A comparison of analgesic efficacy and safety of clonidine and methylprednisolone as additives to 0.25% ropivacaine in stellate ganglion block for the treatment of complex regional pain syndrome: a prospective randomised single blind study

Background@#The role of the sympathetic nervous system appears to be central in causing pain in complex regional pain syndrome (CRPS). The stellate ganglion block (SGB) using additives with local anesthetics is an established treatment modality. However, literature is sparse in support of selective benefits of different additives for SGB.Hence, the authors aimed to compare the efficacy and safety of clonidine with methylprednisolone as additives to ropivacaine in the SGB for treatment of CRPS. @*Methods@#A prospective randomized single blinded study (the investigator blinded to the study groups) was conducted among patients with CRPS-I of the upper limb, aged 18–70 years with American Society of Anaesthesiologists physical status I–III. Clonidine (15 μg) and methylprednisolone (40 mg) were compared as additives to 0.25% ropivacaine (5 mL) for SGB. After medical treatment for two weeks, patients in each of the two groups were given seven ultrasound guided SGBs on alternate days. @*Results@#There was no significant difference between the two groups with respect to visual analogue scale score, edema, or overall patient satisfaction. After 1.5 months follow-up, however, the group that received methylprednisolone had better improvement in range of motion. No significant side effects were seen with either drug. @*Conclusions@#The use of additives, both methylprednisolone and clonidine, is safe and effective for the SGB in CRPS. The significantly better improvement in joint mobility with methylprednisolone suggests that it should be considered promising as an additive to local anaesthetics when joint mobility is the concern.

Design and evaluation of dental pastes Containing anti-inflammatory drugs

Abstract Periodontitis is an oral disease associated with inflammation and pain with swollen and bleeding gums. In the present study, dental pastes containing NSAIDs, namely, diclofenac sodium and nimesulide (1 % w/w) were prepared to treat periodontitis. Dental pastes of diclofenac sodium and nimesulide (1 % w/w) were prepared with/without mucoadhesive hydrocolloid polymers such as sodium carboxy methyl cellulose (NaCMC), hydroxyl ethyl cellulose (HEC) and methyl cellulose (MC) by conventional trituration method. The pH, drug content, viscosity, tube spreadability and tube extrudability of these prepared dental pastes were measured. These dental pastes of diclofenac sodium and nimesulide (1 % w/w) were characterized by FTIR analyses for drug-excipient compatibility. The in vitro drug releases from these dental pastes in 6.4 pH phosphate buffer solution displayed sustained release over longer period and the drug release rate was found to be decreased when the concentration of mucoadhesive polymer was increased. These dental pastes displayed good adhesion to the oral mucosa revealing more retention time in mouth when tested for ex vivo mucoadhesion using bovine cheek pouch. The stability study results reveal that the DC3 and NC3 dental paste formulations were found stable enough over a longer period in different storage conditions. The present study revealed that the prepared mucoadhesive dental pastes of diclofenac sodium and nimesulide (1 % w/w) had good adhesion with the oral mucosa to maintain consistent release of drugs over prolonged time.

Biochemical synthesis of silver nanoprticles using filamentous fungi Penicillium decumbens (MTCC-2494) and its efficacy against A-549 lung cancer cell line / 中国天然药物

Biosynthesis of silver and other metallic nanoparticles is one of the emerging research area in the field of science and technology due to their potentiality, especially in the field of nano-biotechnology and biomedical sciences in order to develop nanomedicine. In our present study, Penicillium decumbens (MTCC-2494) was brought from Institute of Microbial Technology (IMTECH) Chandigarh and employed for extracellular biological synthesis of silver nanoparticles. Ag-NPs formation was appeared with a dark brown color inside the conical flask. Characterization of Ag-NPs were done by UV-Spectrophotometric analysis which showed absorption peak at 430 nm determines the presence of nanoparticles, Fourier transform infrared (FT-IR) spectroscopic analysis, showed amines and amides are the possible proteins involved in the stabilization of nanoparticles as capping agent. Atomic force Microscopy (AFM) confirmed the particle are spherical, size was around 30 to 60 nm and also the roughness of nanoparticles. Field emission scanning electron microscopy (FE-SEM) showed the topology of the nanoparticles and were spherical in shape. The biosynthesis process was found fast, ecofriendly and cost effective. Nano-silver particle was found to have a broad antimicrobial activity and also it showed good enhancement of antimicrobial activity of Carbenicillin, Piperacillin, Cefixime, Amoxicillin, Ofloxacin and Sparfloxacin in a synergistic mode. These Ag-NPs showed good anti-cancer activity at 80 μg·mL(-1)upon 24 hours of incubation and toxicity increases upon 48 hours of incubation against A-549 human lung cancer cell line and the synergistic formulation of the antibiotic with the synthesized nanoparticles was found more effective against the pathogenic bacteria studied.

Osteomyelitis of Scapula with Secondary Septic Arthritis of Shoulder Joint in a Six Month Old Child

We report a case of delayed diagnosis of osteomyelitis of the scapula extending to glenoid, with secondary septic arthritis of glenohumeral joint in a 6-month-old female infant. We performed urgent arthrotomy of the shoulder joint through an anterior approach with drainage of pus from the scapula through a posterior approach and prescribed intravenous antibiotics. Diagnosis was delayed as the patient initially presented with pneumonia, for which she was treated in the neonatal intensive care unit; at that time, all medical efforts were directed toward saving her life. Had the diagnosis been made earlier, septic arthritis of the shoulder might have been prevented. Diagnosis of septic shoulder arthritis is rare and difficult, requiring a high index of suspicion.

