Explore the vast range of titles available.

Landslide and related mass movement activities are common and one of the most destructive natural hazards in the mountainous terrain including the Himalayas. Of the 11 administrative states in the Indian Himalayan region, the state of Uttarakhand has witnessed enhanced activities of these phenomena. It is therefore essential to understand the regional scale landslide susceptibility assessment of the state and in the present study, landslide susceptibility mapping for the entire state has been carried out using bivariate weight of evidence and information value methods which depict that around 51% of the area is located in the high and very high landslide susceptible zones, 22–23% in the moderate and ~26–27% in the low and very low landslide susceptible zones, and slopes ranging between 40° and 60°, located at an elevation of 2000–4000 m, facing towards southern sides and covered with limestone, gneiss, quartzite and phyllite, have higher propensity towards development of landslides in the region.

In the present work, geological, geotechnical, and ground penetration radar studies were carried out along the Mansa Devi hill bypass (MDHB) road Uttarakhand, India in order to assess the slope instability conditions. Seven unstable zones along the entire MDHB road were identified which are prone to landslides. Geologically, the area is composed of mudstone and sandstone with thick overburden constituting sandy soil. The laboratory tests were carried out in order to evaluate the geo-mechanical characterization of soil, sandstone, and mudstone that constitute the slopes. The laboratory tests reveal that the slope is comprised of soil characterized by high permeability and low strength values. The soil is mainly sandy and non-cohesive. The laboratory tests on sandstone reveal that fresh sandstone exhibits exceptionally higher value of unconfined compressive strength (> 100 MPa) than the weathered sandstone (< 35 MPa). The mudstone is non-durable and contains considerable amount of expanded clay minerals which has a tendency to expand in the presence of water. It can weather easily and facilitate instability at shallow depth. A ground penetrating radar survey confirmed that the road is unstable particularly on those spots where the road either lying over mudstone beds or over thick non-cohesive sandy soil. The infiltration rate of water in this sandy soil is generally rapid which allows fast flow of water into the deeper horizons and thus cracks can be seen in road caused by vertical settlement. Similar results are observed in slope stability analysis where the slope covered with sandy soil exhibits factor of safety less than 1.0. However factor of safety is close to 1 where the slopes consist of alternate beds of sandstone and mudstone.

Wilson's disease is a genetic disorder characterized by abnormal accumulation of copper in the brain, liver, eye, and kidney. Various neuropsychiatric manifestations such as dystonia, parkinsonism, choreoathetosis, tremor, ataxia, personality disorders, mood changes, psychosis, cognitive abnormalities, sleep disorders, dystonia, tremor, ataxia, and seizures are known to occur in Wilson's disease. Status epilepticus is a very rare presentation of this disease. Here, we present a case of Wilson's disease occurring in an adolescent, who presented with refractory convulsive status epilepticus. His magnetic resonance imaging of the brain showed bilateral external capsular hyper intensities, with only subtle changes in other brain areas and the only clue to the presence of Wilson's disease was the presence of mildly deranged hepatic enzymes. The 24-h-urinary copper levels were subsequently found to be elevated in this patient.

Background: Cerebrospinal fluid (CSF) Xpert MTB/RIF assay is an initial test for the diagnosis of tuberculous meningitis (TBM). Nevertheless, it is not very clear which of the factors govern CSF-Gene Xpert/MTB positivity. Objective: Hence, we aimed to assess the relationship, if any, between the clinical, laboratory and radiological parameters of the central nervous system (CNS) tuberculosis patients and the Gene Xpert study in CSF in such patients. Methods and Material: First, we studied 200 patients with CNS tuberculosis according to the case definition, and subsequently, we performed a Gene Xpert study on the CSF of these patients. Then, we correlated the clinical, radiological, and CSF criteria with the Gene Xpert positivity using the univariate binary logistic regression method via SPSS 20 (P-value <0.05). Results: Seventy-five (37.5%) patients (57.3% females) of median 24 years of age, were CSF-Gene Xpert/MTB-positive and 125 (62.5%) patients were negative. The mean duration of illness (P = 0.017), weight loss or failure to thrive (P < 0.001), loss of consciousness or seizure (P = 0.001), signs of meningeal irritation (P = 0.027), stage III of TBM (P < 0.001), evidence of dissemination (P = 0.003), basal exudates (P = 0.004), hydrocephalus (P = 0.018), CSF lymphocytic predominance (P < 0.001), and reduced CSF glucose (P = 0.011) correlated significantly with positive the Gene Xpert/MTB results. Also, Gene Xpert had a sensitivity of 80% and a specificity of 74.84% against culture Xpert. Conclusions: Xpert MTB/RIF might be more useful in the later stages of the disease and those with more severe disease.

