Change In Visual Analogue Score Research Articles

Transforaminal Epidural Injection with Local Anesthesia and Steroid for Single-level Radiculopathy and Pain Score: A Prospective Study in the Tertiary Center of Western Nepal

Introduction: Radiculopathy resulting from prolapse of intervertebral disc commonly at L4-L5 and L5-S1, the prominent cause of low back pain affecting daily activities and has a significant socioeconomic burden. Hence, this needs to be addressed with a prominent solution, of which, the transforaminal epidural steroid injection has been one of the promising solutions these days. Aims: To assess the short term and long-term pain relief after transforaminal epidural steroid injection. Methods: 58 patients with radiculopathy at the single level of the lumbar or lumbosacral region were included for transforaminal epidural steroid injection with local anesthesia. Visual analog score, pain score was recorded before, in 15 minutes and four weeks after the steroid injection under C-arm guidance. Statistical analysis was done on the basis of Wilcoxon Signed Ranks Test, Spearman’s correlation test. A p-value < 0.05 was considered to be statistically. Results: The change in Visual Analog Score from the time of presentation in relation to short and long term was significant, viz; VAS0 VAS15m p<0.5 and VAS0/VAS4wks was p<0.5. There was a positive correlation between immediate pain relief and long-term pain reduction however it was not significant (r=0.28, p=0.10) Conclusion: This study suggested the improvement of symptoms with transforaminal epidural steroid injection with local anesthesia and showed a positive correlation between immediate and long-term relief of pain, however it may not be significant.

Pregabalin as an Adjunct Analgesic in Multimodal Pain Management in Patients Presenting with Acute Peri-Anal Fissure

Objective: To assess whether Pregabalin has a role as an adjunct analgesic in anal fissures along with standard conservative treatment.
 Study Design: Quasi-Experimental Study.
 Place and Duration of Study: Sir Ganga Ram Hospital, Lahore Pakistan, from Nov 2021 to Mar 2022.
 Methodology: Thirty patients that fulfilled the inclusion criteria presenting to the Outpatient Department of General Surgery were enrolled in the study and assigned to either the standard Treatment-Group or the Pregabalin-Group. Patients were given standard treatment consisting of 0.2% topical GTN cream, stool softeners and analgesics in the form of NSAIDs and Paracetamol for their acute anal fissure, or they were given standard treatment with adjunct Pregabalin 50mg twice a day. The numerical pain score was recorded at enrollment after one week of follow-up.
 Results: There was a significant difference between the change in visual analogue scores from baseline between both groups, (p-value of 0.008). There was a significant difference between days till maximum pain relief was achieved between the two groups (p-value of 0.01). 29(96.6%) of fissures were caused due to constipation.Conclusion: Pregabalin provides modest analgesic effects in anal fissures and may be used as an adjunct analgesic in patients with severe pain.

Cost-effectiveness of atenolol compared to propranolol as first-line treatment of infantile haemangioma: A pilot study

SummaryPropranolol is the first-line agent for the treatment of infantile haemangioma (IH). Due to its non-selective beta blockade respiratory adverse events are commonplace. Atenolol is a selective beta-1 antagonist and is a second line for patients with a significant respiratory history or those intolerant of propranolol. Previous studies suggest that the two treatments are equally efficacious; however; the narrow side effect profile and once-daily administration of atenolol makes it an attractive alternative. The aim of this study was to compare the cost-effectiveness of atenolol and propranolol in the treatment of IH.Over a two-year period, five patients with nine IH received the first-line treatment with atenolol. Nine individual lesions from six propranolol patients were matched to these lesions, according to patient demographics and IH characteristics. Treatment response was determined by two independent clinician using both the Visual Analogue Score (VAS) and Haemangioma Activity Score (HAS). A cost-analysis of those treated with atenolol was undertaken and compared to the equivalent costing for standard and maximum dose propranolol. Treatment efficacy of atenolol was comparable to propranolol with mean change in VAS and HAS scores of -7.0 (vs -7.2) and 6.1 (vs 5.7), respectively. The cost analysis revealed atenolol was over 20 times less expensive than standard dose propranolol. In conclusion, the findings of this study suggest that atenolol is significantly less expensive and at least as effective as propranolol. These findings highlight the need for a multicentre randomised controlled trial to further investigate the cost-effectiveness of these two agents in the treatment of IH.