Seropositivity of hepatitis C, hepatitis B and HIV in chronically transfused beta -thalassaemia major patients

The purpose of this study was to determine the frequency and trend of transfusion transmitted infections [TTI] in chronically transfused beta-thalassaemia major [TM] patients with reference to the duration of transfusions. A cross-sectional study was done on 160 beta-TM patients and 5517 healthy blood donors to find out the prevalence of HCV, HBV and HIV infections. Out of 160 patients, 21 cases [13.1%] were anti-HCV positive, 2 [1.25%] were HBsAg positive. HIV antibodies were not detected in any sample. However, 109 [1.9%] and 104 [1.8%] of 5517 blood donors were positive for HCV and HBV respectively. No donor showed HIV antibodies. Anti-HCV was positive in 9/111[8.4%] thalassaemics [< 10 years of age] while 11/49 [22%] [> 10 years of age] showing significant difference [p = 0.005] among the two groups. For the past 10 - 12 years the screening of blood has reduced the magnitude of the disease significantly as shown by the trend in two age groups. Further improvements need to be done to implement uniform screening throughout the country

Ligamentotaxis for comminuted fracture of capitate: a case report / 中华创伤杂志(英文版)

We present the technical report for treatment of comminuted fracture of the capitate with ligamentotaxis. The base of third metacarpal was found to be fractured with comminution of the capitate. The decrease in carpal height index and comminution of the third metacarpal base lead to dilemma between conservative treatment and surgical management of this particular injury. The surgical management was chosen to maintain the carpal height index of the wrist to prevent the late degenerative changes.The patient was applied with external fixator in distraction mode expanning the wrist joint for six weeks, and the wrist was mobilised after removal of the fixator. It is shown that the external fixator in distraction mode expanning the wrist joint is a good alternative method for treatment of capitate fracture.

Early ultrastructural changes in the pancreatic islets transplanted into the tongue of diabetic rats

Isolated pancreatic islets transplanted into the tongue of streptozotocin diabetic rats were used for studying early ultrastructural changes, 24 and 72 h post-transplantation. Adult inbred Lewis rats were used both as donors and recipients, the latter were rendered diabetic by a single dose [40 mg/kg] of streptozotocin. The islets were isolated by the collagenase digestion technique. Isolated islets [2500-3000] harvested from 8 rats were injected into the tongue of each recipient rat close to the sulcus terminalis [a total of 6 transplantation was done]. Small pieces [lmm[3]] of the tongue were removed after 24 and 72 h from the site of injection and processed for electron microscopic examination. Our observations 24 and 72 h post-transplantation showed active secretory endocrine cells, most of which belonged to the B cell type as characterised by the morphology of their secretory granules. Some non-B cell entities could also be discerned from the pleomorphism of their secretory granules. Most of these cells showed proliferating Golgi zones along with normal looking rough endoplasmic reticulum ribosomes and mitochondria. Some cells showed degranulation 72 h after transplantation. Functional evaluation showed slight improvement in the diabetic state of the recipient rats

Ultrastructural changes of the kidney following unilateral ureteric occlusion in guinea-pigs

Complete unilateral obstruction of the ureter was studied in male guinea pigs weighing between 700 to 800 grams. Ultrathin sections 60 to 70 nm thick [silver to golden in color] were obtained form the kidney two days after the obstruction and were doubly stained with uranyl acetate and lead citrate in the usual way, then they were examined with JEOL 100 CX transmission electron microscope at 80 KV. The results were compared with the control obtained from the kidneys of the non operated side and sham operated animals. It was observed that the endothelium of the glomerular capillaries in the kidneys with the obstructed ureter appeared more undulating than in the normal and the distance, separating it from the basement membrane was discernable greater in the experimental kidneys than in the controls. The cells of the proximal convoluted tubules showed decrease in the invaginations of the plasmalemma, at their basilar part, whereas there was an increase in lysosomal content of the cells. There was an increase in the number of vacuoles in the cells of loop of Henle and loss of their surface microvilli. Distal convoluted tubules showed scanty microvesicles, mitochondria in the basal part of the cells were also considerably reduced in the number and size. It was also observed that the interstitium of the experimental kidneys contained cells displaying all qualities of cells which are actively engaged in protein synthesis. An attempt was made to explain the pathophysiology of obstructive uropathy on basis of Thendings indicating very early changes in the ultrastructure of kidney after ureteric obstruction

Retroperitoneal abscesses

Of 693 abscesses seen in one year [May 89-90], 19 were retroperitoneal. There were 3 perinephric, appendicular, pancreatic, 10 in the iliac fossal and 2 were cold abscesses

Rheumatic heart disease in school children from Al-Medina Al-Mounawarrah district, Saudi Arabia

The prevalence of rheumatic heart disease was assessed among schoolchildren aged 6 to 15 years. A sample size of 9, 418 [10% of target population] underwent cardiac evaluation. The prevalence of rheumatic heart disease was found to be 2.4 per 1, 000 children. It was more prevalent in rural areas, in females, and in the low socioeconomic class