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

Clinical Application of Soft Tissue Lasers in Periodontics

Laser is an acronym for light amplification by stimulated emission of radiation. The use of laser in dentistry dates way back to 1960s. Since then, its use has increased manyfold. The dental lasers cut tissue by a principle known as photothermal interaction or photothermal ablation. Lasers are effectively usedin operculectomies, gingival depigmentation, gingivectomies, and many more procedures. Laser cannot only be used for surgical procedures but can also be used as an adjunct to scaling and root planing. The diode laser is used on the soft tissue side of the periodontal pocket to remove the inflamed soft tissue and reduce the pathogens. Lasers have been suggested as an adjunct and/or alternative to conventional techniques for various periodontal procedures and considered superior with respect to easy ablation, decontamination, and hemostasis along with less operative and postoperative pain

Periodontitis and Systemic Diseases: A Review

Periodontitis is one of the inflammatory-infectious diseases of the oral cavity, which results in an alteration in the production of host inflammatory mediators. Oral cavity has plentiful diverse bacteria that can spread different sites of the body particularly in immune compromised individuals and results in various systemic diseases. As the oral cavity is the mirror image of our systemic health, hence maintenance of oral health is equally important. This paper reviews the etiology of periodontitis and systemic relation