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Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_300_17

Abstract:
Lumbar surgery for spinal stenosis is the most common spine operation being performed in older patients. Nevertheless, every time we want to schedule surgery, we confront the insurance industry. More often than not they demand patients first undergo epidural steroid injections (ESI); clearly they are not aware of ESI's lack of long-term efficacy. Who put these insurance companies in charge anyway? We did. How? Through performing too many unnecessary or overly extensive spinal operations (e.g., interbody fusions and instrumented fusions) without sufficient clinical and/or radiographic indications. Patients with lumbar spinal stenosis with/without degenerative spondylolisthesis (DS) are being offered decompressions alone and/or unnecessarily extensive interbody and/or instrumented fusions. Furthermore, a cursory review of the literature largely demonstrates comparable outcomes for decompressions alone vs. decompressions/in situ fusions vs. interbody/instrumented fusions. Too many older patients are being subjected to unnecessary lumbar spine surgery, some with additional interbody/non instrumented or instrumented fusions, without adequate clinical/neurodiagnostic indications. The decision to perform spine surgery for lumbar stenosis/DS, including decompression alone, decompression with non instrumented or instrumented fusion should be in the hands of competent spinal surgeons with their patients' best outcomes in mind. Presently, insurance companies have stepped into the "void" left by spinal surgeons' failing to regulate when, what type, and why spinal surgery is being offered to patients with spinal stenosis. Clearly, spine surgeons need to establish guidelines to maximize patient safety and outcomes for lumbar stenosis surgery. We need to remove insurance companies from their present roles as the "spinal police."
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_24_17

Abstract:
In addition to histologic deviation, MG-PNET can present with variable radiographic findings on MRI and a clinical course distinctive from traditional glioblastoma. The hypercellular nature of this lesion can present as a diffusion-restricting lesion.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_120_17

Abstract:
Extradural hemangiomas may present as spinal extradural soft tissue masses that must be differentiated from dumbbell neurofibroma.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_172_17

Abstract:
In our experience nonshaving of cranial hair in DBS surgery does not lead to more infections when compared to shaving. We have changed our protocol to nonshaving based on these findings.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_331_16

Abstract:
As demonstrated in this case report, the presentation and progression of primary intracranial follicular dendritic cell sarcoma can often be misleading, and consideration for this rare entity should be made in cases of hemorrhagic dural-based lesions without a primary source of malignancy.
Rashmi Kumari, Biswanath Behera, Debasis Gochhait, Raj Remya, M R Resmi, Devinder Mohan Thappa
Indian Journal of Dermatology, Venereology and Leprology, Volume 83, pp 702-704; https://doi.org/10.4103/ijdvl.ijdvl_12_17

, Anice George, Ms Vidyasagar, Stanley Mathew, Sudhakar Nayak, Baby S Nayak, Yn Shashidhara, Asha Kamath
Indian Journal of Palliative Care, Volume 23, pp 445-450; https://doi.org/10.4103/ijpc.ijpc_82_17

Abstract:
Introduction: Cancer is a leading cause of death. People living with cancer experience a variety of symptoms. Quality of life (QOL) is a major concern of patients with terminal cancer. Symptoms affect their QOL. Management of symptoms improves distress and QOL. Objective: The objective of the study was to assess the QOL among cancer patients. Materials and Methods: A survey was conducted among 768 cancer patients selected by a convenient sampling technique. Data was collected from cancer patients by interview technique using structured and validated interviewed schedule. Results: Out of 768 cancer patients, 30.2% patients were in the age group of 51–60 years, majority with head–and-neck cancer (40.1%), and 57.7% had stage III disease. QOL of majority of patients was influenced by their symptoms. 82.3% of them had low QOL scores. Conclusion: Cancer patients experienced many symptoms that affected their QOL. There is a need to develop interventions for effective management of symptoms that will empower the patients to have a greater sense of control over their illness and treatment and to improve the QOL.
, Ke Elizabeth, Mathew J Valamparampil, D Kalpana, Ts Anish
Indian Journal of Palliative Care, Volume 23, pp 387-392; https://doi.org/10.4103/ijpc.ijpc_52_17

