Single-blind Randomized Clinical Trial Research Articles

Electromyographic comparison of vastus medialis obliquus facilitatory versus vastus lateralis inhibitory kinesio taping in athletes with patellofemoral pain: A randomized clinical trial

BackgroundPatellofemoral pain (PFP) is among the most common orthopedic complications afflicting active young people. Diminished coordination of the vastii, delayed activation of the vastus medialis obliquus (VMO), and decreased VMO-to-vastus lateralis (VL) activity ratio are well documented as underlying causes of PFP. This study compares the effects of VMO facilitatory kinesio tape (KT) versus VL inhibitory KT on electromyographic (EMG) activity of the vastii, balance, and pain in athletes with PFP. MethodsIn this single-blind randomized clinical trial, thirty-two female athletes with PFP (mean age 26.33 ± 5.93 years) were randomly assigned to VMO facilitatory KT (n = 16) or VL inhibitory KT (n = 16) groups. In the facilitatory group, a Y-shaped strip of KT at 25% of its available tension was attached from the origin of the VMO to its insertion and in the inhibitory group, an insertion-to-origin Y-shaped strip of KT at 15% of its available tension was applied on the VL. Pain intensity, dynamic balance, and EMG data were assessed respectively with a visual analogue scale, the modified Star Excursion Balance Test, and an EMG telemetry system, before and immediately after KT application. ResultsPain intensity decreased and dynamic balance improved significantly after taping in both groups, and VMO: VL activity ratio increased significantly in the VL group. However, none of the parameters differed significantly between groups. ConclusionsBoth VMO facilitatory and VL inhibitory KT can improve pain and balance, while the inhibitory technique might be more effective in regulating the VMO to VL activity ratio in athletes with PFP.

Evaluation of the Clinical Efficacy and Complications of Duloxetine in Comparison to Solifenacin in the Treatment of Overactive Bladder Disease in Women: A Randomized Clinical Trial.

SNRIs (serotonin and norepinephrine reuptake inhibitors) like duloxetine are known to have role in the treatment of anxiety disorder and stress urinary incontinence. According to the correlation of anxiety disorder and overactive bladder, this study aimed to evaluate the clinical efficacy and complications of duloxetine (SNRI) as a medication in the treatment of overactive bladder in the female patients. We were interested to know the probable therapeutic effect and side effects of duloxetine in overactive bladder. In this single-blinded interventional randomized clinical trial, 60 female patients with idiopathic overactive bladder (hyperreflexia) referred to the urology clinic, were divided into two groups as pilots. The first group were treated by 10mg/daily solifenacin and the second group received 20mg/daily duloxetine. The patients were evaluated by the ICIQ-OAB Questionnaire before and after one-month follow-up period. The intervention primary outcomes were evaluated by the patient's presentation of the frequency, nocturia, urgency, urge urinary incontinence and the drugs side effects as secondary outcomes were checked. Results: Sixty women with confirmed overactive bladder disease were evaluated. Solifenacin and duloxetine had the same effect on the treatment of overactive bladder (p value=0.148). The clinical symptoms were obviously relieved in both groups after treatment. Side effects were insignificantly more common in the solifenacin group (p value>0.05). However, the different frequency of blurred vision in the two groups was statistically significant (p value=0.04). The most common complication in solifenacin and duloxetine group was anxiety. The results showed that solifenacin and duloxetine improved overactive bladder symptoms. According to this evaluation, duloxetine can be a suitable alternative option for overactive bladder treatment, due to the acceptable therapeutic effect and side effects.

Effect Of Frailty And Exercise On Fatigue, Physical Activity, Functional Ability And Muscle Strength In Adult Hematopoietic Cell Transplantation Recipients

