Mean VAS Research Articles

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage.

The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear. We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months. Secondary outcomes included 12-month functional independence as assessed with the Functional Independence Measure (FIM; scores range from 18 to 126) and quality of life as assessed with the EuroQolfive-dimension, five-level (EQ-5D-5L) utility index (scores range from -0.1 to 0.95) and a visual analogue scale (VAS; scores range from 0 to 100); on each assessment, higher scores indicate better health status or quality of life. A total of 742 patients underwent randomization at 23 centers. The analysis of the primary outcome at 12 months included 725 patients (97.7%). An unfavorable neurologic outcome occurred in 122 of 364 patients (33.5%) in the liberal-strategy group and in 136 of 361 patients (37.7%) in the restrictive-strategy group (risk ratio, 0.88; 95% confidence interval [CI], 0.72 to 1.09; P = 0.22). The mean (±SD) FIM score was 82.8±54.6 in the liberal-strategy group and 79.8±54.5 in the restrictive-strategy group (mean difference, 3.01; 95% CI, -5.49 to 11.51). The mean EQ-5D-5L utility index score was 0.5±0.4 in both groups (mean difference, 0.02; 95% CI, -0.04 to 0.09). The mean VAS score was 52.1±37.5 in the liberal-strategy group and 50±37.1 in the restrictive-strategy group (mean difference, 2.08; 95% CI, -3.76 to 7.93). The incidence of adverse events was similar in the two groups. In patients with aneurysmal subarachnoid hemorrhage and anemia, a liberal transfusion strategy did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy. (Funded by the Canadian Institutes of Health Research and others; SAHARA ClinicalTrials.gov number, NCT03309579.).

Buffered 4% Articaine Reduces Pain and Enhances Anesthesia in Maxillary Third Molar Extractions: A Randomized, Double-Blind Split-Mouth Study

Background/Objectives: Buffered local anesthetics are suggested to enhance patient comfort and anesthetic efficacy during dental procedures. However, their advantages over non-buffered solutions in maxillary third molar extractions remain under-investigated. This prospective, randomized, double-blind, split-mouth study aimed to compare the efficacy of buffered versus non-buffered 4% articaine in terms of pain, anesthetic onset, and the duration of anesthesia during maxillary third molar extractions. Methods: Each participant randomly received two buccal infiltrations on two single appointments to extract maxillary third molars: one with 4% articaine buffered with sodium bicarbonate and the other with non-buffered 4% articaine. Pain during injection, post-extraction pain, onset time, and the duration of anesthesia were assessed using a visual analog scale (VAS; 0–10). Results: Fifty adult participants (23 males and 27 females) with a mean age of 21.6 years were included in the study. Buffered 4% articaine significantly reduced injection pain (mean VAS: 3.12 ± 1.36 vs. 4.2 ± 0.3, p = 0.0001) and post-extraction pain (mean VAS: 4.4 ± 1.75 vs. 5.76 ± 1.78, p = 0.0002) compared to non-buffered articaine. Additionally, buffered articaine demonstrated a faster onset of anesthesia (mean time (seconds): 85.92 ± 27.37 vs. 126.86 ± 33.15, p < 0.0001) and a longer duration of anesthesia (mean duration (minutes): 70.4 ± 13.64 vs. 51.4 ± 7.2, p < 0.0001). Regarding gender’s factor, the comparisons revealed no statistically significant differences (p < 0.05) in pain perception between males and females for either injection pain or post-extraction pain. Conclusions: Buffered 4% articaine provides superior anesthetic efficacy compared to non-buffered 4% articaine, enhancing patient comfort by reducing pain, accelerating onset, and prolonging the duration of anesthesia during maxillary third molar extractions.

Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.

Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs. The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR. After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores. Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications. UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes. Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.