Abstract:
Introduction: Cerebral palsy (CP) refers to a spectrum of disorders causing physical and intellectual morbidity. Macro and micro nutrient deficiencies often contribute to the subnormal physical and mental capabilities of them. Objectives: To assess the growth, nutritional status, physical and functional ability and quality of life in cerebral palsy children and to determine any relation with their gross motor and functional capabilities. Method: The study was conducted at a Tertiary Care Centre, with the participants in the age group 1-16 years. A pretested evaluation tool was prepared which included Anthropometric measurements, tests for hemoglobin and Vitamin D estimation, evidence of micronutrient deficiencies, Dietary patterns, Epidemiological factors, Functional assessment using GMFM (Gross Motor Function Measure ) and FIM (Functional Independent Measurement) scales and Quality of life (QOL) assessment. The data was statistically analyzed. Results: Out of the 41 children, 30 had quadriplegia, 3 had hemiplegia and 8 had spastic diplegia. 34 (82.9%) were severely underweight, 35 (85.4%) had severe stunting and 38 (92.7%) had severe wasting. Micronutrient deficiencies were noted like vitamin B complex deficiency in 37 (90.2%), vitamin A deficiency in 31 (75.6%), low vitamin D levels in 27 (65.9%) and insufficient levels in 9 (22%), severe anemia in 5 (12.2%) and moderate anemia in 26 (63.4%).The gross motor and functional scores were suboptimum in the majority of patients and the care givers had significant impairment in the quality of life. Conclusion: Majority of children with cerebral palsy had multiple nutritional deficiencies, gross motor and functional disabilities. QOL of the children and their care givers were suboptimum. A comprehensive package that address dietary intake, correction of micronutrient deficiencies especially anemia and vitamin D deficiency, physical and emotional support is recommended for the wellbeing of the affected children.
Davood Hekmatpou, Yasaman Pourandish, Pouran Varvani Farahani, Ramin Parvizrad
Indian Journal of Palliative Care, Volume 23, pp 431-436; https://doi.org/10.4103/ijpc.ijpc_37_17

Abstract:
Background and Objective: Pain is an emotional and unpleasant experience associated with actual or potential tissue damage. The literature shows no study on the effect of aromatherapy with the essential oil of orange on unpleasant feelings of patients with fractured limbs. In this regard, this paper aims at studying the effect of aromatherapy with the essential oil of orange on patients with fractured limbs admitted to the emergency ward. Methods: Sixty patients admitted to the emergency ward of Vali-e-Asr Hospital were selected by purposive sampling method and then were divided into two groups of control and experiment by block method. This study was done in one shift work (morning or afternoon). Four drops of the orange oil were poured on a pad and were pinned with a plastic pin to the patient's collar, about 20 cm distant from head. The old pad was replaced by the new one every 1 h. The patients' pain and vital signs were checked every 1 h for at last 6 h. The data were analyzed by SPSS Version 21. Results: Forty (66.7%) patients were male and twenty (33.3%) were female. Their age average was 37.93 ± 18.19 years old. The most fractured cases were in the scapular (11 patients [18.3%]). Friedman test showed that pain in the experiment group (P = 0.0001) decreased significantly rather than the control group (0.339). However, in vital signs, there could be found that no significant change between the two groups was seen. Conclusion: Aromatherapy with orange oil can relieve pain in patients with fractured limbs but has no effect on their vital signs. Therefore, aromatherapy with orange oil can be used as a complementary medicine in these patients.
Indian Journal of Palliative Care, Volume 23, pp 409-412; https://doi.org/10.4103/ijpc.ijpc_77_17