PURPOSE: Intensive cancer treatment followed by hematopoietic cell transplantation results in moderate to severe fatigue, physical inactivity, diminished functional ability, and reduced muscle strength. These alterations may be magnified by frailty status. This study compared the effects of frailty (not frail, pre-frail, and frail) and exercise (strength training, n = 33, compared to attentional control with health education, n = 34) in adult hematopoietic cell transplantation recipients. Dependent variables included fatigue, physical activity, functional ability and muscle strength. METHODS: Subjects were randomly stratified by type of transplant (allogeneic or autologous) and age (≤ 60 years of age or > 60 years of age) in this single-blind randomized clinical trial. The strength training intervention consisted of a comprehensive program of progressive resistance introduced during hospitalization and continued for six weeks following hospital discharge. Subjects assigned to attention control with health education subjects received weekly health education post hospitalization. A composite frailty score was based on unexplained weight loss, poor hand-grip strength, self-reported exhaustion, slow walking speed, and low physical activity. Variables were assessed six weeks following hospital discharge. MANOVA was used to analyze the data. RESULTS: A significant interaction effect (frailty x exercise) was noted for fatigue, p = .007. Frail subjects in the health education with attention control group reported more overall fatigue compared to the strength training group, p = .04. Frail subjects in the health education with attention group reported more mental fatigue compared to the strength training group, p = .008. Significant frailty main effects were revealed for physical activity (p = .001), functional ability (p = .025), and muscle strength (p = .002). No significant main effects for exercise were identified. CONCLUSIONS: Strength training compared to health education with attentional control improved overall and mental fatigue in those who were frail. As expected, differences in physical activity, functional ability, and muscle strength were noted between frail, pre-frail and not frail hematopoietic cell transplantation recipients.

Superficial cryotherapy using dimethyl ether and propane mixture versus microneedling in the treatment of alopecia areata: A prospective single-blinded randomized clinical trial.

To verify and compare the therapeutic efficacy and safety of superficial cryotherapy using dimethyl ether and propane (DMEP) mixture vs. microneedling in the treatment of mild scalp alopecia areata (AA). In a prospective randomized single-blinded clinical trial, 80 patients with clinically evident scalp mild AA were randomly assigned into two groups of 40 patients each. Group (1) was treated by superficial cryotherapy using DMEP in three freeze-thaw cycles of 5s each. Group (2) was treated by microneedling. Both groups were treated every 2 weeks for 6 sessions and followed up for 3months after the last session. Patients were assessed by photographic documentation, trichoscopic evaluation, severity of alopecia tool (SALT) score, and alopecia areata symptom impact scale (AASIS). An excellent response was achieved in 15 (37.5%) of group (1) compared with 14 (35%) of group (2) patients, while a good response was achieved in 23 (57.5%) of group (1) compared with 21 (52.5%) of group (1) patients, with a statistically insignificant difference. The mean SALT score change percentage was a statistically significantly higher in group (2) patients. The mean AASIS change percentage was higher in group (1) patients, but this was a statistically insignificant. In both groups, the mean numbers of trichoscopic signs of AA significantly decreased from baseline to the end of follow-up period. Both therapeutic modalities were well-tolerated, with no recurrence after the follow-up period. Both superficial cryotherapy using DMEP mixture, and microneedling are simple, effective, and safe therapeutic options for mild scalp AA, however, microneedling showed higher efficacy.

Therapeutic Effects of Intra-articular Botulinum Neurotoxin Versus Physical Therapy in Knee Osteoarthritis.

BackgroundKnee osteoarthritis (KOA) is the most common cause of chronic knee pain, and disability and different modalities have been used to improve pain and function. Botulinum toxin intra-articular injection is proposed to manage resistant joint pains.ObjectivesThis study was carried out to compare therapeutic effects of intra-articular botulinum neurotoxin (BTX) versus physical therapy (PT) in KOA.MethodsIn this single-blind randomized clinical trial, patients with KOA attending to Imam-Reza Hospital, Tehran, Iran, from June 2018 to March 2019 were enrolled. Patients who met the inclusion criteria were randomly divided into BTX receiving a single intra-articular dose of 100 units (250 units from disport brand) and PT groups. The study was described for patients, and informed consent forms were received. For assessment of the pain and related severity, the VAS score and KOOS scales were used. Post-intervention assessment was done 1, 3, and 6 months after the intervention. The level of significance was set at α = 0.05. All data analyses were performed with SPSS version 26 for windows.ResultsIn this study, 50 patients were randomly divided into BTX and PT groups. All patients completed the study, and there was no loss to follow-up. There was no significant difference between demographic data of the two groups, including age and BMI. The VAS score was similar in the two groups at the beginning. KOOS subscales were not significantly different, but the quality of life was better in the BTX than the PT group (86.2 ± 15 vs. 72.1 ± 11.5, P < 0.001). One month after the intervention, all KOOS subscales were improved in the BTX group in comparison to the PT group (P < 0.001). This difference was statistically significant in the 3rd (P < 0.001 in all comparisons except Sport/Rec subscale in which P = 0.02) and 6th months (P < 0.001) after the intervention, and the improvement in all KOOS subscales and VAS score were higher in the BTX group than the PT group. The trend of KOOS subscales and VAS score was improved over time in the BTX (P < 0.001 in all tests), but the PT group showed no improvement (P > 0.05) except for Sport/Rec and VAS score (P < 0.001).ConclusionsTotally, it is concluded that the use of BTX can reduce pain and improve the function and quality of life in patients with KOA.

