CMC SCIENTIFIC PUBLICATION FOR THE YEAR 2015 (JANUARY TO DECEMBER) S.NO. AUTHOR, TITLE, SOURCE, AUTHOR AFFILIATION, ABSTRACT PMID / PMCID INT/NAT 1. Aabidha, P. M., Cherian, A. G., Paul, E. and Helan, J. PMID: 25949977 NAT Maternal and fetal outcome in pre-eclampsia in a secondary care hospital in South India PMCID:PMC 4408711 J Family Med Prim Care. 2015 Apr-Jun;4(2):257-60. doi: 10.4103/2249-4863.154669. Address: Department of Obstetrics and Gynaecology, Christian Fellowship Hospital, Oddanchatram, Tamil Nadu, India. Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India. BACKGROUND: Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population. MATERIALS AND METHODS: This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus. RESULTS: Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26-30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%). CONCLUSIONS: Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes. 2. Aaron S, Mani S, Prabhakar AT, Karthik K, Patil AK, Babu PS, Alexander M(1). PMID: 26238889 NAT Stuck with a drowsy patient, evoke the Percheron. WOS:000359402000017 Neurol India. 2015 Jul-Aug;63(4):542-7. doi: 10.4103/0028-3886.162045. Author information: (1)Department of Neurological Sciences, Neurology Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. BACKGROUND: Strokes caused by normal variants of the cerebral circulation can be difficult to diagnose, hence a high index of suspicion is needed. This case series discusses the clinical and radiological aspects of one such stroke caused by occlusion of the artery of Percheron (AOP). MATERIALS AND METHODS: Computerized discharge summaries, outpatient records and imaging from picture archiving and communication system (PACS, GE), of patients with AOP infarction over a period of 12-years (2002-2014) were identified and their clinical and radiological features analyzed. RESULTS: Of 3589 strokes (both ischemic and hemorrhagic), 17 (0.47%) were due to AOP infarction. Their mean age was 50 years (range: 31-72 years). Disorders of consciousness (94%) were the most common presenting symptoms followed by gaze (53%) and memory impairment (24%). At follow-up, 2/17 (12%) patients developed extrapyramidal features. All patients had bilateral paramedian thalamic infarcts on magnetic resonance imaging (MRI). Associated anterior thalamic (5/17; 30%) and mid brain (10/17; 59%) infarcts were also seen. CT scan done PMID ‐ PUBMED ID; PMCID ‐ PUBMEDCENTRAL ID; WOS ‐ WEB OF SCIENCE ID CMC SCIENTIFIC PUBLICATION FOR THE YEAR 2015 (JANUARY TO DECEMBER) in 11/17 patients prior to the MRI picked up only 6/11 (55%) of these infarcts. The most common etiological factors detected using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria were cardio embolic (8/17; 47%) followed by small vessel occlusion (7/17; 41%). Mortality occurred in 2/17 (12%) patients. At 6 months, a modified Rankin score of 2 or less was seen in 8/17 (47%) patients. CONCLUSIONS: Artery of Percheron infarcts should be considered in the differential diagnosis of patients presenting with sudden alterations in consciousness. MRI should be the investigation of choice. An embolic etiology should be actively looked for. 3. Abhijnhan A, Gopalakrishnan R, Kuruvilla A. WOS:000366494300461 NAT Psychosis in a patient with Immunoglobulin G4 (IgG4) related disease. Indian Journal of Psychiatry. 2015;57(5):S132-S. 4. Abhilash, K. P., Gunasekaran, K., Mitra, S., Patole, S., Sathyendra, S., Jasmine, S. and Varghese, G. M. PMID: 25947985 NAT Scrub typhus meningitis: An under-recognized cause of aseptic meningitis in India WOS:000354387200015 Neurol India; 2015, 63 (2): 209-14 BACKGROUND: Central nervous system (CNS) involvement in scrub typhus is seen in up to a quarter of patients. However, the literature on cerebrospinal fluid (CSF) analysis and outcome in meningitis/meningo- encephalitis due to scrub typhus is scant. MATERIALS AND METHODS: This retrospective study included patients who were admitted to a medical college hospital with scrub