Development of a Caterpillar-Type Walker for the Elderly People

A walker assists elderly people with age-related reduced walking ability and helps to improve stability and balance ability. However, if the general-type walker (GTW) is used on an uneven, obstacle, or sloped terrain, it may cause excessive muscle use and falls. Therefore, in this study, we developed a caterpillar-type walker (CTW) that elderly people can safely use in various terrains. Twelve elderly who were able to walk normally participated in the study. The activity of upper and lower extremity muscles, the number of obstacles overcome, and walking speed was compared and analyzed when using two types of walkers in uneven terrain, obstacle terrain, and sloped terrain. In addition, satisfaction with the use of these walkers was evaluated. When CTW was used, the activity of the muscles of the upper and lower extremities was significantly reduced compared to the use of GTW on all terrains. The walker developed in this study overcame obstacles of all heights, but the GTW failed to overcome obstacles starting from the 2 cm section. In terms of walking speed, when the CTW was used, the walking speed was higher than that of the GTW in uneven terrain and obstacle terrain. In satisfaction, there were significant differences in safety, durability, simplicity of use, comfort, and effectiveness. Through these results, it was confirmed that the CTW can efficiently and safely assist the elderly in walking on uneven terrain, obstacle terrain, and inclined terrain.

Latihan Range of Motion Terhadap Rentang Gerak Sendi Ekstremitas Atas Pasien Stroke di RSUD M.Natsir

Stroke patients who experience hemiparese who do not receive proper treatment can cause complications of functional disorders, impaired mobilization, disruption of daily activities and incurable disabilities. The purpose of this study was to determine the effect of passive Range Of Motion (ROM) exercise on increasing the range of motion of stroke patients in the Neurology Room at RSUD M.Natsir.This research design is quasi experimental with the design used is one group pretest - postest design.In this study, passive Range Of Motion (ROM) was performed on the upper extremities of stroke patients for five days, twice a day.The number of respondents in 30 stroke patients who experienced hemiparese,The data was collected by direct measurement using a measuring instrument for the degree of motion of the joints, namely the goniometer, and data analysis was carried out using the t dependent test (normally distributed data).The results showed a significant difference in the range of motion of the upper limb joints before and after passive ROM exercises. The conclusion that ROM exercises affect the range of motion of the upper limb joints in stroke patients.Passive ROM can be an alternative to increase the range of motion of the joints in the upper and lower extremities in stroke patients.

Gianotti-Crosti Syndrome in a Child with Recent Covid-19 Infection: A Case Report

Gianotti-Crosti Syndrome is a rare skin disease affecting children at the first years of age. The condition is clinically featured by blisters on the skin of the legs, buttocks and arms. A history of viral infection preceding the disease was reported for many cases. A 12-month-old boy, free of any medical illnesses, was presented with a history of acute-onset rash for five days prior to presentation that was preceded by a history of fever for two days then subsided. The rashes appeared initially on his buttocks, then spread to his upper and lower extremities and trunk. The child had fever, sore throat and coryza symptoms with lethargy. A polymerase chain reaction (PCR) swab was taken to test for SARS-CoV-2, which was positive two weeks before rash onset. All symptoms resolved in 1 week with supportive therapy and the current rashes appeared two weeks later in the patient. Gianotti–Crosti syndrome may follow the active phase of infection for some cases. It should not be misdiagnosed with dermatological simple eruptive disorders. The clinical features for covid-19 associated infection are typical for the well-known clinical picture of the syndrome. The case was reported to improve clinicians’ awareness and help in better understanding and reporting cutaneous manifestations of COVID-19. Keywords: Gianotti-Crosti Syndrome; Infants; Children; covid-19; Corona

MANAGEMENT OF SPASTIC QUADRIPLEGIA (SARVANGGHAT) WITH VATKULANTAK RASA & SHASHTIKA SHALI PINDA SWEDA - A CASE STUDY

Background- Spastic Quadriplegia also known as spastic tetraplegia is a subset of Spastic cerebral palsy that af- fects all four limbs (both arms and legs). Spastic quadriplegia usually displays equal involvement of both upper and lower extremities with severe involvement of legs, arms and floppiness of neck. Spastic quadriplegia is gen- erally caused by brain damage either before birth, during or shortly after. In Ayurveda quadriplegia can be corre- lated with Sarvangghat which is a vatavyadhi. It is a nanatmaja vatavyadhi according to charaka. As the disease was caused by vata-kapha dosha. The treatment is mainly aimed at mitigating vata kapha dosha which helps to clear the blocked micro-channels involved in the pathology. Aim and objective- To study the effect of Vatkulan- taka rasa and Shashtika shali pinda sweda in the management of Spastic quadriplegia (Sarvangghat). Material and methods-The present case study is upon 16 years old (male patient) diagnosed case of spastic quadriplegia with complaints of difficulty in walking with stiffness for 6 years at the kayachikitsa IPD of Pt. khushilal Sharma govt. ayurvedic hospital Bhopal. He was treated with shashtika shali pind sweda & Vatkulantaka rasa. The dura- tion of the study is 21 days. The assessment was done on the basis of symptomatic relief after treatment. Observation- The Ayurvedic therapy and oral medication yielded complete symptomatic relief from pain, stiffness and improve quality of life. Conclusion- On the basis of the result obtained, it can be concluded that Shashtika shali pinda sweda and Vatku- lantaka rasa can be used as an effective treatment in the management of Spastic quadriplegia (Sarvangghat). Keywords: Sarvangghat, Spastic quadriplegia, Shashtika shali pinda sweda, Vatkulantaka rasa.

