Pain management after traumatic spinal cord injury

Pain is experienced by people suffering from spinal cord injury leading to disability and affecting the person's functional ability, independence, psychological well - being, ability to return to work and quality of life. Pain management in these patients is notoriously difficult due to multiple factors and varied mechanism leading to pain. Only few treatments have been assessed in randomized, controlled trials and management is based on different case reports. We are reporting our experience of managing 2 patients with neuropathic pain following traumatic spinal cord injury. Both the patients were refractory to conventional pain medications but there was significant reduction in pain following lignocaine infusion in the first patient and with ketamine in the second patient

Effect of 0.5% bupivacaine at the surgical bed after laparoscopic cholecystectomy

To evaluate the effect of 0.5% bupivacaine irrigated at the surgical bed on postoperative pain relief in laparoscopic cholecystectomy patients. This study included 80 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group [n=40] received 20cc saline without bupivacaine, instilled into the gallbladder bed. The bupivacaine group [n=40] received 20cc of 0.5% bupivacaine at the same surgical site. Pain was assessed at 0,6,12, and 24 hours by using a visual analog scale [VAS]. Asignificant difference [p=0.018] was observed in pain levels between both groups at 6 hours post operatively. The average analgesic requirement was lower in the bupivacaine group, but this did not reach statistical significance. The use of bupivacaine irrigated in the surgical bed was an effective method for reducing pain during the first postoperative hours after laparoscopic cholecystectomy

Biomanagement of root knot nematode through non edible oil seed cakes infesting cicer arietinum L.

A pot experiment was conducted to evaluate the efficacy of different oil cakes against the root knot nematode. Root knot nematodes are the major agricultural pest of wide range of crops worldwide. Chickpea, Cicer arietinum L., family Fabaceae, is a high yielding proteinaceous pulse crop with India being the leading producer. Root knot nematodes are one of the major biological constraint that reduces per capita yield of this pulse crops. In the present investigation, studies were made to determine the efficacy of different oil cakes viz. Azadirachta indica (Neem), Brassica campestris (Mustard) and Gossypium hirsutum (Cotton). Two doses (50 and 100 g) of each neem, mustard and cotton oil cakes were applied to reduce nematode infestation in chickpea. Results revealed that root gall development due to Meloidogyne incognita were significantly reduced in all the treatments and enhance all the plant growth characters of C.arietinum. Higher dose of neem oil cake was found to be most effective as compared to other treatments. Hence, it may be concluded that oil cakes are better substitute against nematicide for the effective control of root-knot nematode and reduce environmental hazards for ecologically safe environment.

Frequency of gall bladder carcinoma in patients undergoing surgery for cholelithiasis

To determine the frequency of gall bladder carcinoma in patients undergoing surgery for cholelithiasis at Isra University Hospital, Hyderabad, Singh- Pakistan. This was a descriptive study, conducted from April 2006 to March 2008 at Isra University Hospital Hyderabad, Pakistan. This study included 200 cases of cholelithiasis who underwent cholecystectomy at out Hospital. Patients belonged to both sexes having cholelithiasis, diagnosed on the basis of clinical grounds and supported by ultrasonography. A uniform procedure of history taking, physical examination, investigations and treatment was adopted for all the patients, and data were recorded on the pre-designed proforma. Of 200 cases that were operated for gall bladder stone disease, eight were found to have carcinoma of gall bladder i.e. frequency was 4%. The age ranged from 35 to 70 years, with mean 50[ +/- 5.3] in females and 56[ +/- 2] in males. Male to female ratio was 1:3. On ultrasound, only three [37.50%] patients with advanced disease had a pre-operative clue of carcinoma. The frequency of gall bladder carcinoma in our population seems much higher than Western populations. Females are more affected than males by this problem. Ultrasonography can miss malignant lesions; therefore every gall bladder specimen should be subjected to histopathology. While in unsuspected cases undergoing laparoscopic cholecystectomy, gentle handling of the gall bladder is critical to avoid port site implantation caused by spillage of bile

Awareness and attitudes of people with diabetes regarding their disease in Hyderabad and Adjoining areas

