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

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

Isoniazid hair concentrations in children with tuberculosis: a proof of concept study

Assessing treatment adherence and quantifying tuberculosis drug exposure among children is challenging. We undertook a “proof of concept” study to assess the drug concentrations of isoniazid in hair as a therapeutic drug monitoring tool. Children <12 years of age initiated on thrice-weekly treatment including isoniazid (10 mg/kg) for newly diagnosed tuberculosis were enrolled. Isoniazid concentrations in hair were measured using liquid chromatography-tandem mass spectrometry at 1, 2, 4 and 6 months after tuberculosis treatment initiation. We found that isoniazid hair concentrations in all children on thrice weekly isoniazid were detectable and displayed variability across a dynamic range

Pattern of palpable breast lesions on fine needle aspiration: A retrospective analysis of 902 cases

Background : Breast lumps constitute a significant proportion of surgical cases in women of both developed and developing countries. The aim of this study is to look the frequency distribution of various breast lesions on fine needle aspiration (FNA). Materials and Methods : The 902 patients who presented with palpable breast lump, irrespective of age and sex were included in the study. Frequency distribution of various breast lesions with respect to age and sex was studied. Cytology grading in breast carcinoma was correlated in 69 cases with histology grading. Results : The majority (N = 871) of patients were females with maximum (N = 566) patients between second and third decade. The 773 patients had benign breast lesions and maximum (N = 341) patients were in the second decade. Fibroadenoma was the commonest benign lesion followed by fibrocystic change and mastitis. Out of 119 malignant breast lesions, 31.93% [N = 38] were between 41-50 years of age, 28.57% [N = 34] in 51-60 years and 22.68% [N = 27] in between 31-40 years of age. Out of 119 malignant breast lumps and majority were infiltrating ductal carcinoma (N = 108). Cytology grading correlated maximum with histology grade in Grade I followed by Grade II and Grade III. Conclusion : With experienced hands, FNA is safe, cost effective and a reliable technique for preoperative evaluation of palpable breast lumps. FNA features are more informative when combined with physical and radiology findings (Triple test). Fibroadenoma, fibrocystic change and mastitis form the major bulk of benign breast lesions. Epithelioid cells when seen in inflammatory breast FNA smears, tuberculosis must be ruled out. In India, breast carcinoma arises in younger patients as compared to western countries. Grading of breast carcinomas must be done on FNA smears for selecting neoadjuvent therapy. Clinical breast examination and mammography screening in females should be encouraged in developing countries from the third decade onwards for early detection of breast carcinoma

Role of direct immunofluorescence in the diagnosis of glomerulonephritis

Background: Immunofluorescence microscopy is a vital tool for the diagnosis of glomerular diseases. This study was carried out to study patterns of glomerulonephritis (GN) and to record the sensitivity of direct immunofluorescence (DIF) in renal lesions. The DIF findings were correlated with clinical and histopathology findings and discrepancies were analyzed. Materials and Methods: The cross-sectional analytical study was conducted during the period July 2011 to July 2013 at a tertiary care Hospital, Department of Pathology. A total of 75 renal biopsies were received for routine and immunofluorescence studies in which histopathology and clinical data were reviewed and analyzed. Results: The sensitivity of DIF was 87.9% and specificity was 70.5%. The maximum number of cases were seen in the age group 41-50 years. The pattern of GN by DIF was minimal change disease (MCD) in 24%, IgA nephropathy in 13%, focal segmental glomerulosclerosis in 9% and membranoproliferative glomerulonephritis in 8% of the cases. Twelve histopathologically proven cases of GN were negative on DIF. One case of MCD on histopathology was diagnosed as IgM nephropathy based on DIF. Conclusion: Direct immunofluorescence forms an important diagnostic tool in reaching the exact diagnosis in various types of GN presenting with overlapping clinical and histomorphological features

Evaluation of eperisone hydrochloride in the treatment of acute musculoskeletal spasm associated with low back pain: A randomized, double-blind, placebo-controlled trial

