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Biomedical subjects

V N Mishra

Publications and source records attributed to V N Mishra.

At least 19 recordsLinked to original sources
PubMed2006

Effect of neck flexion on F wave, somatosensory evoked potentials, and magnetic resonance imaging in Hirayama disease.

BACKGROUND: Flexion myelopathy is one of the suggested mechanism for Hirayama disease (HD) but simultaneous radiological and neurophysiological evaluation is lacking. This study therefore evaluates the effect of neck flexion in HD using somatosensory evoked potentials (SEPs), F waves, and magnetic resonance imaging (MRI). METHOD: Eight HD patients and seven matched controls were subjected to median and ulnar F wave (minimal latency, FM ratio, persistence, and chronodispersion), and SEPs evaluating N9, N13, and N20 potentials in neutral and neck flexion. Spinal MRI was carried out in neutral and neck flexion and evaluated for cord atrophy, signal changes, cord compression, posterior epidural tissue, and loss of dural attachment. RESULTS: The patients were aged 19 to 30 years. Minimal F latency, FM ratio, persistence, and chronodispersion in neutral and neck flexion did not show any change nor was there any change in N13 latency and amplitude on median and ulnar SEPs. The difference in these parameters in neutral and neck flexion were also not significant in HD compared with controls. The change in N13 was also not related to loss of dural attachment and posterior epidural tissue. CONCLUSION: Neck flexion does not produce significant changes in N13 and F wave parameters and is not related to dynamic MRI changes. The other mechanisms for HD should therefore be explored.

Action Potentials↗
PubMed2005

A clinical, magnetic resonance imaging, and survival motor neuron gene deletion study of Hirayama disease.

BACKGROUND: Hirayama disease (HD) is a segmental nonprogressive spinal muscular atrophy found in male patients. OBJECTIVE: To report the results of a comprehensive evaluation of clinical, magnetic resonance imaging (MRI), electromyography (EMG), and survival motor neuron (SMN) gene analysis of HD. DESIGN: Clinical, MRI, and SMN gene deletion study. SETTING: Tertiary care teaching hospital. PATIENTS: Patients with HD diagnosed according to defined criteria were included in the study. INTERVENTIONS: Patients underwent a neurologic evaluation and pedigree charting. Concentric needle EMG was performed on a number of muscles. Motor nerve conduction study of the median, ulnar, and peroneal nerves and sensory conduction study of the median, ulnar, and sural nerves were also performed. Spinal MRI of the cervical region was performed with the 2-T scanner operating at 1.5 T. Gene deletion study of SMN1 and SMN2 was performed in all patients. MAIN OUTCOME MEASURES: History of trauma, occupation, exercise, associated medical disease, and cold paresis and muscle wasting, power, reflex changes, and tone. RESULTS: Fifteen male patients with HD from 14 families participated in the study (mean age at the onset of disease, 18 years; range, 15-23 years). Muscle weakness and wasting were noted in the right upper limb in 12 and the left upper limb in 3, which became bilateral in 8 patients. Cold paresis was present in 6 patients and polyminimyoclonus in all patients. The EMG revealed fibrillations in 10, fasciculations in 15, and neurogenic motor unit potentials in C7, C8, and T1 myotomes in all patients. The EMG abnormalities were unilateral in 5, bilateral in 10, and subclinical in 2 patients. Spinal MRI revealed cord atrophy in 3 of 11 patients. Although family history was present in 1 brother only, the results of both SMN1 and SMN2 gene deletion studies were negative in all patients. CONCLUSIONS: The SMN gene deletion is not found in HD. Exclusive occurrence in male patients and the presence of this disease in 2 brothers suggest a possible role of the X chromosome, which needs further evaluation.

Adolescent↗
PubMed2004

A central demyelinating disease with atypical features.

There are clinical, laboratory and imaging criteria to distinguish multiple sclerosis (MS) from neuromyelitis optica (NMO) and acute disseminated encephalomyelitis (ADEM). While MS has unknown aetiology, NMO is commonly associated with vasculitis and ADEM is supposed to be parainfectious in origin. In the present study, six patients are described from a group of 67 with a central demyelinating disorder whose clinical presentation did not conform to existing diagnostic criteria for ADEM, NMO or MS. Their clinical, laboratory and imaging characteristics were studied and analysed. Some features suggested a particular diagnosis but some other features favoured another diagnosis. The features included spinal cord involvement in a large vertical segment with cord swelling, optic neuritis, no lesions in the cerebral cortex, paraplegia with urinary retention during the acute phase, no oligoclonal band in cerebrospinal fluid, absence of any evidence of vasculitis, wide time-gap between spinal cord and optic nerve involvement, good recovery from acute phase of disease and a relatively benign course. We conclude that there exists a subpopulation of patients with central demyelinating disease in this region with mixed clinical features. Overall features suggested either a widened clinical spectrum of MS, NMO or ADEM or a possible overlap between them.

Adolescent↗
PubMed2002

Clinicoradiological observation in three patients with suicidal hanging.