•No single MRI feature can independently diagnose MSA.•Hyperintense lateral putaminal rim and “hot cross bun sign” were rare.•“Morning glory sign”, corpus callosum atrophy and cerebellar atrophy were common.•Common MRI features were found in more than two-thirds of MSA patients. Rarity of specific MRI features like ‘hot-cross bun’ sign and ‘hyperintense putamen rim’ reduce diagnostic utility of MRI in MSA. We therefore, studied some non-specific MRI features in addition to the specific ones, to find their diagnostic utility. Clinical and MRI features of 53 indoor and outdoor patients with MSA were analyzed in the context of its Parkinsonian (MSA-P) and cerebellar (MSA-C) variants. Of 53 cases (mean age: 59.53±9.74years), 16 (30.2%) had MSA-C and 37 (69.8%) had MSA-P. Midbrain atrophy was found in 37 (69.8%) MSA patients (70.3% of MSA-P and 68.8% of MSA-C), cerebellar atrophy in 45 (84.9%) MSA patients (81.1% of MSA-P and 93.8% of MSA-C), ‘hot-cross bun’ sign in 13 (24.5%) MSA patients (27% of MSA-P and 18.8% of MSA-C), hyperintense putamen rim in 19 (35.8%) MSA patients (37.8% of MSA-P and 31.3% of MSA-C) and corpus callosal atrophy in 39 (73.6%) MSA patients (75.7% of MSA-P and 68.8% MSA-C). The midbrain atrophy was mainly lateral tegmental and resembled a positive ‘Morning glory’ sign in 16 (30.2%). “Hot cross bun” sign and “hyperintense putamen rim” sign were rarely seen in MSA. Combination of mid brain atrophy, corpus callosum atrophy and cerebellar atrophy was more commonly observed in both MSA-C and MSA-P and may be taken as of diagnostic significance.

Garhwal Himalaya has witnessed extreme climatic conditions in the form of incessant rainfall during June 15–17, 2013, generating numerous primary as well as secondary landslide hazards due to flooding event in the Bhagirathi River. This was probably the second highest flood after the 1978 flood in the area. The paper documents the spatial distribution of landslides and its consequences in the lower reaches of the Bhagirathi Valley between Bhatwari and Uttarkashi. It has been observed that within a stretch of 28 km in the study area, the river gradient is highly variable ranging from 3.6 to 66.6 m/km and is marked by three major knick points. These knick points are well correlated with the disposition of thrusts and a fault present in the area. An inventory of 23 active landslides has been prepared. Based on these knick points, the entire area has been divided into four zones. The area between Bhatwari and Ganeshpur is marked by the zone of transportation and between Ganeshpur and Uttarkashi, the zone of deposition of river sediments. It has been estimated that there is an average aggradation of about 0.5 m/year in the Bhagirathi River around Uttarkashi. Further, the huge volume of material deposited in the river around Uttarkashi township is posing serious threat to the slope stability on either banks of river. This calls for an urgent need for the formulation of policy for dredging the material from riverbed in order to maintain the continuous and uninterrupted flow of water during high discharge, in order to mitigate the problems of slope stability along the course of the river.