Abstract:
Introduction: Patients with advanced gynecological malignancies often present with a high burden of symptoms endangering their quality of life. Objective: This study aims at assessing the symptom prevalence in patients with gynecological malignancies referred to palliative care and identify factors that predict high symptom burden. Methodology: This was a retrospective data analysis of gynecological cancer patients referred to palliative medicine department. We reviewed the electronic medical records of patients to obtain data on (1) demography (age, residence); (2) clinical information (diagnosis, stage of cancer, the reason for referral to palliative care service, symptoms, and performance status). The data were reported as frequency and percentages and analysis performed using Chi-square. P< 0.05 was considered to be statistically significant. Results: We analyzed 196 patients with advanced gynecological cancers presenting to palliative medicine department. The pain was the most common symptoms (70.04%) followed by anorexia (34.13%), constipation (28.57%), and fatigue (28.06%). There was a trend toward higher symptom burden in patients younger than 60 years. Among cancer diagnosis, patients with cervical cancer had a higher prevalence of pain (76.66%) followed by ovarian (70.79%) and endometrium (60.97%). Anorexia was the next commonly prevalent symptoms in ovarian (40.45%), endometrium (29.27%), and cervical cancer (28.33%). Conclusion: Considering the high symptom burden among advanced gynecological cancer patients it becomes imperative that patients receive adequate screening for symptoms and appropriate palliative care referral be offered to ensure overall well-being of the patients.
, Elayaperumal Suguna, Amol R Dongre
Indian Journal of Palliative Care, Volume 23, pp 425-430; https://doi.org/10.4103/ijpc.ijpc_80_17

Abstract:
Background: As a part of Memorandum of Understanding with Tamil Nadu Institute of Palliative Medicine, community-based palliative care services have been initiated 2 years back in our urban field practice areas. Aim: The aim of this study was to evaluate the home care service, a major component of our community-based palliative care, with a view to identify the unmet needs of the services rendered for decision-making about the program. Materials and Methods: It was a descriptive qualitative design carried out by the authors trained in qualitative research methods. In-depth interviews were done among four patients, seven caregivers, two social workers, six nursing staffs, and six medical interns for a minimum of 20 min. Interviews were audiorecorded, transcribed verbatim, and content analysis was done manually. Ethical principles were adhered throughout the study. Results: Descriptive coding of the text information was done; later, similar codes were merged together to form the categories. Five categories under the theme of strengths and five codes under the theme of challenges of the home care services emerged out. Categories under strengths were physical management, psychological care, social support, efficient teamwork, and acceptance by the community. Codes for felt challenges were interdisciplinary collaboration, volunteer involvement, training enhancement, widening the services, and enhancing the community support. Conclusions: This review revealed the concerns of various stakeholders. There is a need for more interprofessional collaborations, where team members understand each other's roles for effective teamwork, as evident from the framework analysis.
, Mansooreh Azizzadeh Forouzi, Mohammad Hossein Safarizadeh, Yunes Jahani
Indian Journal of Palliative Care, Volume 23, pp 437-444; https://doi.org/10.4103/ijpc.ijpc_53_17

Abstract:
Background and Aim: Information about spiritual needs and quality of life (QoL) is limited in Iranian cancer patients. This study was conducted to determine the relationship between spiritual needs and QoL among cancer patients in Iran. Methods: This correlational study included a convenience sample of 150 eligible cancer patients who were hospitalized in the oncology wards and outpatient clinics. Using two questionnaires; the spiritual needs survey and the European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 data were collected. The data were analyzed by SPSS software version 19. Results: Our findings showed that the total mean score of spiritual needs was (64.32 ± 22.22). Among the categories, the lowest score belonged to “morality and ethics” component (2.18 ± 1.64), and the highest score belonged to “positivity/gratitude/hope/peace” component (15.95 ± 5.47). The mean score of QoL was (79.28 ± 19.20). Among the categories, the lowest score belonged to “global health status” component (8.44 ± 3.64), and the highest score belonged to “functional” component (36.57 ± 10.28). Pearson correlation coefficient showed that spiritual needs score positively correlated with QoL (r = 0.22; P = 0.006). Conclusion: The results of the present study suggest that information about the relationship between spiritual needs and QoL in patients with cancer. It should be improve QoL to meet spiritual need of these patients. In addition, the continuous and in-service education of cancer patients and nurses who work with them can be helpful in this area.
, Prince John
Indian Journal of Palliative Care, Volume 23, pp 451-455; https://doi.org/10.4103/ijpc.ijpc_72_17

