Central Pontine Myelinolysis (CPM) is the dreaded condition seen in the setting of documented hyponatremia which has been rapidly corrected or even over corrected often with normal saline or even hypertonic saline. Osmotic demyelination occurs due to sudden osmotic changes most often seen in the white matter tracts traversing the pons.

Schizophrenia is perhaps the most devastating neuropsychiatric illness. Worldwide, its prevalence rate is about 1%. Schizophrenia is considered a neurodevelopmental disorder involving the interplay of susceptibility genes and environmental factors. There is a wide range of pathologic findings, but there is no specific or diagnostic laboratory abnormality. Till date, the aetiology, neuropathology, and pathophysiology of schizophrenia remain elusive. Over the last forty years, the dopaminergic model has been the leading neurochemical hypothesis of schizophrenia. Yet it remains unlikely that dopaminergic dysfunction, on its own. Glutamatergic models provide an alternate approach for conceptualizing the brain abnormalities associated with schizophrenia. New pharmacological and behavioral approaches aimed at potentiating glutamatergic neurotransmission, offer new hopeforfuture clinical development

Outcome data on fluid therapy in trauma and critically ill patients suggests a direct correlation between positive fluid balance and increased mortality. Randomised-controlled trials over the past decade comparing the effects of hydroxyethyl starch (HES) preparations and crystalloids for fluid resuscitation in critically illpatients have demonstrated an increased mortality and use of renal replacement therapy (RRT) associated with HES solutions. Balanced salt solutions have shown promise as initial resuscitation fluids, though there is not enough clinical data regarding their comparative safety and efficacy.

Books and words cannot describe disaster. Only those who have gone through the pain and agony can visualize what disaster really means. The Earthquake & Tsunami disaster of 2004 left an unprecedented impression on those who were involved-taking many lives and scarring the lives, forever, of those who survived it Many were physically bruised and many battered in their thoughts with Psychosis and Post Traumatic stress disorder. This article is the personal ring-side experience of an Anaesthesiologist posted at INHS Dhanvantari, who saw it all happen. This article provides an insight into how it happened, how such a calamity can be managed and future lessons that can be learned in the chapter of Disaster management.

Brachytherapy concerns primarily the use of radioactive sealed sources which are inserted into catheters or applicators and placed directly into tissue either inside or very close to the target volume. The use of radiation in treatment of patients involves both benefits and risks. It has been reported that early radiation workers had developed radiation induced cancers. These incidents lead to continuous work for the improvement of radiation safety of patients and personnel The use of remote afterloading equipment has been developed to improve radiation safety in the delivery of treatment in brachytherapy. The widespread adoption of high dose rate brachytherapy needs appropriate quality assurance measures to minimize the risks to both patients and medical staff. The radiation safety program covers five major aspects: quality control, quality assurance, radiation monitoring, preventive maintenance, administrative measures and quality audit. This paper will discuss the radiation safety program developedfor a high dose rate brachytherapy facility at our centre which may serve as a guideline for other centres intending to install a similar facility.

Background: Patients with haemorrhoids or piles visit surgical out-patient departments frequently and are offered various methods of treatment including some Day Care Surgery. Infrared coagulation and Rubber band ligation are considered as two common office procedures for haemorroids. Patients in general are concerned about the effectiveness, post procedure pain and the possibility of future recurrence of a particular procedure and insist on a non-ambiguous reply from the treating surgeon. The surgeon has the moral responsibility to explain to the patient regarding the comfort and efficacy of a particular procedure. In the present study, a comparison has been made between infrared coagulation and rubber band ligation giving greater emphasis on post procedure discomfort and effectiveness. Materials & Methods: One hundredfive patients with second degree bleeding haemorrhoids were treated either by infrared coagulation (N = 51) or rubber band ligation (N = 54). Post procedure, parameters like pain, discomfort, reliefin incidence ofbleeding, time to return to work and recurrence rate were studied and compared following each procedure. Result: The mean duration of disease was 16.5 months (range 12 to 32 months). There were 68 males and 37 females. The mean age was 42.71 years (range 20–71 years). Post procedure pain in first week was more in Rubber Band Ligation group (2-5 vs 0-3 on a visual analogue scale). In Band ligation group post-defecation pain and rectal tenesmus was more intense (P = 0.0059). Patients in Infrared coagulation group had a higher recurrence rate (P = 0.03) but resumed their duties earlier (2 vs 4 days, P = 0.03). Postprocedure, Rubber Band Ligation group had more pain and discomfort but the procedure was more effective in controlling symptoms and obliterating hemorrhoids. Conclusion: Rubber Band Ligation was more effective but more painful, while Infrared coagulation was less painful but their efficacy was also lower. Therefore, It is concluded that Infrared coagulation could be considered a suitable alternative office procedure for early stage haemorrhoids as this office procedure can be conveniently repeated in case of recurrence.

Objective: We present some unusual cases of post traumatic epilepsy managed in the high care unit of a tertiary care neurosurgical centre. They were thouroughly evaluated to determine the cause of post traumatic epilepsy. The pathogenesis of Post Traumatic Epilepsy which provides insights into neural injury, rewiring and regeneration paradigms is discussed. Materials and methods: Six male patients aged 19-35 years who suffered head injury and suffered post traumatic epilepsy were enrolled & observed during their hospital stay. They underwent neuroimaging and EEG monitoring to rule out other causes of epilepsy. Two patients were lost due to death. Results: All patients suffered Parenchymal injury. Seizure spectrum included not only motor but also autonomic manifestations. The Autonomic manifestations were more resistant to antiseizure medication but responded to SOS treatment Seizure threshold is probably reduced during episodes of wound site infection, URTI or urinary infections Conclusion: The mechanisms causing seizures in TBI patients are incompletely understood. In our set of patients, the common thread that runs through these cases is that they all had severe brain insults followed by post traumatic epilepsy. Cortical lesions seem important in the genesis of the epileptic activity, and early seizures are likely to have a different pathogenesis than late seizures.

