Serious Concern of Congenital Zika Syndrome (CZS) in India: A Narrative Review.

Congenital Zika syndrome (CZS) is a major concern in India and highlights the multifaceted challenges posed by the Zika virus (ZIKV). The alarming increase in CZS cases in India, a condition that has serious effects on both public health and newborns, has raised concerns. This review highlights the importance of raising concern and awareness and taking preventive measures by studying the epidemiology, clinical symptoms, and potential long-term consequences of CZS. The review also contributes to worldwide research and information sharing to improve the understanding and prevention of CZS. As India deals with the changing nature of CZS, this thorough review is an important tool for policymakers, health workers, and researchers to understand what is happening now, plan for what to do in the future, and work together as a team, using medical knowledge, community involvement, and study projects to protect newborns' health and reduce the public health impact of these syndromes.

Plasmonic Optical Fiber Based Continuous in-Vivo Glucose Monitoring for ICU/CCU Setup.

This paper reports a sensor architecture for continuous monitoring of biomarkers directly in the blood, especially for ICU/CCU patients requiring critical care and rapid biomarker measurement. The sensor is based on a simple optical fiber that can be inserted through a catheter into the bloodstream, wherein gold nanoparticles are attached at its far distal end as a plasmonic material for highly sensitive opto-chemical sensing of target biomolecules (glucose in our application) via the excitation of surface plasmon polaritons. For specificity, the nanoparticles are functionalized with a specific receptor enzyme that enables the localized surface plasmon resonance (LSPR)-based targeted bio-sensing. Further, a micro dialysis probe is introduced in the proposed architecture, which facilitates continuous monitoring for an extended period without fouling the sensor surface with cells and blood debris present in whole blood, leading to prolonged enhanced sensitivity and limit of detection, relative to existing state-of-the-art continuous monitoring devices that can conduct direct measurements in blood. To establish this proof-of-concept, we tested the sensor device to monitor glucose in-vivo involving an animal model, where continuous monitoring was done directly in the circulation of living rats. The sensor's sensitivity to glucose was found to be 0.0354 a.u./mg.dl-1 with a detection limit of 50.89 mg/dl.

Neutronic simulation of medical radioisotope 99Mo and 177Lu production in IPR 14 MeV neutron generator facility.

An accelerator based 14 MeV neutron generator is commissioned at Institute for Plasma Research India. The generator is based on the linear accelerator concept where the deuterium ion beam impinged to the tritium target to produce neutrons. The generator is designed to produce 1 × 1012 neutrons per sec. The 14 MeV neutron source facilities are an emerging tool for the lab scale experiments and research. In order to utilize the generator for the welfare of humanity, the assessment is made for the production of medical radioisotopes using the neutron facility. The usage of radioisotopes in the treatment and diagnosis of a disease is an important factor in the healthcare sector. A series of calculations are conducted to generate radioisotopes, especially 99Mo and 177Lu those are having huge applications in the medical and pharmaceutical industries. 99Mo can be also generated through neutron reactions 98Mo(n, g)99Mo and 100Mo(n, 2n)99Mo apart from fission reaction. The cross section of 98Mo(n, g)99Mo is high in the thermal energy range whereas 100Mo(n,2n)99Mo occurs at a high energy range. 177Lu can be produced using the reactions 176Lu (n, g)177Lu and 176Yb (n, g)177Yb. The cross section of both 177Lu production routes is higher at thermal energy range. The neutron flux level near the target is around 1010 cm-2s-1. In order to enhance production capabilities, the neutron energy spectrum moderators are used to thermalize the neutrons. The materials used as a moderator are beryllium, HDPE, graphite, etc. Moderators enhance the capabilities of medical isotope production in neutron generators.

A novel multi-set differential pulse voltammetry technique for improving precision in electrochemical sensing.