typhus meningitis/meningo-encephalitis between 2005 and 2011. The clinical and laboratory profile, details of CSF analysis and outcome were documented. RESULTS: The study included 189 patients with meningitis/meningo-encephalitis due to scrub typhus. The mean age of the patients was 41 +/- 4 years. The mean duration of fever before presentation was 9.4 +/- 3 days. The common presenting complaints were headache (64.2%), nausea/vomiting (60%), altered sensorium (53.7%) and seizures (22.1%). The presence of an eschar was documented in 27.5% of the patients. The mean CSF white blood count was 80 cells/cu mm (range: 5-740). There was a clear lymphocyte predominance (mean 87.6%). The mean CSF protein level was 105 mg% (range: 13-640). The mean CSF sugar level was 63.9 mg% (range 25-350), and was less than 40 mg% in 11.1% of the cases. The case fatality rate was 5.8% (11/189). Univariate analysis showed the presence of an eschar (15.4% vs 2.2%; Odds Ratio [OR]: 8.1) and altered sensorium (9.8% vs 1.1%; OR: 9.2) to be significant predictors of mortality. CONCLUSIONS: In endemic regions, scrub typhus should be considered in the differential diagnosis of aseptic meningitis. Modest elevation of cells in the CSF with lymphocytic pleocytosis and multi-organ involvement may indicate scrub typhus meningitis/meningo-encephalitis. Address: Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India. 5. Abhilash, K. P., Mitra, S., Arul, J. J., Raj, P. M., Balaji, V., Kannangai, R., Thomas, S. A. and Abraham, O. C. PMID: 25559998 NAT Changing paradigm of cryptococcal meningitis: an eight-year experience from a tertiary hospital in South WOS:000352086300005 India Indian J Med Microbiol; 2015, 33 (1): 25-9 BACKGROUND: Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and significant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients. MATERIALS AND METHODS: Patients admitted to a tertiary care centre between 2005 and 2013 with confirmed CM were included in the analysis. Details of the clinical presentation, laboratory findings, treatment details, risk factors for infection and outcome were documented and analysed. RESULTS: During the study period, 102 (87.2%) PMID ‐ PUBMED ID; PMCID ‐ PUBMEDCENTRAL ID; WOS ‐ WEB OF SCIENCE ID CMC SCIENTIFIC PUBLICATION FOR THE YEAR 2015 (JANUARY TO DECEMBER) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 +/- 8.5 years vs. 45 +/- 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 +/- 32 vs. 30 +/- 42; P = 0.03). There was no difference between the cerebrospinal fluid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group. CONCLUSION: HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance. Address: Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India. 6. Abigail Ruth Gojer, Venkateshwaran Rajaram - NAT Autoimmune encephalitis presenting with behavioral changes, seizures, dystonia and regression in a pediatric patient A case report Indian J Psychiatry. 2015 Jan; 57(Suppl 1): S113–S159. CMC Vellore, India E-mails: gmail.com@grliagiba, gmail.com@500narawrd Keyword: Anti-basal ganglia antibodies, neuropsychiatry, autoimmune encephalitis Introduction: Anti-basal ganglia antibodies (ABGA) have been associated with movement disorders and psychiatric disturbances in children. The syndrome associated with positive antibodies is a relatively new one and particularly relevant to psychiatrists, because most patients are initially seen by psychiatric services. With a recognizable clinical picture, availability of a diagnostic test in the form of detecting the presence of auto antibodies targeting the basal ganglia due to molecular mimicry, as well as good improvement with immunotherapy, this condition needs to be explored more. Case Report: We have been identifying and treating this disorder quite regularly at Christian Medical College. In this poster, we would like to present a pediatric patient who presented to our Psychiatry unit with multiple psychiatric manifestations following new onset seizures and right sided dystonia.