severe kyphosis, failed to see horizon. Surgeon done miracle .

1 1/2 year old girl with coarse facies, developmental delay, x ray bullet shaped phalanges, oar shaped ribs and thin bones. Any differentials?

11 years old female, pain in joints from 1 month moderate, inflammation of elbow,wrist, knee, ankle from 20 days, fever high grade from 4 days, deformity of metacarpal joints from 3 years, TB contact +ve (mother & sibling). O/E: inflammation of elbow, wrist, MCP, wrist, knee & ankle joints symmetrical, warm & tender, nodules on MCP, joints pigeon chest, chest b/l clear, GCS 15/15, anterior fontanelle wide open. Ix: WBC 12, HB 10, plt 394, Spinal XRay shows mild Kyphosis, Platyspondyly at lumbosacral joint, ASOT -ve, XRay both hand & feet shows soft tissue calcification, bone density mildly reduced, USG joints: no joint effusion. Diagnosis & Management?

48/ F H/O fall from height of 10 feet, complaints of LBA. No other complaints Neurologically no deficits Paraspinal muscle and tenderness locally present What should be the plan of management?

64 yr old male, presented with gradually progressive spastic quadreparesis, with associated imbalance while walking in dark, for past 2 years, urinary urge for past 2 months, O/E asymmetrical weakness R>L power of 4-/5, all DTR brisk, hoffmans positive, Imapired JPS, vibration, dec pain on R side upto c4 dermatome. what should be the approach for this case ?

male 60 complain of pain in back and both lower limb since two years. diagnose n management plz