Investigation of the home-reablement program on rehabilitation outcomes for people with stroke: A pilot study.

Background:Reablement is 1 approach to conduct rehabilitation in the community (ie, home environment), which aims to enhance an individual's functional ability to perform everyday activities that individuals perceive as important. We investigated the effects of a home-reablement program on different rehabilitation outcomes in people with stroke.Methods:A single-blind randomized clinical trial was conducted. Twenty-six people with stroke were randomly assigned to the home-reablement group or control group. For 6 weeks, participants in the home-reablement group received training for activities of daily living (ADL) that they perceived as important but difficult to perform. Participants in the control group received conventional rehabilitation in the hospital. Outcome measures included the Fugl–Meyer Assessment for the upper-extremity (FMA-UE) and the Stroke Impact Scale 3.0 (SIS 3.0) subscales.Results:No statistically significant differences between the 2 groups were noticed in the FMA-UE and the SIS 3.0 subscales (P = .226–1.000). Small effect size (success rate difference = 0.12–0.25) were noticed in the FMA-UE and the 5 SIS 3.0 subscales. The home-reablement group exhibited a greater proportion of participants with scores greater than the minimal detectable change in the FMA-UE and the 6 SIS 3.0 subscales (ie, strength, ADL/instrumental ADL, mobility, emotion, memory, and participation).Conclusions:People with stroke that underwent the 6-week home-reablement program showed potential for improving their motor function, ADL/instrumental ADL, emotion, memory, and activity participation.

Dry Needling Plus Conventional Physiotherapy for Patients With Chronic Nonspecific Neck Pain: A Randomized Clinical Trial

Purpose: This study aimed to evaluate the effect of conventional physiotherapy plus Dry Needling (DN) technique in patients with chronic nonspecific neck pain with Sternocleidomastoid (SCM) and Upper Trapezius (UT) muscles involvement. Methods: This study was designed as a single-blind randomized clinical trial. A total of 39 patients (19 men and 21 women) with chronic non-specific neck pain with a Mean±SD age of 38.13±5.68 years, a Mean±SD height of 168.28±8.34 cm, and a Mean±SD weight of 75.78±9.02 kg participated in this study. They were randomly divided into conventional physiotherapy (control group: n=19) and conventional physiotherapy plus DN (intervention group: n=20). SCM and UT muscle pain, neck disability, and thickness were assessed for all participants in the pre-test, post-test, and follow-up periods. This study was reviewed and approved by the Faculty of Physical Education and Sport Science, University of Kharazmi, Tehran, Iran. Repeated measures analysis of variance and Bonferroni post hoc tests were used for data analysis using SPSS v. 22. Results: The results of 1-way analysis of variance showed that pain, neck disability, and SCM and UT muscle thickness in the intervention group had a significant decrease compared to the control group in the post-test and follow-up period (P&lt;0.05). Also, according to the results of the corrected Bonferroni post hoc test, the intervention group showed a greater effect size than the control group in the post-test and the follow-up periods in the above variables. Conclusion: The present study results show that adding DN to conventional physiotherapy for neck pain can increase the effectiveness of intervention in relieving pain, disability, and SCM and UT muscle thickness in people with chronic neck pain.

