Objectives: To compare the efficacy of duloxetine with amitriptyline for reductionin the frequency of pain management in patients with diabetic neuropathy. Study Design: It isa Comparative, Randomized and Prospective study. Setting: Medical Unit-4, DHQ, Hospital,Faisalabad. Study Duration: 5 months, October, 2016 to February 2017. Methods: A total of100 cases (100 in each group) between the age 20-65 years of any gender, ≥ 5years historyof diabetes, symptoms of peripheral neuropathy for at least six months, having HbA1c >7.5%were included while those with co-existing other causes of peripheral neuropathy (porphyria,chronic renal failure, amyloidosis, leprosy, hypothyroidism), pregnant and lactating womenand use of Duloxetine or amitriptyline in previous three months were excluded from the study.Randomization was done by computer generated random number table, to allocate patientsto either group A (Duloxetine group) or group B (Amitriptyline group). Patients were instructedto take study medication in the morning, with a glass of water for up to 6 weeks. Group A wasgiven 60mg Duloxetine each day and Group B was given 75mg amitriptyline in a single dose.Baseline pain was recorded on VAS. Diary card was provided to all patients at the baseline visit.Each morning during the 1st 3 weeks, patients would be instructed to record the severity of thesymptoms in term of reduction in pain score recorded by visual analogue scale. After 3 weeks,an additional three weeks supply of medication was dispensed and patients were scheduled toreturn at week 6 for the final evaluation that was recorded by me in terms of reduction in painscore and also assessed for 50% reduction in pain score from base line that was labeled asreduced. Patients were followed up by keeping telephonic contacts of patients. Results: In ourstudy, out of 200 cases (100 in each group) 21%(n=21) in Group-A and 17%(n=17) in Group-Bwere between 20-40 years of age while 79%(n=79) in Group-A and 83%(n=83) in Group-Bwere between 41-65 years of age, mean+SD was calculated as 47.08+11.43 and 48.37+10.83respectively, 56%(n=56) in Group-A and 49%(n=49) in Group-B were male while 44%(n=44)in Group-a and 51%(n=51) in Group-B were females, comparison of efficacy in both groupswas done which shows that 62%(n=62) in Group-A and 35%(n=35) in Group-B were treatedeffectively, which shows a significant difference between the two groups. Conclusion: It isconcluded that the efficacy of duloxetine as compared to the amitriptyline in terms of reductionin frequency of pain in the management of patients of diabetic neuropathy is significantly higher.
Introduction: Epidural/subgaleal abscesses in craniosynostosis surgery are rare but serious complications that may compromise neurological functioning in pediatric craniofacial populations. We evaluated the risk and evolution of management of post-operative subgaleal/epidural abscesses in craniosynostosis patients treated over 20 years by a single surgeon. Methods: Pediatric patients who underwent transcranial procedures for craniosynostosis by a single surgeon from 1997 to 2018 were included. The patients were stratified into groups based on the development of post-op abscess. The primary outcome measure was bone salvage success. Post-op abscesses were drained in the following manner: either open packing with delayed closure or no elevation of the scalp flap, followed by copious irrigation and deep (epidural) drain placement plus long-term intravenous antibiotics. Results: A total of 384 patients underwent 413 cases in this period: 177 sagittal, 85 unicoronal, 49 metopic, 4 lambdoid, and 69 cases of multiple suture synostosis. In this cohort, epidural/subgaleal abscess were found in 6 patients (1.5%) who all had bilateral fronto-orbital advancement ( P = .03). Bone salvage was attempted in all 6 patients with only minor bone resorption seen in 3 of the patients who presented with abscess. Conclusion: This study found that patients undergoing bilateral fronto-orbital advancement were at increased risk of a deep space infections, while those undergoing clavarial vault remodeling with barrel staves alone, were not. We were able to salvage the bone grafts and prevent neurological sequela with surgical washout, placement of drains and intravenous antibiotic therapy.
Objective: To compare the outcome of salbutamol nebulization with controls (normal saline) in transient tachypnea of newborn. Methods: In this randomized controlled trial 284 (142 in each group) neonates were included with gestational age above 35 weeks of any gender. Study was conducted in Department of Pediatrics Holy Family Hospital Rawalpindi. Sampling technique was consecutive non probability sampling. Duration of study was 6 months. Sample size had been calculated using WHO calculator; Significance level 5%, Power of test 80%, Population mean 5.4, Test value of population mean 4.8, Standard Deviation 1.8. At admission complete blood picture, C-reactive protein and chest x-ray were done. Group-1 received salbutamol nebulization at a dose of 0.15mg / kg / dose for 10 minutes in 2ml normal saline QID while Group-2 received only normal saline nebulization 2ml QID in 24 hours. Double blinding was ensured and in case of any side effects of salbutamol (tachycardia, arrhythmias and hypoglycemia) treatment was stopped immediately and managed accordingly. Results: In this study, comparison of outcome of inhaled salbutamol with controls in transient tachypnea of newborn shows that respiratory rate per minute was 50.15+2.34 in Group-1 and 64.92+2.70 in Group-2, p value was 0.0001, heart rate per minute in Group-1 was recorded as 120.08+2.36 and 134.79+3.27 in Group- 2, p value was 0.0001, oxygen saturation(%) was 97.27+0.92 in Group-1 and 83.28+1.81 in Group-2, p value was 0.0001, duration of oxygen therapy(hours) was recorded as 15.49+1.84 in Group-1 and 27.78+5.57 in Group-2, value of p was 0.0001, duration of hospitalization(days) was recorded as 2.03+0.45 in Group-1 and 5.07+0.72 in Group-2 while value of P was 0.0001 Conclusion: Salbutamol Nebulization is more effective than normal saline in TTN. Key Words: Transient Tachypnea of newborn, management, inhaled salbutamol, outcome.
