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Singh L.,Central India Institute of Medical science | Agrawal N.,Central India Institute of Medical science
World Neurosurgery | Year: 2010

Background: Self-retaining brain retractors are commonly used during intracranial surgery, and they are indispensable during microneurosurgery. There is a common severe complication due to the use of self-held retractors, that is, formation of a hemorrhagic infarct area in the brain region exposed to traction. All the more, present retractor systems are fixed and rigid and obstruct surgeons during surgery. Sometimes these retractors create glare in the microscope that distracts the surgeon. We hereby propose a simple and easy method of retraction of brain especially the temporal lobe using the transsylvian approach and vermis using the transvermian approach. Methods: This is retrospective analysis of 47 patients in 4 years in which we have used our stitch retractor. We have analyzed their outcome, postoperative scan, and ease of performing surgery. Results: In 47 patients, there was only 1 postoperative contusion, and the longest period it was kept for is 6 hours. The other advantage was that it does not obstruct in any way while doing dissections and surgery. There was no glare while operating under a microscope. Conclusion: We hereby propose a simple and easy method of retraction of brain especially the temporal lobe using the transsylvian approach and vermis using the transvermian approach. It is minimally traumatic, reducing insult to the brain. It allows the surgeon to dissect without any obstruction and glare in the way. The biggest advantage of the present stitch retractor is that it is very cheap and simple to use. © 2010 Elsevier Inc. All rights reserved.


Shekhawat S.D.,Central India Institute of Medical science | Purohit H.J.,Indian National Environmental Engineering Research Institute | Taori G.M.,Central India Institute of Medical science | Daginawala H.F.,Central India Institute of Medical science | Kashyap R.S.,Central India Institute of Medical science
Clinical Neurology and Neurosurgery | Year: 2016

Objectives Diagnosis of tuberculosis meningitis (TBM) remains challenging in tuberculosis (TB) endemic countries. The need for TB biomarkers arises, in part, from the difficulty of accurately diagnosing TBM with the available methods. Patients and methods To explore the potential of host Hsps (Hsp 25, Hsp 60, Hsp 70 and Hsp 90) as an alternative marker in TBM diagnosis, we evaluated cerebrospinal fluid (CSF) sample of TBM (n = 49), Pyogenic Meningitis (PM) (n = 20), Viral Meningitis (VM) (n = 09), Fungal Meningitis (FM) (n = 04) and non infectious control (n = 79) patients using indirect ELISA. Results Out of four Hsps, Hsp 70 and Hsp 90 yields 89% & 88% sensitivity and 82% & 89% specificity, respectively. The positive (PPV) and negative (NPV) predictive values yielded in TBM group for Hsp 70 was 86.27% (73.74-94.27) and 93.51% (85.48-97.83), respectively. For Hsp 90 the obtained PPV was 89.36% (76.88-96.41) and NPV was 91.36% (82.99-96.44). In 86% of TBM patients all the four Hsps were found to be positive and none of the patient was found to be negative for all Hsps in the same group. Conclusions The data presented in the study indicate that host Hsp 70 and Hsp 90 shows good sensitivity and specificity and have potential in the diagnosis of TBM disease. The combined use of all Hsps (Hsp 25, Hsp 60, Hsp 70 and Hsp 90) effectively distinguishes patients with TBM from other disease controls. © 2015 Elsevier B.V.


Nagdev K.J.,Central India Institute of Medical science | Kashyap R.S.,Central India Institute of Medical science | Parida M.M.,Defence Research and Development Establishment | Kapgate R.C.,Central India Institute of Medical science | And 3 more authors.
Journal of Clinical Microbiology | Year: 2011

Diagnosis of tuberculous meningitis (TBM) is often difficult. A reliable, simple, and rapid diagnostic test that can be performed in any standard laboratory could be helpful in TBM diagnosis. In this study, a loop-mediated isothermal amplification assay (LAMP) was evaluated to rapidly detect and diagnose TBM infection and was compared to the performance of nested PCR. Six specific primers were used to recognize the IS6110 genomic sequence from Mycobacterium tuberculosis, which included one forward outer primer, one reverse outer primer, two respective inner primers, and two loop primers. The optimum reaction temperature and time were 63°C and 60 min, respectively. Nested PCR was performed targeting the IS6110 region from M. tuberculosis using a commercial kit. The LAMP method yielded a sensitivity of 88.23% and a specificity of 80%, compared to the nested-PCR assay, which yielded a sensitivity of 52.9% and a specificity of 90% for TBM diagnosis. Comparative experiments showed that the LAMP assay is a rapid, sensitive, and specific method to detect TBM infection and that it is superior to the nested-PCR assay. LAMP is very simple, and it can be performed in any laboratory and in rural settings. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Jain R.K.,Central India Institute of Medical science | Nayak A.R.,Central India Institute of Medical science | Husain A.A.,Central India Institute of Medical science | Panchbhai M.S.,Central India Institute of Medical science | And 5 more authors.
Disease Markers | Year: 2013

The present study was designed to investigate Rv2623 antigen, a major dormancy regulon protein of Mycobacterium tuberculosis (MTB) in CSF of suspected latent and active tuberculousmeningitis (TBM) patients.Atotal of 100 CSF samples fromTBM(n = 31), suspected latent TBM(n = 22), and suitable noninfectious control subjects (n = 47)were collected and evaluated for Rv2623 antigen level using ELISA protocol. A significantly high (P < 0.05)mean absorbance was observed in samples of suspected latent TBM and active TBM patients as compared to non-TBM control patients. However, no significant difference in Rv2623 level was observed between suspected latent TBM and TBM patients. Our preliminary findings suggest that Rv2623 may be useful as a potential biomarker for the diagnosis of the latent as well as active TBM infection. Futher evaluation of this biomarker in large number of samples is therefore needed to confirm the result. Copyright © 2013 Peter Kruzliak et al.


Nayak A.R.,Central India Institute of Medical science | Kashyap R.S.,Central India Institute of Medical science | Kabra D.,Central India Institute of Medical science | Purohit H.J.,Indian National Environmental Engineering Research Institute | And 2 more authors.
Annals of Indian Academy of Neurology | Year: 2012

Background: Biomarker for prognosis of stroke is urgently needed for the management of acute ischemic stroke (AIS) patients. Objective: To evaluate the course of inflammatory cytokines in AIS patients and its comparison with inter-alfa trypsin inhibitor heavy chain 4 (ITIH4) and outcome after AIS. Materials and Methods: A panel of 12 inflammatory cytokines and ITIH4 were estimated in serial blood samples collected at admission, 24 h, 48 h, 72 h, 144 h and at discharge of AIS patients (n = 5). Results: Out of the 12 cytokines, only interleukin (IL)-2, tumor necrosis factor-alfa (TNF-a), IL-10, IL-6, IL-1B and IL-8 were in the measurable range of the kit (10 pg/mL). We found high IL-2 at admission, which decreased (P < 0.05) in the follow-up samples. TNF-a initially increases (P < 0.05) at 24 h followed by gradual decrease (P < 0.05) after 72 h. IL-10 decreases initially (P < 0.05) till 72 h as compared with its level at admission and then increases (P < 0.05) after 144 h. Similarly, ITIH4 was down-regulated in the early 72 h followed by further increase with improvement of the patient. ITIH4 correlates with IL-10 and computed tomography scan infarct volume. Serum IL-6, IL-1B and IL-8 increased in the AIS patients, but did not show any pattern. Conclusions: Serial measurement of IL-10, IL-2 and TNF-a and ITIH4 may be useful for the follow-up of clinical outcome after AIS.

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