Abstract:
Introduction: Understanding the profile of end users is a key input for designing a service. Centers that provide full-scale palliative care are few and far between in our country, and there is a need to open more centers to extend the services to a larger percentage of patients. Methods: Patient data from the inception of the center till January 2016 have been stored in a database. The data were mined, exported to Excel, and analyzed. Results: The data of 11,258 patients revealed the profile of patients, including their age, gender distribution, marital status, symptomology, and outcome. The present paper describes the profile of patients opting for palliative care in our country. Conclusions: The profile of patients registered at this center validates certain assumptions while debunking others. It is hoped that this profile gives some guidance to those desirous of setting up palliative care services.
Mehdi Heidarzadeh, Younes Khalili-Parapary, Naser Mozaffari, Parisa Naseri
Indian Journal of Palliative Care, Volume 23, pp 419-424; https://doi.org/10.4103/ijpc.ijpc_63_17

Abstract:
Context: Edmonton Symptom Assessment Scale (ESAS) was developed to assess objective and subjective symptoms in patients with cancer in all stages of their disease. Aim: The aim of the study was to translate and determine the psychometric properties of ESAS in an Iranian population. Materials and Methods: The current study was carried out to determine reliability and validity of ESAS using 246 patients with cancer in Imam Khomeini Hospital, Ardabil, Iran. After translating the instrument to Persian, content and face validity, discriminant validity, internal consistency, and test-retest were done to determine psychometric properties of ESAS. Furthermore, the construct validity was determined using confirmatory factor analysis to evaluate factor structure of the tool in two models: single factor and three factor. Results: With regard to goodness of fit indices including comparative fit index, incremental fit index, and normed fit index, factor structure of ESAS was confirmed with one factor and nine items. Because the values of average variance extracted of each dimension were less than the square of correlation coefficients between the three dimensions of ESAS, three-factor model was not confirmed. Discriminant validity was confirmed by finding significant differences between the two groups, patients with good general and critically ill conditions. Cronbach's alpha for the overall ESAS was 0.88, and correlation between test-retest with 4–6 h interval was 0.86 (r = 0.86 P< 0001). Conclusions: This study showed that Persian version of ESAS with same factor structure mentioned in the original version is an applicable tool for assessing objective and subjective symptoms in Iranian patients with cancer.
, , Biswajit Dubashi, S Adinarayanan
Indian Journal of Palliative Care, Volume 23, pp 403-408; https://doi.org/10.4103/ijpc.ijpc_90_17

Abstract:
Context: Palliative care services, until recently, were mainly restricted to cancer patients with incurable diseases. Hence, evaluative studies of palliative care are sparse in areas other than oncology. Aims: To estimate what proportion of patients attending the Departments of Neurology, Cardiology, and Nephrology of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, required palliative care and to identify the palliative care needs of those patients. Settings and Design: This was an exploratory descriptive study conducted in the three departments of JIPMER. Materials and Method: There was no predetermined sample size for the study. The participants were all adult inpatients and outpatients who were in need of palliative care in the departments of Cardiology, Nephrology, and Neurology on the day of study. Statistical Analysis: Percentage distribution was used to analyze the categorical variables such as education, gender, age, patients in need of palliative care, and their needs. Results: The study showed that one in ten non-cancer patients in tertiary care hospitals may require palliative care services. Apart from issues in physical domain, a substantial proportion of participants also had issues in the psychological, emotional, and financial domains. Conclusion: This study highlights the need for incorporation and initiation of palliative care services in other non-cancer specialties in tertiary care hospitals to ensure holistic management of such cases. Counseling service has also to be rendered as part of palliative care since a good share of the patients had psychological and emotional issues.
, Ruchi Nimish Nanavati, Rohit Nathani, Nandkishor Kabra
Indian Journal of Palliative Care, Volume 23, pp 372-378; https://doi.org/10.4103/ijpc.ijpc_84_17