Dexamethasone 5 mg Versus Dexmedetomidine 20 μg as Adjuvants to 0.5% Levobupivacaine and 2% Lidocaine for Peribulbar Block Anesthesia

Abstract Background: The addition of adjuvants to local anesthetics in the peribulbar block might be a method to elevate block quality. This study aimed to determine the effectiveness of peribulbar local anesthesia adjuvants using dexmedetomidine 20 mcg and dexamethasone 5 mg. Patients and Methods: This study was a single-blind randomized clinical trial. Patients were divided into three groups who received peribulbar group: Group C (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of normal saline), Group D (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexamethasone 5 mg), and Group M (received 4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexmedetomidine 20 mcg). Sensory and motor block onsets and durations were assessed. Results: There were 42 patients included. The sensory block onset was 70.7 s in Group M and the slowest in Group C (152.1 s). The longest sensory block duration was found in Group D (259.3 min) and the shortest in Group C (143.2 min). Conclusion: Dexamethasone 5 mg adjuvant affected sensory block onset, sensory, and motor block duration but did not affect motor block onset, while dexmedetomidine 20 mcg adjuvant affected sensory and motor block onsets as well as sensory and motor block durations.

Remineralization potential of grape seeds extract gel versus casein phosphopeptide-amorphous calcium phosphate in white spot lesions in post orthodontic patients: A randomized clinical trial

Aims: To determine the effectiveness of grape seed extract (GSE) gel compared to Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) application in managing white spot lesions (WSLs) in post orthodontic patients. Statistical analysis used: All statistical calculations were done using computer program IBM SPSS advanced statistics (Statistical Package for Social Sciences), version 25 (SPSS Inc., Chicago, IL). Methods and Material: This study was a single-blinded randomized clinical trial where 24 participants with white spot lesions in at least two teeth were included and randomized into two groups (12 patients each) to receive either GSE gel or CPP-ACP paste application. GSE gel was used on WSLs after orthodontic treatment every week, while CPP-ACP paste was applied twice daily by the patients themselves. Baseline and post-intervention measurements of quantitative changes of WSLs were measured by KaVo DIAGNOdent at 1, 3 and 6 months. Data for quantitative changes of WSLs were recorded and analyzed for each group. Results: There was no statistically significant difference in overall DIAGNOdent mean readings between GSE gel and CPP-ACP paste groups at P=0.360. Conclusions: Based on the data obtained in this study, it is suggested that GSE promotes remineralization of WSLs post orthodontic treatment and, thus, might be considered an effective natural agent for treatment of early enamel carious lesions.

A comparison of single-dose versus divided-dose of metronidazole on bacterial vaginosis among female sex workers in Surakarta

&nbsp; Background : Bacterial vaginosis (BV) is the most common vaginal infection in sexually active women. Metronidazole (MTZ) is still one of the recommended regimens for BV either as a single-dose or divided-dose. In addition to its affordability and availability, oral metronidazole also produces fewer adverse effects. This study aimed t o determine the efficacy of single-dose versus divided-dose metronidazole for BV among female sex workers (FSWs) in Surakarta. Methods:&nbsp; A single-blind randomized clinical trial was conducted in Surakarta. FSWs with BV ( ⩾ 3 Amsel criteria) were enrolled. The subjects were grouped into two, and treated with MTZ either as a single-dose of 2 gr (single-dose group) or 500 mg twice daily for one week (divided-dose group). &nbsp;After two weeks, we performed second&nbsp; vaginal swabs and reassessed the Amsel criteria, complaints and&nbsp; adverse events .&nbsp; Results:&nbsp; Out of 75 FSWs, 30 (42%) were diagnosed with BV. The efficacy between two groups was not significantly different. However, patients in the single-dose group were 2 times more likely to develop recurrent BV (OR = 2.000; 95% CI 0.146 &ndash; 27.447), and 1.5 times more likely to have vaginal discharge complaints&nbsp;&nbsp;&nbsp;&nbsp;(OR = 1,500; 95% CI 0,181-12,459) than divided-dose group. Conclusion:&nbsp; Single-dose and divided-dose metronidazole produce similar efficacy for treating BV in sexually active women. Single-dose metronidazole has a higher risk of BV recurrence and vaginal discharge complaint. Divided-dose metronidazole is recommended for treating BV.&nbsp; &nbsp; Keywords: bacterial vaginosis, female sex workers ,&nbsp; metronidazole

Comparison of Core Stability Exercises with Williams’ Flexion Exercises in Patients with Non-Specific low back pain

