Movement Disorders Associated With Radiotherapy and Surgical Procedures

Occasionally, movement disorders can occur following interventional procedures including but not limited to radiotherapy, dental procedures, and cardiac, cerebral and spinal surgeries. The majority of these disorders tend to be unexpected sequelae with variable phenomenology and latency, and they can often be far more disabling than the primary disease for which the procedure was performed. Owing to poor knowledge and awareness of the problem, delays in diagnosing the condition are common, as are misdiagnoses as functional movement disorders. This narrative review discusses the phenomenology, pathophysiology, and potential treatments of various movement disorders caused by interventional procedures such as radiotherapy and neurological and non-neurological surgeries and procedures.

Sialidosis Type I without a Cherry Red Spot— Is There a Genetic Basis?

Sialidosis is an inborn error of metabolism due to a defect in the NEU1 gene and manifests as two phenotypes: mild type I and severe type II. The cherry red spot (CRS) is a characteristic feature in both types of sialidosis; reports of sialidosis without a CRS are rare. We report two cases of genetically confirmed sialidosis type I with a typical presentation of progressive cortical myoclonus and ataxia but without the CRS. A previously reported homozygous pathogenic variant p.Arg294Cys was detected in the first case, and a novel homozygous pathogenic variant p.Arg305Pro was detected in the second case. Additionally, we reviewed the literature describing cases with similar mutations to find a genetic basis for the absence of a CRS. Milder mutation of both alleles detected in both patients may be the reason for the absence of a CRS.

Clinical and Imaging Profile of Patients with Joubert Syndrome

Objective@#Joubert syndrome (JS) is a rare syndrome characterized by ataxia and the molar tooth sign (MTS) on imaging. The present study aims to explore the clinical and radiological features in a cohort of patients with JS. @*Methods@#This was a retrospective chart review of patients with JS evaluated by movement disorder specialists. @*Results@#Nine patients were included in the study. All patients had facial dysmorphism and ocular abnormalities, and 4 patients had dystonia. Ocular tilt reaction and alternate skew deviation (66%) were the most common ocular abnormalities. Horizontally aligned superior cerebellar peduncles were observed in all four patients with diffusion tensor imaging, with a lack of decussation in three. Exome sequencing performed in four patients revealed novel variants in the MKS1, CPLANE1, and PIBF1 genes. @*Conclusion@#Facial dysmorphism, ocular abnormalities and classical imaging findings were observed in all patients with JS. Apart from ataxia, dystonia and myoclonus are other movement disorders observed in JS.

Clinical and Imaging Profile of Patients with Joubert Syndrome

Objective@#Joubert syndrome (JS) is a rare syndrome characterized by ataxia and the molar tooth sign (MTS) on imaging. The present study aims to explore the clinical and radiological features in a cohort of patients with JS. @*Methods@#This was a retrospective chart review of patients with JS evaluated by movement disorder specialists. @*Results@#Nine patients were included in the study. All patients had facial dysmorphism and ocular abnormalities, and 4 patients had dystonia. Ocular tilt reaction and alternate skew deviation (66%) were the most common ocular abnormalities. Horizontally aligned superior cerebellar peduncles were observed in all four patients with diffusion tensor imaging, with a lack of decussation in three. Exome sequencing performed in four patients revealed novel variants in the MKS1, CPLANE1, and PIBF1 genes. @*Conclusion@#Facial dysmorphism, ocular abnormalities and classical imaging findings were observed in all patients with JS. Apart from ataxia, dystonia and myoclonus are other movement disorders observed in JS.

Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis

Objective@#The novel coronavirus disease (COVID-19) pandemic and public health measures to control it have resulted in unique challenges in the management of patients with deep brain stimulation (DBS). We report our experience with the management of acute worsening of symptoms due to battery exhaustion in 3 patients with DBS. @*Methods@#Patients with DBS for movement disorders who visited the emergency room due to battery exhaustion during the nationwide lockdown from April to May 2020 were included. @*Results@#Two patients with subthalamic nucleus-DBS for Parkinson’s disease (PD) and one with globus pallidus interna-DBS for generalized dystonia presented with acute worsening of symptoms due to battery exhaustion. Urgent battery replacement was performed in both patients with PD. The patient with generalized dystonia was managed with medication adjustment as he chose to defer battery replacement. @*Conclusion@#DBS battery replacement can be an emergency. Decisions regarding DBS battery replacement should be individualized during this COVID-19 pandemic.

