Outcome of Endoscopic Discectomy in Patients with Lumbar Prolapsed Intervertebral Disc

Objective: To determine the outcome of endoscopic discectomyin patients with lumbar prolapsed intervertebral disc in terms of back pain and leg pain using the visual analogue scale.Material and Methods: Descriptive case series, was conducted at, PINS, LGH Lahore for 6 months. 15 patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All patients’ low back pain and leg pain was documented using visual analogue scale before and after 2 months of surgery.On the basis of VAS we calculated % age improvement of low back pain and leg pain after endoscopic discectomy, while ≥ 5 scale improvement was considered clinically significant.Results: Patients mean age was 44.46 years. Among them, 9 (60%) were males and 6(40%) were females. On average, the basal metabolic index (Kg/m2) was 29.29 However, the BMI of females was 31.76 and male was 27.65 Kg/m2. On average, the duration of symptoms was 8.05 months. On average, the Straight Leg Raise was 24.7o at the time of treatment. A decreased sensation was observed in L5 of 3 (20%) and in S1 of 4 (26.67%) participants. Whereas Absent sensation was observed in L5 of 3(20%) and in S1 of 5 (33.33%). Mean preoperative back pain and as well as leg pain was 7.05 that improved to 0.41 and 0.86 4 weeks post operatively.Conclusion: Endoscopic discectomy is equally effective in alleviating the symptoms without notable difference in surgical outcome

Role of interventional treatment in acute pain of herpes zoster and prevention of postherpetic neuralgia

Acute pain associated with herpes zoster (HZ) is the most debilitating symptom, which if not treated in early phase may lead to postherpetic neuralgia (PHN), a potentially crippling disorder with prolonged intractable chronic pain. The socioeconomic consequences secondary to prolonged severe pain include decreased socialization, depression, fatigue, restricted daily activities, and poor quality of life. HZ and PHN impose a significant economic burden in the form of direct inpatient care and loss of productivity. Early interventional treatments attenuate central sensitization by interrupting the transmission of nociceptive afferent impulses to the central nervous system and minimize nerve damage by improving blood flow to the nervous tissue in addition to the local anti-inflammatory action of corticosteroids. Interventions treatment options have been increasingly used as a part of multimodal approach in the management of acute pain of HZ in addition to pharmacological agent. This article reviews the various interventional treatment options which have used in the recent years for the management of acute pain of HZ and subsequent prevention of PHN

Interaction of anesthetic supplement thiopental with human serum albumin

Thiopental (TPL) is a commonly used barbiturate anesthetic. Its binding with human serum albumin (HSA) was studied to explore the anesthetic-induced protein dysfunction. The basic binding interaction was studied by UV-absorption and fluorescence spectroscopy. An increase in the binding affinity (K) and in the number of binding sites (n) with the increasing albumin concentration was observed. The interaction was conformation-dependent and the highest for the F isomer of HSA, which implicates its slow elimination. The mode of binding was characterized using various thermodynamic parameters. Domain II of HSA was found to possess a high affinity binding site for TPL. The effect of micro-metal ions on the binding affinity was also investigated. The molecular distance, r, between donor (HSA) and acceptor (TPL) was estimated by fluorescence resonance energy transfer (FRET). Correlation between the stability of the TPL-N and TPL-F complexes and drug distribution is discussed. The structural changes in the protein investigated by circular dichroism (CD) and Fourier transform infrared (FT-IR) spectroscopy reflect perturbation of the albumin molecule and provide an explanation for the heterogeneity of action of this anesthetic

A Study of the Use of Laryngeal Mask Airway (LMA) in Children and its Comparison with Endotracheal Intubation

