Neuropathic Pain after Adolescent Idiopathic Scoliosis Correction Surgery

Methods@#Forty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors. @*Results@#Based on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022). @*Conclusions@#Chronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.

The anatomical locations of postoperative pain and their recovery trajectories following Posterior Spinal Fusion (PSF) surgery in Adolescent Idiopathic Scoliosis (AIS) patients

@#Introduction: This study looked into the different anatomical locations of pain and their trajectories within the first two weeks after Posterior Spinal Fusion (PSF) surgery for Adolescent Idiopathic Scoliosis (AIS). Methods: We prospectively recruited patients with Adolescent Idiopathic Scoliosis (AIS) scheduled for PSF surgery. The anatomical locations of pain were divided into four: (1) surgical wound pain; (2) shoulder pain; (3) neck pain; and (4) low back pain. The anatomical locations of pain were charted using the visual analogue pain score at intervals of 12, 24, 36, 48 hours; and from day-3 to -14. Patient-controlled analgesia (morphine), use of celecoxib capsules, acetaminophen tablets and oxycodone hydrochloride capsule consumption were recorded. Results: A total of 40 patients were recruited. Patients complained of surgical wound pain score of 6.2±2.1 after surgery. This subsequently reduced to 4.2±2.0 by day-4, and to 2.4±1.3 by day-7. Shoulder pain scores of symptomatic patients peaked to 4.2±2.7 at 24 hours and 36 hours which then reduced to 1.8±1.1 by day-8. Neck pain scores of symptomatic patients reduced from 4.2±1.9 at 12 hours to 1.8±1.1 by day-4. Low back pain scores of symptomatic patients reduced from 5.3±2.3 at 12 hours to 1.8±1.1 by day12. Conclusions: Despite the presence of different anatomical locations of pain after surgery, surgical wound was the most significant pain and other anatomical locations of pain were generally mild. Surgical wound pain reduced to a tolerable level by day-4 when patients can then be comfortably discharged. This finding provides useful information for clinicians, patients and their caregivers.

Prevalence And Associated Factors Of Muscoskeletal Disorders Among Arabic Calligraphers Living In Saudi Arabia: A Cross-Sectional Study

@#Musculoskeletal disorders (MSDs) represent a significant occupational problem. Only limited research is available about the impact of MSD on the active Calligraphers. Uncertainty remains about MSD prevalence and associated factors among Arabic calligraphers in Saudi Arabia. A cross-sectional study was conducted among 124 Arabic calligraphers in Saudi Arabia. Data were collected by telephonic interviews using a structured questionnaire that consisted of the validated Standardized Nordic Questionnaire, socio-demographics and working characteristics. A total of 124 completed questionnaires were analyzed. The majority were men (96.8 %), worked for less than 10 hours/week (63.7%). The majority had musculoskeletal pain (59.7%) and about half of them worked for less than 15 years. The most commonly reported MSD was back pain (26.6%) followed by neck pain (21.0%) and shoulder pain (12.1%). In multiple logistic regression the significant predictors in the model were: not exercising (OR=7.1, 95% CI 2.6-19.2), age ≤40 (OR=2.8, 95% CI 1.1- 7.3), worked for ≤20 years (OR=3.4, 95% CI 1.3 -9.1) and being a professional calligrapher (OR=2.3, 95% CI 1.1 – 6.2). The total model is significant (p<0.001) and the adjusted r square= 0.37.MSDs among Arabic calligraphers in Saudi Arabia is relatively high; further clinical assessment is needed. We recommend that health authority in Saudi Arabia should increase the awareness among calligraphers about MSDs and its prevention.

Phytochemical constituents, antioxidant and antibacterial activities of methanolic extract of Ardisia elliptica

Objective To investigate the antioxidant, antibacterial, and chemical ingredients of Ardisia elliptica (A. elliptica) methanolic extracts. Methods The plant was extracted using methanol. Antibacterial and antioxidant activities were evaluated. Results The results showed that both fruit and leaf extract of A. elliptica have significant antibacterial activities against Gram-positive and Gram-negative bacteria. Fruit extracts showed higher content of phenolic (71 ± 0.03 GAE/mg extract dry weight), in comparison to the leaf extracts (37 ± 0.05 GAE/mg extract dry weight). Flavonoid content, and Fe