Long-term Outcomes of Coalition Resection in Adult Tarsal Coalition

Category:Hindfoot; OtherIntroduction/Purpose:Although the diagnosis, treatment, and natural history of tarsal coalitions has been well described in the adolescent population, there remains a paucity of orthopaedic literature on outcomes associated with coalition resection with or without interposition in the adult population. This study is the first to evaluate clinical and radiographic outcomes in adult patients with tarsal coalition resection without interposition.Methods:All patients with symptomatic tarsal coalition (subtalar, calcaneonavicular, or talonavicular) who failed conservative management and underwent coalition resection with concomitant procedures as indicated by their pathology between January 2006 and December 2014 were included in our retrospective case series. Demographics, clinical outcomes, patient comorbidity information, visual analogue scale (VAS) pain scores were collected. Advanced imaging (CT or MRI) was reviewed to determine fibrocartilaginous or osseous coalition. The primary outcome was reoperation. Secondary outcomes were change in visual analog score (VAS), and minor complications (local wound care, use of antibiotics, and skin dehiscence).Results:68 patients (52.9% males, 47.1% females; average age 35.9 years old, range 18 to 70) met inclusion. Calcaneonavicular, subtalar, and talonavicular coalitions were resected in 45.6% (n=31), 54.4% (n=37), and 0% of patients, respectively. At average final clinical follow up of 36 months, there were a total of 33 reoperations in 33.8% of patients (n=23) most commonly including subsequent fusion (n=11), exostectomy (n=10), and removal of hardware (n=15). There was no significant difference in reoperation (42.3% versus 63.1%, p=0.454) or fusion (19.4% versus 19.2%, p=0.99) following subtalar or calcaneonavicular coalition resection. Average VAS score preoperatively and postoperatively was 5.8 to 3.0. Minor complications were present in 16.2% of patients (n=11; 3 local wound care, 10 use of antibiotics, and 0 skin dehiscence).Conclusion:The present study demonstrates overall improvement in VAS score by an average of 2.8 points following subtalar and calcaneonavicular coalition resection. Although 33.8% of patients may anticipate additional surgery, the majority of patients may expect long-term maintenance of improvement in pain without subsequent fusion.

A Comparative Study Between 2 Intracarpal Partial Shortening Osteotomy Techniques for Type II Lunate Kienbock Disease

Partial capitate shortening is a decompression procedure for the treatment of positive or neutral ulnar variance Kienbock disease. In 45% to 73% of population, the lunate has a separate hamate facet which is also known as a type II lunate. We hypothesized that capitate shortening alone may not ensure adequate decompression of type II lunate, therefore, an added hamate shortening was performed aiming at a better distal unloading in these situations. Thirty Kienbock patients, stage II, type II lunate, and ulna positive or neutral variance, were recruited in this study, Half of which underwent an isolated partial capitate osteotomy, while the other half underwent a combined partial capitate-hamate osteotomy. The 2 groups were matched making the osteotomy type the only variable in the study. Postoperative changes in visual analogue score, the quick Disability of the Arm Shoulder and Hand questionnaire, Stahl index, and radioscaphoid angle in lateral view radiograph were recorded. Flexion and extension range of motion using a goniometer, and grip strength using dynamometer were recorded as percentage of the contralateral normal wrist. All the patients were followed up for 18 months. The 2 groups were comparable preoperatively as regards to the clinical and radiologic parameters. Postoperatively, there was no clinical nor radiologic, statistically significant differences between the 2 groups. We conclude that either isolated capitate shortening osteotomy or combined capitate/hamate osteotomy techniques can achieve very comparable results, both with good outcomes.

360o View of a Day Hospital Program Performing Exchange Transfusion and Outpatient Pain Management on Adults with Sickle Cell Disease

