Background: Opsoclonus myoclonus syndrome is a rare condition characterized by the amalgamation o... more Background: Opsoclonus myoclonus syndrome is a rare condition characterized by the amalgamation of multidirectional saccades of eye movements, involuntary myoclonus predominantly affecting trunk and limbs and cerebellar ataxia. Typical malignancies associated with paraneoplatic opsoclonus myoclonus syndrome (POMS) in adults are small cell lung carcinoma and breast cancer with variable outcomes. Case Report: The authors report here a patient with stage IV recurrent right breast cancer, presenting to the hospital with unsteady gait, jerky movements of the limbs and body. She was clinically diagnosed with POMS with positive cerebrospinal fluid anti-Ri antibody. Medical treatment with intravenous methylprednisolone and early initiation of rehabilitation improved her balance, coordination and ataxia. This led to an overall improvement in her physical function. Conclusion: This case illustrates the importance of early recognition, prompt treatment of POMS and initiation of rehabilitation in achieving better functional outcomes.
The Journal of the International Society of Physical and Rehabilitation Medicine, 2020
Snapping pes anserinus is a cause of extraarticular medial knee snapping. It results from the tra... more Snapping pes anserinus is a cause of extraarticular medial knee snapping. It results from the translation of the semitendinosis or gracilis tendon during active knee flexion and extension. A 60-year-old female with left medullary infarct and no prior left knee pathology presented with left painful knee snap on walking 3 years after the stroke onset. Clinical examination detected a medial knee snap on the left knee extension. Dynamic ultrasound identified the semitendinosis tendon causing the knee snap. Magnetic resonance imaging of the left knee excluded intraarticular causes of knee snap and confirms soft-tissue edema and bursitis near the pes anserine. The patient was treated with local anesthetic injection and physical therapy with immediate pain relief. This case describes pes anserine syndrome in a stroke patient without prior knee pathology. Poststroke gait deviation can possibly cause repetitive excessive knee loading, leading to secondary musculoskeletal complications such as snapping pes anserinus.
The Journal of the International Society of Physical and Rehabilitation Medicine, 2019
I agree with the authors that there remains uncertainty revolving antiplatelets’ effects on PRP t... more I agree with the authors that there remains uncertainty revolving antiplatelets’ effects on PRP therapy. Gaps in the literature pertaining to the timing of PRP during antiplatelet therapy remain to be filled, and the International Cellular Medicine Society is working toward efforts to bridge these gaps.[2] It can be tricky to manage the periprocedural aspect of withholding antiplatelets in patients. These patients often need antiplatelets for secondary cardiovascular prevention. For various clinical and medicolegal reasons, physiatrists might consult another relevant specialist. While this practice is acceptable, the referring physiatrist should still be aware of the details of relevant drug pharmacokinetics. As Ramsook and Danesh had suggested, the key lies in understanding the pharmacokinetics of these antiplatelets or antithrombotic agents to guide clinicians in risk-and-benefit discussion with the patients.[3] Aspirin, for example, with an effect on platelets by irreversibly inhibiting cyclooxygenase for 8–9 days, should be withheld for about a week prior to PRP injection. Resuming aspirin after PRP therapy can be as early as 2 h. Clopidogrel, another example, should be discontinued 7 days prior to procedure. A summary of the recommendation of discontinuation of various drugs prior to treatment should be readily available in the physiatrist clinic.
The fields of public history and public archaeology both deal with questions related to interacti... more The fields of public history and public archaeology both deal with questions related to interactions between academics and the wider public. Over the last four decades, debate among researchers and practitioners has focused on just what is meant by "public history" and "public archaeology" The authors present a case for active engagement with the public by scholars and argue that film, and important mass communication media, can be effectively leveraged by academics to speak directly to a general audience. Moreover, using the example of their public television series America from the Ground Up, which over three seasons presents a comparative analysis of colonialism in America, we argue that film is a tool for public engagement that is also appropriate for the presentation of scholarly research, and that the use of one approach does not preclude the use of the other.
