Sandifer syndrome: the mis-interpretable disorder

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine. An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.

Sandifer syndrome: the mis-interpretable disorder

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine. An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.

Knowledge about COVID-19 Infection and Stress Levels among Ambulance Drivers during COVID-19 Pandemic — A Cross Sectional Study

Introduction : The medical personnel especially have to deal with both the Biological and Psychological consequences originating from the influence of virus. Emergency Care Units equipped with ambulance service always should be at the fore front to face all emerging untoward incidents. Ambulance Drivers often disregard their physical health and mental stress in order to fulfil the duties entrusted on them. Methodology : Cross-sectional questionnaire based on-line survey was conducted. Ambulance drivers were North and South India were taken as study subjects. Knowledge based questions and mental stress were assessed using Perceived Stress level Scale (PSS). The questionnaires were translated toTamil, Kannada, Telugu, Malayalam and Hindi languages. Chi-square test was done to find the association between variables. Results : Among the 101 respondents, 84.2% were having good knowledge about the pandemic. Statistically significant association between number of patients transported per day and the knowledge levels of Ambulance drivers was found (p =0.048)(Chi-square value=15.65). Drivers in Government sector were having more knowledge compared to private sector (p =0.038)(Chi square value=6.53). The perceived mental stress was found to increase with a greater number of patients being transported per day, which was statistically significant (p =0.001)(Chi-square value= 30.42). Conclusion : Knowledge regarding COVID-19 virus was adequate among the Ambulance Drivers. Knowledge was found to be more among drivers who work in Government medical establishments. Mental stress was more among drivers who transported more than 5 patients per day.

Clinical Outcomes of Del Nido Cardioplegia and St Thomas Blood Cardioplegia in Neonatal congenital Heart Surgery

Objectives:Cardioplegia is essential for adequate myocardial protection. There continues to remain ambiguity regarding the ideal cardioplegia for adequate myocardial protection in congenital heart surgery. This study compares clinical outcomes using St Thomas II solution and Del Nido cardioplegia in neonates undergoing cardiac surgery. Methods: All neonates (<30 days) from 2011 to 2017 who underwent surgery requiring cardioplegic arrest were analyzed retrospectively. We divided the cohort into two groups depending on cardioplegia received, as group A (Blood cardioplegia with St Thomas II solution, n = 56) and group B (Del Nido cardioplegia, n = 48). Various demographic, intraoperative, early postoperative, and discharge variables were analyzed. Results: Two groups were similar in age, gender, pre?operative diagnosis, and risk category. Cardiopulmonary bypass (CPB) time (P = 0.002), aortic cross?clamp (ACC) time (P = 0.018), and the number of doses of cardioplegia (P < 0.001) were significantly lower with Del Nido group. Though vasoactive inotropic score (VIS) (P = 0.036) was high during the first 24 h in the immediate postoperative period in group A, there was no difference in early mortality among both groups (P = 0.749). Both groups did not show significant differences related to various postoperative and discharge variables. Conclusion: When compared to St. Thomas solution, the use of Del Nido cardioplegia solution in neonates is associated with a significant decrease in CPB and ACC times and VIS in the first 24 h after surgery. The choice of cardioplegia (St Thomas/Del Nido) in neonates does not affect early mortality and early postoperative clinical outcomes.

A Survival Case of Premature Infant with Hepatoblastoma (Fetal Pattern) along with Other Serious Comorbidities and Surgical Interventions

An estimated ratio (i.e., 1 in 10) babies are born too early every year. Roughly 1 million children die each year due to impediments raised pertaining to preterm birth. One such extreme preterm male baby was presented in the neonatal care unit with respiratory distress and grunting. Baby was confirmed to have ventricular septal defect along with patent ductus arteriosus and craniosynostosis which was treated with medications and surgical managements. He was also engaged with various prophylactic and empirical antibiotic therapies to cover the microbial growth. The most disturbing stage here was the appearance of liver mass sizing 5.8 cm × 1.3 cm accompanied with area of necrosis, diagnosed with hepatoblastoma which was evident with the aid of ultrasound. Hence, chemotherapy was commenced which was in accordance with Societe Internationale d Oncologie Pediatrique Epithelial Liver Tumor Study Group-3. Although the existing comorbidities haunted the baby for a long time, he finally made it successfully to get into track by fighting all the hurdles bravely, which was a sheer miracle. Along with the clinicians/surgeons, we Clinical Pharmacists worked hand in hand to ensure the baby to be receiving optimized drug regimen keeping in mind the risk-benefit ratio.

