We present a case of apparently uncomplicated lumbar decompression and discectomy with delayed postoperative neurological deterioration secondary to subdural hematoma at the thoracolumbar level of the spinal cord. Previously described subdural hematomas have occurred spontaneously or related to iatrogenic Case Report Case presentationA 76-year-old presented with a 9-month history of radiating lower extremity pain, left worse than right, with minimal back pain. The symptoms onset acutely after lifting a heavy ice box. He reported intermittent paresthesias in bilateral L4−L5 distributions without any complaint of weakness. Symptoms worsened with extension, upright posture and Valsalva maneuver and improved with forward flexion. He had no prior spine surgery. He had 3 separate transforaminal epidural steroid injections containing anesthetic and cortisone directed at the left L3-4 and L4-5 space, the most recent of which was 1 month prior to presentation. With all injections he noted marked improvement during the anesthetic phase but no durable effect. His past medical history was significant for coronary artery disease status post remote stenting and peripheral arterial disease status post remote carotid endarterectomy. Aside from fish oil and daily low dose aspirin, he was not on anticoagulant medications.On exam, he had 5/5 motor strength in his bilateral lower extremities with no fixed, focal sensory deficits. His lower extremity reflexes were diffusely diminished though

ZAP-70 and CD 38 positivity were detected 25% and 36%, respectively, with concordance rate of 56%, which is higher than Western literature. There was no correlation of ZAP-70 and CD 38 positivity with age, sex, lymphadenopathy, organomegaly, and Rai staging.

Introduction:Rabies is a viral zoonosis. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. About 30% of the victims of dog bites are children under the age of 15. Objective: To assess the epidemiological pattern of dog bite cases, which formed the majority of cases attending anti-rabies clinic. Materials and Methods: This study was conducted at the Primary Health Centre,Poolavari, Salem, Tamil Nadu, India between Feb 1st-May 1 st 2018. It is a cross sectional study, where all dog bite cases attending injection OPD were studied. A questionnaire-based survey was conducted amongst dog bite patients in the Primary Health Centre at Poolavari, Salem. Results: Highest percentage of dog bite victims belonged to the age group of 5-25Years (33.7%). The bites were mostly by pet dogs (75.5%). 91.8% of the dogs were not vaccinated. Running, patting were the most common factors leading to dog bites (50.0%). 52% of the study population had awareness of first aid for dog bite. 88.8% population had awareness about Anti rabies vaccines for dog bites. Most of the victims took the treatment within ½ hr (30.6%). 81.6% of the victims took allopathy treatment. Conclusion: The study concludes that awareness of first aid for dog bites ,pet dog vaccination, awareness about Anti rabies vaccine for dog bites and completion of the treatment should be increased in the rural population.

A ccidental application of cyanoacrylate adhesives (superglue) to the skin, eye, ear, and mouth has been widely reported. We report the first case of cyanoacrylate drops accidentally applied into the nasal cavity. The treatment of the condition is described and recommendations to the manufacturers to prevent recurrence of this potentially serious situation are made.

Introduction Painful diabetic peripheral neuropathy (PDPN) complicates 25% of type II diabetes mellitus. It has a profound impact on diabetes-related morbidity and worsens the quality of life. Both pregabalin and duloxetine may be indicated for PDPN. In this study, the efficacy of duloxetine and pregabalin was compared in patients with PDPN. Methods It was a single-centre open-label study conducted with patients of diabetes mellitus type II diagnosed with PDPN. Patients were randomized to receive 60 mg/daily duloxetine or 300 mg/daily pregabalin. Pain scores were recorded using visual analogue scale (VAS) on day 0, week 4, and week 12. Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY). Results In the duloxetine group, the mean VAS score decreased from 6.81 ± 0.91 to 4.01 ± 1.12 with 12 weeks of therapy (p <0.0001). In the pregabalin group, the mean VAS score decreased from 6.99 ± 1.12 to 4.91 ± 0.82 with 12 weeks of therapy (p <0.0001). At 12 weeks, duloxetine showed lower VAS scores than pregabalin (p <0.0001). In the duloxetine group, the mean change in VAS score over time was-2.80 and in the pregabalin group, the mean change was-2.80. Adverse events were reported in 17.9% of the participants. Lethargy/somnolence (8.1%) and peripheral edema (3.4%) were commonly reported in the pregabalin group and constipation (6.9%) and orthostatic hypotension (4.6%) were commonly reported in the duloxetine group. Conclusions Duloxetine at a daily fixed dose of 60 mg is efficacious in the relief of neuropathic pain. Pregabalin also showed a comparable outcome. Both duloxetine and pregabalin have a promising safety profile and are well-tolerated.

