Objective: Analysis of spastic equinus gait, ankle movements, and spasticity change in Indian cerebral palsy (CP) children. Design: Prospective study with follow up at 2 weeks and 2 months after injection. Setting: Department of Physical Medicine and Rehabilitation, AIIMS, New Delhi between 2009 and 2011. Participants: 22 Spastic CP children (12 diplegic and 10 hemiplegic), 14 males and 8 females aged 2-8 years (mean 4.44 years) having gastrocnemius spasticity with equinus gait. Intervention: Botulinum Toxin-A marketed as Botox^® (Allergan, Inc.) was administered in both the medial and lateral heads of gastrocnemius. Dosage: 4 Unit/kg/muscle, maximum of 50 U per injection site, 50 U/ml with 0.9% normal saline dilution. After injection, the children continued participating in routine rehab exercise therapy and provided ankle foot orthosis. Main Outcome Measure(s): Temporospatial parameter of gait (stride, step length, cadence, velocity, percentage contact of foot with ground), Spasticity as per modified Ashworth Scale, active and passive range of motion at ankle. Results: Significant improvement (n = 34, P < 0.0001) noted in foot contact % (50.29 to 80.08), ankle active (−16.32 to −2.71) and passive (11.03 to 19.63), range of motion and, gastrocnemius spasticity (2.97 to 2). Other gait parameters (n = 22) such as stride length, cadence, velocity, and step length did not show any statistical change. Parents felt subjective improvement in >90% of children in terms of comfort, ease of care, and walking. The improvement lasted for 2 months. Conclusions: Botulinum Toxin-A injection is effective in treatment of equinus gait with easy OPD procedure and minimal side effects which are very tolerable.

Background: Allergic Rhinitis (AR), a common health problem, imposes a substantial burden on public health. New evidence suggests a possible link between AR and Vitamin D deficiency. This study was done with the purpose of determining whether serum Vitamin D levels are altered in AR as opposed to healthy controls and whether such alterations modify the severity of the disease. Materials and Methods: A cross-sectional study was done on 100 adults aged 18–50 (50 clinically diagnosed with AR and 50 age and sex matched controls). They were evaluated clinically and by determining serum levels of 25-hydroxyvitamin D [25(OH) D]. Results: The most common symptom was paroxysmal sneezing (96%). The mean concentration of serum 25(OH) D was 16.52 ng/ml in test patients and 22.47 ng/ml in controls. This study demonstrated a statistically significant Vitamin D deficiency (defined as serum 25(OH) D, <20 ng/mL) among patients with AR as compared to healthy controls (P = 0.001). The deficiency was significantly more (P = 0.01) in patients with moderate–severe AR (n = 28, mean serum 25(OH) D = 12.36 ng/ml) than that in mildly symptomatic patients (n = 22, mean serum 25(OH) D = 21.82 ng/ml). Conclusions: A strong association exists between low serum Vitamin D levels and AR in this population sample of AR patients, suggesting that suboptimal levels of Vitamin D may modify the disease behavior. Supplementation can be a useful therapeutic adjunct.

Introduction: Ischemic stroke is a major cause of morbidity and mortality. However, the interface of various premorbid medical conditions, vascular risk factors prior, prior antithrombotic or statins medication use, and in-hospital complications in effecting outcomes is not clearly established. We attempt establishing factors associated with improved outcomes after an acute ischemic stroke (AIS). Materials and Methods: Using the prospectively collected database, University Health Consortium from 1999 to 2004, a national USA database, multivariate step-wise backward regression analysis was performed and we were able to define premorbid characteristics, and medications that affect the outcome of AIS. Results: Initial stroke severity and poststroke in-hospital complications were associated with a poor outcome, while prior antiplatelet drug use was associated with an improved outcome. Statin use demonstrated a trend toward an improved outcome.