Assessment of Clinical, Risk Factors Profile and Clinical Pharmacist Care Services on Management and Prevention of Coronary Artery Disease Complications Among Diabetic Patients in a Tertiary Care Hospital Practice

@#Introduction: Diabetes is a chronic metabolic disease and noted to be incidence is intensifying globally and contemplated as epidemic. The study is aimed to assess the coronary artery disease risk profile associated diabetes mellitus patient and to identify the clinical pharmacist care services in the management and to control the risk burden in the clinical practice. Method: A prospective observational study was conducted among the consecutive patients of coronary artery disease associated diabetic patients in a tertiary care teaching hospital over 6 months period. A sample of 150 patients was recruited in the study. Data analysis was done with graph pad prism software 5.01. Results: The present study revealed that coronary artery disease in diabetes was more prevalent in age group between 41-50 years. About 54.66% patients with hyperlipidemia were at risk to develop the coronary artery disease complication. Glycated hemoglobin test was detected in 40% of the patient showing abnormal levels and around 43.33% of patient had an abnormal fasting blood sugar level. The study showed only 32% of patients was prescribed Insulin & oral hypoglycemic agents and 13 % were treated with statins. Conclusion: It could be concluded that the causative factors should be controlled and treated with an early need for amalgamation of clinical pharmacist care services with the health care team on life style modification counseling could ultimately improve the patient health outcomes and also lowers progression of coronary artery disease risk complications among diabetic patients.

Idiopathic multilocular thymic cyst-an incidental anterior mediastinal mass

Acquired thymic cyst are multilocular and they occur de novo or in association with mediastinal neoplasm, systemic autoimmune diseases and trauma. Here, we report a case of acquired multilocular thymic cyst due to non-specific inflammatory etiology in a 42-year old gentleman and our approach to diagnosis and management of anterior mediastinal mass. With no specific clinical symptom, he was diagnosed with anterior mediastinal mass incidentally by imaging studies. Definitive diagnosis of multilocular thymic cyst was obtained by tissue diagnosis of the anterior mediastinal mass resected during the surgery.

Iron deficiency anemia as a risk factor for simple febrile seizures in pediatric patients

Background: Febrile seizure (FS) is the most common cause of seizure in children, occurring between 6-60 months. It coincides with peak age of incidence for Iron deficiency anemia (IDA). Iron is required for optimal growth and development and its deficiency is associated with numerous problems including persistent cognitive and motor delays. The objective was to study the role of IDA as a risk factor for simple febrile seizure and its recurrenceMethods: A case control study was conducted among 90 febrile children - 45 cases with simple febrile seizure and 45 cases with febrile illness, between the age group of six months to five years of age at Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, between September 2013 and June 2015. The hematological parameters like Hemoglobin, Serum ferritin and RDW were compared between the two groups with respect to fever and different temperature intervals, recurrence of FS.Results: Hb and Serum Ferritin levels were found to be significantly associated with simple febrile seizure, with p value of <0.002 and 0.001 respectively. Similar association was found at different temperature intervals. However, there was no association of hematological parameters with FS recurrence.Conclusions: IDA is a significant risk factor for FS in children while same may not have any effect on the recurrence of FS.

Assessment on awareness of rational prescribing practices among medical interns in a tertiary care hospital: a questionnaire based study

Background: Awareness about rational use of Medicines is required to improve the quality of health care system. Attitude towards rational drug use is also an utmost importance as they constitute the future generation doctors.Methods: A set of 13 questionnaire is given to the interns through an online link to their e-mail which contains informed consent and questionnaires. Respondents has to select the best suitable option and after which the data will be compiled and statistically analyzed.Results: Age of the study participants range from 22-26yrs. Half of them have finished major postings. Almost 96.1 % of them were aware of the term essential drugs. Only 25% of them said that they have NLEMI at work place, 75% of them were aware of the term Rational use of Medicines. Only 32% of them were aware of the term P drugs. 44% of them were aware of STEP criteria for selection of drug and 47% of them were aware of the updated prescribing format. 8% knew the difference between old and new prescription format, 25% of them always prescribe. Almost 82% of them narrate regarding the disease and drug therapy, 31% of them prescribe only generic name.Conclusions: Educational intervention like CME and practical hands on training in Rational use of Medicines would help them in better understanding of the subject and its clinical implications thereby decreasing the prescribing errors.

Prevailing pattern of feeding practices and malnutrition among infant and young children

Background: Nutritional factors like breast feeding practices, weaning practices and diet during illness influence the growth and development of children. Recurrent'' infections are other important factors that lead to malnutrition.Methods: This was a non-randomized prospective study using pretested, predesigned questionnaires. Study was done in a single centre to determine the pattern of feeding practices and malnutrition among infant and young children. This study was carried out in the Department of Paediatrics at Sri Manakula Vinayagar Medical College and hospital, Puducherry.Results: Out of the 200 babies studied, 22% of the babies were exclusively breast fed and 5% of the babies were bottle fed. The remaining 73% of the babies were on both breasts feeding and bottle feeding. A 52% of children in the age group 6-12 months, 50% children under12-24 months and 52% of children >24 months were found to be malnourished according to WHO growth standards.Conclusions: Quantity and quality of complementary feeds given is inadequate due to lake of awareness, fear and food stigmata. Hence feeding practices are far from satisfactory. Complementary feeding and weaning practice guidelines are better practiced as the age advances but their practice at a younger age would lead to a better outcome.