Chronic lymphocytic leukaemia (CLL) is reported to be an uncommon hematopoietic malignancy in the Indian subcontinent (1.7-8.8%), whereas it is seen in 25-30% of all leukemias in west. Previous reports from India report CLL to occur at younger age, have larger spleen and present in high risk Rai stages. It is possible that this more aggressive disease in India may be due to differences in the biology of CLL in India. Thus, in the present study we aimed to elucidate the prevalence of various known biological and molecular prognostic parameters in CLL patients in India to evaluate the biology of CLL in India. 100 newly diagnosed cases of CLL along with 50 healthy individuals in similar age group, were taken for the study. Flowcytometry was performed for ZAP70 and CD38. Molecular studies were performed to include mutational analysis of IGVH and P53 gene, and PCR RFLP for polymorphism of P2X7 (1513 A-C) and BaxG (-248) A gene. Sandwich ELISA was performed to determine level of serum beta 2 microglobulin and Thymidine kinase. FISH cytogenetics was available in 30 patients. Patients with asymptomatic early stage disease (Rai 0) were monitored without therapy unless they had evidence of disease progression. Patients with intermediate (Rai stage I and II) and high (Rai stage III and IV) risk were treated conventionally with Fludarabine+ Cyclophosphamide + Rituximab (FCR) or Bendamustin+ Rituximab (BR).Response to induction chemotherapy was assessed according to the criteria proposed by the National Cancer Institute (NCI) sponsored Working Group Guidelines for CLL. Outcome analysis was based on Progression free survival (PFS), Treatment free survival (TFS) and Overall survival (OS). Median age of CLL patients at presentation was 60.5 years (range 35 - 82); M:F:: 3.7:1 and haemoglobin 11.3 g/dl (range 4.6 - 15.3g/dl); Rai stage 0 was seen in 26% patients, Rai stage I in 15%, Rai stage II in 28%, Rai stage III in 16% and Rai stage IV in 15% patients. Diffuse involvement of bone marrow biopsy by CLL was seen in 65% patients. Treatment was given to 78% patients during the study period. Response to chemotherapy was observed in 48/78 (61.5%) with complete response (CR) in 19 (24.3%) patients and partial response (PR) in 29(37.2%) patients, while 30/78 (38.5%) patients showed no response. The median follow-up of the study group was 36.11 months (range 1.03 to 71.7 months). High risk cytogenetic abnormalities like 17p- and 11q- were seen in 13.3 % patients .This is thus more common in India than that reported in the West. Expression of Zap70 only was seen in 37% patients, CD38 only expression in 44% of patients and combined expression of Zap70 and CD38 expression was present in 26%.Unmutated IGVH genes were seen in 36% patients, a prevalence similar to that in the West.The highest prevalence was of VH1-69 gene segment (10%) followed by VH3-73; (7%), VH3-48; (6%), VH2-70; (5%), VH3-23; (4%) and VH1-03; (3%). 8/10 of VH1-69 IGVH gene were unmutated and 5/8 patients died. Gene segments VH3-23 and VH3-21, each of which is known to be a bad prognostic marker, were found in 4 and 2 % each. However, VH3-73, VH3-48, and VH2-70 gene segments, which were found to be associated with poor prognosis in our study, showed a higher prevalence in Indians, compared to West. TP53 mutation ,examined in highly conserved region between Exon-5 and Exon-9,was seen in 18/100 (18%) patients,5/18 mutations were seen in Exon-6 and Exon-8. 2 mutations was present each in Exon-7 and Exon-9, and four patients showed mutation in Exon-5. Analysis of P2X7 (1513A-C) gene polymorphism revealed 33/100 (33%) patients to have heterozygous genotype (1513A/C) and 13/100 (13%) patients to have homozygous genotype (1513C/C), while Bax G(-248)A gene polymorphism showed the frequency of GG, GA, and AA genotypes were 78%, 18%, and 4% respectively. P2X7 and Bax gene polymorphism had no prognostic significance. Serum β2-microglobulin level (≥ 4.5 ug/ml) was seen in 36% patients and Thymidine kinase level (≥7.4 U/L) was seen in44% patients. The above results indicate that ,in contrast to reported prevalence from the West, Indian CLL has higher prevalence of bad prognostic markers like CD38 expression, combined Zap70 and CD38expression, 17p-, 11q-, TP53 mutation, β2-microglobulin level and VH3-73, VH3-48, and VH2-70 gene segments of IGVH which may be responsible for a different biology. Disclosures No relevant conflicts of interest to declare.

Background: Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi. The present study was conducted to study the clinical features, laboratory profile, complications and response to therapy among children suffering from scrub typhus in a tertiary health care institution of Tamil Nadu, India.Methods: The study was conducted at Saveetha Medical College Hospital, Tamil Nadu, India. Duration of the study was from August to December, 2015 in the Department of Pediatrics. Children with clinically suspected Scrub typhus were subjected to detailed clinical examination and investigation. Diagnosis of scrub typhus was confirmed by IgM ELISA. Results: 34 patients were diagnosed as suffering from scrub typhus. Common symptoms noted were fever, headache, cough and cold, chills, rigor, myalgia and vomiting. The common complications noted were thrombocytopenia in 16 children (47%) and features of meningoencephalitis and hepatitis were present in 2 children (5.8%). Eschar was identified in 24 (70.5%) patients. Mixed infection was seen in 4 (11.7%) children who had concurrent culture positive Urinary Tract Infection.   Conclusions: Scrub typhus is an acute febrile illness which requires high index of suspicion for early diagnosis, monitoring of the clinical and laboratory parameters and prompt treatment which may help in complete cure without further complications and morbidity.

Background: India is not only growing in terms of population but also developing in terms of communication. Internet has become an essential tool for education, entertainment, communication and sharing of information. Excessive and undisciplined use of internet has led to emergence of internet addiction (IA), especially among students. The objective of the study was to know the magnitude of internet addiction among medical students and to determine the factors associated with it.Methods: The present cross sectional study was carried out over a period of two months among 138 medical students of SSIMS and RC Davangere. Data was collected using a pre designed, pretested questionnaire, with questions adapted from Young’s internet addiction questionnaire to test internet addiction.Results: In our study 30% students had mild internet addiction and 10% had moderate internet addiction. Male gender, internet usage of more than 5 hours per day and expenditure on the monthly internet pack of more than Rs. 400 were found to be significantly associated with internet addiction.Conclusions: More than one third of the students, especially males had internet addiction. It is essential for the parents and institutions to supervise the medical students and limit the time as well as expenditure on the internet usage.