Role of extracorporeal shockwave therapy and injectable corticosteroids in the treatment of lateral epicondylitis: a comparative study of 100 patients

Background: Even though considered to be self-limiting, lateral epicondylitis (tennis elbow) can cause significant impediment in professional and activities of daily living. A safe and minimally invasive procedure that will enable patients to return to their daily activities as soon as possible should be advocated in the management of this condition. The aim of the present study was to investigate the role of extracorporeal shock wave therapy (ESWT) and injectable corticosteroids in the treatment of lateral epicondylitis with the secondary objective of comparing the difference in pain relief and functional improvement in patients treated with both modalities.Methods: A cross sectional analytical study was conducted over an 18 month period.100 patients were randomized into two groups, A (51 patients) who received three sessions of ESWT on weekly intervals and B (49 patients) who received two intra-lesional injections of 1ml of methylprednisolone and 2% lignocaine on weekly intervals. The patients were followed up at 3 weeks, 6 weeks and 6 months after the interventions. Subjective and objective improvements were measured using visual analogue score (VAS) and Patient Rated Tennis Elbow Evaluation Score (PRTEE).Results: The mean VAS in both groups reduced from 8.47 and 8.53 to 2.51 and 1.67 respectively at the end of the follow up (p <0.001) .The mean PRTEE score in Group A reduced from 80.59 to 26.53 (p<0.001) and Group B from 82.76 to 13.59 (p<0.05). In Group A (ESWT), the average reduction In PRTEE Score at the end of follow up was 54.06 and Group B (steroids) was 69.16. The difference was found to be statistically significant (p<0.001) favouring steroid injections.Conclusions: Both ESWT and steroid injections were found to be effective in producing symptomatic pain relief and improving the functional disability in the management of lateral epicondylitis. The comparison of both modalities showed a statistically significant improvement in pain and functional disability in favour of steroids at a short duration of follow up i.e., 03 weeks, 06 weeks and 06 months.

Role of crossmatch testing when Luminex-SAB is negative in renal transplantation

The human leukocyte antigen (HLA) system plays an important role in the acceptance of renal graft. Long and better graft survival has been reported in patients with HLA-identical siblings and a nonreactive cytotoxicity assay (CDC). New methods of HLA-typing and anti-HLA antibody detection techniques such as flow cytometry, solid-phase immunoassays, or antigen bead assays have further improved the outcomes of renal transplant recipients. In the present review, the explicit details of these methodologies are discussed in detail

Synthesis of Substituted Pyrimidine Derivatives and Evaluation of their Antimicrobial Activity

ABSTRACT Keto group of cyano pyridine moiety have been treated with various aromatic aldehydes to give corresponding chalcones. The Chalcones have been reacted with urea and thiourea to get corresponding novel oxopyrimidines and thiopyrimidines, the structure of all newly synthesized compounds were confirmed by spectral analysis. The synthesized compounds were evaluated for their antimicrobial activity. All the synthesized pyrimidine compounds have show good to moderate antimicrobial activity

China’s rising hydropower demand challenges water sector

Demand for hydropower is increasing, yet the water footprints (WFs) of reservoirs and hydropower, and their contributions to water scarcity, are poorly understood. Here, we calculate reservoir WFs (freshwater that evaporates from reservoirs) and hydropower WFs (the WF of hydroelectricity) in China based on data from 875 representative reservoirs (209 with power plants). In 2010, the reservoir WF totaled 27.9 × 109 m3 (Gm3), or 22% of China’s total water consumption. Ignoring the reservoir WF seriously underestimates human water appropriation. The reservoir WF associated with industrial, domestic and agricultural WFs caused water scarcity in 6 of the 10 major Chinese river basins from 2 to 12 months annually. The hydropower WF was 6.6 Gm3 yr−1 or 3.6 m3 of water to produce a GJ (109 J) of electricity. Hydropower is a water intensive energy carrier. As a response to global climate change, the Chinese government has promoted a further increase in hydropower energy by 70% by 2020 compared to 2012. This energy policy imposes pressure on available freshwater resources and increases water scarcity. The water-energy nexus requires strategic and coordinated implementations of hydropower development among geographical regions, as well as trade-off analysis between rising energy demand and water use sustainability