Outcomes of Conservative Treatments Evaluations for Lumbar Radiculopathy

Background: Lumbar Radiculopathy (LR) is a condition characterized by motor, reflex and sensory changes, often causing significant pain and disability. Conservative treatments are commonly recommended as initial management options. This study aims to evaluate the outcomes of various conservative treatments for LR. Materials and methods: This prospective cohort study involved 100 patients diagnosed with LR who underwent conservative treatments between January 2023 and December 2023 at our Physical Medicine Department, Institute of Applied Health Sciences (IAHS). Treatments included physical therapy, NSAIDs, epidural steroid injections and activity modification. Baseline data, including demographic information, pain intensity (VAS) functional status (ODI) and quality of life (SF-36), were collected. Follow-up assessments were conducted at 6 weeks, 3 months and 6 months. Primary outcomes were changes in VAS, ODI and SF-36 scores. Secondary outcomes included patient satisfaction and the need for additional interventions. Data were analyzed using descriptive statistics, paired t-tests and ANOVA. Results: The mean age of participants was 45.3 years, with a slight male predominance (56%). At baseline, mean VAS was 7.8, ODI was 45.6 and SF-36 was 62.5. Significant reductions in VAS (2.6), ODI (18.7), and improvements in SF-36 physical (80.3) and mental (81.7) scores were observed at 6 months (p<0.05). Patient satisfaction at 6 months was highest for epidural injections (90%), followed by NSAIDs (85%), physical therapy (80%) and activity modification (70%). The need for additional interventions decreased to 8%. The incidence of adverse events was low, with physical therapy showing the lowest rates. Initial ODI score was a significant predictor of positive outcomes (p=0.03). Conclusion: Conservative treatments for LR are effective in reducing pain and disability and improving quality of life. All treatment modalities showed comparable efficacy, with low adverse event rates, supporting their use as first-line treatments. Initial disability levels should be considered in treatment planning to optimize outcomes. Further research is needed to refine predictive models and enhance individualized treatment strategies. IAHS Medical Journal Vol 7(1), June 2024; 80-85

Treatment of Diaphyseal and Metaphyseal Fractures of the Upper Limbs (Humerus, Radius, Ulna) Using Extension Casts

Fractures occur more often in the pediatric age group than in healthy adults. One reason for this is that children and adolescents are less skilled at-risk assessment. Humeral fracture comprises approximately 7-8% of all adult fractures in the western world. Adult humeral diaphysis fractures account for roughly 3% of all fractures and 20% of all humerus fractures. The aim of this study is to evaluate results of Management of Upper Limb Diaphysis and Metaphyseal Fractures (Humerus, Radius and Ulna) with Application of Extension Cast in closed fractures in adults to assess the functional acceptance of the procedure. The present study was carried out at Department of Orthopaedic Surgery BSMMU from June 2022 to July 2023. This hospital-based study is conducted to manage diaphysis and metaphyseal fractures by applying extension cast to improve range of motion. The study included upper arm fracture patients. Forty- two newly diagnosed cases of the fracture of upper extremities whose radiological and clinical record were intact, constituted the study cases. So, the individual was registered as a "case" after clinical diagnosis was confirmed. During follow-up after casting two patients never showed up so only 60 patients were chosen for the extension casting method. Patients in extension casting group were followed up from 14 to 22 months, with an average of (17.34±2.61) months. The full-length cast was applied from 4 to 6 weeks with a mean of 5 weeks. All casts were converted to the above elbow cast when the fracture became sticky. Radiological evidence of a fluffy callus appeared at an average of 35 days and bony union was achieved at a mean of (3.48±0.59) months. In current study after 1 year of treatment, the mean range of motion of all joints of affected limb became normal the mean VAS score after 6 weeks was 8 after 3 months the mean VAS score was 4 and after 6 months the mean was score was 1. Extension cast allows gravity to work all the time which is especially beneficial for comminuted fractures. This reduces the chances of limb shortening.