STUDY DESIGN: A hospital-based clinical, radiological and neurophysiological study. OBJECTIVES: Hanging is a common mode of suicide in India, but there is paucity of MRI and neurophysiological findings in the context of clinical and neurological changes. We report the clinical, neurophysiological and MRI studies of three females who attempted suicide by hanging. METHODS: All three patients who attempted hanging underwent detailed clinical, electroencephalographic, motor, somatosensory and brainstem-evoked potential and magnetic resonance imaging studies. Patients were clinically followed up for 6 months. RESULTS: Their ages were 21, 26 and 35 years. They developed altered sensorium, decorticate posturing and had a wide variety of movement disorders. Patient no. 1 had the most severe illness and recovered by the seventh month while the others recovered earlier. MRI revealed hyperintense signal changes in the globus pallidus, caudate nucleus and thalamus in all patients and in the midbrain in one patient. Electroencephalography showed nonspecific slowing. Somatosensory, motor and brainstem-evoked potential studies were normal. CONCLUSION: Hanging leads to hypoxic brain damage resulting in signal changes mainly in the basal ganglia and thalamus and may be associated with transient movement disorders.

Adult↗
PubMed2002

Pitfalls in diagnosis of epilepsy of Janz and its implications.

84 patients of juvenile myoclonic epilepsy (JME) of Janz were studied. Diagnosis was confirmed using clinical and electro-encephalographic (EEG) criterias. 58 (78%) patients of JME were referred as 'refractory or uncontrolled seizures'. Ignoring myoclonic episodes and non-use of activation procedures in EEG were important reasons for diagnostic delay. Sodium valproate (VPA) or clonazepam are the drugs of choice while phenobarbitone (PB), carbamazepine (CZ), and phenytoin (PHT) are ineffective. Clinical spectrum of JME is slightly different in India. Family history of epilepsy or JME is not forthcoming and there is gross delay in the diagnosis. Other differences include age of presentation and mild cognitive impairment. All juvenile patients of generalized epilepsy, not responding to more commonly used CZ, PB and PHT should be strongly suspected for JME by carefully searching for myoclonus.

Adolescent↗
PubMed2001

Effect of common anti-epileptic drugs on cognition in schoolchildren with epilepsy.

This study was conducted to observe the effect of some commonly used anti-epileptic drugs (AEDs), on cognition, in 118 school going children with epilepsy, in an age range of 9-12 yrs., (Mean 10.4 +/- 1.7 yrs.). For comparison, 28 healthy, age and sex matched schoolchildren served as controls. After a clinical, electrophysiological and radiological evaluation, the cognitive functions were assessed in both groups, using a modified Wechsler's Intelligence Scale. It was observed that cognition was impaired in only 2.5% of children with epilepsy, there being no relationship between cognitive performance and the type of AED used. It is concluded that cognitive functions are impaired in only a limited number of children with epilepsy and effect of phenobarbitone and phenytoin on cognitive functions is comparable to carbamazepine and sodium valproate, particularly when demand of task is not very high.

Anticonvulsants↗
PubMed1993

Neonatal mortality in Meerut district.

A study of neonatal mortality in Meerut district revealed an infant mortality rate of 50.1 per 1000 live births. Neonatal mortality accounted for 37.8% of infant mortality with a neonatal mortality rate of 19.0 per 1000 live births. 90.5% of these neonates were delivered at home largely by untrained personnel (57.2%). Only 28.6% of these neonates were treated by qualified doctors and only 30.9% of their mothers were fully immunized against tetanus. At least 2/3rd of neonatal mortality was due to exogenous factors with tetanus neonatorum and septicaemia being the principal causes of mortality each accounting for a mortality rate of 4.7 per 1000 live births.

Cause of Death↗
PubMed1990

Respiratory disorders in females of Delhi.

A retrospective study was carried out on 1532 female patients attending chest clinic, over a period of 13 years. The incidence of smoking was found to be 6.6%, maximum incidence (17%) being in those above 60 years of age. High incidence (66%) of exposure to kitchen smoke was observed in women above 40 years of age. Chronic bronchitis was found to be the commonest illness followed by bronchial asthma, pulmonary tuberculosis and bronchiectasis. Bronchial asthma and pulmonary tuberculosis were common in younger age groups, while above the age of 40 years 42% patients had chronic bronchitis and 27% had bronchiectasis. Incidence of smoking and exposure to kitchen smoke was also high in this subset. This shows that they may be important contributory factors for chronic obstructive pulmonary disease in females. Evidence of chronic cor pulmonale was found in 130 (8.5%) patients. Maximum incidence (28%) was seen in the age group of above 60 years. Chronic bronchitis with or without emphysema turned out to be the commonest cause of cor pulmonale, followed by bronchiectasis, pulmonary tuberculosis and bronchial asthma.

Female↗
PubMed1989

Diabetes mellitus in geriatric females.

A study was carried out on 36 geriatric diabetic females (above 60 years). Marked exhaustion and significant loss of weight were common presenting complaints (60%) besides usual symptomatology. Only 25% patients were asymptomatic for diabetes. Generalised itching (20%) and pruritus vulvae (33.3%) were other common presenting complaints. Neuropathy was found to be the commonest complication being present in 77.7% patients, followed by retinopathy (50%) and nephropathy (27.7%). Hypertension was found to be associated in 44% patients and evidence of ischaemic heart disease was found in 42%. Development of nephropathy, retinopathy, neuropathy, and hypertension showed direct correlation with duration of illness ie, longer the history of diabetes higher was the incidence of complications.

Aged↗