Assessment of musculoskeletal ultrasound guided injection of the new regenerative medicine techniques (neural prolotherapy and platelet rich plasma) impact versus well established techniques (steroid injection) in cases of carpal tunnel syndrome secondary to rheumatoid arthritis

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming poly-arthritis with extra-articular manifestations in 10­20% of patients, especially those with high titers of rheumatoid factor. Extra articular pathology includes bursitis, tendonitis and neuritis, which results from entrapment, nerve ischemia due to vasculitis or drugs used to treat this condition. Carpal tunnel syndrome is the most common compression neuropathy associated with rheumatoid arthritis. Aim of the Work: To evaluate the efficacy of Neural Prolotherapy and Platelet Rich Plasma in treatment of carpal tunnel syndrome secondary to rheumatoid arthritis. Patients and Methods: Ninety patients with Rheumatoid Arthritis (RA) that were all fulfilling the 2016 ACR/EULAR classification criteria for RA. All were over the age of sixteen years at time of diagnosis, complaining of burning pain or paresthesia in the median nerve distribution of the hand. They were recruited from Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from December 2018 to July 2019. Results: Neural Prolotherapy and Platelet Rich Plasma (PRP) have improved all measured parameters like visual analogue scale (VAS), nerve conduction studies and neuromuscular ultrasonography parameters in carpal tunnel syndrome secondary to rheumatoid arthritis. Conclusion: Neural Prolotherapy and Platelet Rich Plasma proved to be effective treatments of carpal tunnel syndrome secondary to rheumatoid arthritis

Effect of steroid loaded middle meatal gelfoam sheet on endoscopic sinus surgery outcome

Background: Endoscopic sinus surgery (ESS) represents the overall accepted type of surgical treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP) refractory to medical treatment. Presence of postoperative Middle meatal adhesions are a potential cause of surgical failure. Triamcinolone is recently proposed as a solution for these adhesions. Objective: This study was designed to evaluate the effect of steroid loaded middle meatal gelfoam sheet on endoscopic sinus surgery outcome regarding middle meatal adhesions and synechiae formation in patients with CRSwNP refractory to medical treatment. Patients and Methods: This prospective, randomized, single-blinded, placebo-controlled study was conducted on 62 nasal cavities of 31 patients with bilateral CRSwNP. At the end of ESS, randomly gelfoam sheet loaded with triamcinolone was placed in one middle meatus and another gelfoam sheet loaded with saline in the contralateral middle meatus for 1 week. Results: Our results as regards topical application of steroids to the middle meatus showed a statistically significant difference between the steroid side and the saline (control) side in reduction of synechia formation after ESS. Therefore, topical application of steroids is effective in minimizing synechiae formation after ESS. It is also safe and no local or systemic complications were noted during the study. Conclusion: Results of our study demonstrated that the steroid loaded middle meatal gelfoam sheet has a role in minimizing middle meatal adhesions and synechiae formation after endoscopic sinus surgery for patients with CRSwNP

Proximate and phytochemical compositions of leaf and root of (cattle stick) Carpolobia lutea G. Don

ABSTRACT: Carpolobia lutea is a medicinal plant commonly utilized in Nigeria to boost libido. The ethnomedicinal importance of any plant lies in some secondary metabolites. Hence, the present study was carried out to investigate the proximate and phytochemical composition of roots and leaves of this plant using standard methods. The proximate composition of leaves and roots showed moisture, ash, fibre, protein, fat and carbohydrate contents with values that ranged between 8.84-9.55, 3.48-3.65, 1.10-1.06, 6.64-8.39, 1.80-1.80 and 76.16-77.47% respectively. The leaves contained higher amount of ash, crude protein and fat than the roots. The results of ethanolic extracts showed the presence of alkaloids, anthraquinones, steroids, saponins, tannins, phenols, terpenoids, anthocyanin, carotenoids and flavonoids in both the leaves and roots. These phytochemicals were found to be significantly higher in roots except for anthraquinones, flavonoids and steroids which were significantly higher in the leaves. Among the phytochemicals, alkaloids were found to be highest in concentration followed in decreasing order by saponins, steroids, tannins, flavonoids, anthraquinones, anthocyanin, terpenoids, phenols and carotenoids. The results indicated that, C. lutea leaf and root have high nutritive and medicinal values and this could be explored for pharmaceutical purposes

