Follow Ups Research Articles

Difficulties in Conducting Long Term Follow Ups in Psychotherapy Research-Issues in the Literature and Data From a Randomized Therapy Comparison Study for Posttraumatic Stress Disorder.

Studies of psychotherapy for posttraumatic stress disorder (PTSD) typically encompass short follow-up periods, leading to a dearth of information on the long-term course of symptoms after treatment. We summarize existing long-term follow-up studies and highlight the issues making such research difficult. In this context, we report on a 2-year follow-up on a randomized treatment study comparing dialogical exposure therapy and cognitive processing therapy for adults with PTSD after type I trauma. Many of the problems connected to long-term follow-up also pertained to this study. Attrition was high, and the recruited sample was not representative of the study completers. Gains made during therapy were mostly stable, with no significant differences between interventions. At least for an originally successful subset of patients, the gains made during both treatments in our study tended to stay stable 2 years after the end of treatment.

A comparative study of efficacy of tadalafil and alfuzosin regimens in patients of benign prostate hyperplasia

Background: Aim of the study was to compare efficacy of Tadalafil and Alfuzosin regimens in patients of Benign Prostate Hyperplasia.Methods: It was a comparative, prospective, observational, non-invasive, parallel and randomised study conducted at the Outpatient Department of Urology, Rajindra Hospital, Patiala. 60 patients diagnosed with Benign Prostate Hyperplasia along with Lower Urinary Tract Symptoms, out which, 30 patients, consuming Tadalafil and 30 patients consuming Alfuzosin were considered. History regarding the concerned disease and the compliance of treatment was taken. Symptom scores were assessed with the help of International Prostate Symptom Score, Quality of Lifestyle Score and Erectile Dysfunction Score. Physical examination consisting of Focused Neurological Examination along with Digital Rectal Examination were conducted. Parameters like Renal Function Test, Urine analysis, Ultrasound of Prostate and uroflowmetry were also considered.Results: The mean age selected for study was 64 years for Tadalafil and Alfuzosin group. The mean level of IPS Score, Qol Score and ED Score at the first day of inclusion of patients were 23.96±4.49, 4±0.78, and 25.33±4.02 respectively for Tadalafil group and regarding Alfuzosin group they were 25.23±4.84, 3.56±0.81, and 26.1±4.04 respectively. Follow ups were conducted at 15 days, 1 month and 3 months for both the groups which were found to be statistically significant after 3 months and Alfuzosin showed a favourable result.Conclusions: Alfuzosin 10mg given at daily dose was found to have higher efficacy than Tadalafil (5mg).

Antecubital arteriovenous fistula in hemodialysis; a comparison between side-to-side versus end-to-side venous anastomosis

Introduction: Chronic Kidney Disease (CKD) is a global health problem which is growing in prevalence. Hemodialysis is the most common treatment for end-stage renal disease (ESRD) which requires a permanent vascular access. Vascular accesses should have a good patency and low complication. Objectives: The present study aimed to compare side-to-side (STS) versus end-to-side (ETS) methods in antecubital arteriovenous fistulas in dialysis patients. Patients and Methods: In this randomized, single-blind clinical trial, 100 ESRD patients who scheduled for hemodialysis were divided into two groups. STS arteriovenous anastomosis was employed in one group and in the other, the ETS approach was conducted. Follow ups were done after 1, 8, and 24 weeks to detect fistula maturation and immediate or delayed complications. Results: The STS anastomosis group demonstrated higher rates of delayed maturation, vascular aneurism, and venous hypertension syndrome than ETS anastomosis group. The ETS group, however, showed higher rates of venous thrombosis and vascular stenosis. Overall, the rate of complications was 24% and 8% for STS and ETS anastomosis group respectively (P =0.03). Conclusion: In comparison, ETS arteriovenous fistulas involve less complications than STS method in ESRD patients. However, more thrombosis and stenosis detected by ETS method. ETS arteriovenous fistulas had less delayed maturation, aneurism, venous hypertension and overall complications than STS approach. ETS arteriovenous fistulas contributes to establishing a more stable connection to hemodialysis machine to conduct a more effective hemodialysis.