Journal of Orthopedics, Traumatology and Rehabilitation, 2018
Background: Deep vein thrombosis (DVT) or venous thromboembolism is a fatal complication of patie... more Background: Deep vein thrombosis (DVT) or venous thromboembolism is a fatal complication of patients undergoing elective hip surgeries. Not much evidence is provided in the Indian literature regarding the incidence of DVT in the Indian population and ideal prophylaxis for the same. This issue has gained much importance in recent history due to the increase in a number of elective hip surgeries. Low-molecular-weight (LMW) heparin is commonly used for chemoprophylaxis against DVT. Our study is to identify the role of LMW heparin (enoxaparin) for prophylaxis against DVT. Materials and Methods: The present study is a prospective study for the role of enoxaparin in prophylaxis against DVT in patients of elective hip surgeries carried out over a period of 2 years. A total of 110 patients were selected based on the stringent inclusion and exclusion criteria. Randomization was done and patients were divided into two groups of 55 patients each. Group 1 (case) received postoperative enoxaparin at a dose of 40 mg subcutaneous daily for 7 days whereas Group 2 (control) did not receive any prophylaxis, following which color Doppler was performed on all patients. Results: The overall incidence of DVT in our study group was found to be 23.6%, of which 61.5% had distal thrombus and 28.5% had thrombus in the proximal vein. The incidence of DVT in case group was 12.5% compared to control group, in which the incidence of DVT was found to be 34.5%; hence, statistically significant difference (P = 0.0071) in the incidence of DVT was found in both groups. Duration of surgery and patient's age were two most significant risk factors associated with the occurrence of DVT. No statistically significant difference was noted regarding postoperative bleeding complications between two groups (P > 0.05). Conclusion: DVT/venous thromboembolism is relatively less common in Indian patients following elective hip surgeries as compared to the Western population, and LMW heparin is a safe and effective method of prophylaxis against DVT.
Background: The occurrence of cervical neuromyelitis optica (NMO) in a patient with a thoracic ep... more Background: The occurrence of cervical neuromyelitis optica (NMO) in a patient with a thoracic ependymoma is uncommon. Here, we present a patient with a spinal ependymoma who developed the new onset of NMO 2 months later. Case Description: A 66-year-old male presented with right lower limb weakness. The magnetic resonance (MR) revealed an intramedullary spinal cord tumor at the T2-T4 level. It was surgically excised and proved pathologically to be an ependymoma. 2 months later, the patient presented with an acute partial quadriparesis and a high signal intensity cord lesion at the C2-C3 level attributed to seropositive NMO (i.e. additional diagnostic studies confirmed this diagnosis). Conclusion: Patients with intramedullary thoracic ependymomas may also develop NMO resulting in recurrent/ new neurological deficits. Critical studies utilized to diagnose NMO include brain and spine MRs showing unique intramedullary brain/cord lesions, aquaporin-4 positive serology, and classical abno...
Background: Opsoclonus myoclonus syndrome is a rare condition characterized by the amalgamation o... more Background: Opsoclonus myoclonus syndrome is a rare condition characterized by the amalgamation of multidirectional saccades of eye movements, involuntary myoclonus predominantly affecting trunk and limbs and cerebellar ataxia. Typical malignancies associated with paraneoplatic opsoclonus myoclonus syndrome (POMS) in adults are small cell lung carcinoma and breast cancer with variable outcomes. Case Report: The authors report here a patient with stage IV recurrent right breast cancer, presenting to the hospital with unsteady gait, jerky movements of the limbs and body. She was clinically diagnosed with POMS with positive cerebrospinal fluid anti-Ri antibody. Medical treatment with intravenous methylprednisolone and early initiation of rehabilitation improved her balance, coordination and ataxia. This led to an overall improvement in her physical function. Conclusion: This case illustrates the importance of early recognition, prompt treatment of POMS and initiation of rehabilitation in achieving better functional outcomes.
The Journal of the International Society of Physical and Rehabilitation Medicine, 2020
Snapping pes anserinus is a cause of extraarticular medial knee snapping. It results from the tra... more Snapping pes anserinus is a cause of extraarticular medial knee snapping. It results from the translation of the semitendinosis or gracilis tendon during active knee flexion and extension. A 60-year-old female with left medullary infarct and no prior left knee pathology presented with left painful knee snap on walking 3 years after the stroke onset. Clinical examination detected a medial knee snap on the left knee extension. Dynamic ultrasound identified the semitendinosis tendon causing the knee snap. Magnetic resonance imaging of the left knee excluded intraarticular causes of knee snap and confirms soft-tissue edema and bursitis near the pes anserine. The patient was treated with local anesthetic injection and physical therapy with immediate pain relief. This case describes pes anserine syndrome in a stroke patient without prior knee pathology. Poststroke gait deviation can possibly cause repetitive excessive knee loading, leading to secondary musculoskeletal complications such as snapping pes anserinus.