BackgroundAim of the observational study was to assess which of the gait and balance parameters are most affected in Parkinson-plus syndromes patients with falling tendencies as compared to healthy individuals. MethodsAuthors studied levodopa-responsive patients of multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) who had falling tendencies early in the disease and healthy controls and evaluated the spatiotemporal gait parameters using BTS G WALK and balance parameters by Limits of Stability test on BIODEX Balance system SD in the Gait and Motion Analysis Lab.ResultsIn comparison to controls, Parkinson-plus syndromes patients had significantly different gait and balance parameters, apart from stride time and stance time, pelvic obliquity and pelvic tilt, cadence, hip abduction–adduction and hip rotation, foot progression, gait profile score, gait variable hip abduction–adduction, rotation, gait variable flexion–extension and gait deviation index (p-values < 0.05). Also, in comparison to MSA patients, PSP patients had significantly greater values of all static parameters except for swing time, step width, pelvic tilt and rotation, hip rotation and ankle dorsiflexion-plantarflexion, gait profile score of right limbs and all gait variable parameters except for pelvic tilt and hip flexion–extension, foot progression and gait deviation index of right limb. However, balance parameters were similar in MSA and PSP. Duration of disease and duration since falls may not significantly affect gait and balance parameters in Parkinson-plus syndromes patients.ConclusionsHence, gait differentiates between Parkinson-plus patients and healthy controls and between MSA and PSP patients with falling tendencies and gait and balance parameters may also help in planning rehabilitative strategies.

Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain-Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection.

Coronavirus disease (COVID-19) was a pandemic with many physical, psychological, and socioeconomic effects. COVID-19 caused a global increase in anxiety and depression because of its novelty, high infectivity, varied presentation, and unpredictable mortality. In the face of collapsing healthcare facilities, monetary setbacks, and loneliness because of lockdowns, people were anxious, and this was compounded by media sensationalism. We aimed to study the psychosocial impact of COVID-19 on the adult Indian population. An online survey using SurveyMonkey was floated through WhatsApp messages in April 2020, using the 'chain-referral sampling' method. Responses from individuals >18 years were included, and questions included age, sex, occupation, demographics, and socioeconomic conditions. The prevalence of anxiety and depression was assessed using the Generalized Anxiety Disorder (GAD-7) and the Patient Health Questionnaire (PHQ-9) scales. Data was analyzed using IBM SPSS software, and predictors of anxiety and depression were assessed. A total of 2640 responses from individuals between 18 years and 81 years were analyzed, of which 39% were from females and 85% from those <50 years of age. There were students (15.6%), teachers (10.7%), healthcare workers (16.8%), homemakers (9%), and daily wage laborers (4.1%), among others. Nearly 80% lived in cities, 55% had salaried jobs, 37% were working from home, 22% were temporarily unemployed, 10% were feeling work stress, 11% had increased alcohol intake, and 7.5% saw an increase in domestic violence. The income of 50% was adversely affected. Nearly 50% of our respondents had some symptoms of anxiety, and 23% had significant anxiety (GAD ≥5). The presence of anxiety was significantly higher in females, younger adults, city dwellers, healthcare workers, unemployed people, individuals living away from home, those without fixed salaries, those with work stress, and in people whose incomes had been adversely affected by the pandemic. On logistic regression analysis, female sex, younger age, unemployment, lack of salaried jobs, work stress, being a healthcare worker, and media reports were independent predictors of anxiety. About 60% of our respondents had some symptoms of depression, with 26% having significant depression (PHQ-9 ≥5). The presence of depression was significantly higher in females, younger adults, city dwellers, unemployed people, individuals living away from home without fixed salaries, and people with work stress. On logistic regression analysis, younger age, female sex, unemployment, lack of salaried jobs, work stress, and media reports were independent predictors of depression. Among our respondents, 70% used the time during the lockdown to study, 77% caught up with their families, and 56% reconnected with hobbies. Nearly 88% of our respondents had adjusted to their changing circumstances, helped by their religious beliefs and faith, the support of family and friends, good government measures, and the assurance of healthcare.  Significant anxiety and depression were seen in 23% and 26% of respondents, respectively. Being a healthcare worker was an independent predictor of anxiety. Female sex, younger age, unemployment, work stress, and sensational media reports were independent predictors of both anxiety and depression.