Frequency and intensity of shoulder pain after stroke A hospital based study

Objective: To determine the frequency and intensity of shoulder pain in stroke patients and explore any relation of shoulder pain with the side of involvement and the primary etiology of stroke

Study Design: A cross-sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi from January 2012 to June 2012

Material and Methods: Through non-probability convenience sampling 100 patients of both genders satisfying the World Health Organization clinical definition of stroke and reporting within one year of stroke development were included and those with cognitive dysfunction and rheumatic diseases or a history of chronic pain prior to the stroke were excluded. Shoulder pain was defined as pain in the shoulder area requiring analgesia for two or more consecutive days and its intensity was graded on visual analogue scale [VAS]

Results: Of 100 patients [mean age: 63 +/- 18 years], majority were males [76%], diagnosed with ischemic stroke [80%] and had a right sided pain [44%]. Patients with moderate to severe pain were more common [83.3%]. On comparison with the type of stroke, the pain was more prevalent on left side [72.7%] and in patients of ischemic stroke [62.5%]. However, these relations were statistically insignificant [p=0.061 and p=0.197 respectively]

Conclusion: More than half of the stroke patients reporting to our institute developed shoulder pain in first year after stroke the majority of whom had moderate to severe pain. The shoulder pain is not related to the primary etiology of stroke and side of involvement

diagnostic dilemma of progressive muscular atrophy

Progressive muscle atrophy is a rare subtype of motor neuron disease that affects only the lower motor neurons and presents as asymmetrical rapidly progressive muscle weakness, atrophy and normal sensations. The diagnostic electrophysiological findings are denervation potentials in three out of four body segments [bulbar, cervical, thoracic and lumbosacral]. The disease is fatal and the management is supportive. We present the report of a 45-year-old female patient who presented with unilateral foot drop and rapidly progressed to profound weakness in muscles of all limbs, neck and back along with dysarthria and dysphagia. She had been operated twice for suspected cervical and lumbosacral intervertebral disc herniations and ultimately guided in right direction after muscle biopsy, nerve conduction studies and electromyography

Frequency and the related socio-demographic and clinical factors of phantom limb pain in traumatic amputees presenting at a tertiary care rehabilitation setup

Objective: To find out the frequency of phantom limb pain [PLP] in a sample of Pakistani amputee population presenting with amputation due to trauma and to investigate its relationship with different sociodemographic and clinical factors

Study Design: A cross-sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from August 2010 to October 2013

Material and Methods: Through non-probability purposive sampling, patients of both genders and all ages having a traumatic etiology of amputation were sampled from the outdoor amputee clinic and the indoor amputee ward. Patients having diabetes mellitus, polyneuropathy, memory loss, cognitive deficits and established history of psychiatric disorders were excluded. Through face to face semi structured interviews, information was obtained about presence of PLP, gender, location [urban or rural], ethnicity based on Pakistani provinces [Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan, Azad Jammu and Kashmir], monthly income in Pakistani Rupees [PKR] [<10,000, 10,000 - <50,000 and >50,000], level of education [grade <5, grade 5 - 10, and grade >10], level of amputation and cause of trauma [fall from height, motor vehicle accident, blast injury, bullet injury or others]

Results: Out of 268 patients [mean age 28 +/- 6 years], 266 [99.3%] were male and 2 [0.7%] were female. Majority [79.1%] were rural based, Punjabis [44.8%], had a monthly income <10,000 PKR [85.4%], education from grade 5 - 10 [80.2%] and a lower limb amputation [86.9%]. The commonest cause was blast injuries [72.8%]. PLP was present in 42.5% [n=114] of the individuals and it was not significantly related to gender, living location, ethnicity based on Pakistani provinces, level of education, monthly income, cause of traumatic amputation and level of amputation

Conclusion: PLP was found in 42.5% of our sample of Pakistani traumatic amputees. The frequency was not related to gender, monthly income, ethnicity based on provinces, education, rural or urban based living and etiology or level of amputation