A study of Kapandji intrafocal pinning for the treatment of unstable extra articular distal radius fractures

Intrafocal pinning of distal radius fracture is indicated in unstable distal radius fractures without significant intra-articular displacement. It is a simple and effective, minimally invasive method of fixation for achievement of alignment and stability of unstable fractures. The study was conducted between November 2013 and October 2016. Patients attending the emergency and outpatient departments with history of trauma followed by pain and swelling of wrist, were evaluated clinically & radiologically. Patients with distal radius fracture who met the criteria were enrolled in the study. The operation was performed either under regional anaesthesia or intra venous anaesthesia. Reduction was carried out under image intensifier guidance and intrafocal pinning was undertaken with 2 Kirschner wires as described by Kapandji. Above elbow slab was applied for 3 weeks. Kirschner wires were removed at 6th week. Follow ups were done with radiological and functional evaluation on 1st week, 3rd week, 6th week, 12th week and 6 month. Of the 30 cases enrolled in our study, the age ranged from 40 to 72 years and the mean age of the patients was 54.77 years. The female/male ratio was 5:1 and the majority (83%) of patient sustained injury due to trivial trauma. All fractures united by 6 weeks. In the final follow up at 6th month, assessment of range of motion showed almost full range of motion. Functional evaluation was carried out with Gartland & Werleys Demerit point system (modified by Sarmiento et al). According to the score, 9 patients had excellent, 19 had well and 2 had fair results. None of the patient had poor results. Kapandji intrafocal pinning provides a stable fixation and good functional outcome in extraarticular distal radius fractures with few complications only.

Follow-up of acute pyelonephritis: what causes the diffusion-weighted magnetic resonance imaging recovery to lag clinical recovery?

To analyze with diffusion-weighted magnetic resonance imaging (DW-MRI) the evolution and progress to resolution of acute pyelonephritis (APN) foci over a period of 3months after onset. 30 women (age 22-51years) with clinical, laboratory (white blood cell and C-reactive protein), and DW-MRI (4b-values 0, 50, 600, 1000s/mm2) diagnosis of APN were prospectively enrolled. Two double-blinded radiologists evaluated the number of APN foci, and for each of them dimension (D), absolute diffusion coefficient (ADC), and its ratio R to the ADC of unaffected parenchyma. Signature of radiological recovery was focus no longer visible (DW-) and ADC of its site not inferior to the ADC of the unaffected parenchyma, i.e., R≥0.9. Clinical and DW-MRI follow-ups (FU) were performed at 1 and 3months. At the acute stage (t 0), 187 APN foci were found, with ADC0=1.3±0.2×10-3mm2/s, R 0=0.65±0.12, and D 0=14±7.5mm. By the 1-month FU (t 1), all patients had no symptoms and physiological laboratory values; despite this, only 80 (43%) foci were solved, increasing to 138 (74%) by at the 3-month FU. The ROC curve (AUC ≥ 0.80) identified R 0≤0.6 and D 0>15mm as forecast of slow radiologic resolution. About 80% of foci unsolved at 1month but with R 1≥0.8 and D 1≤10mm reached solution at 3months. DW-MRI recovery of APN foci does not always coincide with clinical recovery. The evolution of an APN focus is shaped by its initial values R 0 and D 0. About half of the foci still visible at 1 month reached radiological resolution in the two following months.