Analysis of Surgical Complications and Functional Recovery Following Arthroscopic ACL Reconstruction with Quadriceps Tendon

Introduction: Anterior Cruciate ligament (ACL) is one of the most important intra-articular ligaments of the knee joint. It is considered the primary restraint to anterior translation of the tibia on the femur. Nowadays the use of quadriceps tendon (QT) autograft has been steadily increasing for ACL reconstruction. Therefore, this study has been designed to assess the functional recovery and analyze the surgical complications following arthroscopic ACL reconstruction with quadriceps tendon. Methods: This was a prospective interventional study conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from March 2020 to August 2022. In our study, we included 30 patients with anterior cruciate ligament injuries who attended the orthopaedic department within the study period. Result: The mean ± SD age was 29.73 ± 7.00 years, with the majority (50%) in the 26-35 age group. This study found that 27 (90%) patients were male and 3 (10%) were female. Both Lysholm score and Tegner activity level score significantly increased after 9 months of operation. The postoperative mean VAS score was also significantly (p=0.001) decreased at 9 months after surgery. The majority (80%) of the patients had no complaints, while 16.7% had effusion and 3.3% had an infection. Conclusion: Our study found that the majority of the patients had no complications. After analyzing the results of the present study, we can say that arthroscopic isolated anterior cruciate ligament (ACL) reconstruction with quadriceps tendon showed satisfactory functional outcomes for the treatment of ACL injury.

The effects of virtual reality on pain, anxiety, and comfort during the chest tube removal procedure: A randomized clinical trial

PurposeThe purpose of the current study is to determine the effects of virtual reality on pain, anxiety, and comfort during chest tube removal. Materials and methodsThe research was conducted in the Cardiovascular Surgery Department of Atatürk University Health Practice and Research Hospital between January 2023 and April 2024. The study was performed as a randomized controlled experimental trial with a pretest-posttest control group. Eighty-two patients (41 in the intervention group and 41 in the control group) were included in the research. Patients in the intervention group watched a video with virtual reality glasses during chest tube removal. The “Descriptive Information Form,” “Visual Analog Scale,” “Verbal Pain Scale,” “State Anxiety Inventory,” and “Comfort Scale” were used to collect data. Number, percentage, mean, standard deviation, chi-square, paired sample t-test, independent sample t-test, Mann-Whitney U test, Wilcoxon test, and linear regression analysis were used in data evaluation. Our study was recorded in the Clinical Trials database with protocol number “NCT06550323.” ResultsThe groups had similar descriptive characteristics (p > 0.05). The pre-procedural mean pain, anxiety, and comfort scores were similar in the two groups (p > 0.05). The post-procedural mean VAS and verbal pain scores, mean anxiety, and comfort scores of the intervention group were lower in comparison with the control group (p < 0.05). ConclusionThe research findings showed that virtual reality significantly reduced pain and anxiety while increasing comfort levels during chest tube removal. Therefore, it is recommended that virtual reality be used during chest tube removal.

Correlation Between Catastrophizing and Pain in Knee Osteoarthritis Patients Awaiting Total Knee Replacement

Objectives: Osteoarthritis is a leading cause of pain and disability, particularly in the elderly population. Total knee replacement is the primary treatment for advanced knee osteoarthritis, but not all individuals who undergo total knee arthroplasty are satisfied with the outcome. Psychological factors, such as pain catastrophizing, have been identified as significant contributors to the development of chronic pain after knee replacement. This study aims to correlate catastrophizing thoughts with knee pain, function, and quality of life in patients with knee osteoarthritis awaiting total knee replacement. Methods: Patients awaiting total knee replacement completed questionnaires assessing pain, function, and quality of life, along with the Pain-Related Self-Statements Scale (pain catastrophizing scale). Results: Fifty-three patients were included in the final analysis (64.2% female). The mean PRSS score was 2.6 on a 0-5 scale. The mean VAS and WOMAC scores were 68.0 and 57.34, respectively. A strong positive correlation was found between PRSS and VAS (ρ=0.615; p=0.000) and between PRSS and WOMAC (ρ=0.682; p=0.000). There was also a negative correlation between PRSS and almost all SF-36 domains (-0.6 &lt; ρ &lt; 0.4; p &lt; 0.01). Conclusion: This study found a high incidence of pain catastrophizing among patients awaiting knee replacement and a direct correlation between pain catastrophizing scores and worse pain, function, and quality of life outcomes.