Low back pain is the most common complaint experienced by the majority of people at some point in their lifetime. Physical therapy has been in favor of effective treatment and prevention of low back pain. However, there is a lack of agreement on the best exercise treatment and abundant studies are in progress. Categorical studies are lacking particularly in this part of the world. This study was designed to compare the effectiveness and efficiency of two specific exercises, core stability exercises with Williams’ flexion exercises, in patients with non-specific low back pain. Objective:The objective of this study was to find out the most effective treatment for patients with non-specific low back pain Methods: This study is a single-blinded randomized clinical trial that was conducted in the physiotherapy outdoor patient department of the public hospital, Jinnah Hospital Lahore (JHL). 20 patients with non-specific low back pain were randomly allocated in two treatment groups, 10 in A (core stability exercises) and 10 in B (Williams’ flexion exercises), after giving informed consent. The conventional treatment of low back pain. e.g. Hot or cold pack, electrotherapeutic modalities was given to the patients of both groups along with their specialized group treatment. The visual analog scale (VAS) and Modified Oswestry Low Back Pain Disability Questionnaire were used before treatment and after the third treatment session during the period of one to two weeks to measure outcomes. The independent samples T-test was used for data analysis. A P-value &lt;0.05 was considered statistically significant Results: The results of this study illustrated that there is a significant difference between the two groups in clinical and therapeutic effect in the reduction of pain as the P-value is &lt;0.05. While the results in the reduction of pain-related disability, measured by the Modified Oswestry Low Back Pain Disability Questionnaire, were not significant as P-value &gt;0.05(P= 0.184). Conclusions: The study indicates that core stability exercises are more effective than Williams’ flexion exercises for the reduction of non-specific low back pain except for a reduction in pain-related disability.

Intra-Carpal Injection of Ozone versus Methylprednisolone in Carpal Tunnel Syndrome of Systemic Sclerosis Patients: A Randomized Single-Blind Clinical Trial

Carpal tunnel syndrome (CTS) is the most entrapment syndrome in general and is the most frequent peripheral nervous system involvement in systemic sclerosis (SSc). Local injection of steroid hydrodissection or ozone-oxygen showed favourable outcome in CTS in general. To compare the clinical efficacy of ozone versus methylprednisolone intracarpal injection upon pain, functional status, and nerve conduction in patients with CTS due to SSc. A randomized single-blinded trial. Anesthesia, pain, and rheumatology clinics in a university hospital. Fifty CTS patients with > 3 months duration of SSc were equally randomized into either group O (injection of ozone/oxygen 25 mu-g/mL in 20 mL) or group M (methylprednisolone acetate 40mg, and 40 mg lidocaine in 20 mL). Visual analog scale (VAS) was measured pre-injection, then re-evaluated post-injection at 4 time points (1 week, 1 month, 3 months , and 6 months); Cochin Hand Function Scale (CHFS); and a median nerve electrophysiologic study was done before injection, then by the end of 3 months and 6 months. VAS was significantly lower in group M after 1 week (P = 0.01). Group O showed significantly lower VAS after 3 and 6 month (P < 0.001). Additionally, there was a significant decrease in the VAS during the whole study period within each group, in comparison to its baseline value. CHFS was significantly lower in the ozone group after 6 months (P < 0.001). The sixth month's sensory conduction was significantly higher in group O (P = 0.002). The motor distal latency was significantly lower in the ozone group after 3 and 6 months (P < 0.001). Follow-up period could be furtherly extended. Both intracarpal ozone or methylprednisolone afford favorable effects upon CTS in patients with SSc. However, ozone alleviates pain much more, enhances the hand functional status, and improves median nerve conduction in study with over six months duration.

Efficacy and Safety of the Two Ayurveda Drug Regimens in Uterine Fibroids: A Randomized Single-Blind Clinical Trial.

This study aims to assess the efficacy and safety of two Ayurveda drug regimens for the treatment of uterine fibroids (UF) in a randomized single-blind clinical trial. 120 participants with UF (volume ≥ 2 cm3) were randomly allocated at a 1 : 1 : 1 ratio to 2 experimental groups and the control group. The 12-week intervention period was followed by 12-week follow-up. The primary efficacy endpoint was the change of the largest UF volume. The secondary efficacy endpoints were assessed by the pictorial bleeding assessment score (PBAC), UF symptoms, and quality of life score. The safety endpoints were changed in hepatic and renal safety parameters and patients experiencing adverse effects. Significant decrease was observed in the volume of UF in the arm II but not in arm I, while a significant increase was observed in the volume of the largest UF in the control group at 12th week. The PBAC score remained stable in all groups. Further mean value of the intervention arms symptom severity subscale (SSS) was significantly reduced compared to the control arm. Health-related quality of life (HRQL) value improved in 12th week of both experimental arms compared to baseline. Control arm HRQL value was reduced compared to baseline. The volume of the largest UF and both SSS and HRQL values remained stable within the follow-up period in the tested arms. The findings of this study demonstrated the safety and efficacy of selected two Ayurveda drug regimens in reducing the volume of UF and related symptoms and improving quality of life.

