put tremendous pressure on it. According to the CDC, mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body's ability to fight germs and sickness. It is an aggressive fulminant invasive fungal infection that can occur in patients with diverse precipitating factors such as uncontrolled diabetes, renal failure, organ transplant, long‐term corticosteroid and immunosuppressive therapy, cirrhosis, burns, Acquired ImmunoDeficiency Syndrome and malignancies such as lymphomas and leukemias. Reportings of mucormycosis in covid patients have posed an additional apprehension and an onus on the already struggling government and health care workers. Objective Description of case series of mucormycosis in post COVID19 patients. Materials and Methods Systematic review of various studies reporting presence of mucormycosis in post covid patients was done. The study was conducted to assess the impact of mucormycosis on patients suffering from a virus. While searching keywords “covid” and “mucormycosis” on Google Scholar and internet, we found 9 studies which reported 13 post covid patients infected with mucormycosis. Result Mucormycosis can be divided into at least six clinical syndromes: rhino‐orbital‐cerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and miscellaneous. Analysis of post covid patients showed four clinical manifestations‐ Rhino‐Orbital‐Cerebral Disease (3 research papers reporting one case each and 1 research paper with 4 patients); Pulmonary Disease (3 research papers with 4 cases); Gastrointestinal Disease (1 research paper with 1 case) and Disseminated (1 research paper with 1 case). Out of these total thirteen patients, seven were reported dead. S.No.AuthorNumber of PatientsMucormycosis associated Clinical SyndromeOutcome1.Mehta et al.1Rhino‐Orbital‐Cerebral DiseaseExitus2.Amanda et al.1Rhino‐Orbital‐Cerebral DiseaseExitus3.Mekonnen et al.1Rhino‐Orbital‐Cerebral DiseaseExitus4.Federico et al.4Rhino‐Orbital‐Cerebral DiseaseDischarged5.Arnaud et al.2Pulmonary Disease1‐ Exitus 1‐ Alive6.Epifanio et al.1Gastrointestinal DiseaseExitus7.Brian et al1DisseminatedExitus Conclusion As per Worldometer approximately 88 million cases of COVID19 have been reported so far of which nearly 1.9 million succumbed to death. Although the reported data relating to presence of mucormycosis in Covid patients is very meagre, yet the fatality rate is more than fifty percent. The situation is alarming. Exhaustive studies need to be undertaken as delayed diagnosis and inadequate treatment may lead to higher risk of negative outcomes.