Background: Lumber prolapsed intervertebral disc induce radiating pain in lower limbs, for which epidural steroid injection is one of the safe and effective therapeutic option. This prospective study compares the results of 2 different techniques of transforaminal epidural steroid injection (TFESI) and subpedicular steroid injection in patients with prolapsed intervertebral disc (PIVD) in relieving lumbar radicular pain. Methods: Records of 80 patients who had undergone transforaminal and subpedicular epidural steroid injection for lumbar radicular pain were analyzed. Visual analogue scale (VAS) score were measured at before procedure and at 4th day post procedure and 2, 4, 6 and 24 weeks thereafter and straight leg raise test (SLRT) were measured before procedure, 4th day and 4 week post procedure. Results:At 24 weeks, the VAS was signicantly lower than the baseline in both groups; VAS in the TFESI group was signicantly lower than VAS in the subpedicular group at 6 and 24 weeks. SLRT score was signicantly higher in the TFESI group and subpedicular ESI group through the 4-week time point (P= 0.0021 at 4th day; P= 0.0001 at 4 weeks). At the end of 24 weeks, a signicantly greater number of patients in the TFESI group and subpedicular ESI showed difference In VAS (P = 0.0003). Conclusions: At the end of 24 weeks, TFESI appears to be a superior technique in relieving lumbar radicular pain in PIVD patients and could be an alternative to the subpedicular approach in severe spinal canal stenosis when it is hard to place the needle in the anterior epidural space through the safe triangle.
Orthopaedic surgeons continue to search for cost-effective bone graft substitutes to enhance bone repair. Teriparatide (PTH 1-34) and demineralized bone matrix (DBM) have been used in patients to promote bone healing. We evaluated the efficacy of PTH and DBM in healing a critical sized femoral defect in three lineage-specific transgenic mice expressing Col3.6GFPtopaz (pre-osteoblastic marker), Col2.3GFPemerald (osteoblastic marker) and α-SMA-Cherry (pericyte/myofibroblast marker). Mid-diaphyseal defects measuring 2 mm in length were created in the central 1/3 of mice femora using a circular saw and stabilized with an alveolar distractor device and cerclage wires. Three groups were evaluated: Group I, PTH 30 μg/kg injection daily, Group II, PTH 30 μg/kg injection daily + DBM, and Group III, DBM + 30μL saline injection. PTH was given for 28 days or until the time of sacrifice. Animals were sacrificed at 7, 14, 28, and 56 days. Radiographs at the time of sacrifice were evaluated using a 5-point scaled scoring system. Radiographs showed a lack of healing across all treatment groups at all time points: Group I, 1.57 +/- 0.68; Group II, 3.00 +/- 1.29; and Group III, 2.90 +/- 1.03. Bone formation in the defect as measured by radiographic healing score was significantly better at 56 days in Groups II (p = 0.01) and III (p < 0.01) compared to Group I. Across all treatment groups and time points the defects were largely absent of osteoprogenitor cells based on gross observation of frozen histology and quantitation of cellular based histomorphometric parameters. Quantitation of frozen histologic slides showed a limited osteoprogenitor response to PTH and DBM. Our results suggest that the anabolic agent teriparatide is unable to induce healing in a critical sized mouse femoral defect when given alone or in combination with the DBM preparation we used as a local bone graft substitute.
BACKGROUND: This study aims to compare of two analgesia techniques for pain management during chest tube removal (CTR) after cardiac surgery.Two groups were compared in terms of pain, sedation levels, and hemodynamic response removal of chest tube.METHODS: The study was designed as a prospective, randomized, double-blinded study.Forty patients who underwent coronary artery bypass graft (CABG) surgery were enrolled.In postoperative period intravenous fentanyl 1µg/kg was given five minutes prior to chest tube removal (CTR).Each patient was explained about CTR procedure and VAS scoring charts.The patients were randomized into two groups as study group (Group S) and control group (Group C).All patients received either adrenaline free xylocaine 2% infiltration (Group S), 6 ml around each of three chest tube (2 mediastinal + 1 pleural) or normal saline 0.9% (Group C) in double blind manner.Severity of pain was recorded by asking Visual analogue scale (VAS) from the patients.Faces rating scale (FRS), Behavioral rating scale (BRS) and Ramsay sedation score (RSS) along with hemodynamic data were also recorded, blinding to group at four time intervals; at baseline (T base) , 2min (T2m,) 5min (T5m) 10min (T10m)and 20 min (T20m.)after CTR.RESULTS: The demographic characteristics of the patients in both groups were similar.Before chest tubes removal (CTR), all the scores of pain intensity (VAS), pain distress (FRS, BRS) and sedation levels (RSS) were comparable, but they differ significantly at T2, T5, and T10.However, these scores were comparable at T20. Patients remained alert and comfortable after 20 CTR regardless of which group they were assigned.CONCLUSION: Intravenous fentanyl 1µg/kg along with local infiltration of 2% xylocaine can substantially reduce pain and better regime than Intravenous fentanyl 1µg/kg alone during chest tube removal in post-coronary artery bypass graft surgery patients.Both techniques are equally safe in terms of sedation and post procedural complications.
