Comparative role of pregabalin and carbamazepine regarding efficacy in painful diabetic neuropathy

Neuropathic pain is the most severe and resistant type of pain which has impact on quality of life ana behaviour; it most commonly occurs at night causing disturbed; sleep. Diabetes mellitus is a common cause of painful neuropathy. In this study, we are comparing the effectiveness of old treatment Carbamazepine with Pregabalin in painful diabetic neuropathy. The study was an open-label trial conducted in Diabetic Clinic of Medical Unit-Ill, Jinnah Postgraduate Medical Center, Karachi. The duration of the study was 90 days, from December 2010 to March 2011. The study has been approved from ethical committee of JPMC, Karachi with the reference NO.F.2-81/2010-GENL/195/JPMC. 60 established patients of painful diabetic peripheral neuropathy from Diabetic Clinic of Medical Unit-Ill OPD were included in the 90-day study, irrespective of gender, with duration of diabetes more than 10 years. All subjects are placed into two groups. In group A, comprising of 30 patients [n=30], Pregabalin was administered and in group B, also comprising of 30 patients [n=30], Carbamazepine. The intensity of pain was compared on visual analog scale of McGill pain questionnaire. In group A [Pregabalin], the mean pain score fell from 6.17+/-0.14 to 3.50+/-0.15 from day 0 to day 90 [p-value=0.001] and the percentage of change also in visual analog scale of McGill pain questionnaire was -43.31%. In group B [Carbamazepine], the changes in pain score from initially 6.07+/-0.14 falling to 4.23+/-0.13 from day 0 to day 90 [p-value=0.001] and the percentage of change was -30.31%. Pregabalin was observed to be more potent. Both drugs were well tolerated by all participants that also completed the entire duration of the trial

Evaluation of hearing impairment in children of school going age

The timely identification of severity of hearing loss in school age children will decrease the morbidity and this morbidity can be corrected by timely treatment. Community-base cohort study. This study was conducted in ENT department of Abbasi Shaheed Hospital, KMC,Karachi from January 2011 to Jan 2012. The suspected cases were referred to the ENT department of Abbasi Shaheed Hospital adjoining schools and suspected cases of hearing difficulty noticed by the parents. After taking informed consent from both sexes and age ranges from 6-16 years were included in the study. This study shows male were slight more 54 patients. Highest number of patients was found in 13 years of age 16 patients i.e 16%. In 53 patients risk factor was present. Maximum number of children had moderate hearing loss 26 children [26%]. Early school going child with mild to moderate hearing loss is difficult to detect during routinr examination. Audiological screening is necessary for detection of hearing loss in early school going child

Comparison of efficacy and safety profile of gabapentin and carbamazepine in painful diabetic neuropathy

Comparison of efficacy and safety profile of Gabapentin and Carbamazepine in painful diabetic neuropathy. open label 12 weeks randomized controlled trial. The present study was conducted in Department of Pharmacology and Therapeutics Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC] in collaboration of Diabetic Clinic of Medical Unit III of JPMC Karachi. December 2010 to May 2011. 60 diagnosed patients of painful diabetic neuropathy were selected for 12 weeks trial after taking written consent. The patients were randomly placed into two groups, 30 patients each. One group received Gabapentin [n=30] while the other received Carbamazepine [n=30]. The primary outcome was reduction in pain scale. It was compared on 11-point numerical visual analog scale [VAS]. In Gabapentin group the reduction in pain VAS was 6.17 +/- 0.15 on day 0 to 3.5 +/- 0.15 on day 90. The percentage of change was 43.3% from baseline [p-value 0.001]. In carbamazepine group the reduction in pain VAS was 6.07 +/- 0.13 on day 0 to 4.23 +/- 0.13 on day 90. The percentage of change was 30.4% [p-value 0.001]. The secondary outcome was improvement in sleep interference that is measured on 11-point numerical VAS of sleep interference. It also improved in both groups which is highly significant. In patients of diabetic painful neuropathy treatment of Gabapentin and Carbamazepine both are effective but Gabapentin is superior in relieving symptoms than Carbamazepine

unusual foreign body in trachea

We report a very unusual case of foreign body [FB] in the tracheo-bronchial tract of a male child, who presented to us in the emergency department at our tertiary care centre with the complaint of FB in throat, cough bouts and choking sensation with pain and difficulty in breathing for whom an emergency rigid endoscopy was carried out after appropriate investigations

Role of tracheostomy [early VS late] in intubated cases of neurosurgical patients in surgical intensive care unit [SICU] setting

To study the role of early vs. late tracheostomy, in neurosurgical intubated cases admitted in surgical intensive care unit, on recovery from pneumonia during ventilation, length of intensive care unit stay and duration of ventilatory support and weaning. The Study was conducted in the Department of Anaesthesia and Surgical Intensive Care Unit with collaboration of ENT Department, Abbasi Shaheed Hospital, Karachi from Jan 2007-Dec 2008. A retrospective analysis of the case file records of the intubated neurosurgical patients admitted in surgical intensive care unit for whom elective tracheostomy was performed, for prolonged ventilation, was made from 2007-2008 of 50 cases. Early tracheostomy was consider, when it was performed within 3 - 7 days of intubation and late was after that or 8- 14 days. Data collected include the information regarding the patient's name, age, sex, etiology and Glasgow coma score [GCS] on admission, time duration of patients' stay in surgical intensive care unit, time period of weaning from mechanical support and recovery from pneumonia during ventilation, along with chest x-ray's, culture and sensitivity reports. Depending on the time of tracheostomy performed two groups were made: Group- I in which tracheostomy was performed early within 3-7 days of intubation and Group- II in which tracheostomy were performed after an interval of more than 7 days or 8-14 days [late tracheostomy]. For group I the early tracheostomy was done at the median of 4th day vs. that of 10th day for the group II. The number of cases that developed pneumonia in group- I was 45.45% versus Group- II 54.54%, [odd ratio 0.27]. Duration of mechanical ventilation was significant with early tracheostomy [mean, standard deviation] 11.95 days +/- 3.14 versus late tracheostomy 21.79 days +/- 6.06. Intensive care unit stay was shorter in group- I [mean, standard deviation] 15.09 days +/- 3.49 versus in group- II 26.71days +/- 7.00. Recovery from pneumonia was shorter in group- I [mean, standard deviation] 9.0 days +/- 1.63 versus in group- II 14.23 days +/- 1.81. Our study shows that early tracheostomy has a positive role in reducing the risk of pneumonia, because of easier access to lower airway for clearance but not statistically significant, decreased the overall time period of surgical intensive unit stay and patients were weaned off earlier from mechanical support, in comparison to those in which tracheostomy was performed late. Therefore early tracheostomy in selected patients may help in reducing unnecessary resource utilization

Correlation between traffic noise induced hearing loss [NIHL] and occupation

To examine the subjects who are more prone to traffic noise exposure such as auto rickshaw drivers, traffic constables and shop keepers in central business area in Karachi [Pakistan]. This was hospital based prospective study comprising of 200 subjects. The results were obtained by testing the subjects which were investigated on the basis of interviews by [a] completing performa [b] Pure tone audiometry [PTA]. Correlation between traffic NIHL and occupation was found statistically significant with P<0.001 distributed as 15 [34.1%] in auto rickshaw drivers, 34 [40%] in shopkeepers and 29 [34.1%] in traffic constables. The fact that road traffic is the most significant source of noise pollution in Karachi was established by investigating our subjects. They had significant degree of hearing impairment i.e. 42%