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Objective: Parkinson's disease (PD) is a neurodegenerative condition that is characterized by bradykinesia, rigidity, and gait instability. Inherent to this condition is an increased predisposition to falls and fractures. Bone health in Parkinson's disease in India has not been studied thus far. This study aimed to assess the bone mineral density (BMD), trabecular bone score (TBS), and hip structural analysis (HSA) in Indian men with PD and compare them with matched controls. Methodology: A case-control study done at a tertiary care center from southern India. Bone biochemistry, BMD, TBS, and HSA were assessed. Results: Among 40 cases and 40 age, gender, and body mass index (BMI)-matched controls, there was no significant difference in BMD between both groups. The mean (SD) TBS at the lumbar spine [1.349 (0.090)] was significantly (P = 0.019) lower in men with PD as compared to matched controls [1.401 (0.089)]. Among the parameters of HSA, the buckling ratios were significantly higher at the femoral neck [11.8 (2.2) vs 9.4 (2.2); P = 0.001] and inter-trochanteric region [9.4 (2.1) vs 7.8 (1.4); P = 0.002] among cases as compared to matched controls. Vitamin D deficiency was significantly higher in this cohort of patients as was bone turnover marker indicating bone loss and a high bone turnover state. Conclusion: A comprehensive bone health assessment comprising BMD, TBS, and HSA may be required to capture all aspects of bone strength in Indian men with PD as BMD assessment as a stand-alone tool may not suffice to obtain all information pertaining to fracture risk in these individuals.

Background and Objective: Neurological involvement is reported in up to a quarter of patients with scrub typhus. However, prospective studies accurately describing clinical findings, temporal evolution, and rare syndromes are sparse. This study characterized scrub typhus-associated neurological syndromes, emphasizing neurological localization, clinical outcomes, and potential predictors. Materials and Methods: This prospective cohort study included patients admitted to a medical college hospital with scrub typhus during a 1-year period. Detailed clinical, laboratory, and radiological profiles and outcomes were documented and analyzed. Results: Among 198 patients included, whose median age was 47 years (range, 18-85 years), 48.5% were men. The mean duration of fever before presentation was 8.2 days. Neurological deficits attributable to scrub typhus were present in 31.3% of patients. The commonest syndrome was meningitis/meningoencephalitis (87.9%). Extrapyramidal disorders occurred in 10%, and cerebellar disorders occurred in 3%. Extrapyramidal disorders often developed during the acute stage and persisted into early convalescence. Ischemic stroke and new-onset peripheral neuropathies occurred in two and three patients, respectively. Parameters in patients with and without neurological manifestations were compared. Multivariate analysis revealed that male sex, headache, vomiting, and elevated creatinine increased the odds of neurological involvement. Myalgia and tachycardia reduced the odds of neurological disease. Overall mortality was 6.1%. Neurological involvement was not associated with poor outcomes. Conclusions: Neurological involvement was present in nearly one-third of patients with scrub typhus, with meningoencephalitis being the most common manifestation. Headache, vomiting, and elevated creatinine predicted neurological involvement, while myalgia and tachycardia were negatively associated.

BackgroundMultiple cerebral venous sinus thrombosis (CVT) registries from various geographical regions indicate that female gender, the use of contraceptive pills, pregnancy and puerperium are important risk factors. In this study, we report the changes in the epidemiology of patients with CVT managed over the past 26 years.MethodsThe CMC Vellore CVT registry is a prospectively maintained database at the Christian Medical College, Vellore since January 1995. Stata software was used to analyse the data and assess the changes in the incidence, age and gender distribution over the previous 26 years.ResultsAmong 1701 patients treated during the study period, 908 (53%) were women and 793 (47%) were men. The mean incidence of CVT was 49 per 100 000 admissions before 2010, which increased to 96 per 100 000 after 2010. Male gender had a higher odds of developing CVT (OR – 2.07 (CI 1.68 to 2.55, p<0.001). This could be attributed to the declining incidence of postpartum CVT after 2010 compared with the decade before 2010 (50% vs 20%). The mean age at presentation had increased from 24.5 to 33.2 years in the last decade.ConclusionsThere was a clear change in the gender pattern from being a condition with female preponderance, to one where equal or more men are being affected. Lower incidence of postpartum CVT cases could be the driving factor. An increase in the overall incidence of CVT cases was noted, probably due to a higher index of clinical suspicion and better diagnostic imaging modalities.