Abstract:
Objective: The objective of our study was to assess the pain associated with suctioning in preterm neonates on assisted ventilation and comparing the use of expressed breast milk (EBM), sucrose, and swaddling to alleviate pain. Methods: Study design: A randomized controlled clinical trial. Inclusion Criteria: Preterm neonates on assisted ventilation. Exclusion Criteria: Major congenital anomalies and severe encephalopathy. Study Duration and Site: 6 months in level III neonatal Intensive Care Unit. In the first phase, we used premature infant pain profile (PIPP) score to assess pain associated with suctioning in preterm neonates on assisted ventilation. In the second phase, the effect of EBM, swaddling, and sucrose on pain relief during suctioning in neonates on assisted ventilation was assessed. Results: There was a significant increase in pain associated with suctioning in preterm neonates on assisted ventilation (preprocedure PIPP score 7.90 ± 2.50; procedural PIPP score 13.63 ± 2.57; P < 0.05). The postintervention mean procedural PIPP score was not significantly different between the EBM, swaddling, and sucrose groups (P = 0.24). Conclusions: Suctioning is painful for preterm neonates on assisted ventilation. There was no difference between EBM, swaddling, and sucrose in relieving pain associated with suctioning.
, Jaivika Govindbhai Patel
Indian Journal of Palliative Care, Volume 23, pp 355-361; https://doi.org/10.4103/ijpc.ijpc_65_17

Abstract:
Background: Fatigue is the most common side effect of cancer treatment with chemotherapy and/or radiation therapy, selected biologic response modifiers. The main purpose of this study is to evaluate the effects of aerobic exercise on cancer-related fatigue in patients of the solid tumor after chemotherapy and radiotherapy. Methods: After screening for cancer-related fatigue, 34 patients fulfilled the inclusive criteria and were assigned into two groups (n = 17 recruited in the intervention group and n = 17 in control group). The intervention group received aerobic exercise program which included treadmill walking with low to moderate intensity (50%–70% of maximum heart rate), for 20–40 min/day for 5 days/week. Control group were taught stretching exercises of hamstrings, gastrocnemius, and soleus (to be done at home) and were encouraged to remain active. Outcome measures such as brief fatigue inventory (BFI), 6-min walk test, and functional assessment of cancer therapy-general (FACT-G) were taken at baseline and after 6-weeks. Results: The data were analyzed using the Wilcoxon matched-pairs signed rank test for within group and Mann–Whitney U-test for between group comparisons. The results of this study showed that there was a significant reduction in cancer-related fatigue BFI score (P< 0.0001,), also there was significant improvement in the physical performance as in 6-min walk distance (P< 0.0001) and quality of life, FACT-G score (P = 0.0001). Conclusion: Aerobic exercise for 6 weeks has beneficial effects on cancer-related fatigue in patients with solid tumor after chemotherapy and/or radiotherapy.
, Lidiya T Paul, Pt Latha, Kusumakumary Parukkutty
Indian Journal of Palliative Care, Volume 23, pp 393-398; https://doi.org/10.4103/ijpc.ijpc_83_17