Intravitreal dexamethasone implant for recalcitrant cystoid macular edema secondary to retinitis pigmentosa: a pilot study

To determine the utility of the intravitreal dexamethasone implant as therapy for cystoid macular edema (CME) secondary to retinitis pigmentosa (RP) recalcitrant to carbonic anhydrase inhibitor therapy over 2years as a pilot study. This was a prospective case series. Patients who showed either an incomplete or no response to topical dorzolamide for at least 1month and oral acetazolamide therapy for at least 15days were recruited for the study with informed consent. A complete anterior and posterior segment examination was performed including fundus fluorescein angiography (FFA), optical coherence tomography scan (OCT) and electroretinogram to confirm the diagnosis. The dexamethasone implant was injected using a standardized technique. Follow ups were scheduled on days 1, 7, and 30 and then monthly thereafter for 2 years. The primary outcome measure was the change in corrected distance visual acuity (CDVA) and central subfield thickness (CST) at months 1, 6, 12, 18, and 24. The secondary outcome measure was complications, if any. Appropriate statistical analysis was done. Five patients (two males; six eyes; median age 49years) were recruited for the study. All patients required at least two injections over 2 years. All patients demonstrated significant improvement in CDVA (p = 0.004) as well as CST measurements (p = 0.0038) over 2years. No complications were noted. The intravitreal dexamethasone implant provides significant improvement in CDVA and CST measurements in patients with recalcitrant CME secondary to RP.

Gebe Kadınların Antenatal Testlere Yaklaşımını Etkileyen Faktörler

Objectives: Prenatal screening tests reduce the maternal and perinatal mortality as known. In our study, we aimed to investigate which factors affect the pregnant women most on how to take antenatal screening tests. We planned to evaluate the effects of media on pregnant women’s approach to antenatal screening tests. Materials and methods: 310 pregnant women who were admitted to the pregnancy outpatient clinic within 30 days have been evaluated by a variety of questions. Results: Follow ups of pregnant women by their gynecologists and family doctors increase the level of knowledge for screening tests. Particularly the pregnant women who do not want to take the diabetes screening test have been mostly affected by the media. Conclusion: Clinicians who examine to pregnant women firstly have a great duty to inform about them antenatal screening tests. We need to make arrangements on mediatic explanations that affect the pregnant women negatively about screening tests.

Patient Clinical Outcome after Reverse Shoulder Replacement: Implementing the Oxford Shoulder Score as a Cost-Effective Tool for Outpatient Assessment.

The aim of this study was to assess and calculate the number of follow-ups (FUs), relative cost, demographics, and overall patient satisfaction (as expressed in pain and function) after shoulder replacement surgery. Subjects included 54 patients (34 female, 20 male) who underwent reverse shoulder arthroplasty between 2011 and 2013 at East Surrey Hospital, United Kingdom. Patients were examined during a period of 3 yr and then 6-12 mo after final discharge. The mean FU period was 2 mo for 11 patients (4-13 mo for nine patients). Thirty-one patients were discharged after completing three FUs, seven needed more than three, and nine needed less than three. Two patients needed revision, and five did not come for review. After discharge, patients were assessed with the Oxford Shoulder Score (OSS), which showed that the majority of the 44 patients out of the 54 who answered (ten did not respond) were doing fine (42), and only two were unhappy. The frequent evaluation of postoperative patients provided the surgical team with the feedback necessary to study the clinical outcomes in relation to the above-mentioned procedure. The use of the OSS as an FU tool was easy and successful and illustrated that it has potential to reduce the number of FUs in the near future.

Levels of Circulating Intermediate Monocytes Decrease after Aortic Valve Replacement in Patients with Severe Aortic Stenosis.

Aortic valve stenosis (AS) is a chronic inflammatory disease. We have previously shown that severe AS is associated with increased levels of circulating intermediate monocytes. Haemodynamics are considered to influence levels of circulating monocyte subsets; we therefore hypothesized that aortic valve replacement may result in changes in the distribution of circulating monocyte subsets. In the present study, we evaluated levels of circulating monocyte subsets in patients with severe AS undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Levels of classical (CD14++CD16–), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) CD86-positive monocytes were determined by flow cytometry in peripheral blood of patients with severe AS before (baseline) and at 3- and 6-month follow-ups (FUP) after SAVR (n = 25 patients) or TAVR (n = 44 patients). Absolute and relative levels of circulating intermediate monocytes decreased from median 39.9/µL (interquartile range [IQR]: 31.7–53.6/µL) and 6.7% (5.6–8.1%) at baseline to 31.6/µL (24.3–42.4/µL; p < 0.001) and 5.4% (4.4–6.7%; p < 0.001) at 6-month FUP after aortic valve replacement, respectively. The decrease in levels of circulating intermediate monocytes appeared earlier (between baseline and 3-month FUP) in the TAVR group compared with the SAVR group (between 3- and 6-month FUP). In conclusion, levels of circulating intermediate monocytes decrease after SAVR or TAVR in patients with severe AS.