Purpose: Therapeutic erythrocytapheresis, known also as automated red blood cell exchange transfusion (RBC exchange), is standard of care for patients with sickle cell disease (SCD) presenting with severe complications and for primary prevention of CNS events in those with increased risks. There is limited data on the framework and experience of performing this procedure in a large adult population and even less on challenges and outcomes. Here, we present demographic and statistical data highlighting characteristics of the chronic exchange transfusion program at a comprehensive and multidisciplinary adult SCD center. Methods: Data were collected from adults (18 years and older) with a diagnosis of SCD that were receiving blood transfusions in the outpatient treatment facility from September 1st, 2017 to August 31st, 2018. Data gathered included age, gender, procedure indications and frequency, hemoglobin S percentage (Hb S%), target pre and post Hb S%, ferritin trend, and type of intravascular device used for procedure. Three hundred and forty-four (344) episodes of transfusions, were performed in 52 unique patients, corresponding to 21 % of the unique patients treated at our center during that period. Two hundred and sixty-two (262) of the transfusion procedures were RBC exchanges. These RBC exchanges were performed in 35 (14%) of the unique patients. Since a sizable proportion of our patients received pain treatment during RBC exchange, we explored how the pain visual analog score (VAS) changed while undergoing pain treatment during RBC exchange and in relation to multiple opiate doses. Descriptive and basic statistical analysis were performed on the data obtained for those receiving RBC exchange alone or in combination with pain management. Results: Thirty-five unique patients underwent RBC exchange during the study period. All but two (2) patients had the procedure via an implanted dual lumen Vortex port, one (1) by an arteriovenous fistula and one (1) via his native veins. Most of the RBC exchanges were performed as part of a chronic transfusion program for one of the following indications: primary prevention of stroke; secondary prevention of stroke; recurrent acute chest syndrome (ACS); intractable pain; presence of multiple comorbidities including pulmonary hypertension, chronic kidney disease and intractable leg ulcers. One patient received RBC exchange in preparation for bone marrow transplant. The three (3) other patients that only received one (1) RBC exchange during that period were previously on exchange transfusion but discontinued the procedure due lack of venous access or benefit from the procedure. The frequency of RBC exchange varied depending of the patient's specific indication for the procedure and the ability to reach a target Hb S% goal of < 30%. The RBC exchange occurred in patients as frequently as every four (4) to seven (7) weeks. The number of transfusions per patient/year ranged from one (1) to thirteen (13) with a mean and median of eight (8). Number of RBC units used per procedure ranged from four (4) to thirteen (13) with a mean of eight (8.6), with each unique patient usually receiving the same amount. Twenty-three (66%) unique patients received, at least once, acute pain treatment - oral, intravenous, or a combination during RBC exchange. The mean change of VAS between presentation and end of the pain management period was 1.9 (p<0.0001). Conclusion: Our data shows that therapeutic RBC exchange are performed on a regular basis on a small but significant subgroup of patients living with SCD and treated at a comprehensive SCD center. Intravenous opioid management of acute pain can be effectively performed while receiving RBC exchange which provides patients with multimodal interventions in the outpatient setting. The relationship between change in VAS and concurrent transfusion deserves further investigation. Although there are standard indications for RBC exchange, we and others use it for indications for which there is low level of evidence or no evidence of efficacy (i.e. leg ulcers). We found that there great variability on the frequency of the procedure, total number of RBC exchanges per year and number of RBC units used. Prospective studies are needed to better understand the short and long-term effects, complications and outcomes of chronic RBC exchange in adults living with SCD. Figure Disclosures Kato: Bayer: Research Funding; Novartis, Global Blood Therapeutics: Consultancy, Research Funding. De Castro:Pfizer: Consultancy; Novartis: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees.

Effects of Mobilization Time on Occurrence of New Fractures after Vertebroplasty.

Introduction Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results The mean follow-up period was 9 months (7–13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p < 0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p > 0.05). Conclusion We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.

Percutaneous balloon compression of Gasserian ganglion for idiopathic trigeminal neuralgia

Objective: The aim of this study was to evaluate the outcome and complication in patients with idiopathic trigeminal neuralgia (TN) posted for percutaneous balloon compression (PBC). Materials and Methods: The study included twenty patients of idiopathic TN presented in the outpatient department of pain clinic posted for PBC from the years 2016 to 2018. All patients were followed up for 6 months after the balloon compression of Gasserian ganglion. Out of the twenty patients, 40% were female and 60% were male. The mean age was 55.4 years (range: 37–70 years). These patients were on antineuropathic (carbamazepine, baclofen, and gabapentin) drugs with inadequate pain relief and 13 patients also had undergone radiofrequency ablation. PBC of Gasserian ganglion was planned by the technique described by Mullan and Lichtor in all patients. Visual Analog Score (VAS) and Barrow Neurological Intensity (BNI) score were compared pre and post procedure. Intraoperative and postoperative complications and side effects were analyzed retrospectively. Results: Eighteen out of twenty patients (90%) had excellent results with improvement in the VAS and BNI scores, which was statistically significant. The difference between the mean change in VAS and BNI scores for single nerve and multiple nerve roots was not statistically significant. Nearly 85% (17) of the patients had initial facial numbness, which improved in about 3 months. Only 10% of the patients had residual facial numbness, which was mild in nature and not bothersome to the patients. Masseter muscle weakness was present in seven (35%) patients. No patient reported corneal anesthesia or any other complications. Intraoperatively, four patients (20%) experienced moderate-to-severe bradycardia during entry to the foramen ovale and on inflation of the Fogarty balloon, which responded to injection atropine 0.6 mg intravenously stat. Conclusion: Hereby, we state that PBC is an effective and safe method with marked improvement in pain scores and improvement in quality of life of patients of idiopathic TN.