A 48-year-old male presented three days after cocaine use with acute, rapid onset of bilateral lower extremity weakness, bilateral foot numbness, acute urinary retention, and significantly elevated creatinine kinase. Further testing revealed unusual symmetrical edema with contrast enhancement on MRI of the lower extremities. The patient was diagnosed with severe non-traumatic, non-exertional rhabdomyolysis causing lumbosacral plexopathy following cocaine use. The treatment was centered around aggressive fluid resuscitation and electrolyte replacement.
Syzygium cumini, also known as Jamun, Jambul, or Indian blackberry, is a species of tree native to the Indian subcontinent. A comprehensive literature review shows that Jamun can be considered one of the most versatile herbal medicines with anti-diabetic, anti-oxidant, anti-inflammatory, and other properties. This review aims to investigate and understand the previous research on Jamun, including its pharmacognosy and pharmacological history, to confirm its potential to treat a variety of illnesses. The study also examined the current pharmaceutical formulations available in the market to understand the potential for developing medications from the components of Jamun. To comprehend the available studies, the analytical backdrop is also reviewed. Despite being the focus of many research studies, there are still many unanswered questions regarding Jamun. Therefore, the best formulations or products may be produced in these sectors, possibly through nutraceuticals, to support improved pharmacological aspects or health promotion. This review will help identify unexplored areas where specific tasks related to Jamun can be done.
Introduction: Lumbosacral radicular pain is characterized by a radiating pain in lumbar or sacral dermatomes ,which may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function.Radiculopathy can cause radicular pain, weakness, impaired sensation and trouble controlling particular muscle groups. Intervertebral disc prolapses, degenerative spondylolisthesis, and spinal canal stenosis can also cause it. Aim: To compare the therapeutic efcacy of peripheral nerve block (sodium channel block) with Transforaminal selective nerve block for management of lumbosacral radicular pain. Methodology: A comparative analytical, cross-sectional study where all 80 patients between the 18 – 75 age group who were suspected of lumbosacral pain with radiculopathy on the clinical and radiological grounds presenting as per the inclusion and exclusion criteria during the study period were included and divided into two equal groups, i.e., Group P (peripheral nerve block) and Group T(Transforaminal selective nerve block). Results: The study compared Group P(n=40) and Group T(n=40) for managing lumbosacral radicular pain, it was found that, there were no signicant differences in chief complaints (72.50% vs. 60.00% lumbosacral pain with radiculopathy), pain distribution (p=0.4223), VAS scores over follow-up (p>0.05 for all), SLRT measurements (p>0.05), ODI scores (p>0.05), with complications. Conclusion: Both treatments are safe, cost- effective, and reliable. Both procedures provide signicant relief from radicular pain in lower limbs for upto 6 months of duration.But peripheral nerve block can be performed in OPD, while transforaminol block needs c-arm and operation theater as a day care OPD or indoor procedure..
Aim:The aim of this clinical trial was compare of anaesthetic efficacy of articane 4%, bupivacaine 0.5% and lidocaine 2% for infraorbital nerve block. Materials And Methods: 75 patients were randomly assigned in to 3 groups where they were injected with eitherarticane 4%, bupivacaine 0.5% and lidocaine 2% and their anaesthetic efficacy was checked . Normality testing was done using the Shapiro-Wilk test. Data for EPT failed normality and hence, non-parametric tests were used for analysis. The EPT scores for pain threshold were compared between the three groups using Kruskal-Wallis test (non-parametric ANOVA) at pre-dosing, post-dosing, 1 hour, 2 hours and 3 hours. Post-hoc Mann-Whitney U test was used for pair-wise comparisons at all time periods. Results:As per the results obtained from the present study, the post-dosing results with electronic pulp tester was highest with Articaine followed by lignocaine and was least with bupivacaine. This showed that the Articaine had early onset amongst all three and bupivacaine showed late onset. Conclusion:This study shows that statistically significant difference was observed between lidocaine, Articaine and bupivacaine.Articaine has a faster onset and provides clinically effective anaesthesia in root canal treatment and other restorative procedures.
Numerous diseases related to gastric distension have been found and shown to be linked with noninvasive positive pressure ventilation (NIPPV). We describe the case of a 93-year-old female who came with progressively worsening shortness of breath that initially responded to NIPPV but subsequently deteriorated. Imaging revealed gaseous distension of a preexisting hiatal hernia with air-fluid levels and compressive effects on the left lower lobe of the lung. She was successfully managed using a conservative decompression strategy. This is the first case to our knowledge of NIPPV causing considerable distension of an existing hiatal hernia to the point of mediastinal tamponade.
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