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.

Students perception towards feedback in clinical sciences in an outcome-based integrated curriculum

Background and Objective: Feedback has been identified as one of the key strategies for learning in the outcome-based curriculum. Students are more interested in their grades paying little attention to the feedback, may not understand the importance of feedback and its effect on their performance because of their perception, and beliefs. Non-constructive feedback will not result in the improvement of the students' performance. This study aims to explore; student's perception of useful feedback; the purpose of feedback and believes about written feedback

Methods: This analytical cross-sectional study was conducted from November 2017 to January 2018 at Majmaah University. Students studying in clinical phase were recruited. Data were collected from 121 students by self-structured questionnaire using complete enumeration sampling method

Results: Majority of the students [45.5%] disagreed that the feedback should always contain marks; [49.6%] commented that the tutor did not provide enough constructive feedback. While we ask the purpose of feedback [62.8%], agree with two-way nature of feedback, and it is helpful to find there expected performance. Almost two third [67.8%] of the students believe that limited feedback is the reason for frustration and they did not receive comments for improvement

Conclusions: Students are aware of the purpose of feedback. Senior students give more value to feedback and in the opinion that feedback provides useful suggestions for future improvement and limited feedback is the reason for frustration. The results highlight the need for more structured feedback mechanism, and there is a need for faculty engagement in training to fill the existing gapes to create an effective educational alliance

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.

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.

Pancytopenia: megaloblastic anemia is still the commonest cause

To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B12 deficieny amongst these patients. It is a prospective study carried out in Medical Unit I [Ward 5] of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Out of 88 patients suffering from Pancytopenia, a large number [40.90%] were diagnosed as Megaloblastic Anemia, out of which 77.77% had vitamin B12 deficiency. Aplastic anemia was found in 28 [31.88%] patients followed by other less common causes. Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B

Malarial hepatopathy in falciparum malaria

To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. A case series. This study was conducted at Medical Unit-1 [Ward 5], Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease [e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice] was excluded on the basis of history, relevant clinical examination and investigations. Age of the patients ranged from 13-48 years [mean 26.04 +/- 8.33]. All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two [51.6%] had serum bilirubin 3-6 mg%, 20 [32.2%] had 6-10 mg% and 10 [16.1%] had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients [45%] had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 [35.4%], splenomegaly in 48 [77.4%] and both hepatomegaly and splenomegaly in 16 [25.8%]. Gallbladder wall thickness was increased in 5 [8.06%] patients. There was no evidence of biliary dilatation. A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given

Nutritional iron deficiency in women of child bearing age- what to do?

Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia [IDA] can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment

Pharmaceutical cost of diabetes and its co-morbidities

Objectives: To estimate the direct costs of diabetic care and to correlate the disease severity and its complications with the pharmaceutical cost of the care

Design: The research design is non-interventional descriptive study and sample is non-particular purposive

Place and Duration: This study conducted in two cities Karachi and Rawalpindi, Jinnah Postgraduate Medical Center and Holy Family Hospital from March 2003 to May 2003

Patients and Methods: Physician using structured questionnaires interviewed 200 patients. The patients were classified into two clinical groups, those with good glycemic control and without complications were placed in group A while the patients with 6 major complications of diabetic were placed in group B. Health expenditure in first and second year following diagnosis were computed

Results: Patient in Group A spent 2 to 12% of their income, while patient in group B mostly had two or three complications and spent 15 - 22% of their average income on treatment

Conclusion: The study re-emphasizes the need to control diabetes and to make an endeavor to prevent and reduce the incidence of its complications which will not only reduce morbidity, mortality and disability but will also reduce economic burden, This study will serve stimulus for further research into economic aspects of management of various illnesses