Introduction Modified electroconvulsive therapy (MECT) is widely utilized for severe psychiatric disorders, with ongoing exploration of stimulus parameters to maximize efficacy. The pulse width in electroconvulsive therapy (ECT), specifically brief pulse (1.5 ms) versus ultra brief pulse (0.5 ms), may significantly influence clinical outcomes. However, comparative data on efficacy in rural Indian settings are limited. Our objective was to compare the clinical efficacy of brief and ultra brief pulse widths in bitemporal modified ECT in patients with severe psychiatric disorders. Methods: This prospective, randomized comparative study was conducted at a rural tertiary care hospital in Northern India. Sixty-six patients aged between 18 and 60 years, diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or severe depression, were randomly allocated to receive either brief or ultra brief pulse bitemporal MECT. Clinical efficacy was measured using standardized symptom rating scales including PANSS, BDI, YMRS, and CGI-S, administered pre- and post-treatment. Results: Both brief and ultra brief pulse width groups demonstrated comparable clinical efficacy across schizophrenia, schizoaffective disorder, bipolar disorder, and severe depression, with no statistically significant differences observed in symptom reduction between the two groups (p > 0.05). Conclusion: Brief and ultra brief pulse widths in bitemporal modified ECT exhibited similar clinical efficacy in the treatment of major psychiatric disorders. Given their equivalence in therapeutic outcomes, both pulse widths may be considered viable options for clinicians. Further studies with larger samples and diverse populations are recommended to reinforce these findings.

Introduction: Guillain Barre Syndrome or GBS is an acute immune mediated polyradiculoneuropathy which continues to be a serious problem worldwide ,causing respiratory insufficiency requiring mechanical ventilation in up to 30 percent of patients. This study aims to look at the clinico epidemiological profile and treatment outcome in GBS patients admitted in a tertiary level hospital in India. Methods: We conducted a retrospective study of adult patients with Guillain barre Syndome admitted at MOSC Hospital Kolenchery, Kerala, a tertiary care centre in south India, from January 2021 to January 2024. The case records of the study population were retrieved from medical records department and the clinical profile and outcomes were studied. Results: A total of 28 patients were recruited on the study of which 17 (61%) were male and 11 female. The mean age of the study population was found to be 50 years. A preceding history of infection was found in 68% of patients and included respiratory infections and gastroenteritis. Limb weakness was the most common symptom noted followed by sensory symptoms including pain and paraesthesiae in the extremities. Intravenous immunoglobulin was the most common treatment modality given in 65% of patients. The most common clinical variant was Acute Motor Axonal Neuropathy(AMAN) seen in 54% of patients followed by the demyelinating and bulbar onset forms. Ventilatory support was needed in 18% of patients and no cases of mortality were reported in the study population. Good treatment outcomes as calculated by the Hughes disability grading was achieved in 71 % of patients. Significant association was found between male sex and good outcomes. Conclusions: Guillain Barre syndrome affects patients of all ages with a male predominance and a preceding infection seen in the majority of patients. Axonal form of GBS is the most common variety seen and a good outcome is noted in the majority of patients.

Posterior reversible encephalopathy syndrome (PRES) is a relatively rare central nerve condition. Here, we report a case of PRES that developed during acute pancreatitis in a previously healthy man in his 40s. On the third day, his respiratory status worsened during management of acute pancreatitis, requiring sedated ventilatory support. During ventilator management, his blood pressure was well-controlled, and no electrolyte abnormalities were observed; however, the patient was in a state of marked systemic inflammation. On the 12th day, after improvement in acute pancreatitis and respiratory status, with discontinuation of mechanical ventilation, the patient presented with mild disturbance of consciousness and visual field disturbance. Magnetic resonance imaging (MRI) showed diffuse vasogenic cerebral edema, mainly in the bilateral occipital and parietal white matter. The patient was provisionally diagnosed with PRES and was administered oral verapamil, along with supportive care. On the 23rd day, his neurological symptoms disappeared. Cerebral edema completely disappeared on MRI four months later. In the present case, it was speculated that endothelial dysfunction secondary to the severe inflammatory state accompanying acute pancreatitis caused PRES.

Substance use disorder (SUD) remains a deeply entrenched public health challenge in Nepal. Despite advances in understanding addiction as a chronic medical condition, the national response continues to be shaped by cultural taboo, inadequate treatment models, and insufficient pathways for societal reintegration. This editorial argues that unless Nepal transitions from punitive and institutional approaches to a rights‑based, evidence‑driven model, the cycle of relapse, stigma, and marginalization will persist.

Cerebral venous thrombosis (CVT) is one of the rarest causes of stroke in general population, where thrombosis occurs in cerebral venous system. Treatment of CVT is mainly done by heparin followed by vitamin K antagonist. Direct oral anticoagulants are introduced which are safe and effective against traditional therapy, however recent protocol do not recommend. A 22 year-male came to emergency department with chief complaints of severe headache, multiple episodes of vomiting and 2- 3 episodes of loose stool for 3 days. He had two episodes of abnormal body movement in emergency department. Computed tomography (CT) scan of head and then CT venography of head also were done after admission that reported venous thrombosis in superior sagittal sinus, bilateral transverse sinus and internal cerebral vein. Patient was admitted and treated with direct oral anticoagulant (rivaroxaban). He was discharged on 8th day of admission without any neurological deficits.

The peripartum period, covering late pregnancy through postpartum, brings significant changes that increase the risk of neurological disorders such as cortical vein thrombosis (CVT), osmotic demyelination syndrome (ODS), pituitary apoplexy, postpartum cerebral angiopathy (PCA), posterior reversible encephalopathy syndrome (PRES), and intracranial hypotension (IH). Accurate diagnosis relies heavily on MRI and CT, with MRI being especially useful for its detailed images. CVT often presents with severe headaches and seizures, detected on MRI through characteristic signs like the “empty delta sign.” ODS, linked to the rapid correction of low sodium levels, appears as T2 hyperintense lesions at specific locations. Pituitary apoplexy, involving sudden hemorrhage within a pituitary adenoma, typically requires high-dose corticosteroids and, in severe cases, surgery. PCA results from hormonal changes and shows as transient artery narrowing on MR angiography, managed with supportive care. PRES, associated with high blood pressure disorders, manifests as vasogenic brain edema, treated by managing blood pressure. IH, often seen after a dural puncture, leads to positional headaches and shows brain sagging on MRI, with treatments ranging from rest to epidural blood patches. Recognizing these imaging patterns is critical for timely diagnosis and effective treatment, ultimately enhancing outcomes for mothers & preventing peripartum morbidity & mortality.

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.