Tramadol: A valuable treatment for pain in Southeast Asian countries

Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain.Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic.Results: Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain.Conclusions: In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline

A Novel Antenna for 8 Element Beam Forming Antenna Array using Butler Matrix

This paper presents design of novel microstrip antenna for an 8-element linear array with 8x8 Butler Matrix as a beamforming network. The proposed structure resonates at 2.4 GHz frequency and is implemented using Microstrip Technology with FR-4 Substrate having εr=4.3 and height=1.6 mm. Simulation results are given for the components (microstrip antenna, quadrature couplers, crossovers, phase shifters) used to implement the matrix. The 8-element antenna array is connected to the matrix to form a beamforming system and produces eight orthogonal beams at −55◦, −36◦, -21◦, -7◦, 55◦, 36◦, 21◦, and 7◦. The reflection coefficients and isolations at all ports are below −10 dB at the center frequency and side lobes of radiation pattern are sufficiently low. The applications for this technique are in lower frequency bands of 5G and LTE, wearable devices and IEEE 802.11 WLA

Anaesthetic significance and management of a child with neonatal purpura fulminans

Protein C deficiency is a rare autosomal-dominant disorder of varying severity. Patients with homozygous and compound heterozygous protein C deficiency present with neonatal purpura fulminans (NPF). Other presentations usually include disseminated intravascular coagulation and venous thromboembolism. This disorder usually poses a unique anaesthetic challenge to the anaesthesiologist, requiring special precautions to prevent various intra- and post-operative complications. We hereby report the successful anaesthetic management of a 1-month-old infant who presented with NPF

Anesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: A case series

Peripartum cardiomyopathy is a rare cause of dilated cardiomyopathy in parturients, occurring in approximately one in 1000 deliveries, manifesting during the last few months or the first 5 months of the postpartum period. It can result in severe ventricular dysfunction during late puerperium. The major concern while managing these patients is to optimize fluid administration and avoid myocardial depression, while maintaining stable intraoperative hemodynamics. We present a case series of five parturients that were posted for elective cesarean section and managed successfully by the epidural volume extension technique