Postoperative Pain after Use of the WaveOne Gold and XP-endo Shaper Systems: A Randomized Clinical Trial

IntroductionThe present study aimed to clinically compare the incidence of postoperative pain after endodontic treatment of posterior teeth using the WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland) systems. MethodsIn a single-blind randomized clinical trial, 148 vital teeth with an indication for conventional endodontic therapy for prosthetic purposes were treated by 5 specialists following a preestablished protocol. All participants were unaware of the treatment they received. The teeth were randomly divided into 2 groups (n = 74) according to the instrumentation system used (the WOG group and XPES group). The treatments were performed in a single session. The participants were asked to rate the intensity of postoperative pain on a visual analog scale (no pain, mild pain, moderate pain, and severe pain) after 24, 48, and 72 hours and 7 days. ResultsThe incidence of postoperative pain was higher in the XPES group after 24, 48, and 72 hours compared with those in the WOG group (P < .05). Two participants in the WOG group experienced severe postoperative pain after 24 hours. None of the participants in either group reported pain after 7 days (P > .05, Mann-Whitney test). ConclusionsPostoperative pain is expected after preparation of the root canal system with the WOG and XPES systems tested, but it only persists for a short period. Although more common after the use of the XPES system, the pain was classified as mild at all time points.

A Trial on Ishwarimula (Aristolochia indica Linn.) in Dushta Vrana in Patients

Journal of Ayurveda Medical Sciences,2019,4,2,503-507.DOI:10.5530/jams.2019.4.10Published:June 2021Type:Original ArticleAuthors:Mohammed Faisal, Shrikanth Padigar, and Sunil Kumar Koppala Narayana Author(s) affiliations:Mohammed Faisal1,*, Shrikanth Padigar1, Sunil Kumar Koppala Narayana2 1Department of Post Graduate and PhD Studies in Dravyaguna, Sri Dharmasthala Manjunatheshwara Ayurveda College and Hospital, Kuthpady, Udupi - 574118, Karnataka, INDIA. 2Department of Pharmacognosy, Siddha Central Research Institute (CCRS, Ministry of AYUSH, Govt of India), Arumbakkam, Chennai 600106, Tamil Nadu, INDIA. Abstract:Background: From the time immemorial man is dependent on plant resources to get rid of the ailments. Ishwari (Aristolochia indica Linn.) is a drug having wound healing property used frequently by the folklore practitioners. Non healing ulcer is said to be Dushta vrana routinely encountered in the medical practice were most of the treatment modalities failed to show their extensive efficacy. This is the stage where the practitioners search for the better line of treatment and the efficacious medicines. In folklore practice Ishwarimula kalka is mixed with Nimbu swarasa and applied to the wounds. Hence a clinical research has been taken up to explore the efficacy of root of Ishwari. The aim of the current study is to perform preliminary phytochemical analysis of root of Ishwari (A. indica) and to evaluate its clinical efficacy of in Dushtavrana. Methods: The plant is authenticated referring standard flora; the preliminary phytochemical study was done according to standard protocol. A Single blind comparative randomized clinical trial (RCT) with Pre and Post-test design. 20 patients, diagnosed as Dushta Vrana from the OPD and IPD of SDM. Ayurveda Hospital, Udupi. The Patients were divided into two groups, the Control and the Trial. The Control group treated with H2O2 and Normal saline and bandaged with dry Gauze. In trial group the wound was cleaned with H2O2 and Normal saline and Ishwarimula Kalka prepared by mixing it with Nimbu swarasa was applied. Results: Statistically significant improvement was observed in group treated with Ishwarimula Kalka with Nimbu swarasa. Probably the Tikta, Kashaya Rasa and Teekshna, Ruksha Guna of the drug might have done Samprapti Vighatana of the condition, moreover the test drug was positive for protein, carbohydrate, alkaloid, saponin and other antiseptic content, which has accelerated the process of wound healing. Conclusion: Ishwari Moola Kalka Alepa was observed efficacious in patients of Dushtavrana as an external treatment. Keywords:Clinical study, Mulakalka Alepa, Non-healing ulcers, phytochemical, Wound healingView:PDF (969.65 KB)

