Refractory-plantar-fasciitis-prp-or-local-corticosteroid

Background/Purpose: Plantar Fasciitis is often a nuisance to treat because of its intractable nature. Corticosteroid injections have been conventionally used to treat such cases. One emerging therapeutic modality is the use of Platelet- Rich-Plasma. We compare the efficacy of the two modalities. 60 patients with intractable plantar fasciitis wereMethods: randomised to receive either autologous PRP or Corticosteroid injection. All patients were assessed with the Visual Analogue Score (VAS) for pain and the Foot & Ankle Disability Index (FADI) Score. Data was collected prospectively on the cohort, pre-treatment, and at 1st, 2nd, 6th and 12th week post injection and the results were compared. BothResults: treatment cohorts had 30 patients, with the PRP injection group having an average age of 42.0 ± 12.98 years and Corticosteroid injection had an average age of 39.4 ± 10.09 years. PRP injection group had male to female ratio of 0.875 while corticosteroid injection group had a ratio of 0.67. Mean FADI scores and VAS scores on 2nd and 6th week of study were significantly higher in corticosteroid injection group as compared to the PRP injection group, while the mean of two scores had no significant difference between the two groups when measured on 1st and 12th week.Conclusion: Although both techniques have similar immediate and long term results, corticosteroid injection has better pain relief in short term

Gastric residual volume as a measure of feed intolerance/necrotising enterocolitis in very low birth weight infants: an observational cohort study

Background: To evaluate the efficacy of Gastric Residual Volume (GRV) as a measure of feed intolerance /Necrotising enterocolitis in Very Low Birth Weight (VLBW) infants.Methods: This prospective observational cohort study was done in a tertiary care hospital located in rural South India for a period of 2 years. All haemodynamically stable infants born between 30-34 weeks of gestation at birth and 1000-1500 grams of birth weight, admitted to Neonatal Intensive Care Unit (NICU) within first 24 hours of life during study period were enrolled in two groups; GRV group, where pre-feed gastric residual volume' was checked and No-GRV group, where pre-feed gastric residual volume' was not checked.Results: Both groups had similar baseline characteristics. In No-GRV group, the days to reach birth weight (12.1) and days to attain full feeds (8.0) were less when compared to GRV group. In No-GRV group, average duration of NICU stay in days (16.60) and parenteral nutrition (5.25) was less when compared to GRV group. No-GRV group does not have increased incidence of sepsis or mortality compared to GRV group. In this study there was increased incidence of NEC noted in GRV group (30%) when compared to No-GRV group (p value-0.02).Conclusions: In hemodynamically stable preterm VLBW infants, it is recommended not to check gastric residual volume routinely prior to the enteral feeding.

Advantage Of Magnifying Narrow Band Imaging (NBI) Endoscopy Over Conventional White Light Endoscopy In The Diagnosis Of Helicobacter Pylori Related Chronic Gastritis.

Helicobacter pylori is a vital human pathogen involved as a causative organism in chronic gastritis [1]. Peptic ulceration is a common complication of this infection. Several study shows direct association between H. pylori and gastric carcinoma. The upper Gastrointestinal Endoscopy is investigation of choice for the screening and diagnosis of Helicobacter pylori related chronic gastritis. As field of endoscopy is getting advanced some new techniques like NBI (Narrow Band Imaging) are developed. Due to better visualization of Subendothelial Capillary Network (SECN) by using lights of two different wavelengths NBI method it is more useful in visualization of affected area of gastric mucosa [2]. Total 100 cases of chronic gastritis were diagnosed using upper G.I .Scopy, Biopsies were taken using both NBI and WLE and results were compared using Rapid Urease kit. Narrow band imaging was found more effective than conventional white light endoscopy in the diagnosis of H. Pylori related chronic gastritis [3].

A Prospective Comparative Study of Post Total Knee Arthroplasty Pain Management by Epidural vs Local Infiltration.

In a randomized controlled trial, we compared whether local infiltration analgesia would result in better pain management after total knee arthroplasty (TKA) than epidural analgesia (EA). Two groups were made with 30 patients each. Group local infiltration analgesia (LIA) with a total of 30 patients (mean age of 65 years) received LIA with a periarticular injection of a mixture of ropivacaine, adrenaline, and ketorolac that was prepared under strict sterile conditions. In group EA, 30 patients (mean age of 67 years) were given EA. There was no statistically significant difference of pain at rest. The mean opioid consumption was higher in those receiving local infiltration. Most secondary outcomes were similar, but EA patients had lower pain scores when walking and during continuous passive movement. If EA is not readily available, local infiltration provides similar length of stay and similar pain scores at rest following TKA.

Report of a Rare Case: Ligamentum Flavum Cyst.

A rare case of ligamentum flavum cyst of the lumbar spine in an elderly male is reported. The patient presented with low backache and features of bilateral radiculopathy of a sudden onset. The cyst was lying in the extradural space. After surgery, the patient reported complete relief of symptoms.

Hungry Bone Syndrome due to Primary Parathyroid Adenoma with Multiple Bone Fractures.

Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcemia associated with hypophosphatemia and hypomagnesemia which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. It is a relatively uncommon, but serious adverse effect of parathyroidectomy. The severe hypocalcemia is believed to be due to increased influx of calcium into bone, due to the sudden removal of the effect of high circulating levels of PTH on osteoclastic resorption, leading to a decrease in the activation frequency of new remodeling sites and to a decrease in remodeling space, although there is no good documentation for this. Various risk factors have been suggested for the development of HBS, including older age, weight/volume of the resected parathyroid glands, radiological evidence of bone disease and vitamin D deficiency. The syndrome is reported in 25 to 90% of patients with radiological evidence of hyperparathyroid bone disease vs only 0 to 6% of patients without skeletal involvement. There is insufficient data-based evidence on the best means to treat, minimize or prevent this severe complication of parathyroidectomy. Treatment is aimed at replenishing the severe calcium deficit by using high doses of calcium supplemented by high doses of active metabolites of vitamin D. Preoperative treatment with bisphosphonates has been suggested to reduce postoperative hypocalcemia, but there are to date no prospective studies addressing this issue.

A Case of Bilateral Tibial Hemimelia Type IV and V with Bilateral Subdural Hygroma and Atrial Septal Defect.

Congenital absence of tibia is a rare anomaly, and may be total or partial, unilateral or bilateral. Total absence is more frequent than partial, unilateral absence occurs more often than bilateral, with right limb more commonly affected than the left. In partial defect, almost always the distal end of the bone is affected and, of the bilateral cases, there may be total absence on both sides, or total on one side and partial on the other. Males are slightly more commonly affected than the females. Though, the family history is usually negative for congenital abnormalities and other diseases, there is a considerable chance of occurrence of congenital defect of the tibia or of other abnormalities, in near or remote relatives. We report a case of newborn having bilateral tibial hemimelia type V (right) and IV (left).