Context: Ropivacaine has been compared with lignocaine for intravenous regional anesthesia (IVRA). Aims: The objectives of this study were to evaluate the anesthetic efficacy, postblock residual analgesia, and any toxicity of two local anesthetics (LA) agents-ropivacaine and lignocaine. Settings and Design: Study was conducted in the Department of Anaesthesia in a Tertiary Care Hospital after Institutional Ethics Committee Clearance. Materials and Methods: Sixty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo forearm and hand surgery were randomly allocated to administration of 40 ml of either 0.2% ropivacaine or 0.5% lignocaine for IVRA. Onset and regression of sensory and motor block were assessed by response to pinprick and by testing hand movements, respectively. Visual analog scores (VAS) were assessed intraoperatively and postoperatively. Statistical Analysis Used: A computer software program (SPSS) was used. Categorical variables were analyzed with Chi-square test while continuous variables were analyzed with Student's t-test. Visual analog scale was expressed as median and was analyzed with Mann-Whitney test. P < 0.05 was considered significant. Results: Adequate surgical anesthesia was provided with both ropivacaine and lignocaine. The mean sensory block onset and regression times were significantly delayed with ropivacaine as compared to lignocaine (P < 0.05). Postoperatively, the VAS was significantly lower in ropivacaine group in the first 90 min. Time to the first analgesic drug in the postoperative period was significantly longer in ropivacaine group (42 ± 11.41 min) as compared to lignocaine group (24 ± 9.32 min). None of the patients in any group showed any evidence of local anesthetic toxicity. Conclusions: IVRA for upper limb surgery using 0.2% ropivacaine is a better option as compared to 0.5% lignocaine as it provides longer postoperative analgesia.

Instituted by the Medical Council of India in 2002 through a duly vetted legal process, the Foreign Medical Graduates Examination conducted by the National Board of Examinations is a licensure exam, which aims to sift the charlatans from those who have acquired their medical degrees from another country, but are knowledgeable and skilled enough to bolster the country's physician workforce. Set up on the lines of similar screening exams held by countries across the world, the exam is an exercise in transparency, with a well-defined curriculum, which specifies the distribution and weightage of each subject, has no negative marking, and no limit on the number of attempts. Bereft of any competitive edge, the exam is extremely candidate-friendly, and yet, a positive step intent on preserving the piety and nobility of the medical profession.

Neuropsychiatric complications are an under recognized and undertreated aspect of Parkinson's disease (PD). A gamut of psychiatric disturbances can occur in PD and include depression, anxiety, psychosis, dementia, impulse control disorders, apathy, and sleep disturbances. They substantially affect the lives of the patients and their caregivers and have negative impact on the quality of life. Optimal assessment and treatment is the key to manage these patients.

Purpose: To determine the impact of digital imaging and communications in medicine (DICOM) workflow on the linkage of demographic information to ophthalmic data. Design: Evaluation of technology. Materials and Methods: At 3 months before and 12 months after implementation of a DICOM workflow, technicians recorded the work required to enter, confirm, or edit patient demographics in each visual field, optical coherence tomography, and fundus imaging devices. We also determined the proportion of imaging tests sent to an error queue for manual reconciliation because of incorrect demographic information before and 28 months after the DICOM workflow was established. Results: Staff entered, edited, or merged data for 19% of patients before implementation (n = 497). This decreased to 2.2% within 12 of implementing the DICOM archive (n = 2414). Staff could locate a patient in a DICOM work list for 99% at 12 months. Before implementation, 18.59% of the images required additional intervention to be associated with the correct patient (n = 497). This decreased by 2.2% over 12 months (n = 2414; P < 0.05). There was a reduction in the percentage of misfiled images between pre- and postimplementation 12 from 2.2% to 0.95% (P < 0.05). Conclusions: Implementation of a DICOM-compatible workflow in an ophthalmology clinic reduced the need to enter or edit patient demographic information into imaging or testing devices and reduced the need to manage misfiled images. In a clinical environment that demands both efficiency and patient safety, the DICOM workflow is an important update to current practice.