Abstract:
Objective: To examine parent's knowledge, attitude and psychosocial response regarding their child's cancer and treatment after initial disease counseling by doctor. Materials and Methods: Structured questionnaire based study of 43 mothers of newly diagnosed pediatric cancer patients undergoing treatment in pediatric oncology division. Mothers received initial counseling regarding their child's cancer and treatment from the doctor. Questionnaire was administered 2-6 months after initial counseling and mothers self-reported their responses. Results: 83% mothers had school level education only and 84% belonged to lower and middle socio-economic status. More than 80% mothers knew the name of their child's cancer, type of treatment received by child and approximate duration of treatment. 93% knew regarding painful procedures and 84% mothers reported knowledge about chemotherapy side effects. Hope of cure and satisfaction with treatment were reported by 90% mothers. 81% mothers reported high levels of anxiety and 66% worried regarding painful procedures. As high as 60% of parents were afraid to send their child outside to play and 40% were afraid to send their child to school. 40% mothers wanted more information regarding child's higher education, married life & fertility. On statistical analysis, mother's age, educational status or family background did not influence their knowledge and attitude. Conclusion: Relevant information about child's cancer and treatment can be imparted effectively even to mothers with school level education. This knowledge helps to instill hopeful attitude, confidence and satisfaction in parents. Anxiety and fear related to cancer persists in mothers even after the initial stress period is over. Pain related to injections and procedures is a major concern in parents. Involvement of counselor in the treating team is desirable to overcome these problems.
, Aanchal Satija
Indian Journal of Palliative Care, Volume 23, pp 468-479; https://doi.org/10.4103/ijpc.ijpc_100_17

Abstract:
Cancer patients are often poly-symptomatic which distressingly affects their quality of lives (QOLs). Alhough, conventional management provides adequate symptom control, yet is coupled with some limitations. Complementary therapies (CTs) have shown beneficial effects in cancer patients for symptomatic relief. The aim of this article is to provide evidence-based review of commonly used CTs for symptom management in cancer care. Hypnosis has promising evidence to be used for managing symptoms such as pain, chemotherapy-induced nausea/vomiting, distress, fatigue, and hot flashes. Guided imagery increases comfort and can be used as a psycho-supportive therapy. Meditation substantially improves psychological function, mental health, and QOL. Cognitive behavioral therapies effectively reduce pain, distress, fatigue, anxiety, and depression; and improve subjective sleep outcomes along with mood and QOL. Yoga has short term beneficial effects for anxiety, depression, fatigue, perceived stress, QOL, and well-being. T'ai Chi and qigong are beneficial adjunctive therapies for supportive cancer care, but their role in reducing cancer pain is not well proven. Acupuncture is effective for reducing treatment related side-effects, pain and fatigue. Other therapies such as massage techniques, energy therapies, and spiritual interventions have also demonstrated positive role in managing cancer-related symptoms and improve overall well-being. However, the clinical effectiveness of these therapies for symptom management in cancer patients cannot be concluded due to poor strength of evidence. Nonetheless, these are relatively free from risks and hence can be given along with conventional treatments. Only by tailoring these therapies as per patient's beliefs and preferences, optimal patient-centered holistic care can be provided.
, Leila Khanali Mojen, Peyman Eshghi, Ali Akbari Sari, Majideh Heravi Karimooi
Indian Journal of Palliative Care, Volume 23, pp 379-386; https://doi.org/10.4103/ijpc.ijpc_69_17

