Outcome of Guillain-Barré Syndrome with bulbar palsy.

BACKGROUND: Elective intubation is advocated in Guillain-Barré syndrome (GBS) with bulbar palsy to prevent aspiration pneumonia and lung collapse. We evaluate the outcome of GBS patients with bulbar palsy, and also compare the risks and benefits of intubation and MV in them. METHODS: 187 GBS patients with bulbar palsy from a cohort of 547 GBS registry were analyzed. Detailed clinical records and peak disability on a 0-6 GBS Disability Scale (GBSDS) were noted. The patients were intubated if arterial blood gas (ABG) analysis revealed hypoxia, hypercarbia or acidosis. The patients with normal ABG parameters were fed by nasogastric tube, and nursed in lateral position. Occurrence of pneumonia, in-hospital death and outcomes at 6-months were classified as complete (GBSDS <2), partial (GBSDS 2-3) and poor (GBSDS >3). RESULTS: 76/187(40.6%) patients required MV, and they had a shorter duration of illness (p = 0.007), higher peak disability (p < 0.001), autonomic dysfunction (p < 0.001) and more frequently received IVIg (p = 0.02). Pneumonia (63% vs 10.8%; p < 0.001) and in-hospital deaths (7.9% vs 1.8%; p = 0.06) were more frequent in MV group compared to nasogastric fed group. At 6-months,104 (55.6%) patients recovered completely. On multivariate analysis, the independent predictors of poor outcome were peak disability [Adjusted Odds Ratio (AOR) 9.84, 95% Confidence Interval (CI) 3.15-30.74, p < 0.0001], day of hospitalization from disease onset (AOR 1.09, 95% Cl 1.01-1.01; p=0.009) and requirement of MV (AOR 0.10; 95% 0.02-0.50; p = 0.005). CONCLUSION: GBS patients with bulbar palsy may be managed by nasogastric feeding and nursing in lateral position without increasing the risk of pneumonia. Mechanical ventilation based on ABG does not worsen outcomes of GBS with bulbar palsy.

Photo-transformation of ofloxacin in natural aquatic conditions: Impact of indirect photolysis on the product profile and transformation mechanism.

The natural phototransformation of organic pollutants in the environment depends on several water constituents, including inorganic ions, humic substances, and pH. However, the literature information concerning the influence of various water components on the amount of phototransformation and their impact on the development of various transformation products (TPs) is minimal. This study investigated the phototransformation of ofloxacin (OFL), a fluoroquinolone antibiotic, in the presence of various water components such as cations (K+, Na+, Ca2+, NH4+, Mg2+), anions (NO3-, SO42-, HCO3-, CO32-, PO43-), pH, and humic substances when exposed to natural sunlight. The study reveals that neutral pH levels (0.39374 min⁻1) enhance the phototransformation of OFL in aquatic environments. Carbonate, among anions, shows the highest rate constant (2.89966 min⁻1), significantly influencing OFL phototransformation, while all anions exhibit a notable impact. In aquatic environments, indirect phototransformation of OFL, driven by increased reactive oxygen species, expedites light-induced reactions, potentially enhancing OFL phototransformation. A clear difference was visible in the type of transformation products (TPs) formed during direct and indirect photolysis. The impact of indirect photolysis in the product profile was evaluated by examining the unique properties of TPs in direct and indirect photolysis. The primary transformation products were generated by oxidation and cleavage processes directed towards the ofloxacin piperazinyl, oxazine, and carboxyl groups. The toxicity assessment of TPs derived from OFL revealed that among the 26 identified TPs, TP3 (demethylated product), TP7 and TP8 (decarboxylated products), and TP15 (piperazine ring cleaved product) could potentially have some toxicological effects. These findings suggest that the phototransformation of OFL in the presence of various water components is necessary when assessing this antibiotic's environmental fate.

Percutaneous Closure of Bilateral Pulmonary Artery Aneurysms in Behcet's Disease.

Behcet's disease is a multisystemic vasculitis. It can affect the pulmonary artery in 2% to 5% cases. We discuss a case of a young male diagnosed with Behcet's disease on immunosuppressive therapy who presented with bilateral pulmonary artery aneurysms which were closed with covered stent and other devices.

Myositis in H1N1 Infection Compounds to Myasthenic Crisis.

