Fibromyalgia syndrome: an overview of pathophysiology, diagnosis and management

Fibromyalgia Syndrome (FMS) is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. It is also characterized by restless sleep, tiredness, fatigue, anxiety, depression, and disturbances in bowel functions. The etiology of fibromyalgia remains unknown, but recent advances and discoveries have helped to unravel some of the mysteries of this disease. Research highlights some of the biochemical, metabolic, and immunoregulatory abnormalities associated with fibromyalgia. Management of FMS at the present time is very difficult as it has multiple etiological factors and psychological predispositions; however, a patient centered approach is essential to handle this problem

Metabolic syndrome: frequency and gender differences at an out - patient clinic

Objective: To determine the frequency of metabolic syndrome among patients attending an out-patient clinic of a teaching hospital and to compare the clinical features regarding metabolic syndrome among males and females.Study Design: Cross-sectional study.Place and Duration: Aga Khan University Hospital (AKUH), Executive and Family Medicine Clinics, from December 2004 to April 2005.Patients and Methods: All adults, above 25 years, attending the clinics for an executive check-up and giving informed consent were included in the study. Data was collected through a structured questionnaire administered to those eligible to participate. Metabolic syndrome was defined according to ATP-III guidelines.Results: There were 250 participants in this study. Mean age of study participants was 48.94 (SD10.62) years, while approximately two-thirds, 157 (62.8%), were male. Metabolic syndrome (those who had 3 or more risk factors) was present in 35.2% of adults. Fasting blood sugar level was raised in 36.4% of study participants while significant number of participants (78.8%) had a body mass index (BMI) \u3eor= 25 (p = 0.02).Conclusion: Frequency of metabolic syndrome was significantly high in this study with preponderance of males and prevalence similar to that observed in developed countries. Majority of patients had obesity and high fasting blood sugar levels. Males demonstrated higher levels of triglycerides and low levels of high-density lipoprotein (HDL) compared to females while blood pressure reading was observed to be the same in both males and females

A study on management of congenital clubfoot by Ponsetti technique in a rural medical college in India

Background: Congenital clubfoot also known as CTEV (congenital talipus equinovarus) is a common and debilitating congenital musculoskeletal anamoly affecting the children across the world with a slight preponderence in third world countries. The Ponseti technique of casting has now become the mainstay of treatment of this condition. This method is especially effective in rural and underdeveloped areas with limited health care facilities. The purpose of this study was to evaluate the effectiveness of the Ponsetti technique in the correction of this deformity, thorough the assessment of modified Pirani score.Methods: This was a prospective observational study conducted on 75 patients of either sex with 100 feet, with an average age of 3.6 months presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between September 2015 and September 2017, with a diagnosis of congenital clubfoot. All the patients were treated with Ponsetti technique and the results were analysed through the assessment of modified Pirani score. The patients were followed up for a peroid of 1 year after attainment of correction.Results: Majority of the patients obtained full correction with this method. The mean value of the modified Pirani score improved from the pre-treatment value of 5.30 to 0.36 at the final follow up. The average number of casts required for full correction was 7.32.Conclusions: Thus results of our study demonstrate that the Ponsetti method is a safe and effective method of treatment for congenital clubfoot, especially in rural and underdeveloped regions.

Attributes of an effective clinical teacher: a survey on students\u27 and teachers\u27 perceptions

OBJECTIVE: To identify the attributes of effective clinical teacher, using a self-filled survey questionnaire, that students and faculty value most, and to compare the opinion of student and faculty regarding the same. STUDY DESIGN: Cross-sectional study.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital (AKUH), Karachi from October 2006 to January 2007. Subject and Methods: Clinical faculty at AKUH and students in clinical years were included in this survey after taking their written informed consent. Data were collected through a structured questionnaire administered to all participants. Responses were compared.RESULTS: A total of 119 students in clinical years (3, 4 and 5) and 89 faculties involved in clinical teaching responded to the questionnaire. The most important attributes in faculty\u27s and students\u27 perspective were knowledge, interest in teaching and clinical competency. In students and faculty perspective, the fourth and fifth attributes were good communication skills and being non-judgmental. CONCLUSION: Students in clinical years and clinical teachers valued knowledge, interest in teaching and clinical competency as the most important attributes for an effective clinical teacher. There were various areas of agreement and disagreement between faculty and students about attributes of effective clinical teacher

A study on management of neglected shaft femur fractures by open intramedullary nailing

Background: Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. However, it is not uncommon in developing countries especially in rural India for these injuries to be neglected initially due to the wide spred practice of quackery. The purpose of this study was to evaluate the effectiveness of open intramedullary nailing in the management of neglected fracture shaft femur patients in relation to achievement of union and functional results.Methods: This was a prospective observational study conducted on 20 patients presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between August 2013 and December 2016, with a diagnosis of neglected fracture shaft of femur. All the patients underwent single stage open reduction and internal fixation with interlocking intramedullary nails. The patients were followed up for a period of 1 year. The patients were analysed for union and functional results.Results: All the fractures united and the average time of union was 22.6 weeks. The average range of motion of the knees improved from 34 degrees in the preoperative period to 114.5 degrees in the postoperative period.  Two patients developed superficial infections at the incision site which resolved with local drainage and oral antibiotics. All the patients were able to return to their preinjury occupation.Conclusions: Thus results of our study demonstrate that single stage open intramedullary nailing is a safe and effective surgical procedure for the treatment of neglected fractures of shaft of femur.