Abstract:
Introduction: High incidence rates of childhood cancer and the consequent deaths in the Middle East is one of the major reasons for the need for palliative care in these countries. Using the experiences and innovations of the other countries can provide a pattern for the countries of the region and lead to the development of palliative care in children. Therefore, the aim of this study is to compare the status of pediatric palliative care in Egypt, Lebanon, Jordan, Turkey, and Iran. Materials and Methods: This is a comparative study in which the information related to pediatric palliative care system in the target countries (from 2000 to 2016) has been collected, summarized, and classified by searching in databases, such as “PubMed, Scopus, Google scholar, Ovid, and science direct.” Results: Palliative care in children in the Middle East is still in its early stages and there are many obstacles to its development, namely, lack of professional knowledge, inadequate support of policy-makers, and lack of access to opioids and financial resources. Despite these challenges, providing services at the community level, support of nongovernmental organizations (NGOs), using trained specialists and multi-disciplinary approach is an opportunity in some countries. Conclusion: Considering the necessity of the development of pediatric palliative care in the region, solutions such as training the human resources, integrating palliative care programs into the curriculum of the related fields, establishing facilitating policies in prescription and accessibility of opioids, providing the necessary support by policy-makers, doing research on assessment of palliative care quality, as well as NGOs' participation and public education are suggested.
Guang-Jin Wang, Zhao-Xia Zhang, Bao-Qi Yang, Qing Yang, Mei Wu
Indian Journal of Dermatology, Venereology and Leprology, Volume 83, pp 713-717; https://doi.org/10.4103/ijdvl.ijdvl_1084_16

Saumya Panda, Yogesh S Marfatia
Indian Journal of Dermatology, Venereology and Leprology, Volume 83, pp 627-629; https://doi.org/10.4103/ijdvl.ijdvl_725_17

Dincy C. V. Peter, Santhi Kiran Borra, Nirmal Balakrishnan, Susanne Pulimood, Mandeep Bhindra
Indian Journal of Dermatology, Venereology, and Leprology, Volume 83, pp 720-721; https://doi.org/10.4103/ijdvl.ijdvl_260_17

, Shikha Bansal
Indian Journal of Dermatology, Venereology and Leprology, Volume 83, pp 635-643; https://doi.org/10.4103/ijdvl.ijdvl_1050_16

Abstract:
The nail is an important skin appendage, but not many dermatologists are aware of the importance it receives outside our specialty. This article focuses on the nail in non-dermatological contexts. The nail is a keratinized matrix capable of continuous growth with the ability to incorporate various compounds within its structure. Therefore it can be used to monitor long-term consumption of drugs. It is also an excellent source of germ-line DNA for genetic analyses. With an increased undrstanding of nail physiology, there is now a better understanding of its connection to various pathologies as well. Nails, being peripherally placed, are easy to sample without significant discomfort to the patient, making them a valuable diagnostic tool. For this narrative review, we carried out a PubMed search using the key words “nail clipping,” “nail DNA,” “nail diabetes mellitus;” “nail clipping oncology,” and “nail forensics”. Retrieved articles were searched for information pertaining to non-dermatologic uses of nail for evaluation, which is presented in a narrative fashion. It is clear from recent literature that the nail is not just an inert skin appendage, but a dynamic window into the ever-changing metabolic and genetic milieu. We highlight the numerous roles of nail specimens, as well as point towards future research needed therein
, , Talia Sasson, Vinit Khanna
American Journal of Interventional Radiology, Volume 1, pp 4-5; https://doi.org/10.25259/ajir-2-2017

Abstract:
Education is evolving in the field of interventional radiology. Technical skills are no longer the primary focus of training, while a stronger emphasis is placed on longitudinal patient care. Interventional radiologists are now expected to perform rounds on their patients in the hospital and promote continuity of care in the outpatient setting (Murphy et al. Semin Intervent Radiol 2005;22:6-9). The recent establishment of residency programs in interventional radiology (RPIR) aims to foster this transition by integrating clinical rotations such as the intensive care unit and expanding resident time in the clinic (Siragusa et al. J Vasc Interv Radiol 2013;24:1609-12). With the new training model comes a greater need for early exposure of medical students to the field, as trainees now apply for RPIR during their 4th year of medical school. To address this issue, interventional radiology interest groups (IRIGs) have been developed by passionate students with a desire to educate their colleagues and further their own knowledge of IR. IRIGs inform medical students about the specialty through unique activities such as hands-on device workshops and information sessions. In coordination with supportive advisors, IRIGs play a vital role in recruiting talented trainees, many of whom may well become the next leaders of our field. This article will discuss the process of starting an IRIG and how to maximize available resources to foster its success.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_192_16