Outcomes of Hip Arthroscopy in Adolescents: A Comparison of Acute Versus Chronic Presentation. Two-Year Minimum Follow-up.

Hip arthroscopy has been shown to be effective in managing various hip pathologies, including labral tears in adolescent patients. The purpose of this study was to ascertain whether outcomes of hip arthroscopy in patients under the age of 18 treated for labral tears differ depending on whether the presentation was acute or chronic. We also present the outcomes of the largest prospectively collected study on hip arthroscopy performed for labral tears in adolescents. Patient reported outcome scores (PROs) for 194 patients undergoing hip arthroscopy for hip pathology, who were 18 or under at the time of surgery were prospectively collected and retrospectively reviewed. Modified Harris hip score (mHHS), Nonarthritic hip score (NAHS), Hip Outcome score-sport specific scale (HOS-SSS) and Visual Analogue Score (VAS) were the PROs collected. The overall cohort was assessed for outcome and a comparison was made between those patients who presented with acute onset of symptoms versus those who presented with insidious onset. There was significant improvement in all the PROs for the overall cohort, with improvement maintained over an average of 38.5 months. There was no significant difference in outcome scores, between the acute and chronic groups except for change in VAS. Preoperative scores in the acute group were significantly lower, while postoperative scores did not differ. A trend toward more improvement was noted for the acute group. Overall need for revision surgery was 12%, with a higher rate of revision in the acute group. Hip arthroscopy in adolescent patients being treated for intra-articular pathology is a safe procedure with favorable outcomes at minimum 2-year follow-up, with no significant difference in final outcomes between patients with acute onset of symptoms as opposed to those with more a more chronic presentation. Reoperation rate may be higher in patients with an acute onset. Level II.

Particulate vs Non-Particulate Steroids for Transforaminal Epidural Steroid Injections: Systematic Review and Meta-analysis of the Current Literature

Background: The efficacy of particulate and non-particulate steroids in patients receiving epidural steroid injections remains unclear. Objective: The purpose of this meta-analysis was to compare the efficacy of particulate and non-particulate steroids in patients receiving epidural injections for radicular pain over 3 months. Study Design: Systematic review and meta-analysis. Methods: We reviewed PubMed, PubMed Central, Scopus, Central Register of Clinical Trials of the Cochrane Collaboration, Google Scholar, and Directory of open access journals for trials that compared efficacy of particulate steroid with non-particulate. A meta-analysis was performed on treatment related to mean change in visual analogue score (VAS) between the particulate and non-particulate steroids. Two authors independently reviewed the data for inclusion. Results: Seven studies comprising 3,542 patients in the particulate group and 856 patients in the non-particulate group were included. Pooled mean maximum change of VAS was higher by 0.53 (95% CI: 0.14 to 0.92; P = 0.007; I2 = 50.2%) in the particulate group compared to the non-particulate group. The non-particulate group had a larger proportion of patients with more than 50% pain relief than the particulate group [OR 0.81 (95% CI: 0.68 to 0.97, P = 0.024). Limitations: Limited number of trials that fit the inclusion criteria and were available for analysis. Conclusions: As the use of particulate steroids seems to be associated with slightly better VAS scores only, clinicians need to weigh their clinical relevance in the light of complications and recent FDA recommendations on the use of particulate steroids. Key words: Meta-analysis, particulate epidural steroids, non-partiuclate epidural steroids, efficacy, decrease in pain scores

A Prospective Study to study the Efficacy and Side Effects of Ormeloxifene in Regression of Mastalgia and Fibroadenoma: Is It the Ideal Drug?