A comparative study to assess the awareness of antibiotic resistance amongst first and second year medical undergraduate students in a medical college

Background: With the rising instances of antibiotic resistance and decline in the discovery of newer antibiotics, it is high time to prevent the emergence of antibiotic resistance. One of the best measures regarding the above problem is education and creating awareness regarding antibiotic resistance, and that too primarily among healthcare professionals. The initiation should start at the basic level and that too in the early days of medical profession, so that there is greater awareness and strong foundation for antibiotic prescribing pattern. The present study is taken up to compare awareness among 1st year and 2nd year medical students in a private medical college with 2nd year medical students having prior education regarding antibiotics resistance and first year students representing general public without any education regarding antibiotics resistance.Methods: This study was a comparative, cross-sectional, questionnaire based study. The questionnaire was validated for face validity and content validity from subject experts. The two groups selected were 1st year and 2nd year medical undergraduates. Data was analysed using simple descriptive statistics.Results: 136 students from 1st year and 88 students from 2nd year participated in the study. In both the groups studied, majority of the respondents completed the full course of antibiotics. 77% of 1st year and all 2nd year students were aware of the antibiotic resistance. 99% of 2nd year students and only 49% of the 1st year students were aware of the reasons for it (p<0.01). Awareness regarding prophylactic usage of antibiotics, usage for simple common cold and usage of higher antibiotics for mid infection leading to Antibiotic Resistance was significantly less among first year students. 2nd year students were well aware of consequences of antibiotic resistance like ineffective treatment, prolongation of illness, emergence of bacterial resistance and additional cost burden than 1st year students. Awareness regarding other aspects of antibiotic resistance was not significant between two groups.Conclusions: Stressing upon awareness and education regarding antibiotic resistance in the early days of medical curriculum will help in change of behaviour and habits of antibiotic usage and rational prescribing of antibiotics by the future doctors.

Umbilical Pilonidal Sinus: A Rare Presentation.

Pilonidal sinus is common in the sacrococcygeal region. It is rare at the umbilicus. Incidence being 0.6%, we report a case of umbilical pilonidal sinus treated in our hospital. A 20-year-old male patient was admitted to our hospital with complaints of purulent discharge from the umbilicus since 3 months. Patient was posted for omphalectomy. Intraoperatively, a tuft of hair was found in a sinus tract communicating with the umbilicus. Histopathological evaluation was compatible with pilonidal sinus disease. There are only a few reports of the umbilical pilonidal sinus in the literature. Umbilical sinus tract differs from the sacrococcygeal variety in the absence of multiple tracts and low recurrence rates. Treatment options and differential diagnosis are discussed in the article.

Pediatric Polysomnographic Studies at a Tertiary-care Hospital in Singapore.

Objectives: To investigate the indications for conducting polysomnography studies and their outcomes. Methods: Retrospective analysis of pediatric polysomnography studies performed over a four-year period (2009-2012). Results: 425 diagnostic studies and 100 non-invasive positive-pressure ventilation titration studies were conducted. Of these, 389 were performed in male children. Obstructive sleep apnea was the most common diagnosis; 49.6% (211 studies). Other diagnoses included central apnea, narcolepsy, and periodic limb movement disorder. Night time symptoms (snoring, frequent night awakenings, restless sleep) were present in 294 children, and 161 children had daytime symptoms (excessive daytime sleepiness, early morning fatigue, poor concentration at school). 13 studies (2.5%) were inadequate for analysis, reflecting the challenges of conducting studies in children. Conclusion: Dedicated pediatric sleep laboratories with properly trained staff are important to minimize failure rates and diagnose these conditions accurately.

Furosemide Infusion in Children with Dengue Fever and Hypoxemia.

