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Objective: The aim of this study is to find the characteristics of nutritional rickets and the proportion of cases diagnosed prospectively. Methods: Details of 54 cases of nutritional rickets in the age group of 1 month-12 years diagnosed during 2013-2015 in a tertiary care teaching hospital in Kerala were collected. The criteria taken for diagnosis were clinical features, biochemical parameters such as calcium, phosphorous, alkaline phosphatase (ALP), radiological features, and response to vitamin D treatment. Vitamin D level and serum parathyroid hormone levels were collected whenever it is available. The data were then analyzed statistically. Results: Among the 54 cases analyzed, 61.11% were male. A maximum number of cases were identified in the age group of 1-2 years (44.44%). Nearly 88.89% of patients were born term. About 83.3% of patients were intermediate or dark skinned. The most common clinical feature identified was bowlegs. Radiological features were identified in 70.4% of cases. The most common biochemical abnormality noted was elevated serum ALP (83.33%). Hypocalcemic seizures were a predominant manifestation in <6 months’ age group. Rickets was detected prospectively in 26 patients (48.15%) during evaluation for other illnesses. The mean ALP level was found to be significantly lower in patients with clinical or radiological features of rickets compared to those without clinical or radiological evidence. Conclusions: Rickets is very common in the age group of 1-2 years and among exclusively breastfed term babies. The significant number of cases of nutritional rickets was detected prospectively during evaluation for other illnesses. ALP level may be routinely checked in the vulnerable high-risk age group for identification of early rickets as it is significantly elevated even before clinical and radiological changes appear.

Schizophrenia is a strict mental disorder affecting about human population. Being chronic and often incapacitating, it extracts tremendous cost from patients, caregivers and society. Caregivers of patients with schizophrenia face stress and emotional hardship and are frequently forced to assume lifelong care-taking roles. Subjective burden refers to the caregivers’ short term and long term reactions to the patient’s symptoms and behaviors, and the care giving task resulting from it. Perceived distress and interpersonal strain are examples. It refers to the extent to which the care giver feels he or she is burdened. This study aims to conducted for analysis the burden and coping among caregivers of schizophrenia. This study conducted with 30 Schizophrenic patients and 30 primary caretakers of the patients, totally 60 samples were studied. The result shows that there is association between burden assessment schedules of caregiver with that of caregivers coping scale. It revealed statistical significance. Low coping score seen in caregiver who had high burden score. Lower burden score seen in caregivers who had high coping level.

Pseudocholinesterase deficiency, commonly referred to as Butyrylcholinesterase deficiency, is a rare, inherited, or acquired condition that results in decreased or absent enzymatic activity. Pseudocholinesterase is a plasma enzyme that is responsible for the breakdown of succinylcholine and mivacurium, which are commonly used paralytic agents. People with this condition are usually unaware they have the disease, and the disease may not manifest until extubation at the end of surgery. These patients will usually have abnormally prolonged paralysis time and require mechanical ventilation well into the post anesthesia care unit because of failure to meet qualitative and quantitative extubation criteria. Treatment is mainly supportive with continued mechanical ventilation until return of muscle function because paralysis can last from minutes to hours and re-sedation to limit patient discomfort. We present two cases of prolonged paralysis after succinylcholine administration subsequently confirmed by laboratory testing to be pseudocholinesterase deficiency.