Introduction: Echinococcosis also known as hydatid disease is an endemic zoonotic disease with an estimate of 2,00,000 new cases per year worldwide. Its primary definitive host is dog and man being an accidental intermediate host. The most common organ affected is liver, brain, and spine. Surgery is the mainstay of treatment and medical management is reserved for selected cases. Our Objective was to retrospectively evaluate the prevalence of craniospinal hydatid cyst disease in southern Rajasthan. Materials and method: A retrospective analysis of all cases of craniospinal hydatid disease managed at our department was done from 2013 to 2021 and data was analysed. Results: A total number of eight cases were reported with an incidence of 1.8% of all craniospinal space-occupying lesions during the study period with a male to female ratio of 3:1, mean age of presentation 18.5 years, four out of eight patients were in paediatrics age group. All cases were managed surgically with preoperative rupture in one case and recurrence in two cases. Albendazole was given to cases only with rupture or recurrence. Conclusions: Craniospinal hydatid disease should be suspected in all non-enhancing cystic brain lesions especially in endemic regions. In all patients, surgical excision should be done preferably with medical management reserved for inaccessible lesions, unfit patients, rupture and recurrent cases only. The study concludes that primary surgery with gross total excision with no or minimal spillage of cyst content intraoperatively has good results with recurrence rate of only 12.5%.

Introduction: Meningioma is the most common type of benign intracranial tumor, representing nearly one-third of the primary brain tumors. Supratentorial convexity meningiomas are the most amenable to gross total resection owing to their favorable location and operative outcome. Despite the resection and radiological cure, a significant number of patients continue to face troubling postoperative conditions, which include cognitive dysfunction, emotional disturbances, fatigue, and deficits in various social and work activities. These functional and psychosocial outcomes, particularly postoperative QoL, remain scantily documented in the literature. So, a comprehensive evaluation of postoperative QoL is essential to understand the broader impact of the disease and its treatment on patient well-being, and to guide holistic, patient-centered care beyond tumor removal. This study aims to evaluate the quality of life (QoL) in patients with supratentorial convexity meningiomas who have undergone total excision, and to compare their outcomes with those of healthy controls. Material & Methods: A prospective observational study was conducted. Thirty patients with radiologically confirmed total excision of supratentorial convexity meningiomas were evaluated at 3 months post-surgery. QoL was assessed using SF-36 and Lawton’s IADL scale. Thirty cases were taken as a control. Statistical analysis was done. Results: The cases demonstrated significantly reduced scores in SF-36 domains, including physical functioning, role limitations (physical and emotional), social functioning, pain, and general health (p<0.05). Fatigue and emotional well-being did not differ significantly. IADL scores were also significantly lower in patients, indicating compromised functional independence. Conclusion: Despite complete excision, patients with supratentorial convexity meningiomas often continue to experience impairments across multiple quality of life (QoL) domains. These findings highlight the need for comprehensive follow-up care that includes psychosocial support, cognitive rehabilitation, and targeted symptom management.

Dysferlinopathies are rare autosomal recessive muscular disorders with varying phenotypes, including Miyoshi Myopathy (MM) and Limb-Girdle Muscular Dystrophy type 2B (LGMD2B). They result from mutations in the DYSF gene, which encodes dysferlin, a protein crucial for sarcolemmal repair. Diagnosis can be challenging due to clinical variability, necessitating genetic testing. We present the case of an 18-year-old girl with progressive lower limb weakness and elevated creatine kinase levels, who was ultimately diagnosed through genetic analysis. This case emphasizes the importance of genetic testing for accurate diagnosis, improved patient care, and appropriate genetic counseling.

This letter to the editor critiques the study “Postoperative Functional Outcomes in Patients with Highly Migrated Cervical Disc Prolapse” by Periyasamy et al., highlighting its contributions and limitations. While the study provides valuable insights into a rare and complex spinal condition and supports anterior cervical corpectomy and fusion (ACCF) as a treatment option, several methodological issues are noted. These include the small retrospective sample, absence of a comparative surgical arm, omission of patient-reported outcome measures, insufficient follow-up for late complications, and lack of subgroup analysis. Additionally, minimally invasive alternatives receive limited discussion despite potential advantages. The letter emphasizes the need for prospective, controlled studies incorporating PROMs, stratified analyses, and extended follow-up to better define optimal surgical strategies for highly migrated cervical disc prolapse.

