Job satisfaction among physiotherapists working as an academician in Gujarat-A cross-sectional study.

CONTEXT: Job satisfaction is an integral part of an individual's Professional life. It denotes to the worker's perception of their workplace settings, relationships among fellows, salary as well as endorsement opportunities. AIM: To determine job satisfaction among physiotherapists working as academicians in Gujarat, India. STUDY DESIGN: A Cross-Sectional Study. METHODS AND MATERIAL: A self-administered questionnaire was used for data collection. The questionnaire was developed on Google Forms and consisted of 15 closed questions, equally distributed on job and career satisfaction, eight of which focused on job satisfaction, and seven on career satisfaction. The socio-demographic factor and work related factor questions were also added to the questionnaire. A total of 102 responses were received and recorded on an Excel spreadsheet for further data analysis. STATISTICAL ANALYSIS USED: Descriptive analysis and Chi-square test were performed using SPSS. RESULTS: The respondents from different colleges working in government or private colleges, different age groups, marital status and having children or no children and different years of job experience showed non-significant differences in the job satisfaction (p value > 0.05). There was a significant difference in gender and salary the respondents received (p value < 0.05). The study revealed that from a total of 26 (100%) male participants, 10 (38.5%) male participants were satisfied and 16 (61.5%) male were dissatisfied, whereas from a total of 76 (100%) female participants, 58 (76.3) female were satisfied and 18 (23.7%) female were dissatisfied. CONCLUSION: Majority of physiotherapists in the current study were satisfied with their job and career, but different factors need to be considered in order to gain high satisfaction in different factors of job satisfaction. The study also concluded major dissatisfaction in salary. Recognition in the society and research opportunities in India.

Exploring the latent structure of behavior using the Human Connectome Project's data.

How behavior arises from brain physiology has been one central topic of investigation in neuroscience. Considering the recent interest in predicting behavior from brain imaging using open datasets, there is the need for a principled approach to the categorization of behavioral variables. However, this is not trivial, as the definitions of psychological constructs and their relationships-their ontology-are not always clear. Here, we propose to use exploratory factor analysis (EFA) as a data-driven approach to find robust and interpretable domains of behavior in the Human Connectome Project (HCP) dataset. Additionally, we explore the clustering of behavioral variables using consensus clustering. We find that four and five factors offer the best description of the data, a result corroborated by the consensus clustering. In the four-factor solution, factors for Mental Health, Cognition, Processing Speed, and Substance Use arise. With five factors, Mental Health splits into Well-Being and Internalizing. Clustering results show a similar pattern, with clusters for Cognition, Processing Speed, Positive Affect, Negative Affect, and Substance Use. The factor structure is replicated in an independent dataset using confirmatory factor analysis (CFA). We discuss how the content of the factors fits with previous conceptualizations of general behavioral domains.

Stepped care versus center-based cardiopulmonary rehabilitation for older frail adults living in rural MA: Design of a feasibility randomized controlled trial.

Background: Cardiac and pulmonary rehabilitation programs are grossly underutilized, and participation is particularly low in rural regions. Methods: We are conducting a 2-arm, randomized controlled feasibility trial. Eligible participants include older frail adults with cardiac or pulmonary disease living in a predominantly rural county in western Massachusetts. Participants are randomized 1:1 to treatment as usual or stepped care. Patients randomized to treatment as usual participate in twice weekly center-based rehabilitation sessions over eight weeks and are encouraged to exercise at home in between sessions. Patients randomized to the stepped-care arm are offered/enrolled in the center-based rehabilitation program followed by possible step up to three interventions based on prespecified non-response criteria: 1) Transportation-assisted center-based rehabilitation, 2) Home-based telerehabilitation, and 3) Community health worker-supported home-based telerehabilitation. The primary feasibility outcomes are average number of eligible patients randomized per month, baseline measure completion, proportion attending at least 70% of the prescribed sessions, average number of sessions attended in the stepped-care arm, and proportion in the stepped-care arm completing patient reported outcome measures. Each of these process indicators is evaluated by preset "Stop" and "Go" thresholds. Conclusion: The proposed stepped-care model is an efficient, patient-centered, approach to expanding access to cardiac and pulmonary rehabilitation. Meeting the "Go" thresholds for the prespecified process indicators will justify conducting a definitive full-scale randomized controlled trial to compare the effectiveness and value (cost-effectiveness) of stepped-care versus center-based rehabilitation in older frail adults living rural counties.