ABSTRACT Ormeloxifene (Centchroman) is a novel nonsteroidal, selective estrogen receptor modulator birth control pill which has also been used recently for the treatment of mastalgia and fibroadenoma. Fibroadenomas are the most common benign breast tumors in women but worrisome for women fearing cancer. Mastalgia whether cyclic or noncyclic may be severely incapacitating for women. This study aims to analyze the effect of this new drug on the regression of mastalgia and fibroadenoma as an alternative to presently available steroid-based drugs with significant side effects. Materials and methods This was a prospective study involving 100 women of reproductive age group (up to 35 years of age) attending the outpatient department (OPD) in Malhotra Nursing Home, Agra and Rainbow Hospital Pvt Ltd., Agra, India, from August 2011 to August 2014, complaining of mastalgia and/ or fibroadenoma and fulfilling the inclusion criteria. After informed consent, these women were divided into a mastalgia group who had mastalgia with or without nodularity and a fibroadenoma group having sizes 1.5 to 2 cm, single or multiple in one or both breasts. Ormeloxifene 30 mg on alternate days was administered for 3 months in both the groups. Patients were followed at 1, 2, 4, 8, 12 and 24 weeks to assess response to therapy. Clinical examination, change in nodularity by palpation, breast lump size by ultrasonography, change in visual analog score (VAS) and breast tenderness were monitored. Results were analyzed using ‘t’ test. Results A total of 100 patients were included in this study. Eighty percent women belonged to the age group 25 to 35 years with a mean age of 28, 31.2 and 27.2 years in groups IA, IB and group B respectively. Mean interval between drug therapy and onset of response was 6 ± 2 days in mastalgia group and 15 ± 2 days in fibroadenoma group. 97.6 to 100% of women in the mastalgia group reported complete relief at 12 weeks of therapy with a decrease in VAS score from 10 to 3 in the first week of therapy itself while 28% of fibroadenoma group reported complete relief at 12 weeks of therapy, partial relief in 31% and equivocal response in 41%. Side effects observed were allergic rash development (2%) and a delay in menstruation of 7 to 10 days (14%) during therapy. Conclusion Ormeloxifene is a novel nonsteroidal drug found to be effective in treatment of mastalgia and partially in treatment of fibroadenoma in a short period of 3 months. As compared to the drugs presently in use namely danazol and bromocriptine, ormeloxifene is safer as suggested by its side-effect profile and is cost-effective too. There is need for prospective large randomized studies to compare this low-cost drug with the standard but costly drugs being prescribed at present. How to cite this article Gupta N. A Prospective Study to Study the Efficacy and Side Effects of Ormeloxifene in Regression of Mastalgia and Fibroadenoma: Is it the Ideal Drug? J South Asian Feder Obst Gynae 2016;8(1):48-56.

Minimally Invasive Spinal Surgery in the Elderly: Does It Make Sense?

Lumbar degenerative disease can have varied pathoanatomy, with stenosis, spondylolisthesis, and scoliosis contributing to significant pain and disability. Among appropriately selected patients, surgical intervention can treat both back pain and leg pain and improve quality of life in a cost-effective manner with an acceptable safety profile. The evolution of minimally invasive surgical (MIS) techniques offers the potential to decrease the physiological impact of surgery and to improve the complication profile while achieving the same spine surgical objectives. The utility of such techniques among elderly patients >65 years of age has not been rigorously evaluated, and this systematic review sought to define the utility and safety of MIS spinal surgery for decompression, interbody fusion, and deformity correction in this population. Review of 2 studies for MIS lumbar decompression reveals that the majority of elderly patients exhibit significant improvements in pain (change in visual analog score for leg pain, 3.4 points) and disability (change in Oswestry Disability Index, 19 points), with inadvertent durotomy in 3% of patients. Review of 4 studies for MIS lumbar interbody fusion reveals robust improvement in pain (change in visual analog score for leg pain, 3.4 points; change in visual analog score for back pain, 7.2 points), with inadvertent durotomy in 5% of patients. Narrative review was performed for adult degenerative deformity correction, revealing that MIS techniques are feasible for managing such patients with acceptable rates of osseous union and complication. On the basis of largely low-quality, retrospective evidence, we recommend that elderly patients should not be excluded from MIS interventions for symptomatic lumbar degenerative spinal disease.

Partial evacuation of the fracture haematoma does not potentiate the analgesic effect of infiltrated local anaesthetic in the manipulation of distal radius fractures

Wrist haematoma blocks increase the volume of the fracture-soft tissue envelope and the resulting compartment pressures. We hypothesised that evacuating the haematoma before infiltrating with local anaesthetic would reduce the risk of undue swelling and produce a more effective block as measured by changes in a visual analogue score for pain. A total of 100 patients (100 fractures) were recruited; 77 had the haematoma partially evacuated (Group 1) and 23 did not (Group 2). The volumes of infiltrated anaesthetic, timing of manipulation, rates of re-manipulation and splitting of cast were not different between the two groups. The mean visual analogue score before manipulation in the two groups were 7.8 and 7.5, respectively, which declined to 3.2 and 2.5 at 5 min and to 2.8 and 2.4 at 10 min. The differences in change in visual analogue score were not significant at 5 and 10 min ( p = 0.42, p = 0.55). This suggests that evacuation of the haematoma does not influence the analgesic effect of the infiltrated agent.

