Botulinum toxin for the treatment of lower limb cramp pain in patients with Amyotrophic Lateral Sclerosis

Background: Muscle cramps and pain associated with them can be seen in patients with amyotrophic lateral sclerosis (ALS) and are known to reduce the quality of life. Pharmacological treatment may not benefit all patients in treating these cramps. We assess the efficacy of Onabotulinum toxin A (BTX-A) in the treatment of lower limb cramps in patients with ALS. Methods: This retrospective chart review included a total of ten patients with ALS who suffered from pain due to lower limb cramps and were managed with BTX-A. Data including patient demographics, visual analog pain scale at different intervals during follow up, ALS functional rating scale and site of onset of ALS symptoms were documented. The pain score at baseline (before administration), at 3 months follow up and at 6 months follow up were compared using Wilcoxon test to assess BTX-A’s efficacy. Results: A significant improvement in average pain score due to cramps from baseline to the 6-month interval with a change of 3.1±0.7 (p<0.05,95%CI) was seen on the pain scale. No adverse events were noted during administration or post injections. Conclusion: Local BTX-A administration is an efficacious and safe procedure for improving pain associated with cramps in patients with ALS

To Study the Effect of Catalyst on the Physical Parameters of Carbon Spheres

The discovery of fullerenes has opened up modern studies in carbon materials. Carbon nanoparticles have a large surface area and demonstrate good conductivity. Their unique properties has gained attention in many areas such as water filtration, hydrogen storage and battery electrodes. In this research, carbon spheres with high specific area and uniformity were grown using the Chemical Vapor Deposition (CVD) process with silicon substrates, ethylene (C2H4) as a carbon precursor and argon as the inert gas. We observe that the morphology of carbon spheres largely depend on the experimental conditions, including CVD time duration, temperature, catalyst and flow of gases. This thesis discusses the synthesis and effects of catalyst on carbon spheres

Optimal, Multi-Modal Control with Applications in Robotics

The objective of this dissertation is to incorporate the concept of optimality to multi-modal control and apply the theoretical results to obtain successful navigation strategies for autonomous mobile robots. The main idea in multi-modal control is to breakup a complex control task into simpler tasks. In particular, number of control modes are constructed, each with respect to a particular task, and these modes are combined according to some supervisory control logic in order to complete the overall control task. This way of modularizing the control task lends itself particularly well to the control of autonomous mobile robot, as evidenced by the success of behavior-based robotics. Many challenging and interesting research issues arise when employing multi-modal control. This thesis aims to address these issues within an optimal control framework. In particular, the contributions of this dissertation are as follows: We first addressed the problem of inferring global behaviors from a collection of local rules (i.e., feedback control laws). Next, we addressed the issue of adaptively varying the multi-modal control system to further improve performance. Inspired by adaptive multi-modal control, we presented a constructivist framework for the learning from example problem. This framework was applied to the DARPA sponsored Learning Applied to Ground Robots (LAGR) project. Next, we addressed the optimal control of multi-modal systems with infinite dimensional constraints. These constraints are formulated as multi-modal, multi-dimensional (M3D) systems, where the dimensions of the state and control spaces change between modes to account for the constraints, to ease the computational burdens associated with traditional methods. Finally, we used multi-modal control strategies to develop effective navigation strategies for autonomous mobile robots. The theoretical results presented in this thesis are verified by conducting simulated experiments using Matlab and actual experiments using the Magellan Pro robot platform and the LAGR robot. In closing, the main strength of multi-modal control lies in breaking up complex control task into simpler tasks. This divide-and-conquer approach helps modularize the control system. This has the same effect on complex control systems that object-oriented programming has for large-scale computer programs, namely it allows greater simplicity, flexibility, and adaptability.Ph.D.Committee Chair: Egerstedt, Magnus; Committee Member: Ferri, Bonnie; Committee Member: Lee, Chin-Hui; Committee Member: Reveliotis, Spyros; Committee Member: Yezzi, Anthon

Clinical Experience of Edaravone in Amyotrophic Lateral Sclerosis

Objective: To describe clinical experience with edaravone in ALS over a period of 12 months Methods:The current study retrospectively investigated characteristics in a group of patients (n=31) with ALS who underwent edaravone treatment. Information including age, gender, race, and site of onset of symptoms were collected for all patients. Adverse events with edaravone therapy was documented where available. Results:The average age of the patients observed was 62.09 years, with 18 males and 13 females. 18 patients had limb onset, 12 bulbar onset, and 1 diaphragmatic onset. 7 of the 31 patients discontinued treatment at the end of one year. The average age of patients who discontinued edaravone was 65.71 years, of whom which 3 had limb onset, 3 bulbar onset, and 1 diaphragmatic onset. No perceived benefit, port complications, systemic bacteremia, and development of atrial fibrillation were documented as reasons for discontinuation of therapy.Conclusion: Edaravone is well tolerated in ALS patients at the end of one year. Lack of perceived benefit and port related complications are common reasons for discontinuation of treatmen

Efficacy of botulinum toxin for treating cramps in peripheral neuropathy

Abstract Introduction: Muscle cramps are a common occurrence in patients with peripheral neuropathy and are known to cause significant distress and decrease the quality of life. Although several drug formulations have been used in the management of cramps, there is significant variability in terms of efficacy and tolerability in patients with peripheral neuropathy. This study aims to assess the efficacy of botulinum toxin A in the management of lower limb cramps in patients with peripheral neuropathy.   Methods: This retrospective chart review included a total of ten patients with peripheral neuropathy with cramps. Relevant data such as age, gender, race, pain score and cause of peripheral neuropathy were documented. Statistical analyses to compare the variables was done using the Wilcoxon Test. The pain score before the administration, at 3-month, 6 month and 9 months follow up were compared.   Results All patients enrolled in the study showed improvement of pain assessed by visual pain analog scale. An improvement of 1.60 (95%CI, p<0.05), 2.70 (95%CI, p<0.05) and 3.50 (95%CI, p=0.05) was noted between test scores from before administration of botulinum toxin to 3-month, 6 months and 9 months follow up with a range of 6, 4 and 4 respectively.   Conclusion: Local BTX-A infiltration is a likely efficacious and safe procedure for improving pain associated with cramps in patients with peripheral neuropathy

