60 yr old female pt xray lumber spine,h/o pain in thighs radiate to the pelvis nd lumber spine frm 1 yr

Intraoperative view of scoliosis surgery. Scoliosis is a medical condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped. In some the degree of curve is stable, while in others it increases over time. Mild scoliosis does not typically cause problems, while severe cases can interfere with breathing. The cause of most cases is unknown but believed to involve a combination of geneticand environmental factors. It can also occur due to another condition such as muscles spasms, cerebral palsy, Marfan syndrome, and tumors such as neurofibromatosis. Diagnosis is confirmed with plain X-rays.

8yr boy came with Subnormal intelligence and walking difficultly... Pt was near term (born 7 d before EDD), hospital delivered with no significant perinatal event, SGA, antenatal history normal. A/t father no feeding difficulty or jaundice post nataly, first thing they noticed was child not achieving milestones in time like neck holding, sitting, speaking... ie GDD. Then he consulted various practitioners and told to be case of CP and muscle relaxants given. Pt never had convulsion. Pt started walking after 2yrs and speaking monosyllables.. at present he walk unassisted with abnormal gait keeping feet in equinus position and reply to basic question but overall low IQ, he keep smiling in bw interaction. O/e OFC 45cm, heterochromic iris, tone slightly increased, DTR brisk, plantar extensor, contractures felt at both tendoachillis with varus deformity in both knees... CT and X rays done attached. No h/o convulsion so far... Discuss ur opinions and further necessary tests....

V v v important DRUGS OF CHOICE ---------------------------------- 1. Paracetamol poisoning- :- - acetyl cysteine 2. acute bronchial- asthma :- salbutamol 3. acute gout :- NSAIDS 4. acute hyperkalemia:- calcium gluconate 5. severe DIGITALIS toxicity :- DIGIBIND 6. acute migraine :- sumatriptan 7. cheese reaction :- phentolamine 8. atropine poisoning :- physostigmine 9. cyanide poisoning :- amyl nitrite 10. benzodiazepine poisoning:- flumazenil 11. cholera :- tetracycline 12. KALA-AZAR :- lipozomal amphotericin- B 13. iron poisoning :- desferrioxamine­ 14. MRSA :- vancomycin 15. VRSA :- LINEZOLID 16. warfarin overdose :- vitamin-K (NIPER- 2009) 17. OCD :- fluoxetine 18. alcohol poisoning :- fomepizole 19.Epilepsy in pregnancy: carbamezepine safe among older epileptics & lamotrigine, levitracetam safe in newer AED! 20. anaphylactic shock :- Adrenaline 21. MRSA Infection-Vancomycin 22. Malaria in Pregnancy-Chloroquine 23. Whooping Cough or Perteusis- Erythromycin 24. Kawasaki disease-IV Ig 25. Warferin Overdose-Vit-K 26. Heparin Overdose-Protamine 27. Hairy Cell Leukemia-Cladirabine 28. Multiple Myeloma- Melphalan 29. CML-Imatinib 30. Wegner's granulomatosis-Cyclophosphamide 31. HOCM- Propranolol 32. Delirium Tremens-Diazepam 33. Drug Induced Parkinsonism-Benzhexol 34. Diacumarol Poisoning-Vit-K 35. Type-1 Lepra Reaction-Steroids 36. Type- 2 Lepra Reaction-Thalidomide 37. Allergic Contect Dermatitis-Steroids 38. PSVT- 1st-Adenosine, 2nd-Verapamil, 3rd-Digoxin 39. Z-E Syndrome- Proton Pump Inhibitor 40. Chancroid-Cotrimoxazole 41. Dermatitis Herpetiformis-Dapsone 42. Spastic Type of Cerebral Palsy-Diazepam 43. Herpis Simplex Keratitis-Trifluridine 44. Herpes Simplex Orolabialis-Pancyclovir 45. Neonatal Herpes Simplex-Acyclovir 46. Pneumocystis carinii Pneumonia-Cotrimoxazole For Nodulo 47. 47. Cystic Acne-Retinoic acid 48. Trigeminal Neuralgia-Carbamezapine 49. Actinomycosis-Penicillin 50. Plague- Streptomycin 51. Opioid Withdrawal- Methadone 2nd-Clonidine 52. Alcohol Withdrawal- Chlordiazepoxide 2nd-Diazepam 53. Post Herpetic Neuralgia- Fluphenazine 54. WEST Syndrome-ACTH 55. Diabetic Diarrhoea- Clonidine 56. Lithium Induced Neuropathy-AmilorideCommunicable Disease: 57. Tetanus: PEN G Na; TETRACYCLINE; (DIAZEPAM 58. Diphteria: PEN G K; ERYTHROMYCIN 59. Pertusis: ERYTHROMYCIN; AMPICILLIN 60. Meningitis: MANNITOL (osmotic diuretic);DEXAM ETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant) 61. Cholera: TETRACYCLINE 62. Amoebic Dysentery: METRONIDAZOLE 63. Shigellosis: CO-TRIMOXAZOLE 64. Typhoid: CHORAMPHENICOL 65. Rabies: LYSSAVAC, VERORAB 66. Immunoglobulins: ERIG or HRIg 67. Malaria: CHLOROQUINE 68. Schistosomiasis: PRAZIQUANTEL 69. Felariasis: DIETHYLCARBAMAZINE CITRATE 70. Scabies: EURAX/ CROTAMITON 71. Chicken pox: ACYCLOVIR/ZOVIRAX 72. Leptospirosis: PENICILLIN; TETRACYCLINE;ER YTHROMYCIN 73. Leprosy: DAPSONE, RIFAMPICIN 74. Anthrax: PENICILLIN 75. Tuberculosis: R.I.P.E.S. 76. Pneumonia: COTRIMOXAZOLE; ProcainePenicillin 77. Helminths: MEBENDAZOLE; PYRANTELPAMOATE 78. Meningitis: MANNITOL (dec. ICP) ;DEXAMETHASONE ( relieve cerebral edema) ;DIAZEPAM ( anticonvulsant); PENICILLIN 79. Syphilis: PENICILLIN 80. Gonorrhea: PENICILLIN...

Here is a three years old male with poor physical build up having difficulty in holding his head properly, seeks support to get up while sits on ground. He is not able to perform activities like normal children of his age. CPK EMG ECG CXR and other relevant investigations are normal. Spine Muscular Dystrophy is ruled out in genetic evaluation (NGS) and muscle biopsy is not done yet. Here some pics and NGS report are attached. Please share your valuable views regarding what or how would be his lifespan and any treatment possibilities.