Comparison of pain score after giving diclofenac sodium versus nalbuphine in patients undergoing ESWL: our experience in SIMS/ SHL

Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques

Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013

Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated

Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05

Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain

Congenital hypoplasia of first digital ray of hands as an isolated presentation in four subjects

Congenital hypoplasia of thumb is rare malformation which is less likely to appear as an isolated entity. Four independent subjects exhibiting various grades of underdeveloped first digital ray were recruited. The affected autopods had narrow palms, medial or valgus inclinations of index fingers and thenar weakness, while the postaxial digits were least affected. According to the classification of hypoplastic thumb by Blauth and Schneider-Sickert [1981], the phenotypes were concordant with types 3 and 4. In one of the subjects there was contralateral preaxial polydactyly. All cases were sporadic and nonsyndromic and parental consanguinity was witnessed in two individuals. Recurrent appearance of similar phenotypes may suggest genetic etiologies which should be elucidated with the help of high-throughput genetic methods

Shoulder impingement syndrome: outcome of arthroscopic subacromial decompression

To describe the outcome of cases with subacromial impingement syndrome managed with arthroscopic subacromial decompression. Quasi-experimental study. Section of Orthopaedics, Department of Surgery, The Aga Khan University Hospital, Karachi from April 2005 to March 2006. Thirty patients with impingement syndrome who underwent arthroscopic subacromial decompression after failed conservative treatment were included. The Constant and Murley shoulder scoring system was used for the clinical assessment of pain and function pre-operatively and 1, 6 and 24 weeks postoperatively. The postoperatively significant improvement was observed in the Constant and Murley scores in all the patients [by mean 40 points, p < 0.01], which was progressive over six months. Lower scores were noted in patients over 40 years of age, with advanced stage of impingement and partial tears of the rotator cuff. Arthroscopic subacromial decompression was effective in reducing pain and improving function in the studied patients with subacromial impingement syndrome

Retained sponge after abdominal surgery

To study the cause and clinical presentation along with clinical course [coperative and postoperative] of retained abdominal sponge. Design: Observational case series. Place and Duration of Study: Surgical Department, Bahawal Victoria Hospital, Bahawalpur, from April 1, 2000 to August 31, 2002. Materials and The study included 12 patients. All the patients, who presented to surgical department during the stated period with retained abdominal sponge postoperatively, were included in the study. Retained abdominal foreign bodies, other than the surgical sponge, were excluded. A total of 12 patients presented with retained abdominal sponge. Out of these, 33.33% were males and 66.66% females. Modes of presentation were intestinal obstruction, 58.33%, discharging sinus, 41.67%, intraabdominal abscess,16.67%, peritonitis, 16.67% and mass abdomen, 8.33%. One death followed despite provision of due care. Retained surgical sponge is a potentially lethal condition and all preventive measures should be taken to avoid this condition

Quality control of pharmaceuticals by high-performance liquid chromatography

High-performance liquid chromatography of sixteen commonly used drugs and vitamins have been studied. Two different reverse-phase columns have been evaluated for the chromatography of drugs and related compounds. Where as non-polar and slightly polar compounds were retained quite strongly, the columns exhibited little selectivity for polar and ionic compounds. However, the retention behavior of such compounds could be favourably influenced by variation of pH, ionic strength and organic content of the eluent. In general it was observed that the reverse-phase column is applicable to a wide range of drugs both for quality control of drugs and in situ studies