Comparison between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery: a randomized controlled trial

Background: Pain following surgery in children cause discomfort, restlessness and agitation in the postoperative period which may result in an increased incidence of nausea, vomiting and maladaptive behavioural changes. Regional anaesthesia is commonly used as an adjunct to general anaesthesia for perioperative analgesia in children as part of a multimodal approach of pain relief. This study is to compare between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery.Methods: A prospective randomized single blind study was carried out on 30 children aged 1-12 years of either sex undergoing foot surgery. Patients were randomly assigned into caudal epidural block group and Popliteal nerve block group, 15 children each. Both groups receive 1 ml/kg of 0.25% bupivacaine. Foot surgery was carried out under general anesthesia along with regional block for all children. After completion of surgery, children were shifted to PACU and HR, BP, SPO2 were monitored. Patient was discharged from PACU after CHEOPS (1-5 years) or VAS (6-12 years) <4. Parental satisfaction, sedation score, PONV, and any other side effects were recorded.Results: Demographic data and baseline vital signs were comparable between two groups. Statistically significant difference (p=0.025) in number of attempts in giving block in group A (1.20±0.41) than group B (1.80±0.86). The mean postoperative pain scores, CHEOPS and VAS were comparable in both groups.Conclusions: Both caudal epidural block and popliteal nerve block provides comparable and adequate analgesia in children undergoing elective foot surgery.

Studies on new substituted pyridazinones: synthesis and biological evaluation

We report herein the synthesis and pharmacological evaluation of a new series of 6-aryl-2-(imidazol-1-yl/1,2,4-triazol-1-yl)-2-methyl-4,5-dihydro-(2H)-pyridazin-3-one (3a-j) as potential anticonvulsant and antitubercular agents. The title compounds were prepared by reacting 6-aryl-4,5-dihydro-(2H)-pyridazin-3-one (2a-e) with formaldehyde and secondary cyclic amine imidazole or 1,2,4-triazole as per Mannich reaction. Anticonvulsant activity of pyridazinone derivatives was tested at 50 mg.kg-1 dose level against maximal electroshock (MES), isoniazid (INH, 250 mg.kg-1) and pentylenetetrazole (PTZ at 80 mg.kg-1) induced seizure methods. Phenytoin sodium (25 mg.kg-1) and sodium valproate (100 mg.kg-1) were used as reference drugs for comparison purpose. In-vitro antitubercular activity was tested by Microplate Alamar Blue assay (MABA) method and the results were compared with clinically used antitubercular agents such as INH, Pyrazinamide (PZA) and Streptomycin (STM). None of the screened compounds were found to be neurotoxic at a dose level of 100 mg.kg-1. All the screened compounds (3a-j) significantly reduced the MES, INH and PTZ induced convulsions and thus showed good anticonvulsant activity. The minimum inhibitory concentration (MIC) of the title compounds against M. tuberculosis ranged from 1.6 µg/mL to 6.25 µg/mL in comparison to INH, PZA (3.125 µg/mL) and STM (6.25 µg/mL) which indicated good antitubercular activity.

Intraosseous primary malignant peripheral nerve sheath tumor of the calcaneus: An unusual case and review of literature.

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon sarcomas that originate from a peripheral nerve or neurofi broma either spontaneously or in association with neurofi bromatosis type 1. MPNSTs account for approximately 5% of all soft tissue malignancies. The tumor is commonly seen in the extremities and trunk. Most of these tumors are high-grade with the potential to recur and metastasize. Common metastatic sites include the lungs, bone, and pleura. Primary intraosseous MPNST is rare, and the diagnosis of intraosseous MPNST, especially in an unusual location is diffi cult because of its cellular origin, histomorphological similarities with other sarcomas, and bone is the most common site for metastasis. We report an unusual case of MPNST of the calcaneus in a young male.

Self Monitoring of Blood Pressure (SMBP) among Hypertensive patients in Muscat- A pilot study.

Monitoring of blood pressure (BP) is an important aspect of the diagnosis and management of hypertension. SMBP of patients at home can provide patients and physicians with valuable information in the management of hypertension. The aim of this pilot study was to determine the prevalence of SMBP among primary care hypertensive patients in Muscat region and to assess their practices and attitude towards SMBP. The study was conducted in two phases. In the first phase 126 patients visiting primary health care centers or polyclinics in Muscat region were interviewed to identify patients who practice SMBP. In the second phase a closed ended questionnaire containing 10 questions related to demographic characteristics, practice and attitude was self administered to 50 patients enrolled from the first phase to generate the data. It was found that around 40% of the patients use Sphygmomanometer to monitor their BP at home. However, majority of the patients were aware of the significance and importance of BP home monitoring and therefore, recommended the practice of SMBP to other hypertensive patients. Participants acknowledged the role of pharmacist in educating and training the patient about the proper use of BP measuring device. Patients were convinced with the device performance but at the same time the frequency of BP monitoring was poor among the participants. Overall the participants had a positive attitude towards SMBP but the frequency of BP monitoring was poor among the participants and had a room for the improvement. There is a need to aware and educate the Omani hypertensive patients about the importance of SMBP to achieve the desired therapeutic goals. SMBP may be a valuable tool in hypertension self-management, therefore, clinicians should consider recommending it more widely.

Knowledge and Awareness of breast cancer among university female students in Muscat, Sultanate of Oman- A pilot study.

Breast cancer is the most common cancer among women in Oman and worldwide. Breast cancer patients in Oman are commonly presented at a relatively young age and with an advanced stage of disease. This could be due to lack of awareness, knowledge and beliefs about breast cancer and its management among females. The present pilot study assessed the awareness and knowledge about the screening method (Breast self examination), risk factors and symptoms of breast cancer among 157 university female students in Muscat region. The study results indicated that female students were well informed and aware about breast cancer in general but their knowledge of breast cancer symptoms was better than the risk factors of breast cancer. The study also revealed that majority of the students knew that Breast self examination (BSE) is the most common and easy method of breast cancer detection but their knowledge regarding frequency and the appropriate time to practice BSE was not very good. Thus, more educational programs could be designed to provide comprehensive information on breast cancer and BSE to improve women’s knowledge and awareness which can help in the early detection and reporting of breast cancer for the better treatment.

Spinal tuberculosis mimicking malignancy: atypical imaging features.

Here is reported a 14-year-old boy with spinal tuberculosis. The imaging features were suggestive of non hodgkin's lymphoma with sparing of intervertebral disc. The atypical imaging features of spinal tuberculosis is discussed.

Tuberculosis of the sternoclavicular joint.

A rare case of tuberculosis of the stemoclavicular joint in a 13-year-old girl is presented. The occurrence of tubercular infection in the sternoclavicular joint is extremely rare.