Waddling Gait: A complication of valproate therapy and a thought beyond vitamin D deficiency

Proximal muscle weakness is a common presentation in paediatric-orthopaedic clinics and is frequently paired with a vitamin D deficiency diagnosis. Recently, side effects of the extensive use of antiepileptic and antipsychotic drugs such as sodium valproate in childhood disorders are being documented. Sodium valproate causes a time-dependent, drug-induced proximal myopathy. We report a 13-year-old female patient who presented at the Orthopaedic Outpatient Department at Lady Hardinge Medical College, New Delhi, India, in 2019 with an abnormal gait. The patient was taking a combination therapy of sodium valproate, risperidone and trihexyphenidyl for absence seizures and a mood disorder. Following clinical investigations, the patient was diagnosed with proximal myopathy. As a result of elevated serum alkaline phosphatase and creatine kinase myocardial band levels, sodium valproate was replaced with ethosuximide and a carnitine supplementation was prescribed. The patient fully recovered and regained full mobility. Proximal myopathy had been incorrectly managed and assumed to be caused by a vitamin D deficiency.Keywords: Muscle Weakness; Carnitine; Myopathy; Valproic Acid; Vitamin D Deficiency; Gait; Case Report; India

Experience, challenges and lessons learnt from microsurgical clipping of intracranial aneurysms at an emerging neurosurgical centre

Objectives: To share our experience, challenges faced, lessons learnt and analyze the results of surgical management by microsurgical clipping of intracranial aneurysms at an emerging neurosurgical centre at Guru Gobind Singh medical college and hospital (GGSMC&H) Faridkot, Punjab. India. Material and Methods: This study includes all the patients who presented with the diagnosis of intracranial aneurysm on CT angiography and were treated with the microsurgical clipping,  between March 2017 to April 2019. Results: There was a total of 23 patients 11female and 12 male. Age range 32 to 85years. On admission 22 patients had SAH on CT scan and one was admitted after incidental detection of the aneurysm without SAH. The time interval between ictus and admission was 0-3 days in 13 patients, 3-14 days in 8 patients and more than 14 days in 1 patient. WFNS grade (gd) I-15 patients, gd II-2, gd III-2, gd IV-3 patients. Fisher gd I-nil, gd II-9, gd III-4, gd IV-9 patients. In 23 patients 27 Aneurysms were clipped. Distribution of location was Anterior Communicating-12, Distal Anterior Cerebral Artery- 4, Middle cerebral artery (MCA) Bifurcation-3, MCA trifurcation-1, Anterior Choroidal-1, Posterior Communicating (P-com) -1, Ophthalmic Internal Carotid Artery (OICA)-4 and three patients had associated multiple aneurysms. Size of aneurysms varied from < 02mm diameter in 2 patients, 2-25mm - 23 and, more than 25mm-2 aneurysms. There was intra op rupture in 2 cases. Post-operatively 2 patients developed hemiparesis, which recovered, nine patients developed vasospasm. Two patients developed chest related complications. One patient developed renal failure.  There were 8 deaths. Patients are on follow up since March 2017 till date. Conclusions: Intracranial aneurysms are challenging to manage due to their proximity to vital intracranial structures, and difficulty in securing intracranial proximal control. Thorough knowledge of intracranial anatomy of adjacent relations, arachnoid planes and skilful dissection is a key element for a successful outcome. Data collected from GGSMC & Hospital may not be representative of the entire state or country’s population. Therefore, a large-scale data collection is necessary to create our own database to ascertain the risk factors and preventive measures that are exclusive to our state and nation

Management of Hypertension with Conventional and Herbals Drugs

In this article, we have discussed about Types (primary, secondary, isolated, white coat, malignant, resistant and pulmonary hypertension), classification, adverse drug reactions of antihypertensive drugs (beta-blocker induce psoriasis and calcium channel blocker cause peripheral oedema. ACE inhibitor produce ankle oedema and thiazide diuretics causes hypenatremia and also hyperglycaemia. These are some of the serious adverse drug reactions associated with patients who are being treated with these drugs), measurement, management, diagnosis and associated diseases (e.g. diabetes mellitus, heart disease, cerebrovascular disease) lastly concluded about the herbal approach for management of hypertension  . Keywords: Hypertension, conventional drugs, Herbal drug

Extradural spinal schwannoma in a 5 year old non NF child: A rare entity

Pediatric spinal schwannomas constitute 2.5-4% of all pediatric spinal tumors. They often occur in the setting of neurofibromatosis type 2 (NF-2) and are almost always intradural (with/without dumbbell extension). Rarely are they confined to extradural space alone. Till date only one case of totally extradural lumbosacral schwannoma in a non NF child has been reported. We here report the second case of totally extradural spinal schwannoma in a non NF child. A five year old female child presented with progressively increasing paraperesis and bladder symptoms, with no clinical features of Neurofibromatosis type I or II. Imaging revealed a dorsolumbar extradural lesion from DV11 to LV1. Patient underwent laminoplasty with total excision of tumour. Intraoperatively, the tumor was confined to extradural space alone. Histopathology confirmed Schwannoma. This case highlights that possibility of schwannomas should be considered as a differential diagnosis for intraspinal extradural tumors even in children without NF