Digoxin toxicity: crucial to diagnose

Digoxin is mainly used for heart failure and arrhythmias like atrial flutter and fibrillation. Digoxin is like double edged sword because of its potency to cause life threatening complications like various arrhythmias. Furthermore, it is difficult and important to recognize cardio toxicity caused by digoxin to prevent threat to life. We report a case which was initially diagnosed as arrhythmia and later turned as digoxin toxicity

Clinical profile of HIV positive patients attending ART centre of a tertiary care hospital

Background: HIV infection/AIDS is a global pandemic greatly exceeds earlier prediction. With widespread availability and uses of Anti Retroviral Therapy (ART), HIV becomes a chronic manageable illness but immediate and long term side effects become a major problem. The objective of the study was to study clinical profile of HIV positive patients attending A.R.T. centre of a tertiary care hospital.Methods: Observational and prospective study was carried out over 100 HIV positive Patients attending ART centre of G.G.G Hospital, Jamnagar, Saurastra, Gujarat over a period of 12 months.Results: Out of 100 HIV positive studied patients, maximum cases (95%) were in the age group of 15-49 years, 75% were males. (58%) cases were from rural area and (56%) were illiterate. Maximum cases were having sexual (79%) route of transmission. Most common symptom among HIV positive patients was weight loss (62%) followed by fever (58%). Mycobacterium tuberculosis (65%) was the most common opportunistic infection. (84%) patients had CD4 count between 50-200/cub.mm, (66%) were in stage III. ART was well tolerated, ADRs were found in 43% of patients.Conclusions: HIV is more common in reproductive age group with males being more affected and major route of transmission of HIV infection remains heterosexual mode

Unusual Radiographic Presentation of Pneumocystis Pneumonia in a Patient with AIDS.

Pneumocystis jirovecii pneumonia (PCP) typically presents as an interstitial and alveolar process with ground glass opacities on chest computed tomography (CT). The absence of ground glass opacities on chest CT is thought to have a high negative predictive value for PCP in individuals with AIDS. Here, we report a case of PCP in a man with AIDS who presented to our hospital with subacute shortness of breath and a nonproductive cough. While his chest CT revealed diffuse nodular rather than ground glass opacities, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies confirmed the diagnosis of PCP and did not identify additional pathogens. PCP was not the expected diagnosis based on chest CT, but it otherwise fit well with the patient's clinical and laboratory presentation. In the era of combination antiretroviral therapy, routine prophylaxis for PCP, and increased use of computed tomography, it may be that PCP will increasingly present with nonclassical chest radiographic patterns. Clinicians should be aware of this presentation when selecting diagnostic and management strategies

Polyradiculitis in autoimmune encephalitis: a case report and review

Background Limbic encephalitis is a subacute progressive disorder characterized by disturbances in memory and behavior along with seizures. Antibodies against leucine-rich glioma-inactivated 1 (LGI1) are associated with a subtype of encephalitis which along with the abovementioned symptoms is also characterized by severe pain and autonomic dysfunction. The classical radiological presentation of LGI1 encephalitis is that of amygdala and hippocampal enlargement unilaterally or bilaterally with a T2 hyperintensity. Extratemporal involvement is considered a rare feature. Case description We present the only known case in our knowledge of anti-LGI1 encephalitis in a 47-year-old male presenting as dorsal root ganglia and spinal nerve enhancement on imaging. Discussion Clinicians should be aware of this atypical presentation and consider anti-LGI1 encephalitis as a possible diagnosis when presented with such a neuroradiological feature

Pharmacovigilance study of beta adrenergic receptor antagonists in patients visiting department of medicine of a tertiary care hospital, Surendranagar, Gujarat, India

Background: The objective of this study was to evaluate incidence, patterns, and severity of Beta blockers induced adverse drug reactions (ADR).Methods: A total of 500 patients taking Beta blockers were enrolled in the study by taking an informed consent. Reporting of all Beta blockers-induced ADRs was done by filling CDSCO ADR form. All ADR reports were evaluated according to WHO-UMC causality assessment scale.Results: A total of 64 ADRs (48 males and 18 females) was observed in 500 patients taking beta blockers. Of 64 ADRs, 20 (31.25%) were mild, 34 (53.13%) were moderate, and 10 (15.62%) were classified as severe. 26 (40.62%) ADRs were classified as Probable, followed by 22 (34.38%) ADRs were in Possible category, 8 (12.5%) were in certain category, 4 (6.25%) ADRs were unlikely and 4(6.25%) ADRs were Conditional. Among 64 ADRs, 22 (3.43%) patients developed bronchospasm, 10 (1.56%) bradycardia, 8 (1.25%) fatigue, 8 (1.25%) nausea/GI upset, 4 (0.62%) erectile dysfunction, 4 (0.62%) dry cough, altered lipid profile, insomnia, night mares and diarrhea are other rare ADRs.Conclusions: Incidence of ADRs by beta blockers is 12.80% with bronchospasm as the most common ADR followed by bradycardia. As atenolol is most frequently used beta blocker, ADRs due to atenolol are more common