Peroneus Longus Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Safe and Effective Alternative in Nonathletic Patients.

INTRODUCTION: Anterior cruciate ligament (ACL) is a common injury which has been conventionally managed by various graft reconstruction using bone patellar tendon bone, or quadruple hamstring autograft, to name a few. However, all these grafts are associated with many complications. Lately, peroneus longus tendon (PLT) autograft has shown promising results in this field, although there is still a dearth of data on its use. We, therefore, aimed at carrying out a study to evaluate the functional outcome and knee stability results of ACL reconstruction using PLT graft. PATIENTS AND METHODS: Patients with a completely torn ACL were included in the study. The PLT was harvested, and graft length, thickness, and harvesting time were noted intraoperatively. Knee stability and functional scores were evaluated clinically and using Lachman test (primarily) and KT-2000 arthrometer and subjectively with International Knee Documentation Committee (IKDC) score at 6, 12, and 24 months (secondary outcome) postoperatively. Ankle scores were also recorded by making use of American Orthopedic Foot and Ankle Score (AOFAS)-Hindfoot Scale. RESULTS: Forty-eight patients met the inclusion criteria. The graft harvest time was 7.4 min (5-9 min). The mean thickness of the graft on doubling was 7.9 mm (7-9 mm). Ninety-six percent of the patients were satisfied with their results of the knee surgery, and 95% of the patients had no complaints of ankle joint. The mean IKDC score postoperatively was 78.16 ± 6.23, and the mean AOFAS score was 98.4 ± 4.1. None of the patients had any neurovascular deficit. CONCLUSION: ACL reconstruction using PLT graft yields a good functional score (IKDC, KT-2000 arthrometer) even at 2-year follow-up. It is a safe and effective autograft option for ACL reconstruction.

Essential oil related seizures (EORS): A multi-center prospective study on essential oils and seizures in adults.

OBJECTIVE: Essential oils (EOs) like eucalyptus and camphor have pro-convulsant properties. These EOs are present in many over- the- counter balms and oils. The effect of exposure to these EOs and occurrence of seizure is not systematically studied. The aim of this study was to evaluate the relationship between essential oils and the first episode of seizure and breakthrough seizures in known epileptic patients. METHODS: This was a multi-center prospective study, conducted in four hospitals over four years. Every person presenting with the first episode of seizure or breakthrough seizure was asked about exposure to EOs, mode of exposure, time to onset of a seizure in relationship to exposure, duration of seizure, type of seizure, and antiepileptic drug therapy. RESULTS: During the four-year period there were 55 patients with essential oil-related seizure (EORS). 22(40 %) had essential oil-induced seizures (EOIS) and 33(60 %) had essential oil-provoked seizures (EOPS). The female: male ratio was 1:1.1, the age of the patients ranged from 8 months to 77 years. In the EOIS group, 95 % had generalized tonic-clonic seizures and 5% had focal impaired awareness seizures. In the EOPS group, 42.4 % had focal impaired awareness seizures, 27.3 % generalized tonic-clonic seizures, 15 % focal to bilateral tonic-clonic seizures, and 15 % focal aware motor seizures. EOs implicated were preparations containing eucalyptus and camphor. CONCLUSION: Exposure to essential oils of eucalyptus and camphor is an under-recognized cause of the first and breakthrough seizure. Identifying the true causative factor will prevent unnecessary antiepileptic drug therapy and future recurrence.

COVID-19-related strokes are associated with increased mortality and morbidity: A multicenter comparative study from Bengaluru, South India.

BACKGROUND: COVID-19-related strokes are increasingly being diagnosed across the world. Knowledge about the clinical profile, imaging findings, and outcomes is still evolving. Here we describe the characteristics of a cohort of 62 COVID-19-related stroke patients from 13 hospitals, from Bangalore city, south India. OBJECTIVE: To describe the clinical profile, neuroimaging findings, interventions, and outcomes in COVID-19-related stroke patients. METHODS: This is a multicenter retrospective study of all COVID-19-related stroke patients from 13 hospitals from south India; 1st June 2020-31st August 2020. The demographic, clinical, laboratory, and neuroimaging data were collected along with treatment administered and outcomes. SARS-CoV-2 infection was confirmed in all cases by RT-PCR testing. The data obtained from the case records were entered in SPSS 25 for statistical analysis. RESULTS: During the three-month period, we had 62 COVID-19-related stroke patients, across 13 centers; 60 (97%) had ischemic strokes, while 2 (3%) had hemorrhagic strokes. The mean age of patients was 55.66 ± 13.20 years, with 34 (77.4%) males. Twenty-six percent (16/62) of patients did not have any conventional risk factors for stroke. Diabetes mellitus was seen in 54.8%, hypertension was present in 61.3%, coronary artery disease in 8%, and atrial fibrillation in 4.8%. Baseline National Institutes of Health Stroke Scale score was 12.7 ± 6.44. Stroke severity was moderate (National Institutes of Health Stroke Scale 5-15) in 27 (61.3%) patients, moderate to severe (National Institutes of Health Stroke Scale 16-20) in 13 (20.9%) patients and severe (National Institutes of Health Stroke Scale 21-42) in 11 (17.7%) patients. According to TOAST classification, 48.3% was stroke of undetermined etiology, 36.6% had large artery atherosclerosis, 10% had small vessel occlusion, and 5% had cardioembolic strokes. Three (5%) received intravenous thrombolysis with tenecteplase 0.2 mg/kg and 3 (5%) underwent mechanical thrombectomy, two endovascular and one surgical. Duration of hospital stay was 16.16 ± 6.39 days; 21% (13/62) died in hospital, while 37 (59.7%) had a modified Rankin score of 3-5 at discharge. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality. A comparison to 111 historical controls during the non-COVID period showed a higher proportion of strokes of undetermined etiology, higher mortality, and higher morbidity in COVID-19-related stroke patients. CONCLUSION: COVID-19-related strokes are increasingly being recognized in developing countries, like India. Stroke of undetermined etiology appears to be the most common TOAST subtype of COVID-19-related strokes. COVID-19-related strokes were more severe in nature and resulted in higher mortality and morbidity. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality.