English

BACKGROUND Post-operative pain is a ubiquitous finding following any surgeries. It has physiological and psychological effect in patients. The source and degree of nociceptive stimulation differ among individuals and type of surgeries. In this regard, multimodal analgesic approach has been encouraged for post-operative pain relief, local infiltration of wound site being simplest among them. This procedure reduces the sensitisation and consequent hyperalgesia by cutting down afferent impulses from site of incision and injury. METHODS This is a single blind randomized clinical trial conducted at surgery main operation theatre, surgery indoor wards for a duration of 2 years. 60 patients posted for routine surgeries under general anaesthesia were taken as study subjects and were randomly divided into 2 groups of 30 each. Before skin closure, skin wound site was infiltrated at 1ml/cm according to the following schedule - Group B: received Inj. Bupivacaine plain (0.2 %), Group R: received Inj. Ropivacaine plain (0.2 %). All the patients were followed up for 24 hours and post-operative pain score parameters (Visual Analogue Score) were taken at 1 hour, 2-hour, 6-hour, 10 hour and 24 hours. The time duration till the requirement of first dose of rescue analgesia was noted down. Data was analysed using chi-square test, student t - test and statistical significance was set at P &lt; 0.05. RESULTS Hemodynamic stability was more with Ropivacaine as the fall in blood pressure and heart rate was not drastic. Duration of analgesia was longer with Ropivacaine. Analgesia was better with Ropivacaine. Both the drugs caused analgesia of significant extent. No cardiotoxicity or any other adverse reaction was observed with either drug in this study. CONCLUSIONS Ropivacaine is having longer duration of analgesia and better analgesic effect than bupivacaine. KEYWORDS Postoperative, Analgesic, Wound, Infiltration, Bupivacaine, Ropivacaine

The efficacy of magnesium sulphate as an adjunct to local anaesthetics for perineal pain relief after episiotomy.

Episiotomy is a deliberate surgical incision of the perineum with the aim of increasing the vulval outlet to facilitate childbirth. However, it could be associated with some complications, such as pain, hemorrhage, and wound infection. It is a surgical procedure that requires adherence to basic surgical principles of providing adequate analgesia. To determine the efficacy of magnesium sulphate (MgSO4) as an adjunct to local anesthetics for analgesia during episiotomy repair among women that had vaginal delivery at Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria. This was a single-blind randomized clinical trial. Pregnant women who had episiotomy during the study period were randomized into two groups. Those in Group A had xylocaine administered alone, whereas those in Group B had xylocaine + MgSO4 administered for repair of episiotomy. Pain was assessed by numeric rating scale at commencement of the repair, at 2 and 6 h after the repair. Patient's level of satisfaction, request for additional analgesia, and side effects were also assessed. The pain score in the xylocaine + MgSO4 group was lower throughout the period of assessment. There was no significant difference in the pain scores between the two groups at 0 and 6 h. However, there was significant difference in the mean pain scores between the two groups at 2 h (P < 0.001). There was no significant difference in the level of satisfaction, request for additional analgesia, and side effects between the two groups. Both xylocaine alone and xylocaine with MgSO4 provide adequate perineal pain relief during episiotomy repair. MgSO4 improves the analgesic effect of xylocaine at 2 h after episiotomy repair without any significant side effect.

Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome.

