The incidence of stroke in patients with atrial fibrillation (AF) is five times greater than that in age-matched controls. Warfarin reduces this incidence by two thirds and is the most effective agent for this indication. However, despite its efficacy, warfarin management is tedious and is useful only in a subsegment of the population who needs anticoagulation and has no contraindications. Many agents are poised to replace warfarin as an effective anticoagulant for stroke prevention in AF. The direct thrombin inhibitor dabigatran is furthest along in clinical development, followed by the factor Xa inhibitors rivaroxaban and apixaban. All these agents seem effective, and none appears mechanistically superior over another. Dabigatran's advantage is that it was tested in two dosages in a phase 3 evaluation based on earlier phase 2 studies in patients with AF, whereas dosage data for the other agents were extrapolated from phase 2 programs for venous thromboembolism prevention. The vitamin K antagonist ATI-5923 offers clinical benefits similar to warfarin's, but with no or fewer drug-drug interactions, potentially greater time in therapeutic range, and probably less need for dose adjustment and laboratory monitoring. It challenges the newer mechanistic agents in efficacy and raises the bar for comparison in future head-to-head trials. Further analysis and clinical trial testing are still needed to determine whether one or all of these agents are effective anticoagulants for stroke prevention in patients with AF.

<p class="abstract"><strong>Background:</strong> The anterior tibial spine fracture occurs almost at a same frequency both in adolescents and in adults. These injuries are often overlooked at emergency room. Stable internal fixation requires to gain optimum function of ACL by securing its length and nascent tension. We treated anterior tibial spine (ACL avulsion) fracture patient with open reduction and screw fixation.</p><p class="abstract"><strong>Methods:</strong> Study of Ten patients of anterior tibial spine (ACL avulsion) fracture, with minimum of 06 months and maximum of 18 months follow up. Classification of anterior tibial spine (ACL avulsion) a fracture done by Meyer and Mckeever. All patients operated with open reduction and internal fixation with screw via medial parapatellar approach. Functional and clinical outcome measured with Lysholm knee score at final follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> We studied 10 patients with anterior tibial spine (ACL avulsion) fractrure where mean age of patient was 36.4 years. Mean radiological healing was 10.6 weeks in anterior tibial spine (ACL avulsion) fracture. We observed mean motion of knee 133 degree in anterior tibial spine (ACL avulsion) fracture. Mean Lysholm score at final follow up was 86.8.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction for anterior tibial spine (ACL) fracture provides direct visualization with easy application of screws ultimately confers stable osteosynthesis enables to start early range of motion and further rehabilitation protocol. Open reduction internal fixation is comparative less technically demanding, less expansive and gives excellent to good results as compared to other techniques.</p><p class="abstract"> </p>

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Brooke–Spiegler Syndrome (BSS) is a rare autosomal dominant familial disorder resulting in dermatologic neoplasms of copious nodular appendages. Here, we report a case of Familial Cylindromatosis (FC), a subtype of BSS, in a patient with the largest cylindroma of 7.4 × 5.6 × 3.8 cm on the scalp. The patient had undiagnosed cylindromas growing for 36 years at presentation; however, he did not seek out healthcare evaluation. Excision and pathologic investigation of three large masses from different body sites determined a shared phenotype of cylindromas. Subsequent evaluation of the patient's son separately, after primary patient excision, confirmed cylindroma development as well. The pathologic evidence of cylindromas in the patient with a new history of family incidence confirmed the diagnosis of the FC variant of BSS.

Spinal muscular atrophy (SMA) represents the second most common fatal autosomal recessive disorder after cystic fibrosis. Due to the high carrier frequency, the burden of this genetic disorder is very heavy in developing countries like India. The aim was to study the clinical and molecular characteristics of patients suspected with SMA. It was a cross sectional study of 105 cases from January 2008 to August 2012. Patients demographic and presenting features and PCR findings were noted. 65 (62%) cases had a confirmed diagnosis of SMA. Werdnig Hoffman disease (SMA type I) was the commonest variant seen in 34 (52.3%) children. Molecular analysis demonstrated deletion of both exon 7 and 8 of SMN1 gene in 83.1% of cases.