ABSTRACT: Infection is an important trigger of myasthenic crisis (MC), and those infections manifest with pneumonia and muscle involvement may result in more frequent MC. We report two myasthenia gravis (MG) patients with H1N1 infection, and highlight the reasons for deterioration. Two patients with MG had H1N1 infection. The diagnosis of MG was confirmed by neostigmine, repetitive nerve stimulation, and anti-acetylcholine receptor antibody tests. H1N1 was confirmed by nucleic acid detection study, and myositis by creatinine kinase. The patient with pneumonia and myositis had MC needing mechanical ventilation for 10 days, and the other patient without myositis did not have MC. They were treated with oseltamivir 75 mg twice daily for 5 days, and the patients with MC received ceftriaxone intravenously. Both the patients were on prednisolone and azathioprine, and none received prior H1N1 vaccination. The lady with MC with myositis was discharged on day 27 in wheelchair bound state, and the other one patient without myositis or MC was discharged on 6th day with full recovery. These patients highlight the need for evaluation for myositis along with pneumonia in the MG patients with H1N1 infection. Vaccination in MG patients on immunosuppression may be useful.

Layer-by-layer assembled graphitic carbon nitride membranes for water treatment.

Meeting societal demand for potable water supply remains one of the prioritized challenges faced in the modern era. The anthropogenic intervention has led to a dire situation threatening ecological balance and human health. There is an inevitable need for the development of new technologies and innovations in existing technologies for water treatment. Photocatalytic Membrane technology, encompassing the merits of membrane filtration and photocatalytic degradation has evolved as a potential and reliable technology for sustainable water treatment. Innovations in photocatalytic materials and membrane fabrication techniques can lead to the goal of commercialization of membrane water treatment technology. Herein, we demonstrate the potential of graphitic carbon nitride (g-C3N4) and its functionalized analog as photocatalytic membranes for sustainable water treatment. g-C3N4 and Tetracarboxyphenylporphyrin sensitized g-C3N4 (g-C3N4/TCPP) was introduced onto commercial nylon membrane surface via a layer-by-layer (LBL) assembly method using chitosan and sodium salt of polystyrene sulphonic acid as polyelectrolytes. The fabricated membranes were characterized to ensure the integration of the photocatalysts. The performance of the membranes for water treatment was assessed by selecting some common dyes as model pollutants. The modified membranes exhibited excellent flux recovery and could afford high rejection rates upon irradiation indicating the prospects for sustainable filtration.

Azathioprine-induced Veno-occlusive Hepatotoxicity in a Patient with Myasthenia Gravis.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disorder of post-synaptic neuromuscular junction characterised by fatigable muscle weakness and is treated with prednisolone with or without other immunosuppressants, including azathioprine (AZA). Veno-occlusive hepatotoxicity of AZA is a rare complication in MG. CASE REPORT: We report a 35-year-old man with MG who was treated with pyridostigmine, prednisolone, and AZA for 5 years. He presented with abdominal pain and increased fatiguability for 7 days. His serum bilirubin and liver enzymes were elevated, and ultrasound revealed a dilated hepatic vein and portal vein suggestive of veno-occlusive liver disease. The clinical symptoms, liver functions, and ultrasound of the hepatobiliary system normalized after withdrawal of AZA. CONCLUSION: A possibility of AZA veno-occlusive hepatoxicity should be considered in an MG patient if presented with abdominal pain, elevated bilirubin and transaminases and ultrasound showing dilatation of hepatic veins. Physicians should be aware of this complication because this toxicity is reversible following dose reduction or withdrawal of AZA.

Occurrence and distribution of steroid hormones (estrogen) and other contaminants of emerging concern in a south indian water body.

Steroid hormones (SHs) are among the important classes of Contaminants of Emerging Concern (CECs) whose detection in aquatic environments is vital due to their potential adverse health impacts. Their detection is challenging because of their lower stability in natural conditions and low concentrations. This study reports the presence of steroid hormones in a major river system, the Periyar River, in Kerala (India). Water samples were collected from thirty different river locations in the case of SHs and five locations within these in the case of other CECs. These were subjected to LC-MS/MS and LC-Q-ToF/MS analyses. Five SHs, estriol, estrone, 17 ß estradiol, progesterone, and hydroxy progesterone, were separated and targeted using MS techniques. The studies of the water samples confirmed the presence of the first three estrogens in different sampling sites, with estrone present in all the sampling sites. The concentration of estrone was detected in the range from 2 to 15 ng/L. Estriol and estradiol concentrations ranged from 1.0 to 5 ng/L and 1-6 ng/L, respectively. The hormones at some selected sites were continuously monitored for seven months. The chosen areas include the feed water sites for the drinking water treatment plants across the river. The monthly data revealed that estrone is the only SHs detected in all the samples in the selected months. The highest concentration of SH was found in August. Twelve CECs belonging to pharmaceuticals and personal care products were identified and quantified. In addition, 31 other CECs were also identified using non-target analysis. A detailed study of the hormone mapping reported here is the first from any South Indian River.