A review of antenatal corticosteroid use in premature neonates in a middle-income country

Background. Antenatal corticosteroid (ANS) use in premature neonates has become a standard of practice. However, there is low ANS coverage in low- to middle-income countries (LMICs). Recent studies have questioned the efficacy of ANSs in such countries.Objective. To review the use of ANSs in preterm neonates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.Methods. This was a retrospective observational study of all neonates with a birth weight of 500 - 1 800 g born at CMJAH between 1 January 2013 and 30 June 2016. Neonatal and maternal characteristics of neonates exposed to ANSs were compared with those of neonates who were not exposed.Results. The ANS coverage of the final sample was 930/2 109 (44.1%). The mean (standard deviation (SD)) birth weight was 1 292.4 (323.2) g and the mean gestational age 30.2 (2.9) weeks. Attending antenatal care and maternal hypertension were associated with increased use of ANSs, whereas vaginal delivery was associated with decreased use. In neonates weighing <1 500 g, the use of ANSs was associated with decreased mortality, decreased intraventricular haemorrhage and decreased patent ductus arteriosus. There was no association between ANSs and respiratory distress syndrome, necrotising enterocolitis, sepsis or need for respiratory support in all premature neonates, and no association with improved outcomes in those weighing ≥1 500 g.Conclusion. The benefits of ANSs in terms of neonatal morbidity in this study were not as marked as those published in high-income countries. A randomised controlled trial may be indicated in LMICs

Predictors of Topical Steroid Misuse among Patrons of Pharmacies in Pretoria

The misuse of topical steroids; i.e. the usage of these products for skin lightening; is a widespread phenomenon among African men and women. Studies have reported prevalence rates of 18.5to 70 among participants. Though women constitute the majority of users; people of various age groups; socioeconomic status; employment and marital status practise skin lightening. Besides topical steroid products; other commonly used products include preparations containing hydroquinone or mercury derivatives. The misuse of these products is associated with skin problems such as cellulitis; contact eczema; bacterial and fungal infections; Cushing's syndrome; acne; skin atrophy and pigmentation disorders. Although these effects are well documented; it seems that there is little wareness of them among the general public. Other less commonly reported problems include delaying the diagnosis of leprosy; and erythrodermic psoriasis. Data on the misuse and side effects of topical steroids have been gathered primarily from prescriptions; despite the fact that these products could be obtained over the counter; shared between relatives or friends; or come from other informal sources. Moreover; we found no community-based study that investigated the prevalence of the misuse of topical steroid products in South Africa. This survey was therefore conducted to examine the misuse of topical steroid products for skin lightening; among patrons of pharmacies in Pretoria and to determine the potential predictors of misuse.Methods: The aim of this study was to examine the misuse of topical steroid products for skin lightening by patrons of pharmacies in Pretoria and to determine the potential predictors of misuse. Exit interviews were conducted at 21 randomly selected pharmacies by trained interviewers using a structured questionnaire. A total of 1 228 patrons were approached; of which 225 gave verbal consent to be interviewed.Results: Of the 225 participants; 83 were female; 50.7 were 20-40 years old; 56 were employed; and 53.3 were married. The majority of participants (75.1) were black Africans. About half of them (50.2) had high school education. The prevalence of topical steroid misuse for skin lightening was 35.5. A logistic regression analysis revealed that being a black female African and initially being advised to use the products by a friend were the only parameters that significantly correlated with topical steroid misuse.Conclusion: In conclusion; the prevalence of the misuse of topical steroid products among the respondents was 35.5. The following predictors were associated with topical steroid misuse: being a black female African; not being aware of the side effects of these products; and initially being advised to use the products by a friend. In a logistic regression model; the last two predictors were the only parameters that significantly correlated with topical steroid misuse. (SA Fam Pract 2006; 48(1): 14)