Socio-economic impact of renewable energy-based power system in mountainous villages of Nepal

Off-grid power system is well acknowledged as a viable alternative to grid extension in rural areas of developing countries. A significant portion of such projects has been installed in many developing countries through government subsidy program or donorfunded projects. Follow ups are necessary for the detailed analysis of the project results and to correctly determine the impact of the project and its success. This paper reports on the impact of tri-hybrid renewable energy off-grid system comprising of hydro, wind, solar energy in the remote mountainous village Thingan and Kolkhop in Makawanpur district of Nepal. A general demographic survey in Thingan and Kolkhop (N = 110) and post-electrification survey in Thingan (N = 48) were conducted after one year of installation of the power system. In this paper, we investigate the impact of electrification on the household’s lighting usage, education, social structure, environment, income and level of satisfaction. We also compare the difference in the quality of life before and after electrifying the village. The study reveals that electricity has played a great role both at individual and communal level in the form of quality lighting and power for productive work in the form of mechanization of daily chores and increasing the economic standard of villagers.

A New Era in Treatment of Non - Vital Primary Molars: One Year Follow-up Study

Background: Pulpectomy is a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma. Aims: The aim of this study is to apply blood clot technique for non-vital deciduous molars. Clinical and radiographical evaluations were carried out after 6 and 12 months. Materials and Methods: Twenty non vital primary molars from twenty children were involved in this study. The root canals are disinfected using triple antibiotic paste. Resembling to blood clot techniques carried out for non vital immature permanent tooth, blood clot created in root canal by by over instrumentation, and put sterile cotton pellet at the canal orifice wait 15 min for blood to clot. MTA barrier placed over blood clot about over the root orifices. The tooth then is restored with a restoration that seals the tooth from microleakage. Clinical and radiographical Follow ups carried out after 6 and 12 months. Results: All of cases have shown good clinical outcomes good radiographic evidences of absence of apical radiolucency and no root resorption. Conclusions: The blood clot technique considered to be the easier method of regenerative endodontics that could be carried out for primary and permanent non vital teeth.

Modified Manual Small Incision Cataract Surgery A Better Approachin terms of Post-operative Visual Recovery

The purpose of this study was to access the outcome of modified manual small incision cataract surgery (M-MSICS) in terms of postoperative visual recovery (Best Corrected Visual Acuity). In this prospective study, the patients having cataracts with nuclear sclerosis not more than early grade 3 were randomly assigned in 2-groups with 50patients in each group [Group A (C-MSICS), Group B (M-MSICS)]. Both techniques were compared for each stage in terms of postoperative visual recovery (Best Corrected Visual Acuity). Follow ups in postoperative period were carried out on 1st and 3rd postoperative days, 2 weeks, 4 weeks and 6 weeks. Significant early postoperative visual recovery was observed in Modified manual small incision cataract surgery (M-MSICS) as compare to conventional technique. Postoperative surgical induced astigmatism at 6 weeks was significantly less in M-MSICS group (p<0.05%). So it can be concluded that M-MSICS is better technique than C-MSICS in terms of early postoperative visual recovery & less postoperative surgical induced astigmatism. Key-wordsConventional manual small incision cataract surgery (C-MSICS), Modified manual small incision cataract surgery (M-MSICS), Postoperative visual outcome -------------------------------------------------IJLSSR----------------------------------------------INTRODUCTION Cataract is leading cause of blindness in India accounting for 62.6% and the prevalence of blindness is 1.1%.1 An estimated 4 million people become blind because of cataract every year, which is added to a backlog of 10 million operable cataracts in India, whereas only 5 million cataract surgeries are performed annually in the country.2 Thus, a technique of cataract surgery that is not only safe and effective but also economical and easy for the majority of ophthalmologists to master, is the need of the hour. MSICS is not only safe and economic but also have easy learning curve and ideal for developing countries. The outcome of cataract surgery in terms of early good visual recovery is single most important indicator of patient satisfaction, so keeping in view this fact, we modified the Access this article online Quick Response Code: Website:

Case Report on Multiple Pathologies in an Adolescent Sickle Cell Disease Patient in Ghana

Sickle cell Disease is the most common genetic disorder in children living in sub-Saharan Africa with a disease burden estimated between 2-4% in malaria endemic regions. The pathologies commonly affect multiple organs and present with other co-morbidities that complicate the disease process, resulting in diagnostic and management challenges. This case study presents a scenario of a sickle cell patient with multiple long term complications and Deep Vein Thrombosis (DVT) as a co-morbid condition. He did not benefit from early diagnosis and preventive management therapies. This 12-year-old known SCD patient presented with 2 months history of inability to walk, weight loss and pain in both legs to a tertiary hospital in Ghana. On examination he was wasted (Weight for Height z-score <-3SD) and pale. He had palpable axillary and inguinal lymph nodes. His right leg was swollen, warm, erythematous and tender. He had a gibbus deformity of the lower thoracic spine. Investigations revealed Hemoglobin 7.1g/dl, WBC of 13.51 X 109/dl with Neutrophils (65.3%). ESR-117, INR-1.05, Prothrombin Time-14.3secs and blood sugar-6.5mmol/L. Radiological findings revealed features suggestive of sickle cell disease with Thoracolumbar spondylodiscitis, likely pyogenic. Bilateral Avascular Necrosis of the femoral head, Septic arthritis of the right hip and left shoulder joint, Osteomyelitis of the left 8th and 9th ribs. Doppler Ultrasound of the lower limb revealed Right Popliteal and Posterior Tibial Vein Thrombosis with Pyomyositis. The patient was treated with Enoxaparin, Warfarin and IV antibiotics (Clindamycin and Ciprofloxacin). Follow ups with a repeat Doppler finding revealed a completely resolved thrombus with no evidence of DVT and normal INR and PT. Attention therefore needs to be paid to a multi-disciplinary preparedness and response approach to the management of SCD patients, as presented in this case report, to improve the quality of life, mitigate disability and reduce mortality.

Strategies for Scaling up HIV prevention among Adolescents: TASO Masaka Safe Male Circumcision Experience

Issue: Uganda has HIV prevelance of 7.3%; however HIV prevalence in Masaka is at 10%. TASO Masaka has 383 active adolescents in care. Men’s uptake of Safe Male Circumcision is at 34% in the central area of Uganda including Masaka. Safe male circumcision (SMC) is one intervention for HIV prevention that targets male adolescents directly. SMC was conducted at the facility with one mobilizer doing mobilization. There was also limited community leadership involvement in the program. To improve adolescents’ uptake of SMC services, TASO Masaka came up with strategies like training community linkage facilitators to mobilize adolescents for SMC, targeting schools, conducting dialogue meetings and setting up circumcision camps. Description: 6 dialogue meetings were conducted in 6 districts to allow community participation. 2 linkage facilitators were trained in SMC and community mobilization. Targeting schools for sensitization and encouraging adolescents seek consent from their parents. Offering free transport to facility and camping sites, Provided IEC through videos, flipcharts, fliers complemented by health talks and one to one counseling. Circumcised Peers were encouraged to do mobilization of their fellow peers. HCT and safe male circumcision services are provided to all eligible clients. Follow ups are done after 48 h, 7 days and 6 weeks. SMC telephone hotline was established for follow ups. Lessons learnt: Dialogue meetings help program implementers to work in a coordinated manner with meaningful involvement of community leadership. A total of 20786 adolescents received HCT and circumcision (6/1/2014 to 17/12/2015 contributing to 85% of the total men circumcised. Peer to peer mobilization has worked more with adolescents as compared to men. A school approach (221 schools) targeted many adolescents for mobilization and follow up services, 16628) adolescents were followed up in the review period. SMC camps bring services nearer to the community a, total of 1883 adolescents were circumcised in camps. 20786 Adolescents have tested for HIV, 100 treated sexually transmitted infections and receive risk reduction messages. The SMC hotline improved follow-ups, linkages and mobilization. Interventions that target a particular group for HIV prevention need a multidisciplinary approach.

Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery.

Objective:To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery (MIVS) for diabetic vitreous haemorrhage.Methods:One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab (Avastin) which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis.Result:A total of 122 patients were included; 78 (63.9%) males and 44 (36.1%) females. Mean age at the time of surgery was 51.4 ± 13.66 years. The mean preoperative BCVA was 1.64 ± 0.427 logMAR which improved to 0.57 ± 0.253 logMAR at 12 months post-operatively (p-value < 0.001). Recurrent vitreous haemorrhage was seen in four patients (3.28%).one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients.

Comparation in outcome of long segment fusion versus short segment fusion for the treatment of adult degenerative scoliosis

Objective To investigate the effect of decompression with long-segment (L) or short-segment (S) fusion on the outcomes of the surgical treatment for degenerative adult scoliosis (ADS) patiens. Methods A retrospective study on 32 patients treated in our department for ADS from April 2013 to May 2015 was carried out, including 12 male and 20 female (1∶1.7). Their average age was 66.4 (range: 51-77 years). All patients underwent decompression and fusion surgeries through posterior approach. They were divided into long-segment fusion group (L) and short-segment fusion group (S) according to fusion range. During follow-ups (FU), clinical outcomes were assessed by means of visual analog scale (VAS) and Oswestry disability index (ODI). Radiographic evaluation on full-length standing film included coronal Cobb's angle, distant between C7 plumb line and center sacral vertical line (C7PL-CSVL), thoracic kyphosis(TK) angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT), PI-LL, sagittal vertical axis(SVA). Postoperative complications were also recorded. Results All patients were followed up for average 2.2 years (range: 1.5-3.5 years). No significant difference of age or gender was found between two groups (L: 22, S: 10) of patients (P=0.066, 0.182). As for the fusion segments, group L (6.3±1.5) was more than group S (2.9±0.3) (P=0.001). Operation time and blood loss of group L were statistically more than group S (P 0.05); at the final FU, group L's ODI showed better functional recovery than group S's〔(12.8±9.3)% vs.(25.4±11.4)%, P 0.05), coronal Cobb's angle corrected more satisfactional in group L than group S (P<0.05). The same situation was found in C7-CSVL correction in two goup in FU (P<0.05). Sagital balance was restored to normal alignment better in group L than group S, with increase of lumbar lordosis after surgery. The overall incidence of postoperative complications was 31.3%, including wound infection, cerebrospinal fluid leakage, transient neurological symptoms and internal fixed rod breakage, more common in group L than group S. Conclusions Decompression and fusion with internal fixation showed good clinical outcomes in the treatment of ADS. Long-segment fusion yielded better coronal and sagittal correction outcomes with higher peri-operation risks; however, short-segment fusion showed higher safety with relatively inferior correction effect. Appropriate fusion mode should be chose according to the patient's deformity features. Key words: Scoliosis; Spinal fusion; Internal fixators

Effect of Nurse-Led Telephone Follow ups (Tele-Nursing) on Depression, Anxiety and Stress in Hemodialysis Patients