Human exposure to methyl and butyl parabens and their transformation products in settled dust collected from urban, semi-urban, rural, and tribal settlements in a tropical environment.

The present study involved monitoring the distribution of two widely consumed parabens (methyl paraben (MeP) and butyl paraben (BuP)) and their transformation products in indoor dust from different categories of settlement (urban, semi-urban, rural, and tribal homes). The results revealed a prevalent occurrence of parabens in all the settlement categories. A non-normal distribution pattern for MeP and BuP levels across the sampling sites was noted. While comparing the residence time of parabens in dust samples, it was found that the half-lives of the analytes were greater in the dust from urban (MeP t1/2: 47.510 h; BuP t1/2: 22.354 h) and rural (MeP t1/2: 27.725 h and BuP t1/2: 31.500 h) areas. The presence of paraben metabolites, such as hydroxy methylparaben (OH-MeP), para hydroxy benzoic acid (p-HBA), and benzoic acid (BA) in dust samples supports their transformation within indoor spaces. The average daily intake of parabens through dust ingestion and dermal absorption by children was higher than adults. BuP was the prime contributor (>85%) to the total estradiol equivalency quotient (tEEQ) in all the settlement categories.

Organic micropollutant removal and phosphate recovery by polyelectrolyte multilayer membranes: Impact of buildup interactions.

Polyelectrolyte multilayer (PEM) deposition conditions can favorably or adversely affect the membrane filtration performance of various pollutants. Although pH and ionic strength have been proven to alter the characteristics of PEM, their role in determining the buildup interactions that control filtration efficacy has not yet been conclusively proved. A PEM constructed using electrostatic or non-electrostatic interactions from controlled deposition of a weak polyelectrolyte could retain both charged and uncharged pollutants from water. The fundamental relationship between polyelectrolyte charge density, PEM buildup interaction, and filtration performance was explored using a weak-strong electrolyte pair consisting of branching poly (ethyleneimine) and poly (styrene sulfonate) (PSS) across pH ranges of 4-10 and NaCl concentrations of 0 M-0.5 M. PEI/PSS multilayers at acidic pH were dominated by electrostatic interactions, which favored the selective removal of a charged solute, phosphate over chloride, while at alkaline pH, non-electrostatic interactions dominated, which favored the removal of oxybenzone (OXY), a neutral hydrophobic solute. The key factor determining these interactions was the charge density of PEI, which is controlled by pH and ionic strength of the deposition solutions. These findings indicate that the control of buildup interactions can largely influence the physico-chemical and transport characteristics of PEM membranes.

mRNA profiling of cytokines to understand paradoxical response in HIV-uninfected tuberculous meningitis.

Paradoxical reaction (PR) in tuberculous meningitis (TBM) is a major management issue. We report mRNA profiling of cytokines to understand PR in HIV-uninfected TBM patients. 72 patients with TBM were included, and their clinical, MRI, and mRNA profiling of tumor necrosis factor (TNF) α, interleukin (IL) 6, IL10 and interferon (IFN) γ genes in the peripheral blood mononuclear cells were done at admission and 6 weeks of antitubercular treatment. Cytokine profiling was done using reverse transcriptase polymerase chain reaction. PR was defined if repeat MRI at 6 weeks revealed new or increase in exudates, tuberculoma, hydrocephalus or infarctions. Outcome was defined at 6 months using modified Rankin Scale (mRS), and categorized as death, poor and good. 44 (61.1 %) patients had PR, and 28 (38.9 %) had paradoxical tuberculoma (PT). The expression of IL6 and TNFα genes were higher in PR and PT groups. Stage of meningitis and hydrocephalus at admission predicted PR. Patients with PR and PT had more frequently poor outcome. About three-fifth HIV-uninfected TBM patients have PR and two-fifth have PT. Paradoxical reaction is associated with higher expression of IL6 and TNFα. Patients with severe meningitis with hydrocephalus develop PR more frequently.