Effect of dietary palm olein oil on oxidative stress associated with ischemic-reperfusion injury in isolated rat heart

BACKGROUND: Palm olein oil (PO), obtained from refining of palm oil is rich in monounsaturated fatty acid and antioxidant vitamins and is widely used as oil in diet in many parts of the world including India. Palm oil has been reported to have beneficial effects in oxidative stress associated with hypertension and arterial thrombosis. Oxidative stress plays a major role in the etiopathology of myocardial ischemic-reperfusion injury (IRI) which is a common sequel of ischemic heart disease. Antioxidants have potent therapeutic effects on both ischemic heart disease and ischemic-reperfusion injury. Information on the effect of PO on ischemic-reperfusion injury is, however, lacking. In the present study, the effect of dietary palm olein oil on oxidative stress associated with IRI was investigated in an isolated rat heart model. Wistar rats (150–200 gm) of either sex were divided into three different groups (n = 16). Rats were fed with palm olein oil supplemented commercial rat diet, in two different doses [5% v / w (PO 5) and 10% v / w (PO 10) of diet] for 30 days. Control rats (C) were fed with normal diet. After 30 days, half the rats from each group were subjected to in vitro myocardial IRI (20 min of global ischemia, followed by 40 min of reperfusion). Hearts from all the groups were then processed for biochemical and histopathological studies. One way ANOVA followed by Bonferroni test was applied to test for significance and values are expressed as mean ± SE (p < 0.05). RESULTS: There was a significant increase in myocardial catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities with no significant change in myocardial thiobarbituric acid reactive substances (TBARS) only in group PO 5 as compared to group C. There was no light microscopic evidence of tissue injury. A significant rise in myocardial TBARS and depletion of myocardial endogenous antioxidants (SOD, CAT and GPx) along with significant myocyte injury was observed in control rats subjected to ischemia-reperfusion (C IR). Hearts from palm olein oil fed rats subjected to ischemia-reperfusion (PO 5 IR and PO 10 IR) were protected from increase in TBARS and depletion of endogenous antioxidants as compared to C IR group. No significant myocyte injury was present in the treated groups. CONCLUSIONS: The present study demonstrated for the first time that dietary palm olein oil protected rat heart from oxidative stress associated with ischemic-reperfusion injury

Cross-Layer Optimization on Different Data Rates for Efficient Performance in Wireless Sensor Network

The traditional protocols used in wireless sensor networks adhere to stringent layering approaches, which decreases the performance of the quality of service (Quality of Service) metrics. As per specifications 802.15.4, wireless sensor networks are inexpensive and energy efficient. It is essential for evaluating the performance of WSNs. Researchers have looked into the fundamental aspects of a single physical layer and the medium access control (MAC) layer protocol using methodologies calculated using several mathematical models or experimental approaches, respectively. In this research, we offer an improved cross-layer analytical model that utilises a thorough combining and interacting&nbsp;of a Markov chain model of the MAC layer's propagation with a model of the PHY layer's propagation. This combination and interaction are described in detail. Various Quality of Service (quality of service) statistics are presented and evaluated, and a cross-layer effectiveness degradation study is conducted under different inputs of multi-parameter vectors. Other parameters, such as Average Wait Time, Reliability, Failure Probability, and Throughput, have been estimated from the simulation results and contrasted with standardised models. The cross-layer model provides a more thorough performance study with various cross-layer parameter sets, some of which comprise distance, power transmission, and offered loads, among other things

Intra-cranial malignant peripheral nerve sheath tumor of olfactory nerve: A case report and review of literature

Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are one of the very rare high grade malignancies usually affecting extremities or trunk. Incidence is 1/Lac. Intra-cranial MPNSTs are even rarer, schwannomatous and commonly affecting cranial nerves VIII &amp;VII). Intra-cranial MPNSTs are usually sporadic, arising de novo. The second most common mode of origin is from malignant transformation from pre-existing schwannomas or neurofibroma. We present an extremely rare and probably the first case of intra-cranial malignant peripheral nerve sheath tumor of the olfactory nerve in a non neurofibrosis patient with no prior history of irradiation

Congestion Aware WSN-IoT-Application Layer Protocols for Healthcare Services

In the healthcare industry, WSN-IoT networks can be used to gather patient data for statistical purposes. IoT-based application-level protocols do not take into account these facts while forwarding the data to the gateway or server, which may degrade the network performance if the data was collected from a patient with ordinary/critical health issues and the route was busy or congested. In this paper, we'll look at the performance of two application layer protocols (i.e. CoAP and MQTT) within the constraints of a scalable network by integrating a congestion-aware scheme with them

Cystic meningioma: Unusual entity with review of literature

Cystic meningioma is a relatively rare condition, radiological appearance of the cystic-solid components of the mass may create a diagnostic dilemma. The presence of a cyst is not a common imaging feature and this makes it difficult to differentiate it from hemangioblastoma, craniopharyngioma, metastasis and gliomas. Cystic meningiomas are present more commonly in children. We present a 60 year old male who presented with seizures and frontal lobe signs. The lesion was suspected as glioma however, postoperative histopathological examination demonstrated as meningioma. Patient showed remarkable recovery after surgery. Complete cyst resection should be considered if it is technically feasible and safe