Over the years, electrochemical sensors have achieved high levels of sensitivity due to advancements in electrical circuits and systems, and calibration standards. However, little has been explored towards developing ways to minimize random errors and improve the precision of electrochemical sensors. In this work, a novel electrochemical method derived from differential pulse voltammetry termed multi-set differential pulse voltammetry (MS-DPV) is proposed with the goal of reducing random errors in chemical- and bio-sensors and thereby improve precision. The proposed MS-DPV improves precision without the need to replicate measurements. Therefore, saving energy use, time consumed, and/or materials required. The method is especially suited for portable or in-field sensing solutions that have strict constraints on sampling, time and energy use. To realize the proposed method, a custom designed plug-and-play-type electrochemical sensing system was employed which was then used for detecting salicylic acid (SA). SA is a key phytohormone deployed during defense responses in plants against biotic stresses. Additionally, SA is widely used in the pharmaceutical and healthcare industry due to its anti-inflammatory and analgesic properties. Using a "4-set-DPV", an error reduction of up to 12% was observed in SA detection when compared to conventional differential pulse voltammetry. In general, the error variance reduces linearly with the number of readings taken in a single scan of the proposed MS-DPV.

Pleural effusion due to Chryseobacterium indologenes: Case report and review of literature.

Chryseobacterium indologenes is found ubiquitously in the environment; it rarely causes human disease. Hence, we report a case of C. indologenes-associated pleural effusion in a patient with aortic dissection. Postoperatively, the patient developed massive right-sided pleural effusion with underlying consolidated lung. Culture of the pleural fluid yielded pure growth of C. indologenes which was susceptible to cotrimoxazole, minocycline, and tigecycline. Therapy was modified; tigecycline and cotrimoxazole were started following which the patient showed improvement, and subsequent cultures of the pleural fluid were sterile. This report promotes awareness of this organism as an emerging pathogen in lung infections and emphasizes the importance of targeted therapy.

A Self-Propelled Mechanism to Increase Range of Bistable Operation of a Piezoelectric Cantilever-Based Vibration Energy Harvester.

In our previous works, we presented a method to increase the harvested energy from vibrations using a piezoelectric cantilever and to increase the frequency range of operation by introducing bistability with the use of magnetic repulsion. However, for small excitations, the cantilever may not be able to overcome the magnetic repulsive force but vibrate at one of its two equilibrium positions with reduced amplitude. This work introduces a method of increasing the range of excitations over which the operation remains bistable. This is achieved by spring loading one of the magnets, previously on a fixed support, allowing motion in one dimension only, toward and away from the cantilever in the horizontal plane. Configured so, as the cantilever moves toward this magnet, the repulsion due to the cantilever-mounted magnet pushes the spring-loaded magnet away, increasing distance, and thus, reducing magnetic force between them, required to be overcome by external excitations for bistable operation. Similarly, as the cantilever moves away, the spring pushes the magnet closer to the cantilever-mounted magnet, increasing vibration amplitude. Thus, the spring introduces a negative feedback which favors bistable operation over an increased range of excitations. This completely mechanical method requires no additional energy cost. Peak power gains of up to 90 and a decrease in excitation voltage of up to 60% were observed over the fixed magnet.

Determination of dynamic variations in the optical properties of graphene oxide in response to gas exposure based on thin-film interference.

We present an effective yet simple approach to study the dynamic variations in optical properties (such as the refractive index (RI)) of graphene oxide (GO) when exposed to gases in the visible spectral region, using the thin-film interference method. The dynamic variations in the complex refractive index of GO in response to exposure to a gas is an important factor affecting the performance of GO-based gas sensors. In contrast to the conventional ellipsometry, this method alleviates the need of selecting a dispersion model from among a list of model choices, which is limiting if an applicable model is not known a priori. In addition, the method used is computationally simpler, and does not need to employ any functional approximations. Further advantage over ellipsometry is that no bulky optics is required, and as a result it can be easily integrated into the sensing system, thereby allowing the reliable, simple, and dynamic evaluation of the optical performance of any GO-based gas sensor. In addition, the derived values of the dynamically changing RI values of the GO layer obtained from the method we have employed are corroborated by comparing with the values obtained from ellipsometry.

Integrated dual-modality microfluidic sensor for biomarker detection using lithographic plasmonic crystal.