Anterior Cerebral Artery: An Anatomical Study

Introduction: Anterior cerebral artery (ACA), the smaller terminal branch of the internal carotid artery is significantclinically due to its wide variety of complexity and technical difficulty in surgical procedures.Methods and materials: This study was done in 50 embalmed adult brain hemispheres at Institute of Anatomy,Madras Medical College, Tamilnadu. The study of the anterior cerebral artery was undertaken to observe themode of origin, its course and branches.Results: Anterior cerebral artery originated from the internal carotid artery in 100% of specimens. ACA passedabove optic nerve in 32 specimens (64%), above optic chiasma in 16 specimens (32%) and above optic tract in 2specimens (4%). The average length of A1 segment of right ACA and left ACA were 14.3 mm and 13.7 mm respectively.The difference in diameter of 1mm or more on both sides was observed in 8%. Left A1 segment was duplicated in1 specimen (2%). Median artery of corpus callosum and Azygous anterior cerebral artery were found in onespecimen each. Fenestration of A2 segment was observed in one specimen (4%). Heubner’s artery arose from A2segment in 32 (64%) specimens, from A1 segment in 6 (12%) specimens and from the level of ACoA in 12 (24%)specimens. The orbitofrontal artery originated on an average distance of 5.73mm on right side and average of4.82mm on left side. Frontopolar artery(FPA) originated at a distance of about 20.2mm on right side and 17.6mmon left side. Callosomarginal artery and pericallosal artery were found in all the specimens. In one specimen theright FPA originated from callosomarginal artery.Conclusion: Rapidly advancing fields of vascular neurosurgery and interventional neuroradiology techniquesrequire a thorough understanding of the anatomy. This detailed study done under various parameters wouldbenefit the radiologists and neurosurgeons.

An Unusual Presentation Of Systemic Lupus Erythematosus With Vasculitic Polyneuropathy

We report a case of systemic lupus erythematosus (SLE), in a 48-year-old woman, a known hypertensive and recently diagnoseddiabetic, with a predominant complain of acute onset bilateral lower limb weakness and loss of sensation of the bilateral palmand soles with bowel incontinence and excessive hair loss. On evaluation, her vitals were stable, cardiovascular, respiratory,and abdominal systemic examination revealed no significant abnormality. Neurological examination revealed a normal tone withdistal muscle weakness more in the lower limb than in the upper limb. She was thoroughly evaluated for the above-mentionedcomplaints and examination findings. Nerve conduction study was done - which revealed upper limb - severe asymmetric motorsensory neuropathy - axonal type and lower limb - axonal symmetrical severe polyradiculoneuropathy. Nerve biopsy revealed avasculitic neuropathy. Autoimmune workup was positive for antinuclear antibodies, and low C3 levels, with direct Coombs testpositive, increased UPCR ratio. According to the Systemic Lupus International Collaborating Clinic criteria, she was diagnosedwith SLE. Hence, this is a case of SLE, with a primary presentation of a vasculitic neuropathy, an unusual occurrence.

Prevalence of anxiety and depression among the primary caregivers of patients with schizophrenia who attended Psychiatry Outpatient Department at Rajah Muthiah Medical College and Hospital, Chidambaram

Background: Schizophrenia is one of the most devastating mental disorders that impair language, thinking, perception and sense of self. Recent estimates suggest that around 1% of the adult population that is around 21 million people is suffering from this disabling disease. In India, caregiving is mainly by family members because there are limited alternatives in institutional facilities and welfare supports for those with chronic illnesses such as mental disorders. Most Indian families prefer to care for ill persons at all stages of illness. But, the changing society places significant demands on the caregivers. Aim of the study: To study the prevalence of anxiety and depression among caregivers of schizophrenia patients. To find the association between anxiety and depression of caregivers with the duration of illness, severity of illness (schizophrenia) and the years of association with the patients. Materials and methods: The study was conducted among patients of schizophrenia and their K. Arun Kumar, R. Gandhi Babu, M. Asok Kumar. Prevalence of anxiety and depression among the primary caregivers of patients with schizophrenia who attended Psychiatry Outpatient Department at Rajah Muthiah Medical College and Hospital, Chidambaram. IAIM, 2019; 6(11): 63-75. Page 64 caregivers attending Psychiatry Outpatient Department Rajah Muthiah Medical College and Hospital, Annamalai University, A hundred patients with a diagnosis of schizophrenia and their primary caregivers had been consecutively selected from Psychiatry Outpatient department, Rajah Muthiah medical college, Annamalai university in the year 2018-2019. Then the Self innovated proforma was filled and details about the patients and their caregivers were obtained. HAM-D and HAM-A scales were administered for caregivers and scored for the level of psychiatry morbidity among them. BPRS scale was administered for patient and the severity of illness was assessed. The prevalence was then compared with different variables and associations if any was found. Results: In 100 peoples, Ham- A anxiety score level was analyzed. Severe anxiety was seen in 8 persons, mild to moderate anxiety was in 9 caretakers. Mild severity was observed in 83 patients. Pearson Chi-Square=27.936**, p<0.001. Depression score was absent and less significant among 61 caretakers, mild depression was observed in 24 peoples, moderate depression in 7 caretakers, severe depression was observed in only 8 cases. Paranoid type is more which was around 64%, hebephrenic was 11 %, residual -7%, simple -7%, undifferentiated -7%, catatonia-4%. BPRS score was < 31 in 74 patients, 31-42 were 12 cases, > 43 in 14 patients. More than 10-20 years in people who were taking care of ill patients had severe anxiety when compared to 1-3 years, up to 1 year, 3-10 years. Pearson Chi-Square = 9.784, P = 0.134 which was statistically significant. Severe depression was seen in the illness of 10-20 years in (8) cases. Up to 1 Year, 1-3 Years, 3-10 Years, 10-20 Years had less incidence of severe depression. Few peoples had less depression, mild, and moderate depression. Pearson Chi-Square = 15.405, P = 0.080 which was statistically less significant. Conclusion: Psychiatric disorders were prevalent amongst caregivers who are first- degree relatives of schizophrenic probands. BPRS Score of the patient gave the best diagnostic accuracy for screening psychiatric morbidity and increased the probability of finding a psychiatric disorder in caregivers. Therefore, routine screening of caregivers will aid early diagnosis of psychiatric disorders and enable timely psychological intervention.