Diacerein: a treatment option in painful primary knee osteoarthritis

To identify the efficacy and side effects of Diacerein in patients with mild to moderate knee mteoarthritis. Quasi experimental study. Outpatient Department of Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from June 2012 to June 2013. Ninety cases fulfilling American College of Rheumatology criteria for diagnosis of Knee Osteoarthritis and falling in Grades I-III of Kellgren-Lawrence Radiological Classification for Knee Osteoarthritis were included. Pre-treatment associated symptoms, complete blood count, renal and liver function tests were documented. After a baseline pain assessment on a 10-Point Visual Analogue Scale, 50 mg of Diacerein was given orally for 4 months followed by pain assessment and inquiry about adverse effects at 6[th] week, 3[rd] and 6[th] months. Post-treatment labs were repeated. Reduction in pain was analyzed by paired-sample t-test using SPSS version 17. Chi-Square test was used to assess the frequency of adverse effects. A p-value < 0.05 was considered sigruficant. Mean age was 61.5 +/- 7.8 years. Majority 77 [85.6%] were females. Mean Visual Analogue Scale at start was 6.1 +/- 0.87. Sigruficant pain reduction measured on Visual Analogue Scale was observed at six weeks [4.6 +/- 1.2] [p < 0.001], three months [2.37 +/- 0.91] [p < 0.001] and six months [2.2 +/- 0.85] [p < 0.001]. Very few patients developed diarrhea 3.3% and nausea 4.4%. Diacerein is effective drug with minimal side effects for treatment of mild to moderate painful Knee Osteoarthritis

Frequency of co-morbidities associated with spinal cord injury

To determine the frequencies of comorbidities [dyslipidemias, diabetes mellitus, and hypertension] in patients with spinal cord injury [SCI] of duration > 1 year. Spinal Cord Injury Department, Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi and Department of Chemical Pathology, Army Medical College, National University of Sciences and Technology [NUST], from October 2013 to March 2014. Thirty six patients with complete spinal cord injury [SCI], level C5 to T12 were included by non-probability, convenience sampling. Control group consisted of age and sex matched healthy individuals. A detailed medical history was obtained. Anthropometric measurements and blood pressure were recorded. Fasting blood samples were obtained and analyzed for plasma glucose and serum lipid profile. Out of thirty six patients, 31 [86.1%] were male and 5 [13.9%] were females; their mean age was 36.6 +/- 11 years. Mean duration of injury was 6.04 +/- 3.35 years. Among cases, dyslipidemias were detected in 25 [69.4%] patients while 7 [19.4%] patients had diabetes mellitus. Whereas in control group, frequency of dyslipidemias and diabetes mellitus were significantly lower than cases i.e 13.8% and 5.5% respectively. Also no significant difference was found between blood pressures of study group when compared with control group. Individuals with chronic SCI had more frequent associated co-morbid conditions like dyslipidemias and diabetes mellitus than normal individuals. Early screening is recommended in patients having SCI >6 months for better patient care and reduction in long term comorbidities in such patients

Searching the research or re-searching the search: where to start from? a post-graduate medical trainees perspective from rawalpindy lslamabad

To explore the post-graduate medical trainees perceptions and practices towards research and to investigate potential barriers to perform research. Cross sectional descriptive study. Military hospital, Combined Military hospital, Rawalpindi and Pakistan institute of medical sciences Islamabad, from Jan 2013-Dec 2013. A pretested, structured and validated questionnaire was used to collect data from 114 final year post-graduate medical trainees [PGMTs]. SPSS version 17 was used for descriptive data analysis. One hundred and fourteen [n=114] final year post-graduate medical trainees [PGMTs] of fellowship program of College of Physician and Surgeons of Pakistan gave their written consent to participate in this study. Among them 68 [59.6%] were males while 46 [40.3%] were female. One hundred and twelve [98.2%] trainees agreed that research is an important and healthy activity and have a great impact on their future carriers. 63 [55.2%] PGMTs had worked as data collector in various studies conducted at their institutions while only 21[18.4%] PGMTs had published their manuscript. Obstacles that prevented the PGMTs from conducting research included: lack of professional supervisors: 103 [90.3%], poor research training: 98 [86.0%], and lack of resources: 84 [73.6%]. Although the majority of the PG trainees believe that research is important in medical field, only about 55.2% of them have participated in the research activities other than mandatory dissertation during their training. Measures should be taken at postgraduate level to involve and support the PGMTs in health research with formal training programs and good mentorship