Introduction: There is scarce literature regarding the clinical course, comorbidities and long-term outcomes after myasthenic crisis (MC). The natural history of myasthenia gravis (MG) in this subset remains uncertain. Methods: The study included a cohort admitted with MC (2007-2017) in a tertiary care hospital. The comorbidities, outcomes after discharge, and prognostic factors were analyzed. Results: Sixty-two patients (89 episodes of MC) were included. Demographic data was comparable between the early- (<50 years) and late-onset (≥50 years) groups. Comorbidities included stress cardiomyopathy (14.5%), arrhythmias (6.4%), neuropathy (17.7%), pancytopenia (12.9%), encephalopathy (11.2%), neuromyotonia (4.8%), myelopathy (3.2%), and myositis (3.2%). Pulmonary embolism (P < 0.008), dysautonomia (P < 0.002), sepsis (P < 0.008), neuropathy (P < 0.002), and phrenic dysfunction (P < 0.016) were associated with prolonged ventilation. Majority of the patients (42, 67.7%) had a favorable outcome (disease status) as defined by remission/minimal manifestations at the time of last follow-up (median 36 months, IQR 15-66). Persistent bulbar weakness (P < 0.001), neuropsychiatric illness (P < 0.001), and comorbidities (P < 0.017) were associated with refractory MG. Eighteen patients (29%) had recurrent crisis. Eleven patients succumbed in the cohort. The main predictors of mortality were tumor progression (P < 0.001) and cardiac illness (P < 0.004). Discussion: A comprehensive treatment approach in MC will translate to good short- and long-term outcomes. The main cornerstones of therapy will include (1) Identification of refractory MG with the implementation of phenotype-based therapy; (2) Addressing comorbidities including cardiac autonomic neuropathy, bulbar weakness, phrenic dysfunction; and (3) Meticulous tumor surveillance.

FRP is extensively used today in all domains like concrete structures in Civil engineering, spacecraft in Aerospace Industry. It is also used in elevator and bridge cables. Although FRP has some remarkable properties, it undergoes fatigue and damage and sometimes, undetectable defects are formed. Defects like de-lamination or voids occur due to manufacturing errors, or exposure to external environmental factors can result in BVID. Thus, FRP structures have to undergo inspection to ensure its continued use and safety. The inspection and maintenance methods most commonly employed in FRP structures are NDT or Non-Destructive Testing and CM or Condition Monitoring. The integral part of both, NDT and CM is SHM. NDT is a type of inspection method wherein the sample is tested without damaging it whatsoever. NDT is commonly used for reasons such as low cost, high reliability. The techniques involving NDT are Acoustic Emission Testing, Thermography, Ultrasonic Testing, Eddy-Current testing, Radiography. This paper discusses and reviews the various types of Inspection Techniques in NDT and SHM.

Beta titanium (β-Ti) alloys have emerged over the last 3 to 4 decades as an important class of titanium alloys. Many of the applications that they found, particularly in aerospace sector, are such that their high cycle fatigue (HCF) behavior becomes critical. In HCF regime, crack nucleation accounts for major part of the life. Consequently it becomes important to understand the mechanisms underlying the nucleation of cracks under HCF type loading conditions. The purpose of this review is to document the best understanding we have on date on crack nucleation in β-Ti alloys under HCF conditions. Role of various microstructural features encountered in β-Ti alloys in influencing the crack nucleation under HCF conditions has been reviewed. It has been brought out that changes in processing can result in changes in microstructure which in turn influence the time for crack nucleation/fatigue life and fatigue limit. While majority of fatigue failures originate at the surface, subsurface cracking is not uncommon with β-Ti alloys and the factors leading to subsurface cracking have been discussed in this review.

BackgroundOpsoclonus–myoclonus–ataxia syndrome (OMAS) is characterised by the combination of opsoclonus and arrhythmic action myoclonus with axial ataxia and dysarthria. In adults, a majority are paraneoplastic secondary to solid organ tumours and could harbour antibodies against intracellular epitopes; however, certain proportions have detectable antibodies to various neuronal cell surface antigens. Anti-N-methyl-D-aspartate (NMDAR) antibodies and ovarian teratomas have been implicated in OMAS.MethodsReport of two cases and review of literature.ResultsTwo middle-aged women presented with subacute-onset, rapidly progressive OMAS and behavioural changes consistent with psychosis. The first patient had detectable antibodies to NMDAR in the cerebrospinal fluid (CSF) alone. Evaluation for ovarian teratoma was negative. The second patient had no detectable antibodies in serum or CSF; however, she had an underlying ovarian teratoma. Patient A was treated with pulse steroids, therapeutic plasma exchange (TPE) followed by bortezomib (BOR) and dexamethasone, while patient B was treated with steroids, TPE followed by surgical resection of ovarian teratoma. Both patients had favourable outcomes and were asymptomatic at the 6 monthly follow-up.ConclusionsWith coexistent neuropsychiatric manifestations, OMAS can be considered a distinct entity of autoimmune encephalitis, pathogenesis being immune activation against known/unknown neuronal cell surface antigens. The observation of absence of anti-NMDAR antibody in patients with teratoma-associated OMAS and vice versa is intriguing. Further research on the potential role of ovarian teratoma in evoking neuronal autoimmunity and its targets is required. The management challenge in both cases including the potential use of BOR has been highlighted.

