Vitamin C supplementation as adjuvant analgesic therapy in post-operative pain management in patients undergoing surgical decompression in a case of prolapsed intervertebral disc

Background: The management of postoperative pain has been a major challenge for the operating surgeons. Vitamin C has shown analgesic effects in specific clinical conditions, reducing patient suffering and improving the quality of life. The objective of this study was to evaluate the efficacy of vitamin C as an adjuvant in postoperative pain management and its effect on analgesia requirements in patients undergoing spinal decompression surgery.Methods: The present study was a prospective study of 50 patients aged 30-60 years with low back pain due to prolapsed intervertebral disc requiring surgical decompression, conducted in a tertiary care institute from 2018 to 2020. All patients underwent open discectomy. 25 patients each were randomized into two groups, those that were given vitamin c supplementation (group A) and those that weren't (group B). The patients were then followed up 1st, 2nd, 4th, and 6th week and the pain was graded at each follow-up according to the NRS scale. The total amount of diclofenac sodium consumed in the 6 weeks was calculated.Results: The mean NRS (A vs B) at 2 (2.68 vs 3.56) and 4 (0.88 vs 1.48) weeks follow-up showed a statistically significant difference between the two groups, but the difference was not significant at 6 (0.16 vs 0.36) weeks follow up. The difference in the consumption of analgesic (3.56 vs 5.46) at 6 weeks was statistically significant.Conclusions: In this clinical outcome-based study, we suggest that for postoperative pain management, vitamin C acts as an efficacious adjuvant with a dose-sparing effect on the consumption of analgesics

Assessment of functional outcome of distal femur intra-articular fractures treated with locking compression plate

Background: Intra-articular distal femoral fracture makes up to 6% of all femur fractures. Because they damage the cartilage surface of the bone, intra-articular fractures can be more difficult to treat. The locking compression plates have nowadays proven to be gold standard in treating both simple as well as complex intra-articular distal femur fractures. This study is to evaluate the complications, functional and anatomical outcome of distal femur fractures, treated by open reduction and internal fixation using distal femoral locking compression plate.Methods: This is a retrospective study of 30 patients with intra articular distal femur fractures operated with distal femur locking compression plate during the period of 2015 to 2018 in a tertiary care hospital with age range from 17 to 71 years and follow up till 2 years. Fractures were classified according to AO classification and functional outcome assessed by using Neer criteria.Results: 10 cases had excellent score (33%), 16 cases (52%) had satisfactory score, 3 cases (11%) had unsatisfactory score and only one case had poor score. 85.1% of patients were in between satisfactory to excellent results. Complications observed were excessive bleeding, difficulty in reduction, superficial infections, knee stiffness, malalignment and limb length discrepancy.Conclusions: The distal femur locking compression plate is a good implant to be used for distal femur intra-articular fractures. Early surgery, anatomical reduction and early mobilisation are the prerequisites for good functional outcome. Comminution and bone defect on the medial side needs pillar reconstruction by fibular bone graft

Study of the immediate short term clinical and radiological outcome of intertrochanteric neck of femur fractures treated with primary bipolar hemiarthroplasty in geriatric population in a tertiary care centre

Background: Intertrochanteric fracture in elderly patient is a frequent problem and is becoming more common as the proportion of elderly people in the population increases. Unstable intertrochanteric fracture in the elderly patient is associated with a high rate of mortality as much as 20 percent during the first postoperative year. The treatment of such unstable intertrochanteric fracture is still controversial. So as to allow for earlier postoperative weight-bearing, primary hemiarthroplasty was proposed by some authors. The purpose of this study is to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in the elderly patient.Methods: It was an observational retrospective plus prospective study design over a period of 18 months in a tertiary care setting with a sample size of 41. Patients fulfilling the inclusion criteria were assessed clinically using Harris hip score and radiologically were operated for bipolar hemiarthroplasty. They were assessed intraoperatively, immediate postoperatively and after 4 weeks for functional outcome using Harris hip score and assessed radiologically. Patients were also be evaluated for intraoperative and postoperative complications if any. The outcome was analysed statistically to comment on functional outcome of bipolar hemiarthroplasty.Results: In our study majority of the patients 70% (29) had excellent and good outcomes at the end of 1 month. Out of the rest 22% more had fair outcome at the end of month. Thus 93% patients had favorable outcomes at the end of 1 month while 7% (3 cases) had poor outcome when measured using Harris hip score.Conclusions: Primary cemented bipolar hemiarthroplasty is a viable option that leads to good functional outcomes and allows early mobilization and weight bearing

Barriers and facilitators to seek treatment for gynecological morbidity among women from urban slums in Pune, India

Background: The high burden of gynecological morbidity along with poor treatment seeking practices indicate the need to identify barriers and facilitators for treatment seeking. Methods: A community based study using mixed methodology was conducted among women in reproductive age group in slums of Pune city. A pretested semi open ended questionnaire was used to record data on sociodemographic variables, symptoms of gynecological morbidity, domestic violence, autonomy and treatment seeking. Data were analysed using logistic regression analysis. Reponses to in-depth interviews were analysed using grounded theory. Results: Out of the 202 women recruited in the study, 116 (57%) reported symptoms of gynecological morbidity of which 64 (55%) reported to have sought treatment. The factors significantly associated with treatment seeking were: discussing symptoms with husband [p=0.001, OR=6.99 (2.11 - 23.12)]; having a role in decision making for major household purchase [p=0.005; OR=4.36 (1.54-12.32)] and reporting four or more symptoms [p=0.015; OR=4.57 (1.34-15.61)]. In-depth interviews identified barriers and facilitators at individual, family, community and health service levels. Conclusion: There was a high prevalence of self-reported gynaecological morbidity amongst women in urban slums and only half of symptomatic women reported to have sought treatment for their symptoms. Women empowerment, health education and initiatives planned under National Urban Health Mission such as linkages with health care set up through ASHAs and community based groups and appointment of lady medical officers and gynecologists at Urban PHCs will facilitate treatment seeking