The Journal of the International Society of Physical and Rehabilitation Medicine, 2019
I agree with the authors that there remains uncertainty revolving antiplatelets’ effects on PRP t... more I agree with the authors that there remains uncertainty revolving antiplatelets’ effects on PRP therapy. Gaps in the literature pertaining to the timing of PRP during antiplatelet therapy remain to be filled, and the International Cellular Medicine Society is working toward efforts to bridge these gaps.[2] It can be tricky to manage the periprocedural aspect of withholding antiplatelets in patients. These patients often need antiplatelets for secondary cardiovascular prevention. For various clinical and medicolegal reasons, physiatrists might consult another relevant specialist. While this practice is acceptable, the referring physiatrist should still be aware of the details of relevant drug pharmacokinetics. As Ramsook and Danesh had suggested, the key lies in understanding the pharmacokinetics of these antiplatelets or antithrombotic agents to guide clinicians in risk-and-benefit discussion with the patients.[3] Aspirin, for example, with an effect on platelets by irreversibly inhibiting cyclooxygenase for 8–9 days, should be withheld for about a week prior to PRP injection. Resuming aspirin after PRP therapy can be as early as 2 h. Clopidogrel, another example, should be discontinued 7 days prior to procedure. A summary of the recommendation of discontinuation of various drugs prior to treatment should be readily available in the physiatrist clinic.
The fields of public history and public archaeology both deal with questions related to interacti... more The fields of public history and public archaeology both deal with questions related to interactions between academics and the wider public. Over the last four decades, debate among researchers and practitioners has focused on just what is meant by "public history" and "public archaeology" The authors present a case for active engagement with the public by scholars and argue that film, and important mass communication media, can be effectively leveraged by academics to speak directly to a general audience. Moreover, using the example of their public television series America from the Ground Up, which over three seasons presents a comparative analysis of colonialism in America, we argue that film is a tool for public engagement that is also appropriate for the presentation of scholarly research, and that the use of one approach does not preclude the use of the other.
Journal of Orthopedics, Traumatology and Rehabilitation, 2018
Background: Deep vein thrombosis (DVT) or venous thromboembolism is a fatal complication of patie... more Background: Deep vein thrombosis (DVT) or venous thromboembolism is a fatal complication of patients undergoing elective hip surgeries. Not much evidence is provided in the Indian literature regarding the incidence of DVT in the Indian population and ideal prophylaxis for the same. This issue has gained much importance in recent history due to the increase in a number of elective hip surgeries. Low-molecular-weight (LMW) heparin is commonly used for chemoprophylaxis against DVT. Our study is to identify the role of LMW heparin (enoxaparin) for prophylaxis against DVT. Materials and Methods: The present study is a prospective study for the role of enoxaparin in prophylaxis against DVT in patients of elective hip surgeries carried out over a period of 2 years. A total of 110 patients were selected based on the stringent inclusion and exclusion criteria. Randomization was done and patients were divided into two groups of 55 patients each. Group 1 (case) received postoperative enoxaparin at a dose of 40 mg subcutaneous daily for 7 days whereas Group 2 (control) did not receive any prophylaxis, following which color Doppler was performed on all patients. Results: The overall incidence of DVT in our study group was found to be 23.6%, of which 61.5% had distal thrombus and 28.5% had thrombus in the proximal vein. The incidence of DVT in case group was 12.5% compared to control group, in which the incidence of DVT was found to be 34.5%; hence, statistically significant difference (P = 0.0071) in the incidence of DVT was found in both groups. Duration of surgery and patient's age were two most significant risk factors associated with the occurrence of DVT. No statistically significant difference was noted regarding postoperative bleeding complications between two groups (P > 0.05). Conclusion: DVT/venous thromboembolism is relatively less common in Indian patients following elective hip surgeries as compared to the Western population, and LMW heparin is a safe and effective method of prophylaxis against DVT.
Background: The occurrence of cervical neuromyelitis optica (NMO) in a patient with a thoracic ep... more Background: The occurrence of cervical neuromyelitis optica (NMO) in a patient with a thoracic ependymoma is uncommon. Here, we present a patient with a spinal ependymoma who developed the new onset of NMO 2 months later. Case Description: A 66-year-old male presented with right lower limb weakness. The magnetic resonance (MR) revealed an intramedullary spinal cord tumor at the T2-T4 level. It was surgically excised and proved pathologically to be an ependymoma. 2 months later, the patient presented with an acute partial quadriparesis and a high signal intensity cord lesion at the C2-C3 level attributed to seropositive NMO (i.e. additional diagnostic studies confirmed this diagnosis). Conclusion: Patients with intramedullary thoracic ependymomas may also develop NMO resulting in recurrent/ new neurological deficits. Critical studies utilized to diagnose NMO include brain and spine MRs showing unique intramedullary brain/cord lesions, aquaporin-4 positive serology, and classical abno...
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