Effectiveness of Distal Sodium Channel Block in Managing Lumbosacral Radicular Syndrome: A Pilot Study.

OBJECTIVE: To find the effectiveness of distal sodium channel blocks in managing lumbosacral radicular syndrome. STUDY DESIGN: Open-labelled, non-randomised, single-group, prospective, pilot study. Place and Duration of the Study: Pain Clinic of Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, Pakistan, from January to June 2022. METHODOLOGY: Patients having low back pain radiating to L5/S1/both dermatomes with severity of numerical rating scale (NRS) score of more than 4/10 were included. Straight leg raise (SLR) and NRS score were noted down at baseline and at 30 minutes, 24 hours, 1 week, and 4 weeks post-distal sodium channel block (DSCB). DSCB was performed at beta 1, 2, 3, and 5 portals using 2 ml of 2% injection plain lignocaine + 1 ml (40 mg) injection triamcinolone + 7 ml distilled water. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 21. RESULTS: Out of 50 patients, 24 (48%) were females and 26 (52%) were males. No serious procedural complications were noted. Post-DSCB, follow-up was done for 4 weeks. A significant fall in NRS and an increase in SLR score were observed at every visit. Results were statistically significant (p<0.001) when mean NRS and SLR scores at every follow-up were compared for pre- and post-DSCBs. CONCLUSION: DSCB reduced pain and improved SLR in patients even at 4 weeks of follow-up. Advantages included immediate pain relief, easy to perform as outdoor procedure, cost-effective and a time buying alternative procedure allowing for the analgesic effect of medicine to kick in. KEY WORDS: Radiculopathy, Low-back pain, Epidural spinal injection, Sciatica, Pain management, Distal sodium channel blocks.

Rehabilitation of hemispatial neglect in stroke.

Hemi-spatial neglect (HSN) is a debilitating post stroke cognitive deficit resulting in reduced attention to stimuli presented in the contra-lateral hemi-visual field. It adversely impacts patient's medical recovery, activities of daily living and quality of life. Early referral to Rehabilitation Medicine specialist for thorough evaluation, prompt recognition of functional impairments and formulation of a comprehensive rehabilitation plan unique to patient is important. It is part of the comprehensive and holistic management of stroke patients with HSN. We summarize the current management strategies used for post-stroke HSN rehabilitation with the options including non-invasive brain stimulation, visuomotor feedback training, robotic rehabilitation and trans-dermal nicotine patch.

In silico Structure-based Identification of Novel Acetylcholinesterase Inhibitors Against Alzheimer's Disease.

OBJECTIVE AND BACKGROUND: Inhibition of acetylcholinesterase (AChE) has gained much importance since the discovery of the involvement of peripheral anionic site as an allosteric regulator of AChE. Characterized by the formation of ß-amyloid plaques, Alzheimer's disease (AD) is currently one of the leading causes of death across the world. Progression in this neurodegenerative disorder causes deficit in the cholinergic activity that leads towards cognitive decline. Therapeutic interventions in AD are largely focused upon AChE inhibitors designed essentially to prevent the loss of cholinergic function. The multifactorial AD pathology calls for Multitarget-directed ligands (MTDLs) to follow up on various components of the disease. Considering this approach, other related AD targets were also selected. Structure-based virtual screening was relied upon for the identification of lead compounds with anti-AD effect. METHOD: Several chemoinformatics approaches were used in this study, reporting four multi-target inhibitors: MCULE-7149246649-0-1, MCULE-6730554226-0-4, MCULE-1176268617-0-6 and MCULE-8592892575-0-1 with high binding energies that indicate better AChE inhibitory activity. Additional in-silico analysis hypothesized the abundant presence of aromatic interactions to be pivotal for interaction of selected compounds to the acetyl-cholinesterase. Additionally, we presented an alternative approach to determine protein-ligand stability by calculating the Gibbs-free energy change over time. Furthermore, this allows to rank potential hits for further in-vitro testing. RESULTS AND CONCLUSION: With no predicted indication of adverse effects on humans, this study unravels four active multi-target inhibitors against AChE with promising affinities and good ADMET profile for the potential use in AD treatment.