Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1-C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1-C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infections. Diaphragm pacing with phrenic nerve stimulation may be a way forward for ventilator-dependent tetraplegics in developing countries to pursue effective rehabilitation and improved quality of life.

To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center. Overview of Literature: Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting. Methods: We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or selfvoiding [S]); we correlated these data with the findings of the renal tract US. Results:The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time since injury was 6-12 months for 42.5% of the subjects and 12-18 months for 57.5% of the subjects. A normal US scan was recorded in 65.7% patients, and bladder trabeculation was the commonest finding in 15.1% of the subjects, followed by hydronephrosis (HDN) in 12.3%, and renal calculus and atrophy in 1.3% participants each. We found 22.22% of the IC group participants had higher US abnormalities than those in the reflex voiding group (statistically nonsignificant difference, p=0.7). Trabeculations (21.4%) and HDN (19%) were more common in those who had sustained the injury 12-18 months previously as compared to that in those who had injured themselves 6-12 months previously (p=0.04). The proportion of patients who had a normal US scan was higher in the group who sustained the injury 6-12 months previously versus those who had sustained the injury 12-18 months previously; the difference was statistically significant (p=0.02). There was no significant (p=0.72) correlation in the bladder management method, injury level, and renal tract abnormalities between the groups. Conclusions: This retrospective study shows that 65% of TSCI participants had no renal tract abnormality on US scan and bladder trabeculation ruled out as the most common finding. Long-term supervised rehabilitation may help achieve good renal quality of life; however, further prospective trials are required on this subject.

Physical exhaustion is the temporary physical inability of the muscles to perform optimally. The onset of muscle fatigue during physical activity is gradual and can be reversed by rest and replenishment of electrolyte and hydration. For maximal physical fitness, one should require optimal function of all the body parts and system. It is our humble attempt to find out the underlying disease in patients who presented to us with signs and symptoms of physical exhaustion. Materials and methods: The study was conducted at medical center located at southern part of India from March 2017 to February 2019, and 213 healthy individuals from a physical training institute aged between 18 and 21 was selected, and pre-and post-run blood parameters were measured. Discussion: In our study, more than 20% persons have more than 2-fold rise in blood creatine phosphokinase level which ultimately comes to normal within 48 hours. Eighty-one people among the study population have increase in serum AST/ALT level, and most of them come to normal within 48 hours. Conclusion: For optimal performance and to avoid major catastrophe, it is suggested that before undergoing exhaustive physical exhaustion, one should be properly evaluated.

Introduction: Carpal tunnel syndrome (CTS) was effectively treated by lots of conservative management that includes splints, exercise, different types of heat modality like ultrasonic therapy (UST), etc. This is our humble attempt to explore and find out electrophysiological improvement pattern after treatment with UST in CTS. This analytical study was conducted at

No abstract