This paper reports an integrated dual-modality microfluidic sensor chip, consisting of a patterned periodic array of nanoposts coated with gold (Au) and graphene oxide (GO), to detect target biomarker molecules in a limited sample volume. The device generates both electrochemical and surface plasmon resonance (SPR) signals from a single sensing area of Au-GO nanoposts. The Au-GO nanoposts are functionalized with specific receptor molecules, serving as a spatially well-defined nanostructured working electrode for electrochemical sensing, as well as a nanostructured plasmonic crystal for SPR-based sensing via the excitation of surface plasmon polaritons. High sensitivity of the electrochemical measurement originates from the presence of the nanoposts on the surface of the working electrode where radial diffusion of redox species occurs. Complementarily, the SPR detection allows convenient tracking of dynamic antigen-antibody interactions, to describe the association and dissociation phases occurring at the sensor surface. The soft-lithographically formed nanoposts provide high reproducibility of the sensor response to epidermal growth factor receptor (ErbB2) molecules even at a femtomolar level. Sensitivities of the electrochemical measurements to ErbB2 are found to be 20.47 µA µM-1 cm-2 in a range from 1 fM to 0.1 µM, and those of the SPR measurements to be 1.35 nm µM-1 in a range from 10 pM to 1 nM, and 0.80 nm µM-1 in a range from 1 nM to 0.1 µM. The integrated dual-modality sensor offers higher sensitivity (through higher surface area and diffusions from nanoposts for electrochemical measurements), as well as the dynamic measurements of antigen-antibody bindings (through the SPR measurement), while operating simultaneously in a same sensing area using the same sample volume.

Design and development of a low-cost biphasic charge-balanced functional electric stimulator and its clinical validation.

Functional electric stimulators that produce near-ideal, charge-balanced biphasic stimulation waveforms with interphase delay are considered safer and more efficacious than conventional stimulators. An indigenously designed, low-cost, portable FES device named InStim is developed. It features a charge-balanced biphasic single channel. The authors present the complete design, mathematical analysis of the circuit and the clinical evaluation of the device. The developed circuit was tested on stroke patients affected by foot drop problems. It was tested both under laboratory conditions and in clinical settings. The key building blocks of this circuit are low dropout regulators, a DC-DC voltage booster and a single high-power current source OP-Amp with current-limiting capabilities. This allows the device to deliver high-voltage, constant current, biphasic pulses without the use of a bulky step-up transformer. The advantages of the proposed design over the currently existing devices include improved safety features (zero DC current, current-limiting mechanism and safe pulses), waveform morphology that causes less muscle fatigue, cost-effectiveness and compact power-efficient circuit design with minimal components. The device is also capable of producing appropriate ankle dorsiflexion in patients having foot drop problems of various Medical Research Council scale grades.

Variability of resistance in Black Bengal goats naturally infected with Haemonchus contortus.

A total 290 Black Bengal goats (6 buck, 109 doe and 175 kids born from 11 sires) were studied to evaluate the variability of resistance in Black Bengal goats naturally infected with Haemonchus contortus. The variability of resistance in Black Bengal goat was studied for both genetic and non-genetic factors like village, sex, age dam, sire, dam resistance group and offspring resistance group. Male kids have slightly higher resistance than female kids although it was not significant. Resistance of kids was increased as age increases and kid population showed significantly different resistance status among the offspring resistant groups. The doe population showed significantly different LEPG as per the resistance group in all the collections. The present study found that the resistance of kids under sire were varied significantly and observed that the kids under sire 1, 6-8 were significantly more resistant than the kids of the sire 2, 5 and 11 in 3rd collection and it is also noticed that maternal genetic effect has a very little impact on resistance of kids. Males (buck) were most resistant and the kids were least resistant and the resistance of dam was in between the male and kids population.

Epidemiology and impact of early rehabilitation of spinal trauma after the 2005 earthquake in Kashmir, India.