Abstract:
This report discusses the possible underlying etiologies for the bilateral caudate infarcts and necrosed flaps including bacterial meningitis with associated local vasospasm of nearby vessels resulting in infarction. This case emphasizes the importance of concise management of postendoscopic CSF leak and discusses the guidelines regarding antimicrobial therapy and the management of lumbar drains.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_152_17

Abstract:
Titanium miniplate fixation may irritate the deep division of the supraorbital nerve and may cause a chronic headache. Here, we propound the idea that, postcraniotomy, titanium miniplates should not be placed above the temporal fusion line.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_291_16

Abstract:
In patients with peripherally located brain abscesses less than 2.5 cm in size, bedside twist drill drainage may be a safe and reasonable approach. Positive identification of infective pathogen allows for a decreased hospital length of stay and de-escalation of antibiotics regiment resulting in significant reduction of hospital costs and resources in 2 of the 3 patients treated. This is of benefit to the patient as well as the health system.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_374_16

Abstract:
On the basis of clinical presentation and radiological appearances, schwannoma in unusual sites can easily be mistaken for meningiomas; immunochemistry plays an important role in differentiating them. Till date, to the best of our knowledge, this is the second reported case of schwannoma mimicking meningioma in parasagittal location.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_251_17

Abstract:
This article presents a useful technique with low morbidity and mortality. Further investigation is needed, especially in our Mexico, where neuroendoscopical techniques are still in the development phase.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_21_17

Abstract:
GBM of the spinal cord are rare in the pediatric age group. A 16-year-old male presented with a flaccid paraplegia attributed to an MR-documented GBM of the distal thoracic cord extending from the T9 level through the conus medullaris. Despite partial intramedullary tumor resection, 10 months postoperatively, he remained paraplegic.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_105_17

Abstract:
Early recognition and timely evacuation of spinal abscesses minimized neurological morbidity and potential mortality.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_81_17

Abstract:
The findings of this study suggest that IVT and IT antibiotic therapy is a useful option in patients who are nonresponsive to standard intravenous therapy with little or no side effects.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_299_17

Abstract:
In light of recent studies, lasting bilateral mydriasis may not always be considered a decisive factor for non-escalation of treatment, as variability among TBI patients and outcomes has been demonstrated. Wide decompressive craniectomy is viable for controlling refractory intracranial hypertension in hemodynamically stable patients.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_262_17

Abstract:
Chronic spinal subdural hematoma can mimic intradural extramedullary spinal tumors even in the absence of trauma and/or coagulopathies.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_173_17

Abstract:
Intraoperative three-dimensional imaging and navigation guidance facilitated the resection of anomalous transverse processes in two patients with Bertolotti's syndrome. Excellent outcomes were achieved in both patients.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_244_17

Abstract:
Patients with thoracolumbar facture dislocations, subjected to axial spinal loading postoperatively, should not be considered for SSPF alone. The following factors also contributed to SSPF failures: a burst fracture, a preoperative LSC score of >6, and/or presence of transverse dislocation.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_77_17

Abstract:
EE has moderate sensitivity and specificity for high-grade gliomas. However, larger sample studies are required for further validation of this observations.
Surgical Neurology International, Volume 8; https://doi.org/10.4103/sni.sni_123_17

Abstract:
Preoperative embolization with detachable-tip microcatheters and liquid embolic agents should be taken into consideration when assessing patients with hemangioblastomas of the posterior fossa due to the reduced risks of cardiac arrest, hemorrhage, and death.
, Fernández Ballesteros, M Ayala Blanca, S Simonsen
Indian Journal of Dermatology, Venereology and Leprology, Volume 84, pp 641-642; https://doi.org/10.4103/ijdvl.ijdvl_805_16

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