Low Energy Radial Extracorporeal Shock Wave Therapy as a Treatment for Chronic Patella Tendinopathy

A single application of radial SWT is a safe and effective treatment for chronic patellar tendinopathy Extracorporeal shock wave therapy (SWT) is effective for the management of chronic recalcitrant tendinopathy. The objective of the current study was to assess if SWT is effective for treatment of chronic patellar tendinopathy. Thirty-three patients with chronic patellar tendinopathy received low-energy SWT. Thirty-three patients with chronic patellar tendinopathy received additional forms of non-operative therapy (control group). Evaluation was by change in visual analog score (VAS), Victoria Institute of Sport Assessment Score for patellar tendinopathy (VISA - P) score and by Roles and Maudsley score. Mean pre-treatment VAS scores for the control and SWT groups were 7.5 and 7.8 respectively. One month, 3 months, and 12 months after treatment, the mean VAS for the control and SWT groups were 6.7 and 4.3 (p<0.001), 5.9 and 3.5 (p<0.001), and 5.1 and 2.7 (p<0.001) respectively. One month, 3 months, and 12 months after treatment, the mean VISA for the control and SWT groups were 50.7 and 65.5 (p<.001), 52.1 and 71 (p<0.001), and 54.9 and 74.5 (p<0.001) respectively. At final follow-up, the number of excellent, good, fair, and poor results for the SWT and control groups were 8 and 3 (p<0.001), 17 and 10 (p<0.001), 5 and 16 (p<0.001), and 3 and 4 (p<0.001) respectively. The percentage of patients with excellent (“1”) or good (“2”) Roles and Maudsley scores (i.e. successful results) 12 months after treatment was statistically greater in the SWT group compared to the control group (p<0.001). A single application of radial SWT is an effective treatment for chronic patellar tendinopathy.

Safety and effectiveness of insulin analogues in Moroccan patients with type 2 diabetes: a sub-analysis of the A1chieve study

AimTo determine the safety and effectiveness of insulin analogues in the Moroccan cohort of the prospective, multinational, non-interventional, 24-week A1chieve study. MethodsMoroccan patients with type 2 diabetes (T2D) starting biphasic insulin aspart 30, insulin detemir, and insulin aspart alone or in combination were included. The primary outcome was the evaluation of serious adverse drug reactions including major hypoglycaemic events. Secondary outcomes were changes in hypoglycaemic events, glycaemic parameters (HbA1c, fasting plasma glucose [FPG], postprandial plasma glucose [PPPG]), systolic blood pressure (SBP), body weight and lipid profile. Quality of life (QoL) was evaluated using the EQ-5D questionnaire. ResultsIn this analysis, 1641 patients (923 insulin-naive, 718 insulin-experienced) having a mean age 57.1 years, mean BMI 26.8 kg/m2 and mean diabetes duration 10.3 years, were included. Baseline HbA1c in the entire cohort was poor (9.7%, 83 mmol/mol). Insulin analogues statistically significantly improved glucose control (HbA1c, FPG and PPPG, p < 0.001) at Week 24. The rate of hypoglycaemia decreased from 9.31 to 4.71 events/patient-year (change in proportion of patients affected, p = 0.0002). A statistically significant improvement in lipid parameters (except HDL cholesterol) was observed while body weight changed minimally. Additionally, QoL was positively impacted (mean change in visual analogue scores from EQ-5D was 15.8 points, p < 0.001). ConclusionsInsulin analogue therapy resulted in improved glycaemic control and a significant overall decrease in hypoglycaemia in Moroccan T2D patients.