PURPOSE: The Kashmir earthquake, also known as the South Asia earthquake, hit Jammu and Kashmir (India) on 8th October 2005 (registered as 7.6 on Richter scale) and was quite devastating, with the official toll being 1,360 (some estimates being around 1,800). The injured registered around 6,300. In such an enormous disaster, rescue operations, relief and rehabilitation is a great challenge. One week after the Kashmir earthquake (2005), a multidisciplinary rehabilitation team headed by the corresponding author went to Srinagar (Kashmir). The purpose was to tackle the medical rehabilitation issues of the victims of the earthquake and later study the epidemiology of various injuries, especially the spinal injuries, so as to improve the future rehabilitation strategies in similar scenarios. METHOD: This is a single-phase, hospital-based study of spinal injury patients of the Kashmir earthquake (October 2005) admitted in various hospitals of Srinagar (the capital city of Kashmir, India) and around it. This was conducted one week after the Kashmir earthquake (October 2005). Detailed history of patients, clinical and radiological evaluation was done. In consultation with neurosurgeons and spine surgeons, issues of rehabilitation were noted, and need based on early rehabilitation care was provided by means of rehabilitation orthoses (aids/appliances), physiotherapy, psychotherapy, etc. RESULTS: Out of 2,621 cases who received various injuries (as per records of different hospitals and health institutions), 1,366 (52.11%) were referred to different health institutions of Kashmir valley, of which 429 (31.40%) cases were admitted for orthopaedic intervention at different referral hospitals of Srinagar and Baramula. Out of 429 admitted patients of different hospitals, we covered 266 patients of four major hospitals, of which 38 (12.33%) cases were spinal injuries, 20 cases (52.7%) had dorsolumber segment involvement with 12 cases (31.5%) having cervical and six cases (15.8%) sacrococcigeal injury. CONCLUSION: In a massive natural calamity like the Kashmir (India) earthquake of 2005, a collective effort by a rehabilitation team for providing supportive/assistive devices along with physiotherapy and psychotherapy has significantly helped in recovery of functional and psychological status of the spinal trauma victims. No doubt that the life saving operations and definitive surgery are important to combat major catastrophe in such disasters but early medical rehabilitation is equally important to reduce injury-related disability.

Therapeutic management of the hallux rigidus.

Background. Hallux rigidus is a chronic, disabling condition of foot characterized by reduced great toe extension. The manual therapy approaches are described theoretically however their practical published evidence has not been analyzed well. Objective. Aim of the present paper was to systematically review the literature available for therapeutic management of the hallux rigidus by identifying and evaluating the randomized controlled trials (RCTs) and non-RCTs. Methods. To view the hallux rigidus and its rehabilitation, a webbased published literature search of Pubmed, Ovid Medline, Science direct, Cochrane Database, PEDro database, CINAHL was conducted for last 35 years in August 2010 using 4 specific keywords "hallux rigidus, physical therapy, chiropractic, and manual therapy" typed in exactly same manner in the search column of the databases. Result. the review finds that there is acute need of the quality studies and RCTs for the manual therapy, chiropractic, or physiotherapeutic management of the hallux rigidus. Conclusion. Review conclude that conservative programs for hallux rigidus consists of comprehensive intervention program that includes great toe mobilization, toe flexor strengthening, sesamoid bones mobilization and long MTP joint. The clinician should put an emphasis on the mobilization program with proper follow up along with comparative studies for rehabilitation of hallux rigidus.

The effect of a spinal orthosis on posture and cardio-respiratory functions in progressive myopathic scoliosis.

BACKGROUND: Historically, the orthotic treatment in progressive myopathic scoliosis has not been as effective as expected. The purpose of this study was to investigate the effect of a spinal orthosis on scoliotic curve correction, alignment of altered posture and cardio-respiratory functions. CASE DESCRIPTION AND METHODS: An 11 year-old girl diagnosed with myopathy was fitted with a custom molded thoraco-lumbo-sacral orthosis to enhance the sitting ability. The cardio-respiratory tests were performed by a COSMED K4 b(2); metabolic analyzer. The anterior posterior radiographs were analyzed for measuring Cobb angle and Ferguson angle. A plumb line test was used to assess the postural improvements. FINDINGS AND OUTCOMES: No significant difference was observed for variables such as O(2) consumption level, PaO(2), tidal volume, heart rate and energy expenditure/min. The improved posture was evident by shifting of the plumb line 18 mm towards the mid line with the use of orthosis. Very minor improvements in both angles were observed with the use of the brace. CONCLUSION: The brace treatment cannot be expected to have a lasting corrective effect although it can be used as a sitting support and for maintaining posture Clinical relevance This case study provides an objective prescription of thoraco-lumbo-sacral orthosis as a sitting support and for improving posture in progressive myopathic scoliosis if suitably designed and properly fitted.

Surface EMG analysis and changes in gait following electrical stimulation of quadriceps femoris and tibialis anterior in children with spastic cerebral palsy.