Comparative Study Of Fentanyl Versus Tramadol As Adjuvant With Low Dose Local Anaesthetic Ropivacaine (0.1%) For Epidural Labour Analgesia

Background: Epidural nerve block is widely used for labor analgesia because of its effective pain relief, reduced maternal stress response, improved parturient satisfaction, and potential ability to provide anesthesia. The quality of analgesiais improved with the combined use of a local anesthetic and an opioid when combined with the use of either agent alone. An example of avcombination epidural therapy that provides excellent sensory block with relatively little motor block includes a co-administration of ropivacaine and fentanyl or tramadol. Materials and Methods: The study was carried out at the Department of Anaesthesiology, Katihar Medical College &amp; Hospital, Katihar, Bihar, study was done for 1 Year, 100 individuals were enrolled, Group F (Fentanyl Group) with 50 patients received Ropivacaine and Fentanyl and Group T (Tramadol Group) with 50 patients received a Ropivacaine and Tramadol. Every variable was subjected to statistical analysis within the same individual and between 2 treatment categories using a suitable biostatistical methodology. Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 23.54±2.5, mean age in group T (ropivacaine with tramadol) was 23.86±2.17, and weight in group F was 56.78±2.75 and group T was 56.68±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (p&gt;0.05). More side effects were seen in group F. Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

Comparing the Exactech Equinoxe Reverse TSA for Fracture versus Degenerative Conditions: Five-Year Minimum Follow-Up

Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exists on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up. Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007-2018. Patients with a minimum follow-up of 5 years were then split into fracture and degenerative cohorts and matched 1:3 based on age, sex, and follow-up duration. Clinical and radiographic outcomes were compared between the cohorts including range of motion (ROM), patient-reported outcome measures (PROM), VAS pain score, complication and revision rates, implant characteristics, and scapular notching. This data was analyzed using Welch's t-test, Fisher's exact test, or Wilcoxon rank sum test. There were 384 total patients included in the study, with 96 fractures and 288 degenerative. At a mean follow-up of 6.4 years, the degenerative cohort had significant improvements in all PROMs and ROM, compared to their preoperative status. At the latest follow-up, the mean ASES score was 83 and the mean VAS pain score was 1.1 for both cohorts. Patients with degenerative indications had greater forward elevation which did not meet the minimally clinically important difference and greater internal rotation which did not meet the substantial clinical benefit threshold. Patient satisfaction was very high for both cohorts, with 97% in the degenerative cohort and 91% in the fracture cohort satisfied with the procedure (p=0.276). Complication and revision rates were similar between the two cohorts. Patients in the fracture cohort had a larger glenosphere diameter (p=0.045) and greater combined liner/tray offset (p=0.05). Patients in the elective cohort more frequently required an augmented baseplate (p<0.001). Scapular notching was 11% in the degenerative cohort and 9% in the fracture cohort (p=0.82). This study demonstrates no significant differences in the clinical or radiographic outcomes at a minimum of 5 years follow-up for patients undergoing rTSA for acute fracture versus degenerative conditions. Patients undergoing rTSA for either indication have similar rates of complications, revisions, and scapular notching, with high patient satisfaction. Patients undergoing rTSA for an acute fracture can expect similar results to those undergoing rTSA for degenerative conditions at minimum 5-year follow-up.

Selective Deep-Lobe Parotidectomy for Benign Parotid Gland Tumors.