Best Evidence for Each Surgical Step in Minimally Invasive Right Hemicolectomy: A Systematic Review.

Objective: The aim of this study was to systematically review the literature for each surgical step of the minimally invasive right hemicolectomy (MIRH) for non-locally advanced colon cancer, to define the most optimal procedure with the highest level of evidence. Background: High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients' postoperative and oncological outcomes. Methods: A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication. Results: Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites. Conclusion: According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.

Degradation studies of bisphenol S by ultrasound activated persulfate in aqueous medium.

The degradation of recalcitrant organic pollutants by sulphate radical (SO4•-) represents one of the most recent developments in oxidation-based water treatment. In most cases, persulfate (PS) acts as a precursor of sulphate radicals. This study employed ultrasound-activated PS to generate reactive species, facilitating the degradation of bisphenol S (BPS), a well-known contaminant of emerging concern (CECs). An ultrasound with a frequency of 620 kHz and 80 W power was utilised for the degradation studies. The applied oxidation system successfully resulted in the complete degradation of BPS in both pure and real environmental water samples. Additionally, the Chemical oxygen demand (COD) was reduced to an acceptable limit in both matrices, with a reduction of 85 % in pure water and 73 % in river water. The degradation was monitored by varying chemical parameters such as pH, inorganic ions, and organics concentration. The results indicate that under specific pH conditions, the degradation efficiency followed the order of pH 3 > 4 > 7 > 11. The presence of coexisting matrices suppressed the efficiency by scavenging the reactive species. Utilizing high-resolution mass spectrometry (HRMS) analysis, this study identified seven intermediate products during identified during the degradation of BPS. Furthermore, a comprehensive mechanism has been deduced for the transformation and degradation process. All the results presented in this study underscore the applicability of the US/PS system in the removal of CECs.

Bioderived cellulose fibre-guar gum grafted poly (N, N'-dimethylacrylamide) polymer network for controlled release of metformin hydrochloride.

An interpenetrating polymer network (IPN) of areca cellulose and guar gum grafted with poly (N, N'-dimethylacrylamide) was made by microwave irradiation technique. N, N-methylenebisacrylamide (MBA) was used as the crosslinking agent. The network polymer was characterised using Fourier Transform Infrared Spectroscopy (FTIR), Thermogravimetric Analysis (TGA), Powder X-ray Diffraction (XRD) and Field Emission Scanning Electron Microscopy (FESEM). The chemical interaction between the drug and the polymer was studied using Differential Scanning Calorimetry (DSC). The swelling of the gel was measured under different pH conditions and the swelling parameters were evaluated. The gel was loaded with an anti-diabetic drug, Metformin Hydrochloride, and the in vitro drug release was studied in gastric and intestinal conditions. The results indicated complete release of the drug in 6 h under pH 1.2 and in 10 h under pH 7.4. The kinetic analysis of release data indicated the drug release to follow Higuchi's model. The release exponent "n" of Korsmeyer-Peppas model was found to be >0.45 indicating the drug diffusion to be a non-Fickian process.

Singlet oxygen in the removal of organic pollutants: An updated review on the degradation pathways based on mass spectrometry and DFT calculations.

The degradation of pollutants by a non-radical pathway involving singlet oxygen (1O2) is highly relevant in advanced oxidation processes. Photosensitizers, modified photocatalysts, and activated persulfates can generate highly selective 1O2 in the medium. The selective reaction of 1O2 with organic pollutants results in the evolution of different intermediate products. While these products can be identified using mass spectrometry (MS) techniques, predicting a proper degradation mechanism in a 1O2-based process is still challenging. Earlier studies utilized MS techniques in the identification of intermediate products and the mechanism was proposed with the support of theoretical calculations. Although some reviews have been reported on the generation of 1O2 and its environmental applications, a proper review of the degradation mechanism by 1O2 is not yet available. Hence, we reviewed the possible degradation pathways of organic contaminants in 1O2-mediated oxidation with the support of density functional theory (DFT). The Fukui function (FF, f-, f+, and f0), HOMO-LUMO energies, and Gibbs free energies obtained using DFT were used to identify the active site in the molecule and the degradation mechanism, respectively. Electrophilic addition, outer sphere type single electron transfer (SET), and addition to the hetero atoms are the key mechanisms involved in the degradation of organic contaminants by 1O2. Since environmental matrices contain several contaminants, it is difficult to experiment with all contaminants to identify their intermediate products. Therefore, the DFT studies are useful for predicting the intermediate compounds during the oxidative removal of the contaminants, especially for complex composition wastewater.