Essential oil-related status epilepticus: A small case series study.

OBJECTIVE: Essential oils are plant-derived oils and are widely used as an over-the-counter remedy for common ailments. Many essential oils are found to have proconvulsant effects. Here we report a small case series of 3 adults with eseential oil-related status epilepticus. METHODS: This was an observational study conducted in a tertiary care hospital in south India from January 2018 to December 2019. We collected the demographic, clinical, and imaging features of all cases of status epilepticus resulting from exposure to essential oils. Cases of status epilepticus secondary to all other causes were excluded. RESULTS: There were 3 young adults with essential oil-related status epilepticus. Two had de novo generalized tonic-clonic status epilepticus, and 1 with posttraumatic occipital lobe epilepsy had focal-impaired awareness status epilepticus. The first 2 cases presented with histories of ingestion of eucalyptus oil. The third case had focal-impaired awareness status epilepticus after topical application of various balms containing eucalyptus and camphor. CONCLUSIONS: Proconvulsant essential oils of eucalyptus and camphor can cause both generalized and focal status epilepticus. Physicians dealing with patients of status epilepticus should enquire about the exposure to proconvulsant essential oils.

Eucalyptus oil inhalation-induced seizure: A novel, underrecognized, preventable cause of acute symptomatic seizure.

Eucalyptus oil (EO) is an essential oil that is widely used across the globe as an over-the-counter remedy for common ailments. EO-induced seizure (EOIS) has not been recognized as an entity, and physicians rarely ask the history of exposure to eucalyptus oil when seeing a patient with first episode of seizure. Here we report 10 cases of EO inhalation-induced seizures seen over the past 2 years in three tertiary care hospitals. Eight patients had GTCS and two had CPS. We aim to raise awareness of seizures induced by exposure to eucalyptus oil.

Repetitive compound muscle action potentials in electrophysiological diagnosis of congenital myasthenic syndromes: a case report and review of literature.

Congenital myasthenic syndromes (CMSs) are a heterogeneous group of disorders, characterized by dysfunction of neuromuscular junction (NMJ) transmission. These syndromes are genetically inherited and are present since birth. Some have characteristic clinical or electrodiagnostic features but in many cases determination of the specific form requires genetic studies or specialized morphological and electrophysiological studies on muscle tissue. We report a case of a 4-year-old boy with progressive ptosis and limitation of ocular movements who was diagnosed as slow-channel CMS based on the characteristic electrodiagnostic features. Repetitive compound muscle action potentials (R-CMAPs) were recorded after single nerve stimulus, with decremental response after repetitive trains performed at 3 Hz. CMSs are at times clinically difficult to distinguish from acquired myasthenia. The characteristic clinical and electrodiagnostic features help in the diagnosis and enable rational therapy. In this article we discuss the characteristics of synaptic R-CMAPs.

A rare cause of foot drop after radiofrequency ablation for varicose veins: case report and review of the literature.

The treatment option for varicose veins (VV) is mainly surgery both open and minimally invasive. Even though mortality and major morbidity are rare with surgery, minor neurological complications like cutaneous nerve injuries remain a common problem. Involvement of major branches of sciatic nerve is extremely a rare complication of radiofrequency ablation (RFA), the other treatment option for VV. To the best of our knowledge, injury to both peroneal and tibial nerves has not been reported following RFA procedure. We report a very rare complication of sudden onset foot drop after RFA for VV. Lack of knowledge of such symptoms may lead to misdiagnosis and electrodiagnostic and magnetic resonance imaging studies can help in correct diagnosis.