Managing Further Rehabilitation in Longer-Term Stroke Patients in the Community: A New Approach

Stroke is becoming a major public health issue in our country due to the fact that there is an increasing life span of our population. Due to advancement of acute management of stroke, three out of four people will survive beyond the acute phase of stroke. Stroke care providers are still debating regarding the exact period of the terminology ‘longer-term stroke’; however many agreed that long-term of stroke refers to the period of one year and thereafter as this period is the determinant for longer-term survival. Management beyond the first year of stroke is complex, encompasses all aspects of patient’s life; physical, psychological and integration into community. Rehabilitation being the cornerstone of longer-term stroke management should now focused on more evidence-based approach as to be effective and relevant to the stroke patients.

prospective, randomized study of periprostatic lignocaine injection versus intrarectal lignocaine or placebo gel for pain relief during transrectal ultrasound [TRUS] guided needle biopsy of the prostate

Objective: The aim of our study was to compare the efficacy and complications of periprostatic lignocaine injection with transrectal instillation of lignocaine gel or placebo for the relief of pain associated with transrectat ultrasound [TRUS] guided needle biopsy of the prostate

Patients and Methods: Between March 2003 and January 2004, 210 patients were prospectively randomized to recieve periprostatic injection of 10m12% lignocaine [Group 1, n = 83], intrarectal instilation of 15ml 2% lignocaine gel [Group 2, n = 64] or intrarectal instilation of l0mI water-souluble gel [placebo] [Group 3, n = 63]. The degree of pain experienced during and 15 minutes after completion of the biopsy was recorded by the patient himself, using a visual pain score [VPS] with a scale from 0 [no pain] to 10 [the most severe pain possible]. Statistical evaluation was performed using analysis of variance [ANOVA] with post-hoc analyses using the Bonferroni correction

Results: There were no statistically significant differences between the groups with regard to the mean number of biopsy cores, serum PSA or prostate volume. The mean VPS during biopsy was 2.02, 3.05 and 5.16 in Groups 1, 2 and 3, respectively [all differences statistically significant]. The mean VPS 15 minutes after biopsy was significantly lower in Group 1 [1.43] compared to Group 3 [3.28, p<0.001] but not Group 2 [2.17, p = 0.086], and it was significantly lower in Group 2 compared to Group 3 [p=0.006]. With regard to complications, there were no statistically significant differences between the groups, except for rectal bleeding which occurred more frequently in Group 3 [23.2%] than in Groups 1 [7.9%, p 0.033] and 2 [11.5%, p=0.l86]. There was no significant difference with regard to the percentage of patients who would be willing to return for a repeat biopsy [95.7%, 87% and 91.7% in Groups 1, 2 and 3 respectively]

Conclusions: For pain relief during and after TRUS guided needle biopsy of the prostate, periprostatic injection of 10 ml 2% lignocaine was significantly more effective than intrarectal instillation of 15 ml 2% lignocaine gel, which in turn was more effective than intrarectal lubricant [placebo] gel. The incidence of complications was not increased after periprostatic lignocaine injection. Although the greater pain experienced by the patient during biopsy without anesthesia did not result in a significantly greater unwillingness to return for repeat biopsy, considerations of human compassion dictate that all patients undergoing TRUS guided prostate biopsy should routinely be offered local anesthesia

Epidemiological and risk predictors of severity of school injuries

Accidents are the leading cause of morbidity and mortality among schoolchildren. Epidemiological and risk predictors of injury severity were investigated among all school injuries presenting at the Students' Hospital in Alexandria during the scholastic year 1996-97. In all, 3422 injured pupils were surveyed. Age, nature of injury, place and mechanism of school injury and referral method were significant risk predictors for hospitalization. Age, referral method and nature of injury were significant predictors of referral to specialized health services. Injury severity score was significantly predicted by the presence of acute disease during time of injury, place and mechanism of injury as well as by provision of first aid and referral method and time