IntroductionMedical education is known for its demanding nature and intense academic pressures, often leading to elevated levels of psychological distress among students. Depression, anxiety, and stress are commonly reported mental health concerns that may adversely impact academic performance. This study aimed to assess the prevalence and severity of these psychological parameters among MBBS students and examine their correlation with academic functioning. MethodsA descriptive cross-sectional study was conducted over 18 months at a tertiary care teaching hospital in Sitapur, Uttar Pradesh. A total of 384 MBBS students from all academic years were enrolled using convenient cluster sampling. Data were collected through a self-administered questionnaire including a semi-structured socio-demographic proforma, the DASS-42 for assessing depression, anxiety, and stress, and the Academic Performance Scale (APS). Diagnoses were clinically validated using ICD-10 criteria. Statistical analysis was performed using SPSS v26, employing chi-square tests and multivariate logistic regression. ResultsThe prevalence of depression, anxiety, and stress among participants was found to be 32.0%, 38.0%, and 45.0%, respectively. Severity analysis revealed that a significant proportion of students experienced moderate to extremely severe symptoms. A statistically significant inverse relationship was observed between the severity of depression, anxiety, and stress and academic performance (p < 0.001 for depression, p = 0.001 for anxiety, and p = 0.003 for stress). Logistic regression identified moderate to severe depression (AOR: 2.63), anxiety (AOR: 2.35), and stress (AOR: 1.92) as independent predictors of poor academic outcomes. ConclusionA substantial proportion of MBBS students suffer from psychological distress, which significantly affects their academic performance. These findings underscore the need for routine mental health screening, accessible counseling services, and structured wellness programs within medical institutions to promote emotional resilience and academic success.

Introduction: Dystonia is a movement disorder characterized by involuntary, sustained, and patterned muscle contractions, which cause twisting and repetitive movements. Dystonia includes various types of movement disorders such as cervical, generalized, task specific focal hand dystonia. Several potential stereotactic targets have been suggested for the treatment of dystonia such as GPi and PTT. Materials and methods: All the patients of generalized dystonia who underwent surgical interventions in Annapurna Neurological Institute and Allied Sciences since January 2015 till December 2023 were included in our study. We performed unilateral pallidotomy/ pallidothalamic tractotomy for cervical dystonia and bilateral pallidotomies or unilateral pallidotomy and contralateral pallidothalamic tractotomy for generalized dystonia. We used ZD Fishers frame and the thermal lesioning machine of Cosman Radiofrequency (RF) generator with the lesioning electrode of 0.75 mm internal diameter and 2 mm exposed tip was used. Results: There were altogether 16 cases of generalized dystonia. There was overall 70 percent decrease in the symptoms of dystonia. The mean age was 41.49 years±12 years. The male: female ratio was 3:1. The mean percentage change in BFMDRS was 70 percent (p value<0.05) in postoperative period. There was relapse of symptoms in 3 cases of generalized dystonia. One case of tardive dystonia with repeated bilateral pallidotomy had status dystonicus and finally she got better with intrathecal baclofen pump. One case had transient hemiparesis, three cases had transient dysarthria and two cases had dysphagia. Conclusion: Lesioning surgery is quite rewarding for generalized dystonia. However, tardive dystonia and some cases of generalized dystonias have higher relapse rate. Recurrent cases may need DBS or further potential targets. Unilateral PTT and contralateral Gpi lesioning in generalised dystonia is rewarding.

Background: Traumatic Brain Injury (TBI) is a medical and surgical disease of major importance globally. Prognostic models are useful for making decisions in the clinical practice. The aim of this study was to assess the accuracy of International Mission for Prognosis and Analysis of Clinical Trials in TBI(IMPACT) score in predicting outcome in moderate to severe TBI in 6 months. Methods: All patients admitted to Tribhuvan University Teaching Hospital (TUTH) with moderate to severe TBI from April 2019 to February 2020were included in the study. IMPACT scores (core/extended core/ lab) were recorded separately at admission.Outcome was measured with Glasgow Outcome Scale (GOS)at the time of discharge and in six months.Correlation between observed and predicted outcomes was evaluatedbyPearson’s correlation coefficient (r). Sensitivity and specificity were plotted in the receiver-operating characteristic (ROC)curve, and the area under the curve (AUC) was calculated to determine the discrimination ability of this prognostic model. Results: A total of 139 patients were enrolled in the study. Twenty-four (17.3%) patients died within 6 months of TBI, and 40 (28.8%) patients had an unfavorable outcome.Pearson correlation coefficient showed good correlation between observed and predicted outcomes.The ROC curve indicated that all 3 models could accurately discriminate between favorable and unfavorable outcomes, as well as between survival and mortality(unfavorable outcome AUC= 0.905, 0.940, 0.955; mortality AUC= 0.875, 0.914, 0.917 respectively) in our patient population. Conclusions: The IMPACT score is a good prognosticmodel to predict 6-month outcomesin moderate to severeTBI at admission in Nepalese patient population.