Laryngeal mask airway (LMA) is increasingly being used in children as it is less invasive compared to endotra-cheal intubation and causes less discomfort in the postoperative period. However, some concerns remained about its safety during positive pressure ventilation in children. In a prospective randomized trial, 100 ASA I and II children weighing between 10-20 kg in the range of 2-10 years of age, scheduled for elective surgery were randomly allocated to one of the two groups of 50 patients each. The efficacy of LMA in children during positive pressure ventilation, its haemodynamic changes and postoperative complications were compared to endotracheal intubation. Insertion of LMA was easier in 94% patients while endot-racheal intubation was done easily in 53% of patients only (p< 0.05). The changes in haemodynamic parameters were significantly higher after endotracheal intubation as compared to LMA placement. Furthermore these changes per-sisted for longer duration after endotracheal intubation in comparison to LMA insertion (5 min vs 3 min). Incidence of postoperative complications i.e. bronchospasm, laryngospasm and soft tissue trauma was significantly higher (p< 0.05) after endotracheal intubation as compared to LMA insertion. To conclude, the laryngeal mask airway is a suitable alternative to endotracheal intubation for positive pressure ventilation in children

Noninvasive neuromodulation of supraorbital and occipital nerves as an adjunct to management of chronic headache: A pilot study

Background: Chronic daily headache (CDH) results in significant distress and a substantial impact on the quality of life. Due to its nature of refractoriness to conservative management, exploring other modalities seems worthwhile. Invasive nerve stimulation, though promising, has seen complication rates in plenty. The goal of the present study was to assess the efficacy of noninvasive neuromodulation of supraorbital and occipital nerves (SON and ON) using hybrid pulsed radiofrequency device (Stimpod NMS460) in patients of CDH. Methods: Thirty patients suffering from CDH were enrolled in this randomized double-blind sham-controlled trial and randomly allocated to two groups of 15 patients each. SON and ON stimulations were given using the device Stimpod NMS460 thrice a week for 3 weeks. Follow-up visits were scheduled at 6 and 12 weeks of therapy. Pain relief was measured using numerical rating scale score. The overall change in quality of life (measured by Short Form-12 Health Survey) and associated complications were also noted. Results: Successful stimulation (50% or greater decrease in pain intensity) was seen in 66.67% patients; inadequate response in 33.3% in the intervention group. The 50% responder rate in sham control group was 13.3%; remaining 86.6% showed an inadequate response. This response remained sustained up to 12 weeks of follow-up. Similar changes were observed in the quality of life of patients. No adverse effect was documented during the study period. Conclusion: Noninvasive neuromodulation may serve as a safer and cost-effective treatment option in CDH refractory to conservative management

Analyzing The Existing Undergraduate Engineering Leadership Skills

Purpose: Studying and analyzing the undergraduate engineering students\u27 leadership skills to discover their potential leadership strengths and weaknesses. This study will unveil potential ways to enhance the ways we teach engineering leadership. The research has great insights that might assist engineering programs to improve curricula for the purpose of better engineering preparation to meet industry\u27s demands. Methodology & Findings: 441 undergraduate engineering students have been surveyed in two undergraduate engineering programs to discover their leadership skills. The results in both programs were revealing that undergraduate engineering students are lacking behind in the visionary leadership skills compared to directing, including and cultivating leadership styles. Recommendation: A practical framework has been proposed to enhance the lacking leadership skills by utilizing the Matrix of Change (MOC), and the Balanced Scorecard BSC) to capture the best leadership scenarios to design virtual simulation environment as per the lacking leadership skills which is the visionary leadership skills in this case. After that, the virtual simulation will be used to provide an experiential learning by replacing human beings with avatars that can be managed or dramatized by real people to enable the creation of live, practical, measurable, and customizable leadership development programs

Simulation and Goal Programming Approach to Improve Public Hospital Emergency Department Resource Allocation