Repeated intravesical onabotulinumtoxinA injections are effective in treatment of refractory interstitial cystitis/bladder pain syndrome

To evaluate the efficacy and safety of repeated intravesical onabotulinumtoxinA (BoNT-A) injections for treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients confirmed to have IC/BPS and refractory to conventional treatments were treated with intravesical injections of 100 U of BoNT-A plus hydrodistention every 6 months for up to four times. Primary end-point was 6 months after the fourth BoNT-A injection. Measured parameters included O'Leary-Sant symptom score (OSS) including symptom and problem indexes (ICSI/ICPI), visual analogue score (VAS) for pain, voiding diary variables, urodynamic parameters, maximal bladder capacity (MBC), glomerulation grade, and global response assessment (GRA). Multiple measurements and Wilcoxon rank-sum test were used for comparison between groups. In overall patients, GRA, OSS, ICSI and ICPI scores, VAS, functional bladder capacity (FBC) and cystometric bladder capacity (CBC) all showed significant improvement. The glomerulation grade decreased (1.77 ± 1.06 vs. 1.19 ± 1.05, p = 0.026), but MBC remained unchanged. Among 31 patients, 19 (61%) had a GRA ≥ 2 and 12 (39%) had a GRA < 2 at end-point. Patients with a GRA ≥ 2 had significantly greater changes in OSS, ICPI, VAS, FBC and CBC than patients with a GRA < 2. Extended study revealed that persistent symptomatic improvement lasted 6-12 months in seven, 13-22 months in six and 23-51 months in six after the fourth BoNT-A injection. Five women who had GRA < 2 were found to have Hunner's ulcer. Lack of control is the main limitation. Four repeated intravesical BoNT-A injections were safe and effective for symptom and pain relief and increased bladder capacity for treatment of IC/BPS.

Safety and effectiveness of biphasic insulin aspart 30 in type 2 diabetes: Results from the ASEAN cohort of the A1chieve study

AimTo determine the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) in the ASEAN cohort of the A1chieve study. MethodsType 2 diabetes patients from Indonesia, Malaysia, Philippines and Singapore prescribed BIAsp 30 therapy were included. The primary outcome was evaluation of serious adverse drug reactions including major hypoglycaemia over 24 weeks. Secondary outcomes were changes in hypoglycaemic events, serious adverse events (SAEs) and effectiveness parameters. ResultsThis sub-analysis included 2798 patients (insulin-naive, 1903; insulin-experienced, 895) with mean age ± SD, 55.3±10.8 years, BMI, 24.9±4.6kg/m2 and diabetes duration, 7.5±5.9 years. Baseline HbA1c in the entire cohort was poor (9.9%, 85 mmol/mol). A total of 15 SAEs were reported in 7 insulin-experienced patients (1 moderate event was related to BIAsp 30). Overall hypoglycaemia at Week 24 was 0.88 events/patient-year compared to 1.71 events/patient-year reported at baseline (change in proportion of patients affected, p < 0.0001). No major hypoglycaemia was reported at Week 24. BIAsp 30 significantly improved glucose control (HbA1c, fasting plasma glucose and postprandial plasma glucose, p < 0.001) at Week 24. The proportion of patients achieving HbA1c <7.0% at Week 24 was 35.3% compared to 3.5% at baseline. The lipid profile and systolic blood pressure also improved significantly (p < 0.001). Quality of life was positively impacted (mean change in visual analogue scores from EQ-5D = 10.6±13.8 points, p < 0.001). ConclusionBIAsp 30 was well-tolerated and improved glucose control while decreasing the risk of hypoglycaemia.

Clinical safety and effectiveness of biphasic insulin aspart 30 in type 2 diabetes patients switched from biphasic human insulin 30: Results from the Indonesian cohort of the A1chieve study

AimTo evaluate the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) in Indonesian type 2 diabetes patients switched from biphasic human insulin 30 (BHI 30) as a sub-analysis of the A1chieve study. MethodsClinical safety and effectiveness over 24 weeks was evaluated in Indonesian patients who switched from BHI 30 to BIAsp 30 at the discretion of their physician. ResultsA total of 244 patients with mean age ± SD 55.6±9.5 years, BMI 24.6±3.8kg/m2, and mean diabetes duration 7.8±5.7 years were included. The mean pre-study BHI 30 dose was 0.56±0.25 IU/kg and the baseline BIAsp 30 dose was 0.60±0.26U/kg titrated up to 0.65±0.25 U/kg by Week 24. No serious adverse drug reactions were reported throughout the study. Overall hypoglycaemia decreased from 2.18 to 0.06 events/patient-year with a significant decrease in the proportion of patients affected (p < 0.0001). No nocturnal or major hypoglycaemia was reported at Week 24. HbA1c improved from 8.8±1.2% at baseline to 7.3±0.8% at Week 24. A total of 45 patients achieved HbA1c <7.0% as compared to 5 patients with HbA1c <7.0% at baseline. FPG and PPPG improved significantly after 24 weeks (p < 0.001). Quality of life was positively impacted (change in visual analogue scores, 3.0±11.6 points, p < 0.001). ConclusionSwitching from BHI 30 to BIAsp 30 in this Indonesian cohort was well-tolerated and improved glycaemic control with a decreased risk of hypoglycaemia.