PURPOSE: To evaluate the clinical feasibility and effect of neuromuscular electrical stimulation (NMES) therapy of quadriceps femoris (QF) and tibialis anterior (TA) muscles on improving gait and functional outcomes in children with spastic cerebral palsy (CP). METHOD: Ten children with spastic diplegic/hemiplegic CP who were in the age group of 7 to 14 years recruited from a rehabilitation institute were randomly assigned either to a control group or a NMES group. Both groups obtained conventional physiotherapy and muscle strengthening exercises. The NMES group in addition received surface electrical stimulation to QF and TA muscles for four weeks duration. RESULTS: The NMES group showed significant improvements as compared to the control group in walking speed (mean difference: 7.83 meters per min, 95% confidence interval: 3.13 to 12.53, p<0.01) and cadence (mean difference: 23.33 steps per min, 95% confidence interval: 5.90 to 40.77, p<0.01). The NMES group also showed significant reduction in physiological cost index of walking or PCI (mean difference: -1.32 beats per meter, 95% confidence interval: -1.83 to -0.80, p<0.001) indicating greater energy-efficiency of walking. No significant changes were seen in EMG parameters. CONCLUSIONS: The findings of this study suggests that NMES therapy together with conventional physiotherapy more efficiently improves walking ability and functional outcomes as compared to conventional physiotherapy alone in children with spastic CP.

Functional electrical stimulation of dorsiflexor muscle: effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients.

OBJECTIVE: To evaluate the therapeutic effects of Functional Electrical Stimulation (FES) of the tibialis anterior muscle on plantarflexor spasticity, dorsiflexor strength, voluntary ankle dorsiflexion, and lower extremity motor recovery with stroke survivors. DESIGN: We conducted a prospective interventional study. SETTING: Rehabilitation ward, physiotherapy unit and gait analysis laboratory. PARTICIPANTS: Fifty-one patients with foot drop resulting from stroke. INTERVENTION: The functional electrical stimulation (FES) group (n=27) received 20-30 minutes of electrical stimulation to the peroneal nerve and anterior tibial muscle of the paretic limb along with conventional rehabilitation program (CRP). The control group (n=24) treated with CRP only. The subjects were treated 1 hr per day, 5 days a week, for 12 weeks. MAIN OUTCOME MEASURES: Plantarflexor spasticity measured by modified ashworth scale (MAS), dorsiflexion strength measured by manual muscle test (MMT), active/passive ankle joint dorsiflexion range of motion, and lower-extremity motor recovery by Fugl-Meyer assessment (FMA) scale. RESULTS: After 12 weeks of treatment, there was a significant reduction in a plantarflexor spasticity by 38.3% in the FES group and 21.2% in control group (P< 0.05), between the beginning and end of the trial. Dorsiflexor muscle strength was increased significantly by 56.6% and 27.7% in the FES group and control group, respectively. Similarly, voluntary ankle dorsiflexion and lower-extremity motor function improved significantly in both the groups. No significant differences were found in the baseline measurements among groups. When compared with control group, a significant improvement (p< 0.05) was measured in all assessed parameters in the FES group at post-treatment assessment, thus FES therapy has better effect on recovery process in post-stroke rehabilitation. CONCLUSIONS: Therapy combining FES and conventional rehabilitation program was superior to a conventional rehabilitation program alone, in terms of reducing spasticity, improving dorsiflexor strength and lower extremity motor recovery in stroke patients.

Medulloblastoma in childhood-King Edward Memorial hospital surgical experience and review: Comparative analysis of the case series of 365 patients.

AIM: Medulloblastoma is one of the most common posterior fossa tumors in childhood. The treatment-related side effects as well as predictive outcome still remain as a major challenge. The improved understanding of the disease and advances in molecular biology is changing the treatment paradigms from Chang's staging system to molecular risk stratification. However, surgery still remains as an important mainstay of therapy and is formidable. The role of radical surgery has always been a crucial factor in the outcome of these patients, the best survival being reported in patients who had total excision of the tumor and with no metastasis. PATIENT AND METHODS: An analysis of 365 patients (age<18 years) of medulloblastoma who underwent treatment at the Seth G.S. Medical College and King Edward VII Memorial hospital (KEM), Mumbai over a 25- year period (1985-2000 and 2001-2010) is presented. The clinical profile, radiological features, pathology and surgical nuances are discussed. RESULTS: The most common age group affected was between 3 and 12 years. 75.3% presented with headaches, vomiting and 63.2% with papilledema. Sitting position was used in majority of cases. A total of 8 patients underwent shunting; all of them were in the postoperative period (5.19%). 92.2% (142 cases) had classical medulloblastoma, 5.1% (8 cases) had desmoplastic variant, 1.9% (3 cases) had anaplastic changes and 0.6% (1 case) had glial differentiation. The 5-year and 10-year progression free survival rate was 73 and 41% for average risk disease while for high risk disease rate it was 34%. The mortality rate was 2%. The quality of life was enhanced in patients who survived 5-10 years after treatment. CONCLUSION: Surgery for medulloblastoma is formidable. The option of sitting position for medulloblastoma surgery is still viable. A vigilant neuroanesthesiologist and a safe surgery are necessary to achieve a good postoperative result. Radiological characteristics are helpful adjuncts for determining effective surgical strategy. Permanent CSF drainage can be avoided in majority of patients and can be definitively considered in progressive symptomatic hydrocephalus. A safe maximal resection and a good Karnofsky score are paramount to ensure compliance with adjuvant therapy and contribute to an overall survival advantage.

