Phenytoin or carbamazepine monotherapy for >6 months duration is associated with hyperhomocysteinaemia in 90% of North Indian children. Elevated homocysteine concentrations were normalised in these children with folic acid supplementation.

Crytococcus neoformans is an encapsulated yeast that frequently affects immune-compromised patients, although increasingly being detected in the immune-competent host as well. We report a case of disseminated cryptococcosis in a young child in whom no immune deficiency was yet identified. A 4-year-old child presented with high-grade fever, intermittent abdominal pain and generalized skin eruptions for the past two months. He had pallor, firm lymphadenopathy, skin lesions with scarring and firm hepatosplenomegaly. Magnetic resonance imaging of brain and bone-marrow aspiration were normal. Fine-needle-aspiration-cytology of cervical lymph nodes demonstrated Cryptococcus. Serum latex-agglutination test showed a positive titer (1:256). Cryptococcus culture was sterile. The patient received intravenous liposomal amphotericin-B and oral flucytosine for 8 weeks followed by oral fluconazole. Disseminated cryptococcosis with involvement of reticuloendothelial and dermatological systems is rare. Early diagnosis and timely management of associated complications would be life saving.

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Background: During the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem disorder with diverse non-motor symptoms (NMS). Aims: The present study aimed to evaluate and characterize the NMS and study their impact on quality of life (QoL) in a PD patient cohort. Material and Methods: This was a cross-sectional study where 92 PD patients fulfilling the UK Parkinson's disease society brain bank criteria were enrolled from a movement disorder clinic. All patients were evaluated using unified Parkinson's disease rating scale, non-motor symptoms scale (NMSS) for the non-motor symptoms, and Parkinson's disease questionnaire-39 (PDQ-39) for the QoL. The impact of NMS on QoL was assessed statistically. Results: A total of 92 patients were enrolled with a mean age of 55.40 ± 7.37 years, mean age of onset of disease 51.62 ± 6.38 years, and mean disease duration of 3.78 ± 1.54 years. Type of disease was akinetic rigid variant in 29.3% (n = 27), tremor predominant type in 36.9%(n = 34), and mixed type in 33.6% (n = 31). Mean Hoehn and Yahr stage was 2.12 ± 0.54. In the NMSS, most common symptom was sleep and fatigue (83%), followed by urinary tract symptoms (63%), mood and cognition (51%), cardiovascular symptoms and falls (43%), gastrointestinal tract symptoms (38%), and sexual function (33%). Univariate analyses showed that all NMS domains had a significant correlation with PDQ-39 with P < 001. Conclusion: Our study shows that NMS in PDare fairly common and significantly impact the QoL.

The association between heavy metals and Amyotrophic Lateral Sclerosis (ALS) patients was explored with respect to the longest and pious Indian river Ganga. This study is designed to investigate the severity and heavy metal contamination in the blood of Gangetic (within 25 km from river Ganga) and non-Gangetic (> 25 km from river Ganga) ALS patients. Out of 65 recruited ALS patients, 36 from the Gangetic belt and 29 from the Non-Gangetic belt. Amyotrophic Lateral Sclerosis functional rating Scale (ALSFRS), Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) were calculated to study disease progression. Lead (Pb), Manganese (Mn) and Cadmium (Cd) concentrations were estimated in the whole blood of 23 subjects from Gangetic belt, 19 subjects from Non Gangetic belt and 23 heathy controls via Inductively coupled plasma mass spectrometry (ICP-MS) technique. A significantly lower FAB score was obtained in Gangetic patients. Pb concentration was significantly higher in both the diseased group than control and Cd concentration was detected significantly higher in Gangetic ALS patients than non Gangetic patients and control group.