ABSTRACT… Objectives:To compare the efficacy of duloxetine with amitriptyline for reduction in the frequency of pain management in patients with diabetic neuropathy. Study Design: It is a Comparative, Randomized and Prospective study. Setting: Medical Unit-4, DHQ, Hospital, Faisalabad. Study Duration: 5 months, October, 2016 to February 2017. Methods: A total of 100 cases (100 in each group) between the age 20-65 years of any gender, ≥ 5years history of diabetes, symptoms of peripheral neuropathy for at least six months, having HbA1c >7.5% were included while those with co-existing other causes of peripheral neuropathy (porphyria, chronic renal failure, amyloidosis, leprosy, hypothyroidism), pregnant and lactating women and use of Duloxetine or amitriptyline in previous three months were excluded from the study. Randomization was done by computer generated random number table, to allocate patients to either group A (Duloxetine group) or group B (Amitriptyline group). Patients were instructed to take study medication in the morning, with a glass of water for up to 6 weeks. Group A was given 60mg Duloxetine each day and Group B was given 75mg amitriptyline in a single dose. Baseline pain was recorded on VAS. Diary card was provided to all patients at the baseline visit. Each morning during the 1st 3 weeks, patients would be instructed to record the severity of the symptoms in term of reduction in pain score recorded by visual analogue scale. After 3 weeks, an additional three weeks supply of medication was dispensed and patients were scheduled to return at week 6 for the final evaluation that was recorded by me in terms of reduction in pain score and also assessed for 50% reduction in pain score from base line that was labeled as reduced. Patients were followed up by keeping telephonic contacts of patients. Results: In our study, out of 200 cases (100 in each group) 21%(n=21) in Group-A and 17%(n=17) in Group-B were between 20-40 years of age while 79%(n=79) in Group-A and 83%(n=83) in Group-B were between 41-65 years of age, mean+SD was calculated as 47.08+11.43 and 48.37+10.83 respectively, 56%(n=56) in Group-A and 49%(n=49) in Group-B were male while 44%(n=44) in Group-a and 51%(n=51) in Group-B were females, comparison of efficacy in both groups was done which shows that 62%(n=62) in Group-A and 35%(n=35) in Group-B were treated effectively, which shows a significant difference between the two groups. Conclusion: It is concluded that the efficacy of duloxetine as compared to the amitriptyline in terms of reduction in frequency of pain in the management of patients of diabetic neuropathy is significantly higher. Key words:Diabetic neuropathy, management, duloxetine, amitriptyline, efficacy.
Objectives: To determine the frequency of common factors leading to stroke inyoung local population. Study Design: It is Descriptive Cross-Sectional study. Setting: Medicalfloor, DHQ, Hospital, Faisalabad. Period of Study: 6 Months, September, 2016 to February,2017. Methodology: A total of 150 diagnosed cases of stoke between 18-40 years of age ofeither gender were enrolled in this trial. We excluded all those cases with recurrent historyof cerebrovascular accidents, space occupying lesion, head injury, hypoglycemia, transientischemic attack, CNS infection. We used CT brain showing either infarct or hemorrhage. Aftera detailed history from patient/relative including the common factors of stroke, all patientsundergoing thorough physical examination, CT/MRI Scan brain, lipid profile and fasting bloodglucose measurement to rule out the presence/absence of hypertension, smoking, Dyslipidemiaand diabetes mellitus being the common risk factors. Results: Age distribution shows 38%(n=57) were between 18-30 years while 62% (n=93) between 31-40 years, mean+sd wascalculated as 35.21+6.47 years. (Table-I) Gender distribution shows 64% (n=96) male and36% (n=54) females. (Table-II). Frequency of common factors leading to stroke in young adultsreveals hypertension in 60.67% (n=91), diabetes mellitus in 41.33% (n=62), smoking in 31.33%(n=47) and dyslipidemia in 23.33% (n=35). Conclusion: The results of the study conclude thatamong common factors hypertension, smoking, dyslipidemia and diabetes mellitus are theleading causes of stroke and these factors are modifiable and by controlling on these factors,the frequency of stroke in young adults may be avoided.
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