“My Back is Fit for Movement”: A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain

A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care. Perspective: This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain

Renal abscess after the Fontan procedure: a case report

<p>Abstract</p> <p>Introduction</p> <p>The Fontan procedure is an intervention that helps to correct single ventricle physiology. There are many known long-term complications of 'Fontan physiology'. However, the occurrence of renal abscess in such patients has not yet been reported in the literature. The first generation of adults has now undergone the procedure and it is necessary to be aware of the long-term outcomes and complications associated with it.</p> <p>Case presentation</p> <p>We report the case of a 22-year-old South Indian man who had developed a staphylococcal renal abscess against a background of xanthogranulomatous pyelonephritis, nine years after Fontan surgery. He presented to our hospital with a high-grade fever of 25-days duration but with no other symptoms. Physical examination identified costovertebral angle tenderness and pedal edema. An ultrasound scan revealed a mass in his left kidney. The results of a computed tomography scan were consistent with a renal abscess. Despite treatment with the appropriate parenteral antibiotics, there was no change in the size of the abscess and a left nephrectomy was performed as a curative procedure.</p> <p>Conclusions</p> <p>The learning points here are manifold. It is important to be aware of the possibility of renal abscess in a post-procedural patient. The early diagnosis of a septic focus in the kidneymay help to prevent the rare outcome of nephrectomy.</p

Uterine selection of human embryos at implantation

Human embryos frequently harbor large-scale complex chromosomal errors that impede normal development. Affected embryos may fail to implant although many first breach the endometrial epithelium and embed in the decidualizing stroma before being rejected via mechanisms that are poorly understood. Here we show that developmentally impaired human embryos elicit an endoplasmic stress response in human decidual cells. A stress response was also evident upon in vivo exposure of mouse uteri to culture medium conditioned by low-quality human embryos. By contrast, signals emanating from developmentally competent embryos activated a focused gene network enriched in metabolic enzymes and implantation factors. We further show that trypsin, a serine protease released by pre-implantation embryos, elicits Ca2+ signaling in endometrial epithelial cells. Competent human embryos triggered short-lived oscillatory Ca2+ fluxes whereas low-quality embryos caused a heightened and prolonged Ca2+ response. Thus, distinct positive and negative mechanisms contribute to active selection of human embryos at implantation

Correlation between hematological parameters, blood urea level and mortality of COVID-19 patients.

Aim: Present study was aimed to analyze difference of hematological parameters and blood urea level between Recovered and Dead cases of COVID-19. Material & Methods: A hospital based study was undertaken wherein hematological parameters and blood urea level of 65 cases were analyzed. Results: Recovered patients, 16 (42.1%) showed higher levels of neutrophils with corresponding 22 (57.9%) patients showing normal level of lymphocytes, 25 (65.7%) with normal hemoglobin and 35 (92%) with normal blood urea. On other hand, among 27 Died cases, 26 (96.2%) showed higher counts of neutrophils, 1 patient showed normal lymphocytes (3.8%) and 26 (96.2%) with low count of lymphocytes. Conclusion: In majority of cases, recovered patients showed normal range of lymphocytes (20-45%), hemoglobin and blood urea levels, whereas mortality was observed associated with deficiency of lymphocytes (except one patient all belo

Primary cutaneous melanoma of the breast: A case report

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Primary cutaneous melanoma of the breast is a very rare tumour, accounting for &lt; 5 % of all malignant melanomas. Case presentation: A young lady was seen in the breast clinic for a skin lesion in the right breast. Clinical examination and investigations confirmed a diagnosis of a primary cutaneous melanoma of the breast. The lesion was excised and the patient made good recovery. She has shown no signs of local recurrence and is under regular follow-up in the dermatology clinic. Conclusion: This case is educational as it shows that the treatment of breast cutaneous melanoma is similar to that for any skin parts with surgery remaining the main therapeutic option. It also shows that mastectomy is unnecessary as it does not improve the results obtained by wide local excision of melanoma. Background Primary cutaneous melanoma rarely affects the breast, accounting for less than 5 % of all malignant melanomas