Central composite design for the formulation and optimization of a multi-unit potential colonic drug delivery system of budesonide for ulcerative colitis.

Budesonide is a potent glucocorticoid with high affinity for the glucocorticoid receptor, which is used for the treatment of inflammatory bowel diseases. Current oral formulations of budesonide present low efficacy against ulcerative colitis because of the premature drug release in the upper part of the gastrointestinal tract. The objective of this study was to develop a colon specific delivery system for budesonide to increase the efficacy in the treatment of ulcerative colitis using a statistical procedure. Pellets were prepared by powder layering of budesonide on nonpareils (0.5-0.6 mm) in a coating pan. Drug-layered pellets were coated with an inner layer of a combination of Eudragit RL PO and RS PO and an outer layer of Eudragit FS in a fluidized-bed apparatus. Central composite design was used to study the effect of three independent variables. The independent variables selected were amount of Eudragit FS outer coating (X1), proportion of Eudragit RL PO in the inner coating (X2), amount of Eudragit RL PO-RS PO inner coating (X3). Fifteen batches were prepared and evaluated for amount of drug released in 6 h (Y1), amount of drug released in 12h (Y2). The proportion of the more hydrophilic polymer Eudragit RL PO had the most significant effect on drug release - higher proportion gave faster release; the amount of inner and outer coat did not have a significant effect on the rate of drug release at either 6 or 12 h in the range studied. The computer optimization process and contour plots predicted the levels of independent variables X1, X2, and X3 (0.79, 0.69 and 0.35 respectively), for colon targeting.

Decreased growth of Vhl-/- fibrosarcomas is associated with elevated levels of cyclin kinase inhibitors p21 and p27.

Inactivating mutations within the von Hippel-Lindau (VHL) tumor suppressor gene predispose patients to develop a variety of highly vascularized tumors. pVHL targets alpha subunits of the heterodimeric transcription factor hypoxia-inducible factor (HIF), a critical regulator of energy metabolism, angiogenesis, hematopoiesis, and oxygen (O(2)) delivery, for ubiquitin-mediated degradation in an O(2)-dependent manner. To investigate the role of Vhl in cellular proliferation and tumorigenesis, we utilized mouse embryonic fibroblasts (MEFs), a common tool for analyzing cell cycle regulation, and generated Vhl(-)(/)(-) MEF-derived fibrosarcomas. Surprisingly, growth of both Vhl(-)(/)(-) MEFs and fibrosarcomas was impaired, although tumor vascularity was increased. Decreased proliferation of Vhl(-)(/)(-) MEFs was correlated with an overexpression of cyclin kinase inhibitors (CKIs) p21 and p27. The transcription of p21 and p27 is inhibited by c-Myc; therefore, the induction of CKIs was attributed to the ability of HIF to antagonize c-Myc activity. Indeed, p21 mRNA levels were elevated under normoxia in Vhl(-)(/)(-) MEFs, while c-Myc transcriptional activity was markedly reduced. Gene silencing of HIF-1alpha by small interfering RNA reduced p21 and p27 protein and mRNA levels in Vhl(-)(/)(-) MEFs. The induction of p21 and p27, mediated by constitutive activation of the HIF pathway, provides a mechanism for the decreased proliferation rates of Vhl(-)(/)(-) MEFs and fibrosarcomas. These results demonstrate that a loss of pVHL can induce growth arrest in certain cells types, which suggests that additional genetic mutations are necessary for VHL-associated tumorigenesis.

Atorvastatin and celecoxib inhibit prostate PC-3 tumors in immunodeficient mice.

