Objective: To explore sleep patterns in individuals with essential tremor (ET) and essential tremor plus (ET-Plus) compared with healthy controls and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers. Methods: We conducted a prospective cross-sectional study at National Institute of Mental Health and Neurosciences, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using The Essential Tremor Rating Assessment Scale (TETRAS) and Fahn‐Tolosa‐Marin Clinical Rating Scale (FTMRS). Sleep symptoms were assessed via the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Mayo Sleep Questionnaire, restless legs syndrome questionnaire, Berlin questionnaire, Generalized Anxiety Disorder Scale 7, and Patient Health Questionnaire-9. All patients and controls underwent overnight video PSG. Sleep scoring was manually performed by a trained sleep research technician and the first author following the American Academy of Sleep Medicine (2017) guidelines, with data analyzed using R studio. Results: Compared with ET-Plus patients, ET patients had a younger onset age (46.8±11.1 years versus 30.8±16.7 years, respectively). Compared with ET patients, ET-Plus patients had higher TETRAS and FTMRS scores (p<0.005). Compared with controls, both ET patients and ET-Plus patients presented poorer sleep quality, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, and restless legs syndrome symptoms. PSG findings supported these clinical observations, showing an elevated apnea‒hypopnea index, reduced total sleep time, prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls. Conclusion The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients compared with healthy controls, with no differences between the ET groups.

Objective: To explore sleep patterns in individuals with essential tremor (ET) and essential tremor plus (ET-Plus) compared with healthy controls and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers. Methods: We conducted a prospective cross-sectional study at National Institute of Mental Health and Neurosciences, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using The Essential Tremor Rating Assessment Scale (TETRAS) and Fahn‐Tolosa‐Marin Clinical Rating Scale (FTMRS). Sleep symptoms were assessed via the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Mayo Sleep Questionnaire, restless legs syndrome questionnaire, Berlin questionnaire, Generalized Anxiety Disorder Scale 7, and Patient Health Questionnaire-9. All patients and controls underwent overnight video PSG. Sleep scoring was manually performed by a trained sleep research technician and the first author following the American Academy of Sleep Medicine (2017) guidelines, with data analyzed using R studio. Results: Compared with ET-Plus patients, ET patients had a younger onset age (46.8±11.1 years versus 30.8±16.7 years, respectively). Compared with ET patients, ET-Plus patients had higher TETRAS and FTMRS scores (p<0.005). Compared with controls, both ET patients and ET-Plus patients presented poorer sleep quality, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, and restless legs syndrome symptoms. PSG findings supported these clinical observations, showing an elevated apnea‒hypopnea index, reduced total sleep time, prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls. Conclusion The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients compared with healthy controls, with no differences between the ET groups.

Objective: To explore sleep patterns in individuals with essential tremor (ET) and essential tremor plus (ET-Plus) compared with healthy controls and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers. Methods: We conducted a prospective cross-sectional study at National Institute of Mental Health and Neurosciences, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using The Essential Tremor Rating Assessment Scale (TETRAS) and Fahn‐Tolosa‐Marin Clinical Rating Scale (FTMRS). Sleep symptoms were assessed via the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Mayo Sleep Questionnaire, restless legs syndrome questionnaire, Berlin questionnaire, Generalized Anxiety Disorder Scale 7, and Patient Health Questionnaire-9. All patients and controls underwent overnight video PSG. Sleep scoring was manually performed by a trained sleep research technician and the first author following the American Academy of Sleep Medicine (2017) guidelines, with data analyzed using R studio. Results: Compared with ET-Plus patients, ET patients had a younger onset age (46.8±11.1 years versus 30.8±16.7 years, respectively). Compared with ET patients, ET-Plus patients had higher TETRAS and FTMRS scores (p<0.005). Compared with controls, both ET patients and ET-Plus patients presented poorer sleep quality, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, and restless legs syndrome symptoms. PSG findings supported these clinical observations, showing an elevated apnea‒hypopnea index, reduced total sleep time, prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls. Conclusion The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients compared with healthy controls, with no differences between the ET groups.