Delineating the cascade of molecular events in protein aggregation triggered by Glyphosate, aminomethylphosphonic acid, and Roundup in serum albumins.

The molecular basis of protein unfolding on exposure to the widely used herbicide, Glyphosate (GLY), its metabolite aminomethylphosphonic acid (AMPA), and the commercial formulation Roundup have been probed using human and bovine serum albumins (HSA and BSA). Protein solutions were exposed to chemical stress at set experimental conditions. The study proceeds with spectroscopic and imaging tools. Steady-state and time-resolved fluorescence (TRF) measurements indicated polarity changes with the possibility of forming a ground-state complex. Atomic force microscopy imaging results revealed the formation of fibrils from BSA and dimer, trimer, and tetramer forms of oligomers from HSA under the chemical stress of GLY. In the presence of AMPA, serum albumins (SAs) form a compact network of oligomers. The compact network of oligomers was transformed into fibrils for HSA with increasing concentrations of AMPA. In contrast, Roundup triggered the formation of amorphous aggregates from SAs. Analysis of the Raman amide I band of all aggregates showed a significant increase in antiparallel ß-sheet fractions at the expense of α-helix. The highest percentage, 24.6%, of antiparallel ß-sheet fractions was present in amorphous aggregate formed from HSA under the influence of Roundup. These results demonstrated protein unfolding, which led to the formation of oligomers and fibrils.

Repurposing Marketed Drugs as Antidepressants with In Silico, In Vivo, and In Vitro Screening Methods.

Drug repurposing is a strategy to identify new therapeutic uses for marketed drugs, discontinued or shelved drugs, and drug candidates in clinical development. Drug repurposing has gained momentum over the past few years. A slow rate of new drug discovery and higher cost of new drug development attracted the attention for repurposing and repositioning of old medications . A deeper understanding of the pathogenesis of depression encourages novel discoveries through drug repurposing to treat depression. In this study, indole- and isatin-containing drugs are going to be repurposed using computational methods for the treatment of depression.

USMLE Step 2 CK Scores and Radiology Residency Applications: Does it Affect Diversity in Selection of Trainees?

RATIONALE AND OBJECTIVES: As residency programs in diagnostic radiology aspire to broaden trainee diversity, reliance on certain criteria may affect the selection of candidates from underrepresented groups. With the conversion of reporting of the United States Medical Licensing Examination (USMLE) Step 1 scores to pass/fail, programs may rely more on numerical USMLE Step 2 Clinical Knowledge (CK) scores. The purpose of our investigation is to assess the effects of Step 2 CK scores on the selection of underrepresented minority (URM) and female candidates. MATERIALS AND METHODS: Applications from United States senior allopathic medical students to a radiology residency program from the 2021-2023 National Residency Matching Program cycles were analyzed. Subjects were classified as male or female and URM or non-URM by self-identification. Step 2 CK scores were compared and the use of cutoff scores was examined for disparate effects. RESULTS: 1017 subjects fulfilled the entry criteria. There were 721 males and 296 females, with 164 URM and 853 non-URM candidates. Comparing males to females, there was no significant difference in the mean score (p = 0.21) and no disparate effects of cutoff scores. There was a significant difference between the mean score of URM versus non-URM candidates of eight points (p < 0.00011). The use of cutoffs showed a disparate effect on URM candidates with a cutoff score of 250 (average score for 2022 matched applicants) excluding 71% of URM candidates while excluding only 46% of non-URM candidates. CONCLUSION: Reliance on USMLE Step 2 CK scores to screen applications for radiology residency can disadvantage URM candidates. Females are not adversely affected.

Role of Nerve Conduction Studies in Hansen's Disease.

