We present a case of apparently uncomplicated lumbar decompression and discectomy with delayed postoperative neurological deterioration secondary to subdural hematoma at the thoracolumbar level of the spinal cord. Previously described subdural hematomas have occurred spontaneously or related to iatrogenic Case Report Case presentationA 76-year-old presented with a 9-month history of radiating lower extremity pain, left worse than right, with minimal back pain. The symptoms onset acutely after lifting a heavy ice box. He reported intermittent paresthesias in bilateral L4−L5 distributions without any complaint of weakness. Symptoms worsened with extension, upright posture and Valsalva maneuver and improved with forward flexion. He had no prior spine surgery. He had 3 separate transforaminal epidural steroid injections containing anesthetic and cortisone directed at the left L3-4 and L4-5 space, the most recent of which was 1 month prior to presentation. With all injections he noted marked improvement during the anesthetic phase but no durable effect. His past medical history was significant for coronary artery disease status post remote stenting and peripheral arterial disease status post remote carotid endarterectomy. Aside from fish oil and daily low dose aspirin, he was not on anticoagulant medications.On exam, he had 5/5 motor strength in his bilateral lower extremities with no fixed, focal sensory deficits. His lower extremity reflexes were diffusely diminished though

ZAP-70 and CD 38 positivity were detected 25% and 36%, respectively, with concordance rate of 56%, which is higher than Western literature. There was no correlation of ZAP-70 and CD 38 positivity with age, sex, lymphadenopathy, organomegaly, and Rai staging.

Introduction:Rabies is a viral zoonosis. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. About 30% of the victims of dog bites are children under the age of 15. Objective: To assess the epidemiological pattern of dog bite cases, which formed the majority of cases attending anti-rabies clinic. Materials and Methods: This study was conducted at the Primary Health Centre,Poolavari, Salem, Tamil Nadu, India between Feb 1st-May 1 st 2018. It is a cross sectional study, where all dog bite cases attending injection OPD were studied. A questionnaire-based survey was conducted amongst dog bite patients in the Primary Health Centre at Poolavari, Salem. Results: Highest percentage of dog bite victims belonged to the age group of 5-25Years (33.7%). The bites were mostly by pet dogs (75.5%). 91.8% of the dogs were not vaccinated. Running, patting were the most common factors leading to dog bites (50.0%). 52% of the study population had awareness of first aid for dog bite. 88.8% population had awareness about Anti rabies vaccines for dog bites. Most of the victims took the treatment within ½ hr (30.6%). 81.6% of the victims took allopathy treatment. Conclusion: The study concludes that awareness of first aid for dog bites ,pet dog vaccination, awareness about Anti rabies vaccine for dog bites and completion of the treatment should be increased in the rural population.

Introduction Painful diabetic peripheral neuropathy (PDPN) complicates 25% of type II diabetes mellitus. It has a profound impact on diabetes-related morbidity and worsens the quality of life. Both pregabalin and duloxetine may be indicated for PDPN. In this study, the efficacy of duloxetine and pregabalin was compared in patients with PDPN. Methods It was a single-centre open-label study conducted with patients of diabetes mellitus type II diagnosed with PDPN. Patients were randomized to receive 60 mg/daily duloxetine or 300 mg/daily pregabalin. Pain scores were recorded using visual analogue scale (VAS) on day 0, week 4, and week 12. Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY). Results In the duloxetine group, the mean VAS score decreased from 6.81 ± 0.91 to 4.01 ± 1.12 with 12 weeks of therapy (p <0.0001). In the pregabalin group, the mean VAS score decreased from 6.99 ± 1.12 to 4.91 ± 0.82 with 12 weeks of therapy (p <0.0001). At 12 weeks, duloxetine showed lower VAS scores than pregabalin (p <0.0001). In the duloxetine group, the mean change in VAS score over time was-2.80 and in the pregabalin group, the mean change was-2.80. Adverse events were reported in 17.9% of the participants. Lethargy/somnolence (8.1%) and peripheral edema (3.4%) were commonly reported in the pregabalin group and constipation (6.9%) and orthostatic hypotension (4.6%) were commonly reported in the duloxetine group. Conclusions Duloxetine at a daily fixed dose of 60 mg is efficacious in the relief of neuropathic pain. Pregabalin also showed a comparable outcome. Both duloxetine and pregabalin have a promising safety profile and are well-tolerated.