Safety and effectiveness of biphasic insulin aspart 30 in type 2 diabetes patients switched from biphasic human insulin 30: Results from the Filipino cohort of the A1chieve study

AimTo evaluate the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) in Filipino patients with type 2 diabetes previously treated with biphasic human insulin 30 (BHI 30). Methods: Safety and effectiveness outcomes were measured in all patients switching from BHI 30 to BIAsp 30 in the Filipino cohort of the 24-week, multinational, prospective, non-interventional A1chieve study. ResultsA total of 111 Filipino patients (mean age ± SD, 57.4±12.8 years; BMI, 25.8±5.6kg/m2) with mean diabetes duration of 9.9±7.1 years switched therapy from BHI 30 to BIAsp 30. The mean pre-study BHI 30 dose was 0.65±0.28 IU/kg and the baseline BIAsp 30 dose was 0.65±0.26 U/kg titrated up to 0.70±0.26 U/kg by Week 24. No serious adverse drug reactions were reported. Overall hypoglycaemia was reduced from 5.62 to 1.98 events/patient-year. Minor and nocturnal hypoglycaemia decreased and no major hypoglycaemia was reported at Week 24. Glucose control improved from baseline to Week 24 (HbA1c, –2.2±2.1% [24±23 mmol/mol]; FPG, –72.0±71.8 mg/dL; PPPG, –145.5±125.4 mg/dL). A total of 24 patients achieved HbA1c levels <7.0% at Week 24 compared to 6 patients reporting this target at baseline. Quality of life was positively impacted at Week 24 (change in visual analogue scores, 15.3±16.9 points). ConclusionSwitching from BHI 30 to BIAsp 30 improved glycaemic control without increasing the risk of hypoglycaemia.

A Retrospective Review of Patient Outcomes in a Multi-Disciplinary Clinic Model for Treatment of Chronic Pelvic Pain

To assess the change in Visual Analog Score (VAS) in patients with Chronic Pelvic Pain treated in a Multi-Disciplinary Chronic Pelvic Pain Clinic. This study is a retrospective chart review of patients enrolled in a Multi-Disciplinary Chronic Pelvic Pain Clinic from July 2009 to January 2012. This study took place in an outpatient clinic setting. Female patients with Chronic Pelvic Pain. The pain level was assessed both pre-treatment and post-treatment with a Visual Analog Score (VAS). Treatments in the Multi-Disciplinary Chronic Pelvic Pain Clinic include oral medications, bladder instillations, trigger point injections, pelvic floor therapy, counseling and surgery when indicated. A total of 61 patients were identified from July 2009 to January 2012. Of these, 13 were lost to follow-up and/or incomplete data was obtained. Of the remaining 48 patients, the mean pre-treatment VAS score was 6.8. After treatment in the Multi-Disciplinary Chronic Pelvic Pain Clinic, improvement was seen in 91.6% (44/48) of patients, with a mean post-treatment VAS score of 2.9. Patients were staged according to the Multi-Organ Pelvic Pain Staging criteria (MOPPS). Please see table 1 below.Table 1MOPPS: MultI-Organ Pelvic Pain StagingSTAGE 0:Duration>1 month, but<6 months and/or one organ system affectedSTAGE 1:Duration > = 6 months, but<1year and/or one organ system affectedSTAGE 2:Duration > = 1 year, but <2 years and/or two organ systems affectedSTAGE 3:Duration > = 2 years, but <5 years and/or three organ systems affectedSTAGE 4:Duration > = 5 years and/or four or more organ systems affected Open table in a new tab Of the 48 patients, twenty-four were MOPPS Stage IV (50%); twelve patients were MOPPS Stage III (25%); eleven patients were MOPPS Stage II (22.9%); one patient was MOPPS Stage I (2.9%). Please see table 2 below for mean VAS score by MOPPS Stage.Table 2Mean VAS Pre/Post Treatment by StageMOPPS StagePre-treatmentPost-treatmentStage I2.01.0Stage II6.12.2Stage III6.22.2Stage IV7.63.7 Open table in a new tab The average length of enrollment in the Multi-Disciplinary Chronic Pelvic Pain Clinic was 6 months. Treatment in a Multi-Disciplinary Chronic Pelvic Pain Clinic results in improvement in patient pain level as measured by a Visual Analog Score.