Deep-lobe tumors have been shown to possess a significantly thicker capsule with less tumor penetration compared to superficial tumors. Thus, more conservative surgical approaches, rather than aggressive methods, have been proposed for treating benign deep-lobe tumors of the parotid gland. To evaluate the surgical outcomes and oncological safety of selective deep-lobe parotidectomy (SDLP) in patients with benign lesions located in the deep lobe of the parotid gland. Twenty-two patients who underwent SDLP were enrolled in the study. Data on age, sex, tumor size, hospitalization duration, recurrence, cosmetic outcomes, and complications-including facial nerve (FN) impairment, Frey's syndrome (FS), sialocele, first-bite syndrome (FBS), wound infection, hematoma, and seroma -were retrospectively evaluated from hospital records. Facial contour symmetry was rated by each patient using a 0-10 VAS score at least six months post-surgery. Final histopathological examination revealed that the most common tumor was pleomorphic adenoma (PA) (59.1%). Three patients (13%) experienced temporary paralysis of the marginal branch of the FN, with a House-Brackman Grade III, which resolved spontaneously within two months post-surgery. No cases of permanent FN paralysis, FS, FBS, or sialocele were observed in any patients. The mean VAS score for facial contour symmetry was 9.43 ± 0.78. No recurrence were noted in any patients over a median follow-up period of 71.7 ± 21.2 months. SDLP may facilitate the safe surgical removal of benign lesions located in the deep lobe of the parotid gland, with oncological safety, reduced complication rates, and improved cosmetic outcomes.

Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation.

The periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases. Between January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysis. In total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow-up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively. In selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure.

Effects of Intraoperative Lignocaine Infusion on Heamodynamics and Postoperative Analgesic Requirement after Day Case Laparoscopic Surgery

Background:Intravenous lignocaine is an amide local anaesthetic known for its analgesic, anti-hyperalgesic, anti-inflammatory and anti-arrhythmic properties. During perioperative period of laparoscopic surgeries haemodynamic alteration occurs due to laryngoscopy, intubation, and surgical excision, gas insufflation during pneumoperitoneum, inadequate analgesia and inadequate depth of anaesthesia. Intravenous lignocaine is often administered to suppress the haemodynamic response and as an analgesic agent. We aimed to evaluate the effect of intravenous infusion of lignocaine on haemodynamic response and post-operative analgesic requirement. Objectives:The purpose of this study was to evaluate the effect of intravenous infusion of lignocaine on haemodynamic and postoperative analgesic requirements after laparoscopic day case surgeries. Material and method:Four hundred Sixty (460) patients were selected who’s were going to be operated for laparoscopic surgeries (Laparoscopic Cholecystectomy, laparoscopic Hernioplasty, laparoscopic appendicectomy, Diagnostic laparoscopy due to infertility) were grouped into exposed (Group L) who were received lignocaine infusion @1mg/kg/hr and controlled (Group C) who were received placebo. Systematic random sampling was employed. Results:Demographic characteristics were comparable between the groups p&gt;0.05. In lignocaine group intraoperative mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate were significantly lower than control group (p&lt;0.05). Twenty four hour mean VAS score (0 – 10 cm) at immediate recovery, 1st, 2nd, 3rd, 6th, 12th and 24th hour were lower in lignocaine group (p&lt;0.05). The mean time of first analgesic requirement were longer (120 minutes) in lignocaine group compared to 40 minutes in control group (p&lt;0.001) and the mean total tramadol consumption is less in lignocaine group (p&lt;0.001). Conclusion:Intra operative lignocaine infusion causes more haemodynamic stability and decreases postoperative pain score, required longer time for first analgesic requirement and reduced total analgesic consumption in laparoscopic surgeries. J Bangladesh Coll Phys Surg 2024; 42: 312-320