PURPOSE: To investigate the effects and mechanisms of atorvastatin and celecoxib administered individually or in combination on human prostate cancer PC-3 cells cultured in vitro or grown as xenograft tumors in immunodeficient mice. EXPERIMENTAL DESIGN: Human prostate cancer PC-3 cells in culture were treated with atorvastatin and celecoxib alone or in combination. Severe combined immunodeficient (SCID) mice were injected s.c. with PC-3 cells. The mice received daily i.p injections starting 2 days before tumor cell inoculation and continuing during the course of treatment with atorvastatin (10 microg/g body weight/d), celecoxib (10 microg/g/d), a combination of atorvastatin (10 microg/g/d) and celecoxib (10 microg/g/d), or a combination of atorvastatin (5 microg/g/d) and celecoxib (5 microg/g/d). RESULTS: Atorvastatin in combination with celecoxib had stronger effects on growth inhibition and apoptosis of PC-3 cells than either agent used individually. Atorvastatin and celecoxib in combination also had a stronger inhibitory effect on activation of nuclear factor-kappaB and extracellular signal-regulated kinase 1/2 in PC-3 cells than either agent alone. Treatment of SCID mice with combinations of atorvastatin and celecoxib more effectively inhibited the formation and growth of PC-3 tumors in the mice than either agent administered alone. CONCLUSIONS: A combination of atorvastatin and celecoxib had a more potent inhibitory effect on the growth of PC-3 cells cultured in vitro or grown in SCID mice than either agent alone. A combination of atorvastatin and celecoxib may be an effective strategy for the prevention of prostate cancer.

The c-MYC oncoprotein is a substrate of the acetyltransferases hGCN5/PCAF and TIP60.

The c-MYC oncoprotein functions as a sequence-specific transcription factor. The ability of c-MYC to activate transcription relies in part on the recruitment of cofactor complexes containing the histone acetyltransferases mammalian GCN5 (mGCN5)/PCAF and TIP60. In addition to acetylating histones, these enzymes have been shown to acetylate other proteins involved in transcription, including sequence-specific transcription factors. This study was initiated in order to determine whether c-MYC is a direct substrate of mGCN5 and TIP60. We report here that mGCN5/PCAF and TIP60 acetylate c-MYC in vivo. By using nanoelectrospray tandem mass spectrometry to examine c-MYC purified from human cells, the major mGCN5-induced acetylation sites have been mapped. Acetylation of c-MYC by either mGCN5/PCAF or TIP60 results in a dramatic increase in protein stability. The data reported here suggest a conserved mechanism by which acetyltransferases regulate c-MYC function by altering its rate of degradation.

Application of an automated natural language processing (NLP) workflow to enable federated search of external biomedical content in drug discovery and development.

External content sources such as MEDLINE(®), National Institutes of Health (NIH) grants and conference websites provide access to the latest breaking biomedical information, which can inform pharmaceutical and biotechnology company pipeline decisions. The value of the sites for industry, however, is limited by the use of the public internet, the limited synonyms, the rarity of batch searching capability and the disconnected nature of the sites. Fortunately, many sites now offer their content for download and we have developed an automated internal workflow that uses text mining and tailored ontologies for programmatic search and knowledge extraction. We believe such an efficient and secure approach provides a competitive advantage to companies needing access to the latest information for a range of use cases and complements manually curated commercial sources.

Clinical and financial outcomes of switching insulin glargine to insulin detemir in a veteran population with type 2 diabetes.

BACKGROUND: Although glargine and detemir are both FDA-approved in the U.S. as long-acting insulin analogues, inherent differences in the insulins may lead to varying outcomes. This study examined changes in clinical measures and associated costs for veterans with type 2 diabetes on insulin therapy converted from insulin glargine to insulin detemir. METHODS: A retrospective before-and-after comparison study was performed at a single-site medical center located in the southwestern U.S., comprising 133 Veterans diagnosed with type 2 diabetes receiving insulin therapy with glargine and converted to insulin detemir using a 1:1 unit dosage ratio. Patients' A1c, weight, body mass index, total daily dose, and estimated monthly insulin costs during and after conversion were compared employing Wilcoxon signed-rank tests. These measures were similarly assessed in patients at A1c goal (<7 %) prior to conversion. RESULTS: When switched from insulin glargine to insulin detemir, an increase in A1c (median of 7.7 % to 8.3 %, p < 0.01) and total daily dose (TDD: 40 to 46 units/day, p < 0.01) resulted. Monthly insulin costs decreased 19 % ($47 to $38, p < 0.01), or roughly a one-year savings of $110 per patient. An increase in A1c was similarly observed for patients at-goal prior to conversion but remained at-goal post-conversion (6.5 % to 6.7 %, p = 0.02). CONCLUSION: The increase in A1c and TDD following conversion from insulin glargine to insulin detemir suggests that glargine requires a smaller amount of units to reach the same glycemic-lowering ability compared to detemir. Despite the observed insulin cost savings associated with detemir, future studies should also determine overall costs (including indirect) and benefits associated with switching from glargine to detemir among Veteran with Type 2 diabetes.