Introduction: Lateral epicondylitis is a common condition causing severe incapacitating pain. Several methods of treatment have been approached for its management. In our study we aim to compare the results of injecting steroid and lignocaine mixture via single injection and peppered injection technique and analyse the outcome in each category. Materials and methods: A prospective randomised study comprising of 25 patients in each group (single vs peppered group) were included in the study after satisfying inclusion and exclusion criteria. Outcome of the treatment was measured in the form of Patient Related Tennis Elbow Evaluation (PRTEE) Questionnaire, Visual analogue score (VAS) and tenderness grading at two weeks, six weeks and six months after injection. Results: Results of our study showed that the mean PRTEE score was 22.36, 18.40 and 14.16 at 2 weeks, 6 weeks and 6 months following peppered injection as compared to 28.96, 21.84 and 25.32 in the single injection group (p value <0.05). VAS score at 2 weeks, 6 weeks and 6 months after the peppered injection was found to be 2.72, 1.72 and 1.36 and in the single injection group was 2.96, 1.92 and 2.72 at 2weeks, 6 weeks and 6 months, respectively (p value <0.05). On comparison of the 2 groups, there was a significant reduction of VAS scores at 6 months post-injection (p value <0.05) and PRTEE score at 6 weeks, 6 months in peppered injection group. Conclusion: The effects of peppered injection technique is seen to be advantageous over the single injection technique in the management of chronic lateral epicondylitis.

Intestinal duplication cyst is a rare congenital anomaly that mimics presentation of an intestinal obstruction in neonates. It is a congenital malformation formed during the abnormal development of the Gastro-Intestinal tract during embryonic development. Ante-natal ultrasound is the imaging modality of choice for early detection. Early detection and prompt referral is of importance for pediatric surgeons, as this reduces morbidity and mortality risks, and offers a more desirable outcome for patient.

Chorea/etiology* ; Humans ; Lupus Erythematosus, Systemic/diagnosis* ; Phototherapy

Background: The mechanism of injury (MoI) for a patellar dislocation has not been fully established. The aim of this study was to use systematic video analysis to determine the MoI of a patella dislocation. Methods: A systematic search was conducted of three video sharing websites and three popular search engines to identify videos demonstrating a patellar dislocation. Videos were reviewed by three surgeons trained in systematic video analysis, who commented on the position of the lower limb and the situation in which the injury occurred.The results were reviewed to build a consensus of the MoI for each video. Statistical analysis was conducted for interobserver agreement (p < 0.05). Results: Initial search yielded 603 videos with 13 meeting the inclusion criteria. The injuries were sustained performing a sporting activity (n = 9) or whilst dancing (n = 4). The injury was predominantly sustained during a non-contact situation (n = 10). The most common mechanism was an unbalanced individual with a flexed hip sustaining a valgus force to their flexed knee with the tibia externally rotated. Conclusions This study provides some insight into the MoI for a patellar dislocation and the findings may assist in developing injury prevention programmes and rehabilitation protocols as well as guiding future research.

PURPOSE: To characterize the population of hypogonadal men who presented to a tertiary academic urology clinic and evaluate risk factors for primary vs. secondary hypogonadism. MATERIALS AND METHODS: We evaluated all men with International Classification of Diseases-9 diagnosis codes R68.82 and 799.81 for low libido, 257.2 for testicular hypofunction, and E29.1 for other testicular hypofunction at a tertiary academic medical center from 2013 to 2017. We included men who had testosterone (T) and luteinizing hormone (LH) drawn on the same day. We classified men based on T and LH levels into eugonadal, primary, secondary, and compensated hypogonadism. Risk factors including age, body mass index (BMI) over 30 kg/m2, current smoking status, alcohol use greater than 5 days per week, and Charlson comorbidity index greater than or equal to 1 were investigated and measured in each group using the eugonadal group for reference. RESULTS: Among the 231 men who had both T and LH levels, 7.4%, 42.4%, and 7.4% were classified as primary, secondary, and compensated hypogonadism, respectively. Only elevated BMI was associated with secondary hypogonadism compared to eugonadal men (median BMI, 30.93 kg/m2 vs. 27.69 kg/m2, p=0.003). BMI, age, comorbidities, smoking, or alcohol use did not appear to predict diagnosis of secondary hypogonadism. CONCLUSIONS: Secondary hypogonadism appears to be the most common cause of hypogonadism among men complaining of low T and decreased libido at a tertiary academic medical center. Secondary hypogonadism is associated with elevated BMI and therefore obesity should be used as a marker to evaluate men for both T and LH levels.
Academic Medical Centers* ; Body Mass Index* ; Classification ; Clomiphene ; Comorbidity ; Diagnosis ; Humans ; Hypogonadism* ; Libido ; Luteinizing Hormone ; Male ; Obesity ; Risk Factors ; Smoke ; Smoking ; Tertiary Care Centers ; Testosterone ; Urology