Background : Eperisone hydrochloride is a centrally acting muscle relaxant inhibiting the pain reflex pathway, having a vasodilator effect. Aims : To evaluate the efficacy and tolerability of eperisone in patients with acute musculoskeletal spasm associated with low back pain. Settings and Design : Prospective, randomized, double-blind, placebo-controlled, multicentric trial conducted at five tertiary care orthopedic centers across India. Materials and Methods : It was planned to enroll 240 patients of either sex between 18-60 years with acute musculoskeletal spasm (AMSP) with low back pain (LBP) due to spondylosis deformans, prolapsed disc or muscle sprain. Patients with other associated unrelated spasm conditions were excluded. Assessments were done for finger-to-floor distance (FFD), lumbar pain, Lasegue′s sign, tenderness of vertebral muscles, need for rescue medication and response to therapy for efficacy and tolerability. Statistical Analysis : Parametric data were analyzed by ′t′ test and ANOVA, and non-parametric data were analyzed using Mann-Whitney ′U′ test and Kruskall-Wallis test. Proportions were compared using Fischer′s (Chi-square) test. Results : Two hundred and forty patients were randomized to receive eperisone 150 mg/day in three divided doses (n=120) or placebo (n=120) for 14 days, of which 15 patients did not complete and 225 patients completed the study (eperisone, 112 and placebo, 113). Significantly greater improvement in FFD (P<0.001) from baseline on Day 14 was seen with eperisone (150.66 to 41.75) compared to placebo (138.51 to 101.60). Improvements in other parameters were greater with the eperisone group. For 89 (79.46%) patients the therapy was rated as good-excellent with eperisone compared to 43 (38.05%) patients with placebo. Nausea, abdominal pain, headache and dizziness were the common adverse events with both therapies. Rescue drug was needed by 40 (35.71%) eperisone patients and 83 (73.45%) placebo patients. Conclusions : Eperisone hydrochloride was effective and well tolerated for the treatment of patients with AMSP with LBP

Evaluation of eperisone hydrochloride in the treatment of acute musculoskeletal spasm associated with low back pain: A randomized, double-blind, placebo-controlled trial

Background : Eperisone hydrochloride is a centrally acting muscle relaxant inhibiting the pain reflex pathway, having a vasodilator effect. Aims : To evaluate the efficacy and tolerability of eperisone in patients with acute musculoskeletal spasm associated with low back pain. Settings and Design : Prospective, randomized, double-blind, placebo-controlled, multicentric trial conducted at five tertiary care orthopedic centers across India. Materials and Methods : It was planned to enroll 240 patients of either sex between 18-60 years with acute musculoskeletal spasm (AMSP) with low back pain (LBP) due to spondylosis deformans, prolapsed disc or muscle sprain. Patients with other associated unrelated spasm conditions were excluded. Assessments were done for finger-to-floor distance (FFD), lumbar pain, Lasegue′s sign, tenderness of vertebral muscles, need for rescue medication and response to therapy for efficacy and tolerability. Statistical analysis : Parametric data were analyzed by ′t′ test and ANOVA, and non-parametric data were analyzed using Mann-Whitney ′U′ test and Kruskall-Wallis test. Proportions were compared using Fischer′s (Chi-square) test. Results : Two hundred and forty patients were randomized to receive eperisone 150 mg/day in three divided doses (n=120) or placebo (n=120) for 14 days, of which 15 patients did not complete and 225 patients completed the study (eperisone, 112 and placebo, 113). Significantly greater improvement in FFD (P<0.001) from baseline on Day 14 was seen with eperisone (150.66 to 41.75) compared to placebo (138.51 to 101.60). Improvements in other parameters were greater with the eperisone group. For 89 (79.46%) patients the therapy was rated as good-excellent with eperisone compared to 43 (38.05%) patients with placebo. Nausea, abdominal pain, headache and dizziness were the common adverse events with both therapies. Rescue drug was needed by 40 (35.71%) eperisone patients and 83 (73.45%) placebo patients. Conclusions : Eperisone hydrochloride was effective and well tolerated for the treatment of patients with AMSP with LBP