A morphometric study of the external ear: age- and sex-related differences.

The human ear is a defining feature of the face. Its subtle structures convey signs of age and sex that are unmistakable yet not easily defined. With analysis of normative cross-sectional data, this study explored anatomic and aesthetic differences in the ear between men and women, as well as changes in ear morphology with age. A total of 123 volunteers were randomly selected for this study. The cohort consisted of 89 women ages 19 to 65 years (median age, 42 years) and 34 men ages 18 to 61 years (median age, 35 years). The average total ear height across the entire cohort for both left and right ears was 6.30 cm, average lobular height was 1.88 cm, and average lobular width was 1.96 cm. As expected based on head size, significant sex-related differences were noted in the distance from the lateral palpebral commissure to both the helical root and insertion of the lobule. Measured distances in both vectors were approximately 4.6 percent longer in men than in women. Similarly, the height of the pinna was significantly larger in men than in women by approximately 6.5 percent. The average height and width of the lobule, however, were nearly identical in men and women. Analysis of age-related data showed a significant difference in the total ear height between the subpopulations; however, this difference was not significant after the lobular height was subtracted from total ear height, suggesting that the lobule was the only ear structure that changed significantly with age. In addition, lobular width decreased significantly with age. This study establishes normative data for ear morphology and clearly demonstrates the changes in earlobe morphology that occur with advancing age.

Systematic drug repurposing through text mining.

Drug development remains a time-consuming and highly expensive process with high attrition rates at each stage. Given the safety hurdles drugs must pass due to increased regulatory scrutiny, it is essential for pharmaceutical companies to maximize their return on investment by effectively extending drug life cycles. There have been many effective techniques, such as phenotypic screening and compound profiling, which identify new indications for existing drugs, often referred to as drug repurposing or drug repositioning. This chapter explores the use of text mining leveraging several publicly available knowledge resources and mechanism of action representations to link existing drugs to new diseases from biomedical abstracts in an attempt to generate biologically meaningful alternative drug indications.

Clerodendrum serratum (L.) Moon. - a review on traditional uses, phytochemistry and pharmacological activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Clerodendrum serratum (L.) Moon. (Verbenaceae) is an important medicinal plant growing in the tropical and warm temperate regions like Africa, Southern Asia; Malaysia and distributed throughout in forests of India and Sri Lanka. It is traditionally valued and reported for treating pain, inflammation, rheumatism, respiratory disorders, fever and malarial fever in India with a long history. To provide a comprehensive overview of the traditional and ethno medicinal uses, phytochemistry and biological activities of C. serratum with clinical and toxicity data and possibly make recommendations for further research. MATERIALS AND METHODS: All relevant worldwide accepted databases were searched for the terms "Clerodendrum", "Clerodendrum serratum", "Bharangi" and "Cheruthekku" along with the other literature from Indian classical texts and pharmacopoeias. There was no specific timeline set for the search. The accessible literatures available on C. serratum were collected via electronic search using Pubmed, Scopus, Science Direct and traditional books reports on ethnopharmacology and traditional medicines. RESULTS: C. serratum has played an important role in Indian system of medicine. In addition to the common local use in respiratory diseases, other ethnomedicinal uses include treatment of pain, inflammation, rheumatism and fever especially malarial fever. Scientific studies on extracts and formulations revealed anti-asthmatic, mast cell stabilization and anti-allergic effects of roots of C. serratum. Reported data on pharmacological activities also includes hepatoprotective, anti-oxidant, anti-inflammatory and anticancer potential of the drug. Saponins (terpenoids and steroids), flavonoids and phenolics isolated from roots have been the focus of phytochemical investigations as the biological activity has been ascribed to the saponins, which are known to possess anti-inflammatory and anti-cancer activity. Isolated bioactives from roots like icosahydropicenic acid and ursolic acid have been claimed to offer anti-allergic and hepatoprotective activity. CONCLUSIONS: Therapeutic potential of roots and leaves of C. serratum has been demonstrated in the conditions like asthma, allergy, fever, inflammation and liver disorders attributed to the presence of various flavonoids, phenolics and saponins present in the drug. Many ethnobotanical claims have been confirmed through modern in-vitro and in-vivo pharmacological studies of different extracts and isolates from plant; however, additional studies on the biomarkers are needed to establish mechanism of action and to validate the traditional use of this drug in clinical practices after proper safety assessment.