The Efficacy of Exercise-Based Rehabilitation in Treating Ulnar Wrist Pain

Background: Exercise-based rehabilitation effectively treats ulnar wrist pain, enhancing pain relief, grip strength, and mobility. Targeted exercises lead to significant pain reduction and functional recovery. Aim of the study: This study aimed to assess the efficacy of exercise-based rehabilitation in treating ulnar wrist pain. Methods: This cross-sectional study was conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2023 to December 2023. This study includes 60 patients with ulnar wrist pain who were divided into two groups: Group A (30 patients) received rehabilitation therapy, and Group B (30 patients) received no therapy. Result: The mean age was 45.2 ± 10.5 years in Group A and 43.2 ± 9.7 years in Group B (P = 0.4466). Gender distribution was balanced, as were the mean pain durations (P = 0.7200). At baseline, Group A's mean VAS score was 7.8 ± 1.2 and Group B's was 7.6 ± 1.4 (P = 0.5548). After 12 weeks, Group A's pain score decreased significantly to 2.5 ± 0.7, while Group B's remained at 6.6 ± 1.2 (P &lt; 0.0001). Group A's grip strength increased from 18.5 ± 3.5 kg to 33.0 ± 2.8 kg, compared to Group B's 20.5 ± 3.8 kg (P &lt; 0.0001). Group A also showed greater wrist ROM and PRWE score improvements. Conclusion: This study concludes that exercise-based rehabilitation significantly reduces pain, enhances grip strength, and improves wrist range of motion in patients with ulnar wrist pain.

Outcomes of acetaminophen infusion on visual analogue scale with varying pain intensity during labour, A randomized controlled trial.

Acetaminophen (Paracetamol) is the most widely used analgesic. We aimed to determine its efficacy in labour with varying pain intensity, to make labour less painful for women. This randomized controlled trial was conducted on primigravida's in their active phase of first stage of labour at Pharmacology department of Army Medical College, National University of Medical Sciences in collaboration with Gynecology department of Pak Emirates Military hospital, Rawalpindi. It was a registered trial with trial number of IRCT20220308054220N1. Duration of study was from May 2022 to October 2022. Patients were divided into two groups, Group-I received two doses of I/V 100 ml normal saline whereas Group-II received I/V two doses of 1000 mg acetaminophen in 100 ml normal saline. Calculated sample size was 130, 65 in each group. Visual analogue scale was used as a tool for data measurement. Data was analysed using split plot anova test. Mean VAS in acetaminophen infusion group was found to be less than placebo for 1st dose, but this effect was apparent only one hour after 2nd dose intervention. The difference in means between groups was statistically significant only for 1st dose with p-value of 0.003 (for second dose p-value 0.21). In acetaminophen infusion group, for both doses mean VAS decreased as an immediate effect of drug, but then it increased with time. The difference in VAS between intervals had p-value of <0.001 for 1st dose and 0.005 for 2nd dose. Acetaminophen is an effective non opioid labour analgesic in active phase of first stage of labour.

Clinical Results of Isolated MCL Grade III Injury in Acute and Chronic Setting: Systematic Review and Meta-analysis.