PURPOSE: The purpose of this study was to evaluate the relative utility and benefits of free-hand 2-dimensional intraoperative ultrasound (FUS) and navigated 3-dimensional intraoperative ultrasound (NUS) as ultrasound-guided biopsy (USGB) techniques for supratentorial lesions. METHODS: All patients who underwent USGB for suspected supratentorial tumours from January 2008 to December 2017 were retrospectively analyzed. The charts and electronic medical records of these patients were studied. Demographic, surgical, and pathological variables were collected and analyzed. The study group consisted of patients who underwent either FUS or NUS for biopsy. RESULTS: A total of 125 patients (112 adults and 13 children) underwent USGB during the study period (89 FUS and 36 NUS). NUS was used more often for deep-seated lesions (58% vs. 18% for FUS, P<0.001). The mean operating time for NUS was longer than for FUS (156 minutes vs. 124 minutes, P=0.001). Representative yield was found in 97.7% of biopsies using FUS and in 100% of biopsies using NUS (diagnostic yield, 93.6% and 91.3%, respectively). The majority of lesions (89%) were high-grade gliomas or lymphomas. Postoperative complications were more common in the NUS group (8.3% vs. 1.2%), but were related to the tumour location (deep). CONCLUSION: Despite the longer operating time and higher rate of postoperative complications, NUS has the benefit of being suitable for biopsies of deep-seated supratentorial lesions, while FUS remains valuable for superficial lesions.
Adult ; Biopsy ; Electronic Health Records ; Glioma ; Humans ; Lymphoma ; Neuronavigation ; Postoperative Complications ; Retrospective Studies ; Ultrasonography

OBJECTIVE: The hallmark of anxiety disorders is excessive fear. Previous studies have suggested that selective neural projections from Basal nucleus of stria terminalis (BNST) to amygdala and vice-versa precisely control the fear learning process. However the exact mechanism how the BNST controls fear consolidation and its extinction is largely unknown. In the present study we observed the changes in the BNST sub-regions following fear conditioning and its extinction. METHODS: The change in the number of positive neurons was determined by immunohistochemistry for Acetyl H3 (Histone 3), Acetyl H4 (Histone 4), cAMP response element binding Protein (CBP) and c-fos in three sub-regions of the BNST namely the anterio-lateral BNST (STLP) and anterio-medial BNST (STMA), and lateral-ventral BNST (STLV) of rats subjected to auditory fear conditioning and extinction. RESULTS: We found significant increase in the number of CBP, acetyl H3 and acetyl H4 positive neurons in the STMA and STLV but not in the STLP after fear conditioning. However, following fear extinction the number of CBP, acetyl H3 and acetyl H4 positive neurons increased significantly in the STLP but not in the STMA and STLV. Similar changes were observed in the number of c-fos positive neurons after fear consolidation and extinction. CONCLUSION: The results from this study suggest that the differential histone acetylation in the different sub-regions of the BNST following fear learning and its extinction may be responsible for changes in the neuronal activation patterns resulting in either fear or less fear.
Acetylation* ; Amygdala ; Animals ; Anxiety Disorders ; Cyclic AMP Response Element-Binding Protein ; Histones* ; Immunohistochemistry ; Learning ; Neurons ; Rats ; Septal Nuclei*