Background: Autoimmune autonomic dysfunction is described in Myasthenia Gravis. In myasthenic crisis, the spectrum of autonomic dysfunction is hitherto uncharacterized. Objective: The objective of this study is to describe the spectrum of autonomic dysfunction in myasthenic crises using the composite autonomic symptom scale 31 (COMPASS 31) autonomic symptom questionnaire and power spectral analysis of heart rate variability (HRV), which is a simple way of estimating general autonomic dysfunction. Methods: Adult patients with myasthenic crisis from January 1, 2014 to March 15, 2015, were prospectively included in this study. The COMPASS 31 questionnaire for symptoms of autonomic dysfunction and power spectral analysis of HRV were assessed. These were compared with the patient's demographic and clinical parameters and with previous literature. IRB approval was obtained. Results: Sixteen patients were included (M:F 3:1). 15/16 patents (93%) had autonomic dysfunction on COMPASS 31 questionnaire. The domains of involvement were gastrointestinal (80%), orthostatic (67.7%), pupillomotor (67.7%); sudomotor (33.3%), and vasomotor (13.3%). Parasympathetic dysfunction predominance was suggested by the symptom profile. HRV analysis showed a low frequency (LF) spectral shift suggesting slowed parasympathetic responsiveness (LF normalized unit (nu): high frequency [HF] nu mean 8.35, standard deviation ± 5.4, 95% confidence interval 2.2-12.5), which significantly exceeded the mean LF nu: HF nu ratios of the majority of previously reported noncrises myasthenic populations. Conclusions: Myasthenic crisis has autonomic dysfunction involving multiple organ systems. Increased latency of parasympathetic reflexes is suggested. A comprehensive management protocol addressing different autonomic domains is required for holistic patient care.

18% Ni maraging steels are based on the Fe-Ni-Co-Mo system with low-carbon content. They display an excellent combination of high strength and high toughness. However, they suffer from a low fatigue ratio, the ratio decreasing monotonically with increasing strength. Considering prospective applications for these steels involving fatigue loading, attempts were made by researchers to improve their fatigue life. The studies suggest that fatigue strengths higher than those realized in peak aged condition can be obtained through controlled overaging with a small amount of reversed austenite playing a critical role. Corrosion fatigue in different environments is a serious problem with these steels. Double aging seems to reduce the susceptibility to corrosion fatigue under high humidity conditions. Inclusion content has a strong influence on the fatigue life, inclusion size and type playing an important role. Surface treatments such as shot peening, laser peening, and nitriding were found to improve the fatigue life; however, it is important to optimize the process parameters. This paper attempts a critical review of studies reported in the published literature aiming to improve the fatigue life of 18% Ni maraging steels.

Background: Osteoporosis and sarcopenia are important aspects of motor neuron disease (MND). Individuals with amyotrophic lateral sclerosis (MND-ALS) have an increased risk of falls and fractures. Currently, the standard of care does not involve a routine assessment of bone mineral density (BMD) and body composition in these patients. We aimed to assess BMD, bone mineral parameters and body composition in men with MND and compared them with healthy controls. Methods: Consecutive males between 50 and 80 years of age diagnosed as MND-ALS by revised El Escorial criteria and able to walk unassisted attending Neurology outpatient clinic were recruited into the study. Age, gender and body mass index (BMI) matched healthy controls were recruited from the local community. BMD and body composition were assessed by dual-energy x-ray absorptiometry (DXA). Bone mineral parameters and bone turnover markers (BTMs) were also assessed in them. Results: A total of 30 subjects with MND-ALS and 33 controls were recruited. The mean age (years) was 59.2 in cases and 61.2 in controls. The mean BMD (g/cm2) between the two groups was similar; however, BTMs were significantly higher in the MND group (P < 0.05). Subjects with MND-ALS had significantly lower mean appendicular lean mass (ALM) (19.9 versus 22.4 kg; P = 0.007) and ALM corrected for BMI than the healthy control group (0.858 versus 0.934 kg/kg/m2; P = 0.034). Sarcopenic obesity (Percentage fat mass >27% + ALM/BMI <0.786 kg/kg/m2) was more prevalent in MND-ALS compared to controls (44.5% versus 16.7%; P = 0.03). Conclusion: Although BMD was not significantly different between subjects with MND-ALS and healthy controls, BTMs were significantly higher in the MND group indicating a high bone turnover state. Sarcopenia and sarcopenic obesity were also more in MND-ALS group than controls. Routine assessment for bone health parameters and body composition indices may be included in management of the patients with MND.