The medial collateral ligament (MCL) is frequently involved in injuries around the knee but is uncommonly treated surgically. There are various techniques to reconstruct the medial side of the knee, which have varying outcomes. The purpose of the present systematic review and meta-analysis is to describe the clinical results of surgical management of acute and chronic isolated grade III MCL injury using various functional scores, such as IKDC, Lysholm, and VAS, and to ascertain complication rates associated with these interventions. A systematic review was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, and two independent authors (L.F and A.M) conducted a comprehensive search across multiple databases (PubMed, Web of Science, and Scopus). They reviewed each article's title and abstract for studies available until April 2024. The search terms used were "((MCL) OR (Medial collateral ligament)) AND (injuries) AND (treatment)". The full texts of the studies were evaluated when eligibility could not be assessed from the title and abstract. The pooled proportion (percentage) of complications from the three studies reporting data on surgery for the MCL acute stage was 15.3% with 95% CI [6.1% to 24.6%]. No complications were reported in studies reporting surgery in the chronic stage. Marked resolution of pain was observed with the mean VAS Score for pain at the final follow-up after surgery for MCL injury in the acute stage was 0.4 with 95% CI [-0.04 to 0.84]. The mean IKDC score at the final follow-up in the three studies reporting data on surgery for the MCL in the acute stage was 79.39 with 95% CI [67.96 to 90.82], and in the chronic stage, was 85 with 95% CI [83.02 to 86.98]. The mean Lysholm Score at the final follow-up after surgery for MCL injury in the chronic stage was 83.04 with 95% CI [75.24 to 94.84], and in the acute stage was 95 with 95% CI [91.76 to 98.24]. This systematic review found that functional outcomes regarding IKDC and LYSHOLM scores were comparable for surgeries performed in acute and chronic MCL tears. There was a marginally increased risk of complication in surgeries performed for acute MCL tears. Compared to the acute phase, a marked resolution of pain was observed at the final follow-up after surgery for MCL injury. Systematic review; level of evidence, 4..

Comparative effectiveness of endoscopic plantar fasciotomy, needle knife therapy, and conventional painkillers in the treatment of plantar fasciitis: a real-world evidence study

Plantar fascia (PF) is the commonest causes of foot pain in the adult population. Several surgical treatments are available to treat PF. This study was aimed to investigate the clinical efficacy of three different treatments for plantar fasciitis. It was conducted among 60 patients, divided equally into three treatment groups named Needle Knife Therapy, Endoscopic Plantar Fasciotomy, and Conventional Painkillers. Descriptive and analytical analysis were done by using SPSS 25 software. VAS and AOFAS scores were analyzed. The maximum (n = 31) participants were in 41–60 year age range group with normal BMI. These differences of mean VAS and AOFAS pain scores between different treatment groups were statistically significant (One-way ANOVA, p < 0.01). Both scores found lower in the Endoscopic Plantar Fasciotomy group. This study opens a new window of knowledge to achieve sustained pain relief and functional improvement. Moreover, the superiority of Endoscopic Plantar Fasciotomy in treating plantar fasciitis compared to Needle Knife Therapy and Conventional Painkillers was explored.

Dorso Lumbar Fractures Type A1 Treated by Segmental Fixation versus Conservative Treatment

Abstract Background Thoracolumbar fractures types A1 of AO classification are very common spine injuries. However, its management is usually without operative intervention especially if its patients are neurologically intact. Objective Dorsolumbar fractures are treated either with operative (posterior fixation) or conservative. The aim of this study is to compare the results of conservative versus operative treatment in a certain type of fracture (type A1 dorsolumbar fracture) regarding fracture and radiological parameters. Patients and Methods 60 patients were enrolled in the current study, 29 were males and 31 were females with a mean age of 31.300 years old in non operative patients and 33.867 years old in operative patients at time of surgery. Results Regarding radiological parameters, this study included measurements of local kyphosis angle, and vertebral body wedging. The results showed statistically significant differences between preoperative values in comparison to both postoperative and follow up values. Regarding the functional assessment scores, the mean VAS was 1.125 in non operative patients and the mean VAS was 1.040 in operative patients. The mean ODI was 10.633 % in non operative patients and about 8.700% in operative patients at the last follow up visit. There is no great difference between operative and non operative patients in VAS and ODI but there is more satisfaction in operative patients. The degree of kyphosis is more in non operative patients which made few of them in mild pain in the last follow up. The complications encountered were very few, not including any major or neurological complications. Conclusion The only purpose to do fixation on those patients of type A1 fracture is to permit early ambulation and to protect them from kyphosis. but VAS and ODI have no big difference between the two groups but more in non operative in cases suffering from post traumatic kyphosis.

