Assam Medical College

Summary: Background: Data of Central Nervous System (CNS) demyelinating disorders from India has been published from limited centres. The Indian Multiple Sclerosis And Allied Demyelinating Disorders Registry and Research Network (IMSRN) is a multicentric database for multiple sclerosis and allied demyelinating disorders in the Indian subcontinent. This study aimed to describe the demographic, clinical, laboratory, treatment, and follow-up details of patients in the IMSRN and summarise the distribution of major disease phenotypes in a real-world cohort. Methods: This was a prospective, observational, registry-based analysis of patients with CNS demyelinating disorders enrolled in the IMSRN between 16 August 2021 and 25 October 2025. Data were collected in a predefined case record form at recruitment and periodically every six months on a secure database. We performed descriptive and comparative analyses, including temporal trends, treatment patterns, and longitudinal follow-up. Findings: As of 25th October, 2025, 4976 patients have been recruited including radiologically isolated syndrome (RIS), 15 (0.30%); clinically isolated syndrome (CIS), 200 (4.02%); multiple sclerosis (MS), 2479 (49.82%); neuromyelitis optica spectrum disorder (NMOSD), 793 (15.94%); myelin oligodendrocyte antibody associated disease (MOGAD), 698 (14.03%); acute disseminated encephalomyelitis (ADEM), 76 (1.53%); chronic relapsing inflammatory optic neuritis (CRION), 34 (0.68%); chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS), three (0.06%), and others, 562 (11.29%). The mean (SD) age of the entire cohort at enrolment is 34.62 (12.16) years, at disease onset was 29.12 (11.80) years and median (IQR) disease duration at recruitment is 2.79 (0.51–7.22) years; longest for MS. There were 65.33% females and 34.67% males, with a female-to-male ratio of 1.9:1; highest in NMOSD (3.58:1). Most patients are from urban areas and educated. Optic nerve and spinal cord involvement were the dominant areas at first presentation. The median (IQR) number of relapses per patient over follow-up was 2 (1–3) highest in the NMOSD population; dominated by optic nerve and spinal cord symptoms. The median (IQR) EDSS was 2 (1–4.5). Rituximab was the commonest disease modifying therapy (DMT) used. Longitudinal trends reflect improvement in time-to-diagnosis and significant shift in the pattern of DMT use in MS towards oral DMTs and B-cell inhibitors. Interpretation: The paper describes a cohort of patients with MS and allied disorders. The key disease characteristics of the MS population seem similar to those reported in international MS registries. The data adds to the existing literature to ascertain disease patterns, response to treatment, and long-term outcome. Funding: The IMSRN registry is funded by the Indian Council of Medical Research (ICMR) vide Grant number 5/4-5/192/NeuroTF/2019-NCD-1.

Cotard and Koro syndromes are rare psychiatric phenomena, with their concurrent occurrence being exceptionally uncommon, that too in context of the unusual history of bestiality. Cotard syndrome involves nihilistic delusions, such as beliefs of body part disappearance, while Koro is characterized by intense fear of penile retraction, often linked to thoughts of impending death. We report a case of a 32-year-old male with psychosis who presented with both syndromes following guilt related to a childhood history of bestiality. The patient developed persecutory delusions, delusions of guilt, beliefs of penile shrinkage (Koro-like), and nihilistic delusions involving his body and the world, finally exhibiting homicidal and suicidal behavior stemming from these fixed beliefs. This case highlights the complex interplay of guilt, nihilism and psychosis in context of bestiality, shaping rare syndromic presentations leading to extreme forms like homicidal and suicidal behavior. Recognizing such patterns is vital for accurate diagnosis, risk assessment, and tailored treatment planning in psychotic disorders.

Background: Diarrhea is a leading cause of morbidity and mortality among children in the developing world. Zinc is a vital micronutrient essential for immune function and intestinal transport of water and electrolytes. Dietary zinc deficiency is common in low-income countries. Aims and Objectives: The primary objective of this study is to assess the level of serum zinc in children between 2 months and 5 years of age with diarrhea as a predictor of its severity. In addition, this study also correlates serum zinc level with the severity of diarrhea as per vesikari scoring system (VSS). Materials and Methods: A hospital-based Observational cross-sectional study was conducted over 1 year at Assam Medical College and Hospital. The 20-point VSS was used for severity scoring. Blood sample was taken for analysis of serum zinc level. Results: A total of 82 cases were enrolled. The severity of diarrhea as assessed by the VSS was moderate in 54.8% (45) of cases, mild in 18.2% (15) and severe in 26.83% (22) cases. About 84.15% (69) of cases had serum zinc levels >60 μg/dL, and the remaining 15.8% (13) had serum zinc levels <60 μg/dL. The comparison of serum zinc levels between various degrees of diarrhea, as estimated by the VSS, showed that serum zinc level decreases as the severity of diarrhea increases. Conclusion: With statistically significant values in all three categories of severity assessment by VSS (P-values of <0.001), it was concluded that serum levels of zinc are inversely proportional to the severity of diarrhea.

Synophthalmia with severe holoprosencephaly is a rare congenital anomaly, with a prevalence of approximately 1 in 100,000 total births and a female preponderance. It is characterised by a single midline orbit with two fused eyeballs, with or without a proboscis, along with absence of the nose and philtrum. The authors report a case of a 38-week-old male stillborn foetus, delivered vaginally to a 24-year-old healthy, non diabetic, second-gravida mother. On gross examination, the foetus exhibited low-set ears, a single midline orbit with two fused eyes, a proboscis above the orbit, absence of the nose and philtrum, microstomia, micrognathia, peripheral cyanosis and bilateral lobster foot. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed a single orbit with ill-defined sinuses and alobar holoprosencephaly, characterised by absence of the corpus callosum, septum pellucidum, interhemispheric fissure and uncleaved thalami. Internal examination revealed a type I single umbilical artery, type A oesophageal atresia and valvular pulmonary stenosis. The presence of more than three associated anomalies in the present case underscores the rarity of this association.

A collection of more than 300 conditions known as interstitial lung diseases (ILDs) limit oxygen delivery by generating persistent inflammation and irreversible lung tissue scarring, or fibrosis. There is progressive impairment of gas exchange and are frequently complicate by nocturnal hypoxemia. It remains under-recognized despite its significant impact on sleep quality and daytime functioning. Therefore, it is of interest to report the effect of nocturnal oxygen supplementation on sleep quality and daytime fatigue in patients with interstitial lung disease. Total included 228 participants were randomized into two groups: nocturnal oxygen supplementation (n=114) and placebo (sham oxygen) (n=114). Sleep parameters were assessed using overnight monitoring. The Pittsburgh Sleep Quality Index (PSQI), while daytime fatigue and sleepiness were evaluated using validated scales. Statistical analysis was performed using appropriate inferential tests, with p< 0.05 considered significant. Nocturnal oxygen supplementation significantly improves both objective and subjective sleep parameters while reducing daytime fatigue in ILD patients.