Physicochemical properties, antioxidant and anti-inflammatory activities of coumarin-carbonodithioate hybrids

Objective: To study physicochemical properties, antioxidant and anti-inflammatory activities of coumarin-carbonodithioate hybrids. Methods: The substituted 4-bromomethyl coumarins were synthesized in first step by the cyclization. Then the reaction of substituted coumarins (a-e) with potassium O-ethyl/methyl carbonodithioate (1) by using absolute ethanol as solvent,afforded coumarin-carbonodithioate (1a-1j) derivatives under microwave irradiation and the conventional method. The spectroscopic analysis was used for the characterization of coumarin derivatives. The title (1a-1j) compounds were confirmed by spectroscopic methods.Antioxidant property was evaluated by using DPPH free radical-scavenging ability assay method and anti-inflammatory activity was evaluated by protein denaturation procedure using diclofenac sodium as a standard. Drug-likeness. In-silico toxicity was predicted with LD50 value and bioactivity score was also calculated for all the compounds. Results: All coumarin (1a-1j) compounds exhibited promising in-vitro antioxidant and anti-inflammatory properties in comparison to standard drugs. All tested compounds were used for evaluating their physicochemical properties as set by Lipinski rule. It was observed that the synthesized compounds followed rule of five, indicating more 'drug-like' nature. Conclusions: All the screened coumarin-carbonodithioates display promising in vitro antioxidant and antiinflammatory activities. From the physicochemical properties of coumarin derivatives, it is found that none of the compounds violate the Lipinski rule and they fall well in the range of rule of five. It is concluded that the coumarin-carbonodithioate hybrids act with more 'drug-like' nature.

Nano Coated Lead Free Solders for Sustainable Electronic Waste Management

ABSTRACT Lead has been used in a wide range of applications, but in the past decades it became clear that its high toxicity could cause various problems. Studies indicate that exposure to high concentrations of lead can cause harmful damages to humans. To eliminate the usage of lead in electronic products as an initiative towards electronic waste management (e waste), lead free solders were produced with suitable methods by replacing lead. But lead free solders are not preferred as a substitute of lead because they are poor in their mechanical properties such as tensile strength, shear strength and hardness which are ultimately required for a material to resist failure.Nano-Structured materials and coatings offer the potential for Vital improvements in engineering properties based on improvements in physical and mechanical properties resulting from reducing micro structural features by factors of 100 to 1000 times compared to current engineering materials.

Extensive osteomyelitis of humerus following Bacille Calmette-Guérin vaccination.

Bacille Calmette-Guérin (BCG) vaccination administered at birth can lead to certain complications which may present immediate or late. We report a rare case of BCG osteomyelitis in a nine months old immunocompetent female child with extensive destruction of middle and distal third of humerus sparing the proximal bone. Surgical debridement revealed casseous material and dead bone. Biopsy showed inflammatory tissue containing Langhan’s giant cells and granulomatous inflammatory infiltrate. Culture was suggestive of BCG osteomyelitis. Anti-tubercular chemotherapy favoured betterment of her condition and the child has no signs of infection after one year.