Parkinsonism with or without dystonia has been rarely described following central pontine myelinolysis and extrapontine myelinolysis. We report 5 cases of reversible parkinsonism and dystonia with imaging evidences of central pontine myelinolysis and extrapontine myelinolysis associated with hyponatremia from a center in Eastern India. Their presentations varied from mild masked facies to extra pyramidal syndromes characterized by progressive supranuclear palsy like feature and marked dystonia. Two cases presented with flaccid quadriplegia later evolved into spasticity and dystonia. The cause of hyponatremia was due to vomiting in two, diuretic-induced, nutritional and psychogenic polydipsia one each. The onset was acute in 4, and gradual in one from psychogenic polydipsia. They responded well to gradual correction of electrolyte imbalance, dopaminergic and antidystonic agents including botulinum toxin. The movement disorders of central pontine myelinolysis with extrapontine myelinolysis represent a treatable manifestationof the osmotic demyelination syndrome and rewarding result can be achieved.

Background: Amenorrhea is the absence of menstrual periods. It has multiple social consequences as it may leads to infertility. This case control study was conducted for determining the association of thyroid hormones with hyperprolactinemia in patient with amenorrhea. Methods: We investigated 50 women with diagnosed cases of secondary amenorrhoea, who attended UCMS hospital, for hormonal evaluations. Fifty two healthy women were taken as the controls. The thyroid dysfunction and serum prolactin level were reviewed in cases and in the controls. Results: Mean serum prolactin level was found to be significantly higher in the cases as compared to the controls. Mean serum fT3 and fT4 level in the hyperprolactinemic cases (mean = 2.67, SD = 1.04 pg/ml) and (mean = 1.38, SD = 0.51 ng/dl respectively) were slightly lower as compared to normoprolactinemic cases (mean = 3.21, SD = 1.86 pg/ml) and (mean = 1.73, SD = 1.37 ng/dl) respectively. Mean TSH of normoprolactinemic and hyperprolactinemic cases were comparable (P = 0.049). There was positive correlation between prolactin, BMI and TSH whereas negative correlation of prolactin was seen with fT3, fT4 and age. In hyperprolactainemic cases, prolactin was found to be negatively correlated with TSH (r = -0.155, P = 0.491) whereas prolactin was positively correlated with TSH (r = 0.296, P = 0.126) in normoprolactainemic cases. Conclusions: Thus, hyperprolactinemia with thyroid dysfunction may be contributory hormonal factor in patient with amenorrhoea and as such, estimation of prolactin, fT3, fT4 and TSH should be included for diagnostic evaluation of amenorrhea.

Angioleiomyoma is a benign soft tissue tumor originating from vascular smooth muscle. We report a case of a 20-year-old student who presented with pain in the right shoulder of 4 years duration. Shoulder movements were pain-free throughout the range of motion except resisted external rotation. Magnetic resonance imaging visualized a well-circumscribed lesion over the infraspinatus tendon. The lesion was surgically removed and sent for histopathological analysis. Morphology and immunohistochemistry results were suggestive of angioleiomyoma. The most common location for such a lesion is the lower limb, with less than 1% being reported in the upper arm, of which an angioleiomyoma of the shoulder is extremely rare.

Objective:To explore natural compounds as potential inhibitors against main protease (Mpro) of SARS-CoV-2. Methods:In the current study, systematic molecular docking analysis was conducted using AutoDock 4.2 to determine the binding affinities and interactions between natural compounds and Mpro. Selected natural compounds were further validated using a combination of molecular dynamic (MD) simulations and molecular mechanic Poisson-Boltzmann surface area (MM/PBSA) free energy calculations. Results:Out of twenty natural compounds, four natural metabolites namely, amentoflavone, guggulsterone, puerarin, and piperine were found to have strong interaction with Mpro of SARS-CoV-2 based on docking analysis. During MD simulations, all four natural compounds bound to Mpro at 50 ns and MM/G/P/BSA free energy calculations showed that all four shortlisted ligands had stable and favorable energies with strong binding to Mpro protein. Conclusions:Guggulsterone is a potential inhibitor of COVID-19 main protease Mpro. Further in vitro and pre-clinical studies are needed.

Angioleiomyoma is a benign soft tissue tumor originating from vascular smooth muscle. We report a case of a 20-year-old student who presented with pain in the right shoulder of 4 years duration. Shoulder movements were pain-free throughout the range of motion except resisted external rotation. Magnetic resonance imaging visualized a well-circumscribed lesion over the infraspinatus tendon. The lesion was surgically removed and sent for histopathological analysis. Morphology and immunohistochemistry results were suggestive of angioleiomyoma. The most common location for such a lesion is the lower limb, with less than 1% being reported in the upper arm, of which an angioleiomyoma of the shoulder is extremely rare.

Purpose:Fractures of distal radius are one of the common orthopaedic injuries.Placing the plate on volar surface requires release of underlying pronator quadratus (PQ) muscle.No consensus is present in the literature about the repair or not of the PQ.The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.Methods:Retrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated.Demographic data,operative notes and physical therapy records were retrieved.Patients were divided into group A where PQ repair was done and group B where no repair was done.Functional data such as range of motion (ROM),grip strength,visual analogue scale (VAS) score and disabilities of arm,shoulder and hand (DASH) score at 4 weeks,3 months,6 months and finial follow-up were retrieved.Results:Totally 63 patients (n =29 in group A and n =34 in group B) with the mean age of 51.64 years were examined.Patients were followed up for a mean of 35.2 months (range 27.2-47.1 months) in group A and 38.6 months (range 28,6-51.0 months) in group B.Though functional outcome of the affected limb was not significantly different between two groups after 3 months,PQ repair did affect the recovery at an early stage.Repair group had significantly better ROM (p =0.0383) and VAS score at 4 weeks (p =0.017) while grip strength (p =0.014) was significantly better at 3 months.Conclusions:Repair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.