Objectives: Dhat syndrome is a cultural bound syndrome in which affected individuals have morbid pre-occupation with semen loss in their urine and its impact on the body. Previous studies have explored the symptomatology and perception regarding seminal discharge of such patients while there is lacked of literature on the assessment by quacks and practitioner of alternative and complementary practitioners (ACMP). Therefore, in addition to objectives of previous studies, this study explores the reprehensibility of such practitioners as they may not be giving correct advice to such patients. Methods: For duration of three months, this mixed method study was conducted in Rohilkhand Medical College campus; individuals were approached both in and outside the Psychiatric Outpatient Department using purposive sampling procedure. ICD-10 diagnostic criterion was used to include affected individual in the study sample. Subsequently, a semi-structured questionnaire to document their socio-demographic data and symptomatology was used. Further, previous consultation to quack, ACMPs and allopathic practitioners other than psychiatrist and advice given to the patient by them was obtained via in-depth interview. The quantitative data was analyzed through proportions whereas qualitative data via thematic analysis. Results: There were 38 out of 110 with Dhat syndrome. Invariably, they complained of undue concern regarding debilitating effects of seminal discharge and harmful for the body. A total 21.1% had prior consultation to ACMPs and attributing it to masturbation and hot weather. Surprisingly, allopathic practitioners consulted gave incorrect advices. Conclusion: Dhat syndrome affects individuals irrespective of their social and education background. Sex education among the masses and emphasis for awareness of this syndrome among ACMPs and allopathic practitioners other than psychiatrist is necessary to reduce this cultural bound syndrome.

Objective: To evaluate correlation of Alberta Stroke Program Early CT Score (ASPECTS) and early and delay outcome measures among acute anterior ischemic stroke patients who presented within 48 hours of stroke onset. Methods: In a prospective cohort study, we recruited consecutive patients with acute middle cerebral artery (MCA) ischemic stroke who presented within 48 hours of stroke onset. All the patients were evaluated at admission (Glasgow Coma Scale - GCS and National Institute of Health Stroke Scale - NIHSS) at discharge (GCS, NIHSS, Barthel Index - BI and modifi ed Rankin Scale - mRS) and at 3 months (BI and mRS). CT ASPECTS was calculated by two observers independently. We divided patients in to two groups with ‘Better’ and ‘Worse’ ASPECTS with score of 8-10 and 0-7 respectively and compared the primary and secondary stroke outcome measures. Results: Among 100 patients with acute MCA infarction (median age 55 yrs, 62 males), median ASPECTS scores had inter-rater reliability of 0.82. The mortality, GCS and NIHSS at discharge, and mRS and BI at 3 months are signifi cantly better among patients with ‘Better’ compared to ‘Worse’ APSECTS. The hospital stay was shorter in patients with Better ASPCTS. Conclusion: In the setting of acute ischemic stroke, ASPECTS has good correlation with severity of stroke, and is strong predictor of early and delayed outcome in acute ischemic stroke.

The frequency of injury of anterior cruciate ligament (ACL), the importance of anatomy in surgical repair and potential of the injured ACL to predispose to osteoarthritis necessitates the need for understanding its precise anatomy.Available studies have focussed on tunnel positioning and hence attachment site of the ligament. Few studies which have focussed on morphology reflect ambiguities in size, fibre bundle, number and disposition. Since a near anatomical repair of the ACL is the treatment of choice, the present study was planned to describe the morphology of ACL. Twenty-two ACL (11 right and 11 left) isolated from knee joints of collection of adult embalmed lower limbs were utilised for the study. The ACL morphology and morphometry were studied for footprints and fibre bundles. Three distinct bundles of differing lengths constitute a spiral ACL complex. These bundles are positioned as- intermediate with posteromedial and anterolateral flanking in respective positions. The tibial and femoral footprints are paw-shaped and oval respectively. Tibial footprints are approximately 2.5 times larger in area than the femoral footprints. The unique morphology of ACL vis a vis its spiralization, and its mechanical advantage of in terminal extension and conjunct rotation of knee (which are peculiarly human trait) are discussed. It is recommended to utilize the concept of spiralization and differing bundle length in ACL surgeries to achieve the favourable clinical outcome.

Background: and Purpose Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19. Methods: Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables. Results: We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase. Conclusions The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.