Meniscal-wall ultrasound-guided steroid infiltration for degenerative meniscal lesions (DML) shows low rate of conversion to surgery

IntroductionDegenerative meniscal lesions (DML) are frequent in the general population. However, the management of stable DML is always a challenge due to the lack of universal consensus and evidence. HypothesisWe assessed ultrasound-guided corticosteroids medial meniscal-wall infiltration as a conservative therapy for symptomatic DML and we searched for associated factors of very good response. Our hypothesis is that these injections will contribute to avoid the surgical treatment and improve clinical and functional scores. Material and methodsAn observational retrospective study included patients with DML of medial meniscus without mechanical symptoms of catching or locking, and without radiological signs of osteoarthritis, who underwent meniscal-wall corticoid infiltration under ultrasound between 2020 and 2021. Evaluations were carried-out at 24 months minimum after infiltration to determine any surgical intervention performed and assess clinical and functional outcome by a standard questionnaire to evaluate pain score using VAS at rest and on walking, SKV and TEGNER. Patient characteristics at the time of the infiltration were collected to determine the factors associated with very good response (SKV > 90). Results187 patients were included. Surgery-free survival was 95% (90–97) (33,17 (SD, 6,40) months), mean VAS pain score at rest of 1.47 (SD, 2.51), mean VAS on walking of 2.47 (SD, 2.91), mean SKV score of 71.32 (SD, 22.75) and mean Tegner score of 6.75 (SD, 1.67) at a minimum of 24 months follow-up. BMI was significantly lower in the very good responders (SKV > 90) with a p = 0,017 (24.04 (SD, 3.82) in patients with SKV > 90 versus 26,23 (SD, 4.93) in patients with SVK ≤ 90). ConclusionUS-guided meniscal wall infiltration is able to provide lasting symptom relief and functional recovery over time, in addition to low rate of conversion to surgery for patients suffering from DML without radiological signs of osteoarthritis. Level of proofIV; retrospective study.

Complications after reverse total shoulder arthroplasty in the Korean population: a single center study of 299 cases

BackgroundKnowledge regarding differences in the order of frequency of complications after reverse total shoulder arthroplasty (RTSA) between Asian and Western populations is limited. We therefore asked for (1) What is the order of frequency of complications after primary RTSA in the Korean population? (2) What are the rates of complication, reoperation, and revision, and clinical outcomes after index surgery? MethodsWe retrospectively reviewed the 299 consecutive cases who underwent primary RTSA with more than 1 year of follow-up over a period of 12 years. The mean age of the patients was 73.4 years (range, 58-88 years) and the mean follow-up period was 3.8 years (range, 1-11.5 years). Evaluation of the clinical outcomes, complications, and reinterventions was performed at the final follow-up. ResultsThe mean VAS pain score, UCLA score, ASES score, and SSV improved from 6.7, 10.2, 30.7, and 27.7% before RTSA to 1.4, 26.4, 80.5, 77.2% after RTSA, respectively (P < .001). Overall, 45 complications (15.1%) were observed in 44 patients. The order of frequency of complications was as follows: 16 cases of scapular stress fracture (5.4%), 9 intraoperative or postoperative periprosthetic fracture (3.0%), 6 brachial plexus injury (2.0%), 4 instability (1.3%), 2 glenoid loosening (0.7%), 2 glenoid disassembly (0.7%), 2 periprosthetic joint infection (0.7%), 1 glenoid fixation failure (0.3%), 1 humeral stem fixation failure (0.3%), 1 hematoma (0.3%), and 1 complex regional pain syndrome (0.3%). Reintervention was performed in 15 cases (5.0%) including reoperation (8 cases; 2.7%) and revision surgery (7 cases; 2.3%). ConclusionAt a mean follow-up period of 3.8 years, primary RTSA showed satisfactory clinical outcomes with a complication rate of 15.1%, a reoperation rate of 2.7%, and a revision rate of 2.3%. Scapular stress fracture appears to be the most common complication after RTSA in the Korean population.