Effect of functional electrical stimulation on the effort and walking speed, surface electromyography activity, and metabolic responses in stroke subjects.

OBJECTIVE: To investigate the effects of functional electrical stimulation (FES) combined with conventional rehabilitation program on the effort and speed of walking, the surface electromyographic (sEMG) activity and metabolic responses in the management of drop foot in stroke subjects. METHODS: Fifteen patients with a drop foot resulting from stroke at least 3 months prior to the start of the trial took part in this study. All subjects were treated 1h a day, 5 days a week, for 12 weeks, including conventional stroke rehabilitation program and received 30 min of FES to the tibialis anterior (TA) muscle of the paretic leg in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral EMG parameters of TA muscle, walking speed, the effort of walking as measured by physiological cost index (PCI) and metabolic responses. RESULTS: The experimental results showed a significant improvement in mean-absolute-value (21.7%), root-mean-square (66.3%) and median frequency (10.6%) of TA muscle EMG signal, which reflects increased muscle strength. Mean increase in walking speed was 38.7%, and a reduction in PCI of 34.6% between the beginning and at end of the trial. Improvements were also found in cardiorespiratory responses with reduction in oxygen consumption (24.3%), carbon dioxide production (19.9%), heart rate (7.8%) and energy cost (22.5%) while walking with FES device. CONCLUSIONS: The results indicate that the FES may be a useful therapeutic tool combined with conventional rehabilitation program to improve the muscle strength, walking ability and metabolic responses in the management of drop foot with stroke patients.

Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke.

PURPOSE: To evaluate the clinical efficacy of functional electrical stimulation (FES) therapy of the tibialis anterior (TA) muscle on gait restoration and enhancing motor recovery with stroke patients. METHOD: Thirty hemiparetic participants with spastic foot-drop impairments who were at least 3 months post-stroke were recruited from a rehabilitation institute and were assigned either to a control group or a FES group. Both the groups participated in a conventional stroke rehabilitation program for 60 min per day, 5 days a week, for 12-weeks. The FES group received the electrical stimulation to the TA muscle for correction of foot-drop. RESULTS: Functional electric stimulation (FES) resulted in a 26.3% (p < 0.001) improvement of walking speed measured with 10-m walkway, whereas the improvement in the control group was only 11.5% (p < 0.01). The FES group also showed significantly greater improvements compared to control group in other gait parameters (e.g. cadence, step length), physiological cost index (PCI), ankle range of motion, spasticity of calf muscle, Fugl-Meyer scores, and the maximum value of the root mean square (RMS(max)), which reflects the capacity of the muscle output. CONCLUSIONS: These findings suggest that, the FES therapy combined with conventional therapy treatment more effectively improves the walking ability and enhances the motor recovery when compared with conventional therapy alone in stroke survivors.

Bilateral recurrent discloation of the patella associated with below knee amputation: a case report.

BACKGROUND: Recurrent dislocation of the patella in patients with below knee amputation is a known entity. Abnormally high-riding patella (patella alta) and medial patellofemoral ligament insufficiency in these patients predisposes them to patellar instability. The established treatment of this problem is surgical realignment. CASE PRESENTATION: A 25 year old male patient with bilateral below knee amputation presented with bilateral recurrent dislocation of the patella while walking on knees on uneven ground. Clinical and radiographic studies showed patella alta. A simple shoe modification was used to treat this patient. CONCLUSIONS: A simple shoe modification can be used to treat such a condition which is otherwise treated surgically.