Background: A large number of neonatal conditions can be anticipated before or identified at birth. Many of these conditions need venous sampling of neonates to determine hematologicalparameters. There are no studies to show whether the easily available umbilical cord sample can be used to obtain these test parmeters in full-term neonates. Materials & Methods: This retrospective, one-year study included full-term neonates with conditions that can be predicted before birth (infection in the infant of a mother with prolonged rupture of membranes, Rh negative mothers' infant, Intra-uterine growth retardation, transient tachypnoea ofnewborn following caesarean section) or at birth (birth asphyxia). Umbilical cord blood hemoglobin, total and differential leukocyte counts and platelet counts were compared with the same parameters obtainedfrom venous blood drawn from neonates within six hours of birth. Results: A total of 49 neonates were eligible and included. The mean (s.d.) values of parameters for cord blood were 15.49 gm/dL (3.36) for hemoglobin; 12695.26/dL (6181.49) for total leukocyte count; Ploymorphs 48.61% (15.97); Lymphocytes 39.46% (15.83); Eosinophils 4.17% (2.2) and Monocytes 4.7% (2.27) while mean platelet count was 254.4 × 103/dL (91.5). The same parameters for venous blood were mean hemoglobin of15.78 gm/dl (2.76); TLC13373.47/dL (6499.16); Ploymorphs50.04% (14.45);Lymphocytes41.08% (15.26); Eosinophils 4.14% (2.2) and Monocytes 4.7% (2.19) while mean platelet count in venous blood was 265.76 × 103/dL (88.54). There was no significant difference between the cord blood value and the venous blood value of any of the above hematological parameters. Conclusions: This study shows that there is no difference in the hematological parameters tested in cord blood or venous blood collected within six hours of birth in full-term neonates. Larger studies are needed to confirm this finding and evaluate the benefits to neonates after which cord blood testing can routinely substitute venous blood testing for these hematological parameters in neonates with conditions as described in this study.

Background: Correlation between circulating sex steroid levels and breast cancer has been controversial To further elucidate the role of endogenous hormones in breast cancer, we aimed to assess correlation between serum testosterone levels and breast cancer prevalence. Materials & Methods: Levels of serum testosterone by Enzyme Immunoassay (EIA) in 56 patients with histologically verified breast cancer and 55 age-matched control patients. Results: The mean Serum Testosterone level in the control group was 22.58, SD 7.12 (n=55). The mean Serum Testosterone level in the Breast cancer group was 17.69, SD 4.68(n=56). Serum testosterone levels were significantly lower in breast cancer cases vs. controls Conclusions: Serum testosterone levels, are significantly lower in patients with breast cancer compared to age-matched control patients. These findings support the protective role of biovailable testosterone in counteracting the proliferative effects of estrogens on mammary tissue.

Objective: To analyse and discuss the role of multidector CT in the assessment of disease spectrum of oesophageal carcinoma. Materials & Methods: Multidetector CT (MDCT) images of 48 cases of histopathologically proven oesophageal carcinoma were retrospectively reviewed. Axial images in soft tissue, lung and bone windows were analysed along with multiplanar reconstructions wherever necessary. Imaging findings of local extension to various structures were analysed and assessed. The extent of involvement and various complications were also evaluated using established criteria. Involvement of regional and distant lymph nodes as well as distant metastases and their imaging appearances were analysed. A scanning protocol for lungs and abdomen with appropriate intravenous contrast delay with bolus tracking was used to allow biphasic study of the liver. Results: Of 48 cases of oesophageal carcinoma studied, 20 hadperilesional fat involvement, 12 had involvement of the tracheobronchial tree, 10 of the aorta, 2 showed pericardial involvement, 3 had pleural involvement, 5 cases showed gastric invasion, 1 showed direct infiltration of lung parenchyma and 1 case had involvement of the bone by the primary tumour. In 14 cases there was regional lymph node involvement and 4 showed non-regional node involvement There were 11 cases which showed metastatic lesions in the lungs, 8 with metastatic deposits in the liver and 3 with bony metastases. Multidetector CT improves spatial resolution, allows volumetric imaging, muliplanar reformats and enhances confidence in image assessment Conclusion: CT is a widely available and useful investigation in the work up of oesophageal carcinoma. It is an excellent tool for noninvasively determining the extent of oesophageal carcinoma and assessing its resectability. Multidetector CT imaging improves spatial resolution and allows greater confidence in image analysis in addition to providing reformats. Biphasic examination of the liver can routinely be achieved when scanning for chest and abdomen. MDCT should be used routinely in the pretreatment staging and follow-up of the majority of these cases.

Background: The epidemic of non communicable diseases has begun its tragic shift towards the developing world. This survey was undertaken to find out prevalence of alcohol and tobacco consumption amongst Armed Forces personnel posted at Mumbai serving in various Ships & Shore establishments. Methods: The survey was a cross sectional descriptive study based on a questionnaire which was answered by 1531 service personnel Results: It was found that the prevalence of alcohol consumption was 55.32% and that of tobacco consumption was 18.61 %. 65.18% individuals were aware that alcohol use is injurious to health and 91.18% felt that tobacco use is injurious to health. Conclusion: Despite the high level of awareness for harmful effects of alcohol and tobacco, the prevalence of consumption was above 50% for alcohol thereby showing that more effort in the form of Behaviour Change Communication is required to be undertaken. This should address issues of hazards pertaining to alcohol consumption: the adverse effect on both the individual and his family leading to loss of man days thus affecting the moral fibre of the Armed Forces.