Low serum HDL-c levels: a hidden threat to patients with spinal cord injury

To determine the serum lipid profile in patients with traumatic spinal cord injury [SCI] of duration >1 year and to compare the serum HDL-c levels of SCI patients undergoing regular physiotherapy for >60 minutes daily with those who did not undergo physiotherapy. Cross-sectional, comparative study. Spinal Cord Injury Department, AFIRM Rawalpindi and Department of Chemical Pathology, Army Medical College, Rawalpindi, from January 2013 to June 2013. Forty six patients suffering from traumatic spinal cord injury [SCI] wore included. After recording the detailed medical history, fasting blood samples were obtained and analyzed for serum lipid profile. Dyslipidemias were assessed using guidelines from the National Cholesterol Education Project Adult Treatment Panel III [ATP III]. Serum high-density lipoprotein cholesterol [HDL-c] < 0.9 mmol/1 [40 mg/dl] was considered as low HDL-c level. Out of total 46 patients, 33 [71.7%] were male and 13 [28.3%] were females with mean age of 34.9 +/- 9.55 years. Low levels of serum HDL-c were found in 21 [45.7%] SCI patients [mean serum HDL-c levels: 0.97 +/- 0.23]. SCI patients were further categorized in two groups depending upon the status of regular physiotherapy. Statistically significant difference was found in mean serum HDL-c levels of 22]47.82%] SCI patients undergoing regular physiotherapy as compared to 24 [52.18%] SCI patients who did not underwent physiotherapy [p < 0.05]. Patients with SCI have decreased levels of serum HDL-c, imparting an increased risk of cardiovascular disease [CVD] in these disabled persons. SCI individuals following regular physiotherapy, have better serum HDL-c levels as compared to bed-ridden SCI patients, suggesting the physical activity as an important factor to elevate the serum HDL-c in such patients. Knowledge of relative risk of CVD in persons with SCI is important for appropriate interventional strategies, including planned physical activities or exercises and therapeutic intervention

Spinal cord injury without radiographic abnormalities [SCIWORA] in a preschool child: a case report

A 3, 1/2 year old boy presented at the Soldiers' Family Rehabilitation Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi with 2, 1/2 years' history of weakness and numbness in legs and loss of control over bowel and bladder following run over by a vehicle. At presentation, the child was unable to stand without support with power of 2/5 in iliopsoas, 3/5 in extensor hallucis longus and 0/5 in ankle plantar flexors on both sides. The power in quadriceps was0/5 on right and 2/5 on left side. The knee and ankle jerks were absent bilaterally. Sensations to both light touch and pin prick were impaired below T9 level on both sides. Perianal sensations were intact but voluntary anal contraction was absent. He was categorized as a case of Spinal Cord Injury T9 as classified by American Spinal Injury Association [ASIA] with impairment Scale C. X-Rays and Magnetic Resonance Imaging Scans were normal. These investigations aided by relevant clinical features qualified him as a case of Spinal Cord Injury without Radiographic Abnormalities

Penile amputation due to improvised explosive device [IED] blast injury in a pakistani soldier

Penile amputation is a catastrophe and the goal should be to restore adequate mass, sensation and functionality of penis considering penile prosthesis where necessary. A case of a 25 year soldier who had penile amputation due to improvised explosive device blast injury is reported

Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan / 보건의료교육평가

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).