Background and Objective: To report the role of nerve conduction study (NCS) in diagnosis, monitoring, and prognosis of Hansen's disease (HD). Materials and Methods: In a hospital-based prospecive observational study, the patients with HD as per World Health Organization (WHO) criteria were included; muscle wasting power, reflexes, and sensations were recorded. Motor NCS of median, ulnar, and peroneal nerves and sensory NCS of ulnar, median, and sural nerves were recorded. Disability was graded using WHO grading scale. The outcome was assessed after 6 months using modified Rankin scale. Results: In the present study, 38 patients with a median age of 40 (15-80) years and five females were included. The diagnosis was tuberculoid in seven, borderline tuberculoid in 23, borderline lepromatous in two, and borderline in six patients. The disability was grade 1 and 2 in 19 patients each. Out of 480 nerves studied, NCS was normal in 139 sensory (57.4%) and 160 (67.2%) motor nerves. NCSs were axonal in seven sensory and eight motor nerves, demyelinating in three nerves, and mixed in one in seven patients who had lepra reaction. NCS findings did not correlate with disability (p = 1.0) or outcome (0.304) and provided additional information in 11 nerves (seven patients). Peripheral nerves were enlarged in 79. NCSs were normal in 32 (29.90%) in thickened nerves. Conclusion: In HD, NCS abnormalities correlated with respective sensory or motor abnormality but related with neither disability nor the outcome.

Association of antenatal anxiety with adverse pregnancy outcomes: A prospective hospital-based study.

Background: Anxiety is common in pregnant women. Many studies have shown association of antenatal anxiety with adverse pregnancy outcomes, though the results are conflicting. Further, there are very limited studies on the subject reported from India, due to which, the data is limited. Hence this study was undertaken. Materials and Methods: Two hundred randomly selected consenting registered pregnant women reporting for antenatal follow up during third trimester of pregnancy were included in the study. Hindi version of Perinatal Anxiety Screening scale (PASS) was used to assess anxiety. Edinburgh Postnatal Depression rating Scale (EPDS) was used to assess comorbid depression. These women were followed up in the post-natal period to assess pregnancy outcomes. Chi-square test, Analysis of Variance (ANOVA) and correlation coefficients were calculated. Results: Analysis was done for 195 subjects. Most women (48.7%) were between 26 and 30 yrs of age. Primigravidas comprised 11.3 % of total study sample. Mean anxiety score was 23.6 (range 5-80). Adverse pregnancy outcomes were noted in 99 women; however anxiety scores in this group were not different from the group without adverse outcomes. No significant group differences were found with respect to PASS or EPDS scores. None of the women were found to have a syndromal anxiety disorder. Conclusions: Antenatal anxiety was not found to be associated with adverse pregnancy outcomes. This finding is contrary to the results obtained in earlier studies. More enquiry is needed into this area to replicate the results with clarity in larger samples, in Indian context.

Prednisolone 20 mg vs 40 mg in complex regional pain syndrome type I: A randomized controlled trial.

BACKGROUND: High dose of corticosteroid has been found beneficial in complex regional pain syndrome type I (CRPS-I). We report the efficacy and safety of prednisolone 20 mg versus 40 mg in CRPS-I in an open label randomized controlled trial. METHODS: The patients with CRPS-I of the shoulder joint with a CRPS score of ≥8 were included. Their demographic details, comorbidities, and underlying etiology were noted. The severity of CRPS was assessed using a 0-14 CRPS scale, the pain using a 0-10 Visual Analogue Scale (VAS), and sleep quality using a 0-10. Daily Sleep Interference Scale (DSIS). Patients were randomized to prednisolone 40 mg/day (group I) or 20 mg/day (group II) for 14 days, then tapered to 10 mg in group I and to 5 mg in group II by 1 month. Thereafter both groups received prednisolone 5 mg/day for 2 months. The primary outcome was a >50% reduction in VAS score, and secondary outcomes were a reduction in CRPS score, DSIS score, and adverse events. RESULTS: Fifty patients were included, and their baseline characteristics were comparable. At one month, all the patients had >50% reduction in the VAS score. The effect size was 0.38 (95% CI 0.93-0.20; p = 0.20). On the Kaplan-Mayer analysis, the improvement in the VAS score (Hazard ratio-1.43, 95 % CI-0.80-2.56, p = 0.22) and the CRPS score (HR-0.79,95 % CI-0.45-1.39; p = 0.41) was insignificant between the two groups. The DSIS score improved in group II (HR-1.85,95 % Cl-1.04-3.31,p = 0.04). Group I patients needed frequent adjustment of antidiabetic drugs (14 vs 6; p = 0.04). CONCLUSION: The efficacy of prednisolone 20 mg is not inferior to 40 mg in CRPS-I, and is safe in diabetic patients. LIMITATIONS: This is an open label randomized controlled trial with small sample size without a placebo arm.