Arrest of preterm labour by nitroglycerine patch

Preterm labour and delivery before 37 weeks of gestation is a major cause of perinatal morbidity and mortality. To delay preterm delivery, we need a tocolytic agent which is uterospecific with few fetomaternal side effects and which can significantly improve perinatal outcome. Since long the search for such a tocolytic agent that is effective and safe for both the mother and fetus has been frustrating. Recently attention has focused on the use of Nitroglycerine, a nitric oxide donor in the treatment of preterm labour as it has a uterine smooth muscle relaxant properties. This study was conducted to assess the effectiveness of nitroglycerine patches in the treatment of preterm labour. Quasi - Experimental study was conducted in Obstetrics and Gynaecology Department of Abbasi Shaheed Hospital in Karachi. Duration of study was from March2005 to March2006. Women in preterm labour with alive singleton pregnancy, uterine contractions of at least 1 in 10 minutes, intact membranes and cervical dilatation of no more than 2 cm were recruited. Women with premature rupture of membranes, ante partum hemorrhage, hypotension, and chorioamnionitis were excluded from the study. Those women who fulfilled inclusion criteria were included in the study. History and examination were done at the time of admission and baseline observations were made. Nitroglycerine patch delivering 10mg/24 hours was applied on abdominal skin and if needed another 10mg patch applied after 1 hour. After 24 hours previous patches replaced with a new patch for next 24 hours. During treatment two doses of Inj. Dexamethasone were given for fetal lung maturity. Efficacy of transdermal patches were measured in terms of cessation of uterine contractions, cervical dilatation of not more than 2 cms, allowing prolongation of pregnancy for at least 48 hours without significant maternal side effect like headache, nausea, tachycardia and hypotension. Data was analyzed on SPSS version 10.0. 60 patients were enrolled in the study. Mean maternal age was 24.60 +/- 2.25 and mean parity was found to be 1.96 +/- 1.96. Out of them 47 [78.3%] had cessation of uterine contractions for more than 48 hours where as 13 [21.6%] failed to stop contracting. Progressive cervical dilatation of more than 2 cms was found in 29 [48.3%] in less than 48 hours, where as in 31 [51.6%] cervical dilatation remained same after 48 hours. Pregnancy was prolonged for more than 48 hours in 40 [66.6%] patients and 20 [33.3%] delivered in less than 48 hours P = 0.0098. Headache was present in 17[28.3%], nausea 7 [11.6%], tachycardia 8 [13.3%] and hypotension in 3[5%] patients. Transdermal Nitroglycerine Patches were effective tocolytic agents allowing prolongation of pregnancy for at least 48 hours

Risk factors in relation with uterine rupture

To determine the risk factors in relation with uterine rupture in patients coming to Abbasi Shaheed Hospital. Case Control Study. The department of Gynecology and obstetric Abbasi Shaheed Hospital Karachi from January 2001 - December 2002. All cases of ruptured uterus who were either admitted with or who developed this complication in the hospital were included in the study. These cases were compared with their control i.e. women who delivered normal at Abbasi Shaheed Hospital in the same period and did not develop rupture uterus; matched by same age parity socioeconomic status and area of residence. The cases were further divided in two groups, those with previously scarred uterus [n=20] and those with unscarred uterus [n=23]. Risk factors associated with uterine rupture included injudicious use of oxytocin by traditional birth attendants [TBAs] or unskilled persons [88%] no antenatal care [79%] or late referral by TBAs or Dais [58%] and obstructed labour [25.5%]. All cases referred by Dais had crossed the partographic alert line. In unscarred group oxytocin used injudiciously in all cases with no antenatal care [ANC] at all and late referral by Dais in 78% cases. Injudicious use of oxytocin and late referral by TBAs [Dais] and lack of Ante Natal Care are the significant risk factors for uterine rupture

Ovarian tumours: a five years retrospective study at Abbasi Shaheed Hospital, Karachi

The purpose of this study was to determine the pattern, presentation and management of patients with ovarian tumors.Retrospective study carried out from Sept. 1999 to August 2004. Department of Gynaecology and Obstetrics [Unit II] at Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi.Sixty three patients with Ovarian Carcinoma.The epidemiology, presentation and the outcome of manangenient was noted Out of the 63 patients seen during the study period, .fifty [79.36%] had benign and 13[20.63%] malignant ovarian tumours. Most [39-47.61%] women were <40 years of age and the majority[61.90%] of them were married. Ovarian malignancy was found more in patients who were unmarried and nulliparious. The common presenting complaints were abdominal pain [57.14%], GI upsets [47.61%] and an abdominal mass [31.74%]. Out of the 20 cases that presented with masses, 11 [55%] were solid and malignant looking. Thirty two [50.79%] patients underwent unilateral oophrectomy / tumerectomy, 22 [34.92%] total abdominal hysterectomy with bilateral salpingo-oophrectomy, 7 [11.11%] total abdominal hysterectomy with conservation of one ovary and one debulking, while in one case which was inoperable, only biopsies were taken.All the patients with ovarian tumours presented late with symptoms. This was either due to the lack of specific symptoms or delayed referral by the primary care centers. Proper evaluation and attention to minor symptoms like lower abdominal pain, GI upsets, symptoms of mass effect [urinary frequency, constipation, palpable mass, pelvic pressure] by the primary care clinicians can lead to early diagnosis

