Dabigatran etexilate, a novel oral direct thrombin inhibitor, for preventing thromboembolic events after knee replacement arthroplasty

Dabigatran etexilate is one of the few direct thrombin inhibitors with anti-coagulant activities and the following distinctive features: taken orally, no need to closely monitor for complications, and no need for regular dose adjustments. Relying on the above mentioned valuable advantages, dabigatran etexilate can be considered as a premier choice for the prevention of venous thromboembolism after knee replacement arthroplasty. Forty five patients undergoing 50 knee replacement surgeries were included in this case-series study undertaken in Hazrat Rasool Akram and Khatam-alanbia Hospitals during 2010. Dabigatran, etexilate was administered for the prevention of venous thromboembolism after knee arthroplasty in doses of 110 mg in the first 1-4 h after surgery followed by daily doses of 220 mg for 10 days. Patients were examined 3 times and a color Doppler sonography was performed on the llth day to check for venous thrombosis. Finally, the patients were re-examined at the end of the 1st and the 3rd months postoperatively. Only one out of 45 patients was diagnosed to have venous thrombosis on sonography done on the 11th day but the patient did not have any symptoms and repeat sonographies at the end of the 1st and the 3rd months postoperatively showed no venous thrombosis either. No complications were witnessed in the patients in the 3-month follow-up period. Dabigatran etexilate [220 mg/d for 10 days] can be an effective drug against venous thrombosis after total knee replacement surgeries

Comparison of the efficacy of local corticosteroid injection and physical therapy on pain severity, joint range of motion and muscle strength in patients with shoulder impingement syndrome referred to Rasool-e-Akram Medical Center from April 2008 to September 2009

Subacromial impingement is a common cause of shoulder pain and many patients with this condition recover with conservative management. The most commonly used modalities of non-operative treatment include activity modification, anti-inflammatory medication and subacromial injection of steroid and ultrasound and physical therapy programs. This study assessed the value of physiotherapy versus subacromial corticosteroid injection in patients with shoulder impingement syndrome [SIS]. Seventy three patients with SIS enrolled in the study and treated through physiotherapy [n=37] and subacromial corticosteroid injection [n=36]. Two follow-up sessions accomplished at the end of 4[th] week and 3[rd] month of treatment respectively. Corticosteroid injection caused dramatic improvement in the painful state [p<0.0001] and sleep dysfunction score [p=0.039] in the first follow-up. However, physiotherapy showed significantly better results regarding patients' pain score [p=0.016] and their shoulder join range of motions [p=0.017 and p=0.029 for the abduction and extension, respectively] in their second follow-up. Our study results showed that subacromial corticosteroid injection primarily resulted in more improvement in the impingement symptoms. However, with the long-term follow-up the results were better for the physiotherapy. These results suggest that patients should not undergo surgery before having conservative treatment