Introduction:Depressive and anxious patients on hemodialysis have a higher risk of death and hospitalizations. The aim of this study was to evaluate the effect of nurse-led telephone follow ups (tele-nursing) on depression, anxiety and stress in hemodialysis patients.Method & Material:The subjects of the study who were selected based on double blind randomized clinical trial consisted of 60 patients with advanced chronic renal disease treated with hemodialysis. The patients were placed in two groups of 30 individuals. Before the intervention, a questionnaire was completed by patients. There was no telephone follow up in the control group and the patients received only routine care in the hospital. The participants allocated to the intervention group received telephone follow-up 30 days after dialysis shift, in addition to conventional treatment. Every session lasted 30 minutes, as possible. Then the DASS scale was filled out by the patients after completion of study by two groups.Result:Significant differences were observed between the two groups in the posttest regarding the dimensions scores of DASS scale.Conclusion:The result of this trial is expected to provide new knowledge to support the effective follow-up for hemodialysis patient in order to improve their emotional and health status.

In a secondary care setting, differences between neck pain subgroups classified using the Quebec task force classification system were typically small - a longitudinal study.

BackgroundThe component of the Quebec Task Force Classification System that subgroups patients based on the extent of their radiating pain and neurological signs has been demonstrated to have prognostic implications for patients with low back pain but has not been tested on patients with neck pain (NP).The main aim of this study was to examine the association between these subgroups, their baseline characteristics and outcome in chronic NP patients referred to an outpatient hospital department.MethodsThis was an observational study of longitudinal data extracted from systematically collected, routine clinical data. Patients were classified into Local NP only, NP + arm pain above the elbow, NP + arm pain below the elbow, and NP with signs of nerve root involvement (NP + NRI). Outcome was pain intensity and activity limitation. Associations were tested in longitudinal linear mixed models.ResultsA total of 1,852 people were classified into subgroups (64 % females, mean age 49 years). Follow ups after 3, 6 and 12 months were available for 45 %, 32 % and 40 % of those invited to participate at each time point.A small improvement in pain was observed over time in all subgroups. There was a significant interaction between subgroups and time, but effect sizes were small. The local NP subgroup improved slightly less after 3 months as compared with all other groups, but continued to have the lowest level of pain. After 6 and 12 months, those with NP + pain above the elbow had improved the least and patients with NP + NRI had experienced the largest improvements in pain intensity. Similar results were obtained for activity limitation.ConclusionsThis study found baseline and outcome differences between neck pain subgroups classified using the Quebec Task Force Classification System. However, differences in outcome were typically small in size and mostly differentiated the local NP subgroup from the other subgroups. A caveat to these results is that they were obtained in a cohort of chronic neck pain patients who only displayed small improvements over time and the results may not apply to other cohorts, such as people at earlier stages of their clinical course and in other clinical settings.

SAUVE - KAPANDJI PROCEDURE FOR MALUNITED DISTAL RADIUS FRACTURE: A CASE REPORT

AbstractDistal radioulnar joint disorders are a frequent cause of wrist pain and instability. The etiology include displaced fractures or malunions of the distal radius and tears of the triangular fibrocartilage complex with DRUJ instability.A 47 year old gentleman presented to us with complaints of pain and deformity of the right wrist of one and half years duration. Radiographs revealed a malunited distal radius fracture.He underwent Sauve Kapandji procedure. Follow ups were done at periodic intervals and wrist physiotherapy was instituted. He had acceptable wrist motion at six weeks.

Visual outcome of 25-gauge microincision vitrectomy surgery in diabetic vitreous haemorrhage.

Objective:To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery (MIVS) in diabetic vitreous haemorrhage.Methods:This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus (DM) were included. There were 43 (71.7%) males and 17 (28.3%) females. Age range was 40 – 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively.Result:Best corrected visual acuity (BCVA) gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 ±0.226 logMAR, which was improved after final follow up to 0.457±0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract (1.7%), one (1.7%) had ocular hypotony defined as intraocular pressure < 5 mmHg and one (1.7%) developed endophthalmitis.Conclusion:25-gauge micro incision vitrectomy surgery (MIVS) is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications.