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OBJECTIVE: To compare the effectiveness of Simulated Equestrian Therapy (SET) and Standard Physical Therapy (SPT) in improving gait parameters among children with Down syndrome (DS). METHODS: This single-blinded, randomized controlled trial was conducted at Dar-ul-Sukun Institute and Dr. Zaiuddin Hospital, Karachi, Pakistan, from April to August 2023. Sixty individuals, meeting the selection criteria were randomly assigned to either the treatment group (n=30) receiving SET or the control group (n=30) undergoing SPT. Nevertheless, two participants from each group either discontinued the treatment or failed to comply with the therapy and 56 participants (n=28 in each group) were included for analysis. Safety measures included recording blood pressure and heart rate before and after each session. Temporal gait parameters were assessed using the 10-Meter Walk Test at baseline, 6 weeks, and 12 weeks. Data was analyzed using Medcalc software. RESULTS: Temporal gait parameters were analyzed for 56 (33 males and 23 females) children with DS in both groups. Mean age of patients in SET & SPT groups was 7.89±1.7 and 8.07±0.76 years respectively. Baseline showed similar scores in both groups. At 6 weeks, SET demonstrated significant improvement in cadence (1.78 SPM to 1.35) and gait velocity (2.11 MPS to 2.79), paralleled by SPT (cadence: 2.01 to 1.32 SPM, gait velocity: 2.12 to 2.83 MPS). Between-group analysis revealed no significant differences. CONCLUSION: Both SET & SPT effectively improve gait parameters in children with Down syndrome. The comparable outcomes highlight SET as a viable alternative, providing clinicians and caregivers additional options for personalized therapeutic approaches.

OBJECTIVE: to assess the incidence of hyperammonemia in patients receiving valproic acid (VPA) therapy. METHODS: This cross-sectional study was conducted at the Department of Neurology, Ziauddin Medical University and Hospital, Karachi, for six months from April to October 2019. A total of 158 patients of both genders, aged between 18 to 80 years, presented in emergency with complaints of seizures and who had received a minimum dose of valproic acid before blood withdrawal were included. Pregnant women, patients with cirrhotic liver, or chronic renal impairment were excluded from the study. RESULTS: Out of 158 patients, 80 (50.6%) were females and 78 (49.4%) were males. Mean age of patients was 55.53±18.26 years. Among the participants, 27 (17.1%) had undergone VPA therapy for 30 days or more, while 131 (82.9%) had received it for less than 30 days. The mean duration of VPA therapy was 8.58±10.41 days. Among the 158 patients, 95 (60.1%) with seizures receiving VPA treatment were diagnosed with hyperammonemia. The mean serum ammonia level was 66.50±44.59 mg/dL, and mean VPA dose administered was 1000±125 mg/day. There was a statistically significant association between the dose of Valproic Acid and the incidence of hyperammonemia (p