Studies have indicated that the muscle energy technique (MET) and the positional release technique (PRT) are effective in the management of piriformis syndrome (PS); however, evidence is scarce regarding the combination of these techniques in the form of an integrated neuromuscular inhibition technique (INIT) in the management of individuals with PS. Although a previous trial investigated the effect of INIT for PS, that study did not integrate Ruddy's reciprocal antagonist facilitation (RRAF) method into the INIT protocol, nor did the authors diagnose PS according to established criteria. To examine the effects of INIT with integrated RRAF compared with PRT in the management of patients diagnosed with PS. This study was designed as a single blind randomized clinical trial in which participants diagnosed with PS were randomly allocated into INIT and PRT groups. Each group attended two treatment sessions per week for 8weeks. Patients in the INIT group received a protocol in which the patient's tender point or trigger point was palpated in the belly of the piriformis approximately halfway between the inferior lateral angle of the sacrum and the greater trochanter, at which point the therapist applied an intermittent or sustained pressure and maintained the pressure for 20-60seconds (depending on the participant's response to pain reduction). For INIT patients, that protocol was also followed by RRAF, a method in which a patient introduces a series of tiny/miniature contractions or efforts (20 times per 10seconds) against a therapist's resistance. Patients in the PRT group were treated by palpating the same trigger point described in the INIT group, followed by application of light pressure at the location of the trigger point, which was maintained the pressure for 2minutes or until the pain subsided (determined by asking the participant to report a pain score using a visual analog scale at 30second intervals). For both groups, three repetitions of the INIT or PRT treatment were performed over 10minutes at each clinical visit. Additionally, each group also received stretching exercises immediately after the INIT or PRT treatment session. Each participant was assessed at baseline, immediately posttreatment, and at 4months posttreatment for pain, sciatica, functional mobility, quality of life, hip abduction, and internal rotation. A repeated measures analysis of variance (ANOVA) of within-between group interactions was used to analyze the treatment effect. Forty eight participants (age range, 25-47 years; mean age±standard deviation, 32.81±3.27 years) were randomized into the INIT and PRT groups, with 24 participants in each group. No significant between-group differences (p>0.05) were observed in the baseline demographic and clinical variables of the participants. A repeated-measures ANOVA indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (p<0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the INIT group improved significantly compared with the PRT group in all outcomes (p<0.05) immediately posttreatment and at the 4months follow up period. INIT was more effective than PRT in the management of individuals with PS. It should be noted the significant improvement achieved in both the groups may have also been contributed to by the stretching exercises that were used as adjunct therapies by both groups.

The effectiveness of acceptance and commitment therapy on sociooccupational compatibility and acceptance of symptoms in patients with painful Diabetic Neuropathy: A single-blind randomized clinical trial

Introduction: Neuropathic pain is a common complication of diabetic patients. In these people, the pain reduces the work and social adjustment. Aim: The aim of this study was to evaluate the effectiveness of acceptance and commitment therapy on chronic pain acceptance and the work and social adjustment in patients with painful diabetic neuropathy. Method: This study was a quasi-experimental study in which patients were randomly divided into intervention and control groups. Participants were all patients with a diagnosis of diabetic neuropathy referred to the neurology department of Farabi Hospital in Kermanshah in 2019. Instruments included Chronic Pain Acceptance Questionnaire (CPAQ) and the Work and Social Adjustment Scale (WSAS). The results of three phases of pre-test, post-test and follow-up were evaluated. Data were analyzed by descriptive statistics, the repeated measures ANOVA, and chisquare tests using SPSS version 22. Results: The results demonstrate that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and the work and social adjustment in the intervention group as compared to controls. In the acceptance variable, the test results within the group showed that the effect of time (P=0.003, F=6.48) and the interactive effect of time and group (P=0.001, F=12.49) were significant. Also in the variables of work and social adjustment, the effect of time (P=0.046, F=3.21) and the interactive effect of time and group (P=0.028, F=3.74) were reported (p&gt;0.001). Conclusion: Acceptance and commitment therapy can be used as a psychological intervention along with drug therapy to improve the work and social adjustment and acceptance symptoms in patients with painful diabetic neuropathy (PDN).

A community-based computerised cognitive training program for older persons with mild dementia: A pilot study.

Computerised cognitive training programs can improve cognitive function in patients with moderate-to-severe dementia or brain injuries and healthy older adults. However, most previous studies were not randomised controlled trials and did not examine older adults with mild dementia. The current study sought to analyse the effects of a computerised cognitive training program using a randomised controlled trial. In a single-blinded randomised clinical trial, 30 older individuals with mild dementia were split into an experimental (n=15) and a control (n=15) group to analyse the effects of a computerised cognitive training program. Outcomes were assessed before and after each program session, and 1 and 3months afterwards. Participants in the experimental group had better overall subjective memory, subjective retrospective memory and global quality of life, with fewer depressive symptoms than those in the control group 3months following the program. Our computerised cognitive training program improved subjective memory and quality of life in patients with mild dementia and decreased their depressive symptoms. These results may be useful for health-care providers caring for people with mild dementia.