Mining gene-centric relationships from literature: the roles of gene mutation and gene expression in supporting drug discovery.

Identifying drug target candidates is an important task for early development throughout the drug discovery process. This process is supported by the development of new high-throughput technologies that enable better understanding of disease mechanism. It becomes critical to facilitate effective analysis of the large amount of biological data. However, with much of the biological knowledge represented in the literature in the form of natural text, analysis and interpretation of high-throughput data has not reached its potential effectiveness. In this paper, we describe our solution in employing text mining as a technique in finding scientific information for target and biomarker discovery from the biomedical literature. Our approach utilises natural language processing techniques to capture linguistic patterns for the extraction of biological knowledge from text. Additionally, we discuss how the extracted knowledge is used for the analysis of biological data such as next-generation sequencing and gene expression data.

Somatosensory evoked potentials help prevent positioning-related brachial plexus injury during skull base surgery.

OBJECTIVE: Evaluate the use of somatosensory evoked potentials (SSEP) monitoring to detect positioning-related brachial plexus injury during skull base surgery. STUDY DESIGN: Prospective cohort observational study. SETTING: University Hospital. SUBJECTS AND METHODS: Patients undergoing skull base surgery had a focused neurologic exam of the brachial plexus performed before and after surgery. Under stable anesthesia, brachial plexus SSEP values were obtained before and after surgical positioning. Significant SSEP changes required a readjustment of arm or neck positions. SSEPs were assessed every 30 minutes. If changes were noted, position was readjusted and SSEPs were reassessed until surgical completion. Demographic data, neurologic exams, SSEP latency, and amplitude values were recorded. Persistent changes were correlated with postoperative neurologic findings. RESULTS: Sixty-five patients, 15 to 77 years old, were studied. Six patients (9.2%) developed SSEP amplitude changes after positioning (average amplitude decrease 72.8%). One patient had a significant latency increase. The sensitivity of SSEP for detection of injury was 57%, while specificity was 94.7%. The average body mass index (BMI) of patients with normal and abnormal SSEPs was 28.7 ± 5.6 versus 29.2 ± 8.0, respectively. Average BMI of patients with postoperative symptoms regardless of SSEP findings was 33.8 ± 4.3. Two patients who had persistent SSEP changes after positioning had BMIs of 40.1 and 31.2 kg/m(2), respectively. Improvement in neurologic findings occurred in all patients after surgery. CONCLUSIONS: This study demonstrates that upper extremity nerve stress can be detected in real time using SSEP and may be of value in protecting patients from nerve injury undergoing lateral skull base surgery.

Identifying novel drug indications through automated reasoning.

BACKGROUND: With the large amount of pharmacological and biological knowledge available in literature, finding novel drug indications for existing drugs using in silico approaches has become increasingly feasible. Typical literature-based approaches generate new hypotheses in the form of protein-protein interactions networks by means of linking concepts based on their cooccurrences within abstracts. However, this kind of approaches tends to generate too many hypotheses, and identifying new drug indications from large networks can be a time-consuming process. METHODOLOGY: In this work, we developed a method that acquires the necessary facts from literature and knowledge bases, and identifies new drug indications through automated reasoning. This is achieved by encoding the molecular effects caused by drug-target interactions and links to various diseases and drug mechanism as domain knowledge in AnsProlog, a declarative language that is useful for automated reasoning, including reasoning with incomplete information. Unlike other literature-based approaches, our approach is more fine-grained, especially in identifying indirect relationships for drug indications. CONCLUSION/SIGNIFICANCE: To evaluate the capability of our approach in inferring novel drug indications, we applied our method to 943 drugs from DrugBank and asked if any of these drugs have potential anti-cancer activities based on information on their targets and molecular interaction types alone. A total of 507 drugs were found to have the potential to be used for cancer treatments. Among the potential anti-cancer drugs, 67 out of 81 drugs (a recall of 82.7%) are indeed known cancer drugs. In addition, 144 out of 289 drugs (a recall of 49.8%) are non-cancer drugs that are currently tested in clinical trials for cancer treatments. These results suggest that our method is able to infer drug indications (original or alternative) based on their molecular targets and interactions alone and has the potential to discover novel drug indications for existing drugs.