Uncommon presentation of endometroid carcinoma of ovary

We report here two cases of endometroid carcinoma ovary. One was of an 18 years old girl and another was of a 40 years old lady. Both patients complained of lower abdominal pain, distension, scanty menses and constipation. Histopathological examination revealed endometroid carcinoma of ovary. Total abdominal hysterectomy and bilateral salpingo oophorectomy was done in both patients and were put on chemotherapy. [<0.05] to reduce 50% contraction of the uterus produced by oxytocin

Family planning awareness in local population of district central Karachi

According to WHO estimated population of Pakistan in the year 2003 was 149.1 million with a projected population of 249.7 million in 2025 and total fertility rate of 4.8 showing failure to achieve our family planning strategies. The aim of this study was to investigate family planning awareness in local population of district central, Karachi as this is most thickly populated and biggest district of Karachi facing the problems of overcrowding due to population explosion. This questionnaire based study was conducted at family planning center affiliated with Abbasi Shaheed Hospital involving 100 women of reproductive age group. Majority of women of reproductive age group were found to attend family planning center of those most were literate. Main sources of information were television, relatives and neighbours. Majority knew about different contraceptives, injections, intra uterine device and tubal ligation. Most of families and husbands [again from educated families] have favoured attitude towards family planning. Improving literacy level, involving husband and families in discussion and giving them clear information may further improve local trends of contraception

Maternal and perinatal outcome in HELLP syndrome at Abbasi Shaheed Hospital

The Objective of this study was to determine the maternal and perinatal outcome in HELLP syndrome and to reflect the importance of early diagnosis of HELLP syndrome in eclampsia and preclampsia. A case control study was designed; where retrospective review of 15 cases of confirmed HELLP syndrome from January 1997 to January 2002 was undertaken at Gynae /Obstetrics Unit II, Abbasi Shaheed Hospital and thirteen controls were selected of eclampsia with no evidence of HELLP. Maternal and neonatal complications were recorded and resolution of laboratory indices was measured. Seventy five% of the women were delivered within 24 hours of diagnosis; out of this, 83.73% were delivered by caesarean section. There were 73.3% pre-term deliveries and 75% of the babies were admitted to the neonatal intensive care unit [NICU]. The peri-natal mortality was 46.66% while the maternal mortality was 20%. The mean interval of resolution of laboratory indices to within normal ranges was twelve [7-35] days. The neonatal morbidity was high and was closely related to the period of gestation at delivery

Effects of leaving the parietal and visceral peritoneum open at lower segment caesarean section

To evaluate the effects of leaving the parietal and visceral peritoneum open at lower segment caesarean section. A non- randomized controlled trial. Materials and Of the 50 evaluable subjects, 25 had parietal and visceral peritoneum left open whereas 25 were closed. Analgesia requirements assessed by visual and verbal scale, oral analgesia used after 24 hours postoperatively for four days and postoperative satisfaction assessed verbally, shorter surgical time length of postoperative hospital stay, reestablishment of intestinal motility were the main out come measures. Pain at 24 hours was similar in both groups but in subsequent days the non-closure group had decreased maternal pain and had a tendency to require less postoperative analgesics [1500 mg/day Vs 750 mg/day, P = 0.03], shorter hospital stay and early reestablishment of intestinal motility. Non-closure of both visceral and parietal peritoneum at the caesarean section produces a significant reduction in the postoperative use of analgesia and shorter hospital stay postoperatively

Spectrum of dysfunctional uterine bleeding and its conservative management

To find out the proportion of dysfunctional uterine bleeding [DUB] and the response of patients of DUB to medical treatment at Abbasi Shaheed Hospital. Design: Cross sectional and comparative study. Place and Duration of Study: The study was conducted in Gynaecology Unit II of Abbasi Shaheed Hospital, Karachi, from December 1999 to December 2000. Patients and The study included 210 Gynae patients between the age group 13 ' 50 years presenting with DUB. These patients were divided into adolescent, reproductive and perimenopausal group. They were initially assessed by general and pelvic examination, ultrasound of pelvis, Pap smear, hysteroscopy and diagnostic curettage. Results were recorded. The efficacy of treatment was assessed in terms of reduction in the amount of blood loss. Two hundred and ten out of 1300 patients were diagnosed as having DUB with the proportion of 16.1%. Response rate was 20 ' 30% with oral mafenamic acid, 50% with capsule tranexamic acid, 60% and 50% respectively with oral contraceptive pills containing ethinylestradiol and norethisterone, and norethisterone alone. The response rate with capsulated micronised flavonoid and derivative of ethinyltestosterone was 90% and 75% respectively. The patients in adolescent age group are good responders to conservative treatment. Most of the patients preferred micronised flavonoid over derivative of ethinyltestosterone for some misconceptions regarding this medicine. The former was better tolerated with less side effects