Efficient and effective operation of an emergency department is necessary. Since patients can visit the emergency department without making an appointment, the emergency department always treats a lot of critical patients. Moreover, the severity of the ailment determines which patients should be prioritized. Therefore, the patients are greatly impacted as a consequence of longer waiting times caused primarily by incorrect resource allocation. It frequently happens that patients leave the hospital or waiting area without treatment. Certainly, the emergency department’s operation can be made more effective and efficient by examining its work and making modifications to the number of resources and their allocation. This study, therefore, investigates the emergency department of a public hospital to improve its functioning. The goal of this research is to model and simulate an emergency department to minimize patient wait times and also minimize the number of patients leaving the hospital without service. A comprehensive simulation model is developed using the Arena simulation platform and goal programming is undertaken to conduct simulation optimization and resource allocation analysis. Hospital management should realize that all resources must be prioritized rather than just focusing on one or two of them. The case scenario (S3) in this study that implements goal programming with variable weights yields the most favorable results. For example, it is observed in this instance that the number of patients leaving the system without service drops by 61.7%, and there is also a substantial drop in waiting times for various types of patients

Pregabalin versus oxcarbazepine in painful diabetic neuropathy in elderly population: Efficacy and safety in terms of pain relief, cognitive function, and overall quality of life

Background and Aims: The treatment of painful diabetic neuropathy (PDN) in elderly patients is challenging considering the adverse effects associated with long term use of drugs. Pregabalin has been recommended as the first line therapy for relief of neuropathic pain in such patients. However, the occurrence of side effects especially cognitive dysfunction and peripheral edema raised concerns during long term therapy in elderly population. Recently, few studies have highlighted the role of oxcarbazepine, a second generation antiepileptic, in PDN. This prospective, randomized, single-blind, parallel-group study was done to compare pregabaline and oxcarbazepine monotherapy in patients of PDN. Materials and Methods: 150 elderly patients of painful diabetic neuropathy, for at least 6 months of duration with an average baseline pain score ≥ 4 on 11 point numeric rating scale (NRS), were divided into two groups to receive either pregabalin 150 mg/day or oxcarbazepine 600 mg/day. Assessment of pain scores, cognitive functions and quality of life were performed at different time intervals during the course of treatment. Results: Patients in both the study groups showed significant reduction in pain scores from the baseline; however no significant differences in pain scores were noted between the two groups during the course of treatment. The incidence of cognitive dysfunction as measured by BCRS score was significantly more in pregabalin group while no significant changes were noted in oxcarbazepine group. The overall quality of life as demonstrated by SF12 scores was significantly better in both the study groups as compared to baseline. Conclusion: Oxcarbazepine can be used as an alternative to pregabalin in elderly patients with PDN considering the similar degree of pain relief and better cognitive profile

Acute pain services in flail chest-a prospective randomized trial of epidural versus parenteral analgesia in me

Introduction: Flail chest following blunt trauma chest generally leads to severe pulmonary complications. Thoracic epidural analgesia by means of reducing the pain and consequent splinting may prove beneficial in improving the patient outcome in mechanically ventilated ICU patients. Methods: Twenty patients, 18–55 years of age having ⩾3 rib fractures with flail segment, and required mechanical ventilation in the year 2012–14 were included. Patients were randomly divided into groups of 10 patients each to receive either thoracic epidural analgesia with 4 mL of 0.125% bupivacaine bolus followed by infusion @ 4 mL/h with 2 μg/mL fentanyl as adjuvant (Group E) or parenteral analgesia in the form of i.v fentanyl in a dose of 2 μg/kg (group P). Duration of mechanical ventilation, change in tidal volume during initial 24 h, pneumonia, ARDS, length of ICU stay, mortality along with complication were recorded. Results: Duration of mechanical ventilation was significantly less in Group E than in group P (6 ± 2 days v/s 9 ± 3 days, p = 0.02). There was significant increase of tidal volume in 1st 24 h in group E (ΔTV: 156 ± 24 mL v/s 78 ± 13 mL in group E & P; p < 0.001). Incidence of pneumonia was 20% and 40% (p = 0.63) while ARDS was 20% and 35% (p = 0.35), in Group E and P respectively. Mortality was not different; however, length of ICU stay was significantly less in group E (9.5 ± 1.6 d v/s 12.8 ± 2.8 d, p = 0.004). No serious adverse effects were observed in any of the groups. Conclusion: Epidural analgesia significantly decreased the length of ICU stay and duration of mechanical ventilation in our study population