Hepatoprotective activity of ethanolic extracts of bark of Zanthoxylum armatum DC in CCl4 induced hepatic damage in rats.

AIM OF THE STUDY: Zanthoxylum armatum DC is described as a hepatoprotective in Ayurveda, the Indian system of medicine. However, there is no scientific basis or reports in the modern literature regarding its usefulness as a hepatoprotective agent. The present study was carried out to evaluate the hepatoprotective activity of ethanolic extract of bark of Zanthoxylum armatum DC in CCl(4) induced hepatotoxicity in male Wistar rats. MATERIALS AND METHODS: Ethanolic extracts at doses of 100, 200, and 400mg/kg were administered orally once daily for 7 days. The hepatoprotective activity was assessed using various biochemical parameters like alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum bilirubin, total protein and serum antioxidant enzymes along with histopathological studies of liver tissue. RESULTS: The substantially elevated serum enzymatic levels of serum transaminases, alkaline phosphatase and total bilirubin were significantly restored towards normalization by the extracts. Bark extracts significantly increased the levels of antioxidant enzymes: superoxide dismutase, catalase and glutathione. Phytochemical analysis revealed presence of isoquinoline alkaloid, berberine, as well as flavonoids and phenolic compounds, which have been known for their hepatoprotective activities. CONCLUSIONS: Zanthoxylum armatum DC possesses significant protective effect against hepatotoxicity induced by CCl(4) which may be attributed to the individual or combined action of phytoconstituents present in it.

Pharmacological evaluation of "Glyoherb": A polyherbal formulation on streptozotocin-induced diabetic rats.

In the present study, powdered suspension of 'Glyoherb'- sugar control granules, a polyherbal formulation (manufactured by Dhanvantri Guj. herb., Valasan, Anand, Gujarat, India) was evaluated for its antihyperglycemic, antihyperlipidemic and antioxidant effects against normal and streptozotocin-induced diabetic rats. Type I diabetes was induced when streptozotocin 70 mg/kg was administered as a single i.p. injection. After five days of streptozotocin injection, animals showing glycosuria (fasting blood sugar level >200 mg/dl) were considered as diabetic. Daily oral administration of 'Glyoherb' suspension in 200, 400 and 600 mg/kg doses for 28 days produced a dose-dependant decrease in blood glucose levels. It also produced a significant decrease in elevated serum triglyceride, cholesterol, VLDL, LDL, atherogenic index, serum urea, and creatinine and in antioxidant parameters in a dose dependant manner. Results were analyzed using one way ANOVA followed by Tukey's test. No significant changes were noticed in blood glucose, serum lipid levels and kidney parameters in normal rats treated with 'Glyoherb' suspension alone. The efficacy of 'Glyoherb' suspension as an antihyperglycemic, antihyperlipidemic and antioxidant agent in streptozotocin-induced diabetes was comparable to that of the standard drug Glibenclamide (5 mg/kg).

Pharmacological Review on Centella asiatica: A Potential Herbal Cure-all.

In recent times, focus on plant research has increased all over the world. Centella asiatica is an important medicinal herb that is widely used in the orient and is becoming popular in the West. Triterpenoid, saponins, the primary constituents of Centella asiatica are manly believed to be responsible for its wide therapeutic actions. Apart from wound healing, the herb is recommended for the treatment of various skin conditions such as leprosy, lupus, varicose ulcers, eczema, psoriasis, diarrhoea, fever, amenorrhea, diseases of the female genitourinary tract and also for relieving anxiety and improving cognition. The present review attempts to provide comprehensive information on pharmacology, mechanisms of action, various preclinical and clinical studies, safety precautions and current research prospects of the herb. At the same time, studies to evaluate the likelihood of interactions with drugs and herbs on simultaneous use, which is imperative for optimal and safe utilization of the herb, are discussed.

Long term survival in aggressive NK cell leukemia.

Aggressive natural killer cell leukemia (ANKL) is a rare type of leukemia. It is rapidly progressing and the outcome is poor, with short survival. There is paucity of reports of ANKL in the Indian pediatric literature. We report a pediatric ANKL case that is in complete continuous remission after four years.