Certolizumab-induced lichenoid eruption in a patient with rheumatoid arthritis

Certolizumab is a monoclonal antibody against tumour necrosis factor-alpha (TNF-α) commonly used in rheumatologic conditions such as rheumatoid arthritis. Skin rashes are an uncommon side effect with few cases of lichenoid drug eruption reported in the literature. We describe a patient with rheumatoid arthritis who presented 6 weeks after initiating certolizumab pegol. Physical examination showed pink-to-violaceous papules on her upper and lower extremities. Biopsy confirmed a lichenoid drug eruption. The medication was discontinued and she was treated with topical steroids and a calcineurin inhibitor, with resolution of her lesions. Clinicians should be cognizant of such adverse reactions to TNF-α inhibitors and keep drug-induced lichenoid eruptions on the differential. Lichenoid eruptions induced by certolizumab pegol may affect the skin and/or mucous membranes. While most cases occur within weeks to months of starting therapy, eruptions may occur years after treatment initiation, underscoring the importance of a thorough review of medications.

Ultrasonographic Assessment of Entheseal Sites of Upper and Lower Extremities in Hemodialysis Patients using Madrid Sonography Enthesitis Index

Background Musculoskeletal (MSK) complications are one of the most common health concerns that impact individuals on maintenance hemodialysis (HD). However, little is known about the entheseal involvement in HD patients. The aim of this study was to assess the prevalence and distribution of entheseal ultrasonographic (US) alterations in HD patients and to evaluate the association between US findings and both clinical and laboratory data.Methods: This study was conducted on 41 HD and 23 sex- and age- matched controls. All HD patients and healthy controls were evaluated clinically to detect any clinical evidence of enthesopathy. Six entheses sites were scanned bilaterally using grey scale (GS) and power Doppler (PD) ultrasonography (US) and were scored using Madrid Sonography Enthesitis Index (MASEI) scoring system. Results:Clinical examination revealed at least one sign suggestive of enthesopathy in 69 (14.02) of 492 entheses in 41 HD patients. HD patients had statistically significant higher scores of stuctural tendon abnormalities (p<0.001), enthesis thickening (p<0.001), bone erosions (p<0.001) and calcification (p=0.037) than healthy controls. Total MASEI score was higher in HD patients than healthy controls (median ;18 vs 8, p<0.001), also, MASEI-inflammatory (median ;11 vs 3, p<0.001) and damage scores (median ;6 vs 0, p<0.001). There was a statistically significant positive association between total MASEI score and both age (p=0.032) and duration of HD (p=0.037). Duration of HD was predictive for both MASEI-damage component (p=0.004) and total MASEI score (p=0.014).Conclusions: There is a high prevalence of asymptomatic enthesopathy in HD patients. The burden of entheseal US alterations is much higher in HD patients than in healthy subjects. US can be helpful in the early detection of entheseal abnormalities. The duration of HD is the most significant predictor of enthesopathy in HD patients.

Abstract 17116: Recurrent Atrial Myxomas As A Presenting Feature Of Carney Complex

Case Presentation: A 24-year-old man with a history of adrenal insufficiency on hydrocortisone presented to the hospital after losing consciousness in a swimming pool and was found to have an acute MCA stroke. PMHx was significant for left atrial myxoma status post resection 3 years ago, known L frontal brain, L adrenal, and testicular masses status post-resection. His father had a history of resected left atrial mass. Cardiology was consulted for a L atrial mass on the bedside echocardiogram upon initial emergency evaluation, during which the patient was placed on mechanical ventilation with stable vitals. The cardiovascular exam revealed a midsternal scar but was otherwise normal. Pulses were 2+ bilaterally on the upper and lower extremities. The skin was noted to have multiple hyperpigmented macules resembling cafe-au lait spots. The patient underwent mechanical thrombectomy with thrombolysis for his large MCA occlusion. His postoperative course was complicated by a worsening neuro exam in the setting of mid-line shift for which he had undergone decompressive hemicraniectomy. His adrenal insufficiency was managed by endocrinology. A TTE was significant for a L atrial mass measuring 4.8 cm attached to the interatrial septum with a stalk. A CT scan identified 2 discrete hypodensities of 8 mm and 3.8 cm which were thought to be the cardioembolic source for the stroke. An abdominal CT revealed a recurrent L adrenal neoplasm with absent R adrenal gland post resection of neoplasm. Conservative cardiac management was elected in the setting of a worsening neuroprognosis with follow-up post neurologic insult. Discussion: Considering the constellation of neoplastic and cutaneous findings, this was diagnosed as a case of Carney complex. This case identifies recurrent myxoma as a unique feature of Carney complex, ruling out other differentials such as neurofibromatosis and MEN syndrome. It highlights the importance of screening to prevent embolic stroke from recurrent myxomas.