Background: Carpal tunnel syndrome is the most common entrapment neuropathy and has a substantial impact on occupational performance and quality of life. Carpal tunnel release is the standard treatment for moderate to severe cases, but the influence of symptom chronicity on surgical outcomes is not well established. Objective: To assess the association between symptom chronicity and functional outcomes, patient satisfaction, return to work, and complication rates following carpal tunnel release at a tertiary care center. Methods: This prospective observational study included fifty patients undergoing carpal tunnel release. Participants were stratified into three groups according to duration of symptoms: less than six months, six to twelve months, and more than twelve months. Functional outcomes were measured using the Boston Carpal Tunnel Questionnaire before and six months after surgery. Patient satisfaction was assessed with the Patient Global Impression of Improvement scale. Electrophysiological recovery, complication rates, and time to return to work were also analyzed. Results: Patients with symptom duration less than six months showed the greatest improvement in functional scores, highest satisfaction, and shortest return to work time. Longer symptom duration was associated with higher preoperative severity, lower postoperative satisfaction, slower recovery, and more complications. Electrophysiological improvement was observed across all groups but was most pronounced in patients with shorter symptom duration. Conclusion: Symptom chronicity significantly influences outcomes after carpal tunnel release. Early surgical intervention within six months of symptom onset results in better recovery, greater satisfaction, fewer complications, and faster return to work.

Introduction: Traumatic brain injury (TBI) lead significant morbidity and mortality with common causes including motor vehicle accidents, falls, assaults and sports injuries. Objective: Quantify extradural hemorrhage volume in traumatic head injuries and evaluate its impact on brain parenchyma and clinical decision-making. Methods: A prospective observational study was conducted at Jubilee Mission Medical College, Kerala over 18 months including 50 patients with CT-confirmed EDH. Data were analysed to assess their impact of EDH volume on brain parenchymal changes and treatment decisions. Statistical analyses included descriptive statistics, correlation coefficients, unpaired t-tests, ANOVA and chi-square tests. Results: In the study, 70% of the patients were male averaging 45 years old and 70% of injuries resulted from motor vehicle accidents. Larger volumes of EDH are linked to midline shift (16.5cc), cerebral edema (17.5cc), cerebral herniation (18cc) and basal cistern compression (20cc). Conservative management was the predominant approach with 45 cases (90%) treated conservatively compared to 5 cases receiving surgical intervention. EDH volume showed moderate sensitivity (73.3%) and high specificity (80.0%) meaning that approximately 80% of patients with large EDH volumes were accurately identified as needing surgical treatment with high positive predictive value (PPV) of 97.1% and low negative predictive value (NPV) of 25.0%. Conclusion: Larger EDH volumes correlate with more severe clinical outcomes, influencing the need for surgical intervention. However, the predictive capacity of EDH volume alone is limited, suggesting the need for a comprehensive approach including advanced imaging.

Introduction: Chronic subdural hematoma (cSDH) presents a significant neurosurgical challenge, particularly in elderly patients and those with predisposing factors such as chronic alcohol consumption or coagulopathies. While burr-hole evacuation is the standard surgical technique, alternative approaches exist. The cSDH score, incorporating variables such as age, Glasgow Coma Scale (GCS), hematoma thickness, midline shift, motor function, and orientation, offers a comprehensive assessment tool. This study aims to evaluate the cSDH score's predictive ability for outcomes in chronic SDH patients using the Modified Rankin Scale (mRS) at discharge and after six months. Methods: Patients diagnosed with unilateral chronic subdural hematoma at Tribhuvan University Teaching Hospital between December 2019 and April 2021 were included. Data on cSDH score variables were collected at admission, and outcomes were assessed using mRS at discharge and after six months. Analysis included receiver-operating characteristic (ROC) curve to evaluate discrimination ability and analysis of variance to assess predictive variables. Results: The study comprised 74 patients, with headache being the most common presentation. At discharge, fifty-five patients (74.3%) of patients had favorable outcomes, increasing to fifty-six patients (75.7%) after six months. Analysis indicated associations between preoperative GCS, age, hematoma thickness, midline shift, motor function, orientation, and unfavorable mRS outcomes. ROC analysis demonstrated excellent discrimination ability of the cSDH score, with AUCs of 0.936 at discharge and 0.948 after six months. Conclusion: The cSDH score proves valuable in predicting outcomes for chronic subdural hematoma patients. However, largermulticenter studies are needed to validate the predictive ability of the score in patients with chronic subdural hematoma.