Diabetes Mellitus [DM] is a chronic disease, associated with high degree of morbidity and mortality. Together with the advances in management of DM, and the widespread availability of treatment, patient's education and awareness about the disease is equally important for the optimum management of the disease. Hence, this study was designed to explore the prevailing attitudes and awareness of diabetic patients in and around Hyderabad - Sindh. A cross sectional survey. Interviews were made regarding attitude, awareness and education about the disease. Percentage scores were then compared separately among the gender [2 groups: male and female], age of the patients [3 groups; group 1, 18-30 years, group II, 31-50 years and group III 51-80 years], and time since the diagnosis of DM [3 groups; group A, less than 6 months, group B, 6.1 month to 3 years, and group C 3.1 years and more]. Total 127 patients were interviewed including 88[69.3%] men and 39[30.7%] women. Among these, 51.7% men and 51% women had a positive attitude while 55.4% of men and 38.8% women had adequate awareness. Also, 68.8% men and 62.8% women were adequately educated. A positive attitude was observed in 4.8%, 46.8% and 46.1% respectively in group I, II and III patients respectively. Corresponding figures for awareness were 49.6%, 55.1%, 44.4% and for education 63.2%, 69.4% and 65.1%. Regarding relationship to the chronicity of the disease, a positive attitude was observed in 53.8% of group A patients, 47.7% and 41.4% amongst group B and C patients respectively. Corresponding figures for awareness and education were 41.1%, 49.1% and 56.2% and 57.8%, 64.2% and 7.7% and 57.8% respectively. Adequate awareness and education about diabetes is lacking. Some aspects of diabetes education need more emphasis. Diabetes education should be tailored according to the individual patient understanding

Prepubertal testicular tumours in Kashmir--a histopathological report of 15 cases.

A total of 15 cases of prepubertal testicular tumours were reported by the department of pathology, Government Medical College, Srinagar, Kashmir over a period of 15 years, from January 1984 to December 1998. The cases included yolk sac tumour (10 cases; 67%), teratoma [(mature) 2 cases (13%)], rhabdomyosarcoma [(paratesticular) 2 cases (13%)] and NHL-Burkitt's lymphoma [one case (7%)]. The youngest patient was 10 months old and the oldest was of 14 years age. Ten cases (67%) occurred at or below the age of 4 years. The youngest patient had yolk sac tumour and oldest had rhabdomyosarcoma. In 2 cases both the testes were involved with one of these two cases having bilateral undescended testes.

Bilateral Malignant Brenner Tumour

Bilateral malignant Brenner tumour of ovary is extremely rate. A case of malignant Brenner tumour involving both the ovaries with mctastasis to mesentery in a 48 year femalc is presented. Grossly ovarian masses were firm with soft areas, encapsulated and having bosselated external surfaces. Cut sections showed yellowish white surface with peripheral cysts (in both tumours). Microscopy revealed transitional cell carcinoma with squamoid differentiation at places. Metastatic deposits were found in the mesentery. Endometrium showed cystic glandular hyperplasia.

Ultrasonographic anthropometric analysis; anterior abdominal wall subcutaneousfat measurement; influence of age and obesity

There is now growing body of evidence which links the abdominal obesity to the increased risk of developing cardiovascular disease, respiratory problems, infertility. Insulin resistance, obesity is on an increase with improved socio-economic conditions in Pakistan and other developing countries. The anthropometry of the body fat provides useful information. Ultrasonography is now gaining importance as a method for assessment of body composition i.e. fat and fat free mass, the purpose of this study was to determine, the influence of age and obesity on male human anterior abdominal subcutaneous fat. In this study 260 healthy men [20-50 years] were studied by ultrasonographic anthropometric method at even different sites of abdomen. Pearson's correlation coefficient was computed and the results were analyzed statistically by regression analysis and were found to be highly significant [p< 0.01-0.001]. Both, age and obesity influenced the abdominal subcutaneous fat thickness. The influence of age and obesity on abdominal wall resulted in an increased deposition of subcutaneous fat whereas, interestingly the effect of age was found more marked in normal weight individuals than in overweight or obese

Open Fractures caused by high velocity missiles: the outcome of treatment of 39 fractures followed for 1-3 years

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority [33 out of 39] were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well as the inherent limitations of the external fixator. Revision of the external fixator with internal fixation after healing of the soft tissues seems to be the direction of the future

Changes in insulin receptor, hexokinase and NADPH producing enzymes in Choroid plexus during experimental diabetes.

The activities of insulin receptor and the enzymes hexokinase (EC 2.7·1.1) and NADP-dependent malic enzyme (EC 1·1·1·40), glucose 6-phosphate dehydrogenase (EC 1·1·1·49) and isocitrate dehydrogenase (EC 1·1·1·42) were measured in rat choroid plexus in alloxan induced diabetes. A significant decrease was observed in the activities of all the enzymes except isocitrate dehydrogenase and also the choroid plexus insulin receptor activity was decreased. A reversal of the efect was observed with insulin administration to diabetic rats. It may be concluded that the enzymes of choroid plexus together with insulin receptor are directly controlled by-the concentration of insulin.