Objectives: To study the role of furosemide infusion in the management of Acute respiratory distress syndrome (ARDS) associated with dengue fever. Methods: Children between the ages of 1 month to 18 years, who fulfilled the WHO clinical criteria for dengue infection and American European Consensus Criteria criteria for ARDS with Dengue IgM positivity, were evaluated. Patients were studied as group D (receiving diuretic therapy alone) and group B (both ventilation and diuretics), and compared to a historical control group V (ventilation alone). Furosemide infusion was administered at 0.05-0.1 mg/kg/hour for 48 hours, maintaining a urine output of 2-4 mL/kg/hour. Results: There was a significant difference in survival in the three groups. Significant difference was noted between pre- and postintervention arterial blood gases with respect to PCO2 (P=0.02), pO2 (P=0.003), PaO2/FaO2 ratio (P<0.001) and alveolar-arteriolar oxygen gradient (P=0.002). Conclusion: Diuretic infusion improves outcome in dengue with ARDS.

Green Dentistry; Ecofriendly Dentistry : Beneficial For Patients, Beneficial For The Environment.

Green dentistry or eco-friendly dentistry is a practice that reduces waste and pollution, saves energy and money, incorporates high tech innovations and is wellness based. Dentists incorporate a variety of materials and equipment in practice, some of them currently in use present potential challenges to the environment. Dentists are responsible for taking several precautions to ensure that patients, staff and the environment are protected. Precautions must be taken to prevent any harmfull chemicals or materials from polluting the environment and in turn causing ” Global warming”. Green dentistry increase environmental awareness and sensitivity among dental professionals. This review article identifies some common wastes produced by dental professionals and suggestions for reducing the impact on the environment which can help ensure patient and worker safety, prevent the risk of future liability and protect our air, water and land.

Retinopathy of Prematurity –Promising Newer Modalities of Treatment.

Retinopathy of prematurity (ROP) is a disorder of neonatal retinal vascularization. The incidence is increasing in developing countries like India in view of the rising numbers of preterm deliveries and improved neonatal care. Traditional modalities of treatment included cryotherapy and laser therapy, which were laborious and required special training. Hence, research is on way to find novel treatment modalities directed at various levels of pathogenesis for this blinding disease. We reviewed the published and unpublished literature on newer methods of ROP management. The pathogenesis of ROP has been studied with respect to the mediators of angiogenesis. Anti vascular endothelial growth factor (Anti-VEGF) therapy has been extensively studied and the studies have demonstrated its promising role early stages of ROP. The role of Insulin like growth factor (IGF), Granulocyte colony stimulating factor (GCSF), and June kinases (JNK) inhibitors are being studied by various researchers across the world. Gene therapy holds promise in the reversal of ROP changes.

Pattern of injuries due to electric current.

A one year study, from October 2007 to September 2008, was under taken in an attempt to study the pattern of electrical injury, the cause of death, manner of death, and diagnosis by histopathological examination. The study was compromised of 62 cases brought with history of electrical shock. Of the total 62 cases, males were 57(91.93%) and females were 5(8.06%) the mean age is 26 .27 year. The peak age of victims are 21-30 years age group 24 cases (38.71%].In the age group of 1n 0-10 years age group victims 3. Most of cases were due to low tension and domestic circuit. The patterns of electrical injuries are noted, such as entry, exit and both entry, exit wounds, flash burns and no electrical signs. The maximum victims showed dermo-epidermal degree of electrical burns .The histopathological examination is an important aid in diagnosis of electrical injuries and recommendations about preventive safety measures to reduce the mortality.

A study of serum cholinesterase levels in organo phosphorous poisoning cases.

The study period is 11 months that is from 01-01-2007 to 28-11-2007, 35 cases of organ phosphorus poisoning were admitted at Mamata General Hospital, khammam, Andhra Pradesh, India. The cases were studied on various epidemiological parameters and Proforma prepared for detailed data. In our study the majority of victims were males, married, Hindu, Literate, from rural area, medium socioeconomic group and common age of victims is 21 to 30 years. The common mode of poisoning is suicidal, one is accidental poison in child and one is occupational as contact poison while spraying .No homicidal poison was reported in our study. Majority victims have consumed poison in day time, commonly abused poison is monochrotophos, and approximate amount of poison consumed by majority of the victims is 250 ml to 500 ml and majority were admitted within 3 to 6 hours of consumption of poison. The common motive of poisoning was suicidal in both male [24 cases] and female [10 cases], especially young victims from rural domicile with agricultural occupation. The majority of victims consumed poison in summer followed by winter season. The probable reason is rain dependent agricultural occupation, unemployment, joint family and medium socioeconomic status of population of this area.

Synthesis and anti-histaminic activity of some novel pyrimidines

Novel Pyrimidines were prepared by the condensation of Chalcones of 4 -piperazine acetophenone with guanidine HC1. The structures of the synthesized compounds RP 1-5 were assigned on the basis of Elemental analysis, IR, [1]H NMR and Mass spectroscopy. These compounds were also screened for antihistaminic activity. The recorded% of histamine inhibition showed significant antihistaminic activity when compared to the reference antihistaminic drug mepiramine