Poor glycaemic control is the major factor associated with increased frequency of gastrointestinal symptoms in patients with diabetes mellitus

Objective:To compare the GI symptoms in diabetic patients with controls and its relationship with the complications, duration of diabetes and glycaemic control. Methods:Consecutive patients were prospectively enrolled in to two groups. Group I (diabetic patients) and Group II (non-diabetic, Controls). Patient\u27s characteristics, demographic profiles and GI symptoms were evaluated on a questionnaire. Groups were compared for differences in various GI symptoms. Group I was further analyzed for the relationship between GI symptoms with complications, duration of diabetes andglycaemic control.Results:Atotal of 514 patients were enrolled 250 were diabetics (group I) and 264 were non-diabetics (groupII). Mean age was 51.8 +10.6 years and 50.2 +9.2 years in groups i and ii respectively. All GI symptoms;heartburn, dyspepsia, bowel related abdominal pain, diarrhea, constipation, and faecal incontinence were significantly more in diabetics than controls (P7 were significantly (P10 years) was not found significantly linked to GI symptoms.Conclusions:GI symptoms in diabetics were more frequent then control subjects and were significantly associated with poor glycaemic control, neuropathy and retinopathy but not with duration of diabetes. Number of GI symptoms increases with the severity of poor glycaemic control in diabetic patient

Pattern of morbidity among elders attending general practice: health needs assessment of geriatric patients in Oman

The main purpose of this study was to identify specific problems and pattern of morbidities that is common in the elderly. A cross sectional study surveying the health status and needs of targeted population was conducted in selected primary health care (PHC) outpatient settings. All consenting individuals aged 60 years and above who visited the selected PHC clinics were interviewed. Information was collected using face-to-face interviews based on a structured, pre-tested questionnaire. A total of 185 people were evaluated in this study. About 75% of participants were age 60-70 years. Overall, male predominance was noted with 137 (74.1%) males and among all participant’s 80% were married. The mean BMI was 26.47±4.98 kg/m2 and mean waist circumference was 90.16±12.97 cm. The prevalence of smoking, DM, HTN, dyslipidaemia and history of IHD among participants were 7.6%, 37.8%, 49.7%, 27.6% and 8.1%, respectively and males showed a significantly higher prevalence than females in smoking and HTN (p<0.05). Hypertension was common comorbid ailment with 29.2% of stage I and 19.5% of stage II hypertension among 60-70 age groups. The majority of the participants were taking shower; using toilet, feeding and get dressed independently, 88.6%, 87.6%, 87% and 87.6% respectively. These findings provide important information on high prevalence of overweight, hypertension, diabetes, smoking and dyslipidaemia among elders. The other common morbidities were impaired vision, walking difficulty, and hearing problems. The activity of daily living (bathing dressing toileting feeding) is preserved in most of older people

The differential mediating roles of resilience in the relationship between meaningful living and stress among college students during the COVID-19 pandemic

The current literature, mostly Euro-American based, indicates that the presence of meaning in life (MIL) improves resilience and lowers stress. However, the differential mediating roles of resilience in the relationship between the search for and presence of MIL, and stress have not been explored. This study aimed to investigate the differential mediating roles of resilience in the relationship between the presence of and search for MIL, and stress among Omani college students amid the COVID-19 pandemic. This cross-sectional study consisted of the Brief Resilience Scale, Perceived Stress Scale 4, and Meaning in Life Questionnaire, as well as socio-demographic questions. A path analysis model was used to examine the hypothesis. A total of 970 Omani college students responded to the questionnaire. Findings indicate that searching for MIL was significantly associated with a high level of stress directly (β = 0.023; p < 0.001) and indirectly, through a negative effect on resilience (β =  0.006; p < 0.001). Conversely, the presence of MIL was significantly associated with a decreased level of stress directly (β = − 0.045; p < 0.001) and indirectly via a positive effect on resilience (β = − 0.151; p < 0.001). In keeping with the proposed hypothesis, this study contributes to the current knowledge, by extrapolating the effect of searching for MIL on resilience and stress, and culturally re-contextualizing MIL research. University counseling centers could adopt meaning-based strategies to mitigate stress by promoting meaningful living and resilience