Introduction: Tuberculosis (TB) is endemic in South Asia including Nepal. TB spine is the most common musculoskeletal manifestations and can have devastating complications. Early diagnosis by proper history, physical and radiological examination is mandatory. Chemotherapy is effective in most cases while some require surgical treatment. Methods:Forty-four patients with clinico-radiological evidence of TB were treated with four drug regime for 18 months and all patients were followed up till the end of the chemotherapy.Results: All 44 patients (M-28/ F-16) had back pain not responding to analgesics and physiotherapy while few had constitutional symptoms. Localized tenderness and paravertebral muscle spasm was present in 32/44 (72.7%) and the rest had palpable swelling at the dorsolumbar and lumbar regions. According to the classiÞ cation by Oguz et al. the majority of the patients were in the Type I B. Six patients who did not show any improvement in pain and resolution of swelling were admitted and two more drugs (Steptomycin and Oß oxacin) were added. Conclusions:Conservative treatment of TB spondylitis of the lumbar spine can be treated with chemotherapy and appropriate investigations should be performed in patients with back pain who do not respond to rest, analgesics and physiotherapy.
Introduction: There are different pharmacological modalities currently in practice for the treatment of osteoarthritis knee. Broadly these are divided into anti-inflammatory drugs such as NSAIDs and symptomatic slow-acting drugs in osteoarthritis (SYSADOA). Diacerein, an anthraquinone derivative inhibits IL-1b and has been shown to significantly decrease the symptoms.Methods: This is open label, prospective comparative study. Total 40 patients were divided into two groups: group A (diacerein) and group B (aceclofenac) by alternate method. In group A diacerein was given 50mg orally for 1 week followed by 50 mg orally twice a day for 3 weeks. In group B aceclofenac 200 mg sustained release tablet was given orally once a day for 4 weeks. Outcomes were measured at the end of the treatment period i.e. at four weeks and after two weeks of discontinuation of treatment i.e. at 6 weeks.Results: Improvement is observed in both treatment groups in their baseline value in terms of efficacy parameters. Results of VAS and WOMAC scores were better in group B (aceclofenac). However intra-group analysis showed VAS scores and WOMAC scores significantly decreased in patients receiving diacerein as well. (p<0.05).Conclusion: Though not superior to the control drug, diacerein showed efficacy in terms of measurement by patient self-reported WOMAC and VAS scores for the treatment of Osteoarthritis knee.
Background: Trochanteric fracture is the commonest fracture in elderly people. These fractures carry risks associated with prolonged immobility. Early fracture fixation allowing early mobilization of the patients is the aim of the treatment. Dynamic hip screw and plate remains the most common method for treating stable intertrochanteric fractures. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization, lesser requirement of analgesics and shorter hospital stay.Objectives: The study was done to evaluate the amount of intraoperative blood loss, reduction of post operative haemoglobin, requirement of post-operative analgesics and days of postoperative hospital stay in the patients of stable intertrochanteric femur fracture treated with minimal invasive dynamic hip screw (MIDHS).Methods: Twenty-five cases of stable intertrochanteric fractures of femur were treated with minimal invasive Dynamichip screw technique. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied.Results: Mean intraoperative blood loss was 53 ml, mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of five cm. Postoperative analgesic requirement was twice a day in an average and for five days. Mean hospital stay after surgery was five days.Conclusion: Minimal invasive Dynamic hip screw is a safe technique having advantages of less blood loss, minimal soft tissue dissection, lesser requirement of post-operative analgesics and shorter hospital stay in treating stable intertrochanteric fractures.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11739 Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 170-174
Background: Total knee arthroplasty is associated with significant peri-operative blood loss. Various studies have shown that the use of tranexamic acid reduces post-operative blood loss and need for allogeneic blood transfusion in total knee arthroplasty. Objectives: To assess the effect of tranexamic acid in the reduction of the postoperative blood loss in total knee arthroplasty. Methodology: An analytical cross-sectional study was carried out in 14 patients who underwent primary total knee arthroplasty during the study period of 12 months at Kathmandu Medical College. Seven patients were allocated to the case group and received one gram (gm) of tranexamic acid thirty minutes prior to the incision and five hundred milligram (mg) orally three times a day till the drain was removed. Tranexamic acid was not given to the seven patients in control group. The haemoglobin of the patient was recorded on the day of surgery and the total amount of drain output was recorded on postoperative period until the drain was removed. Results: Out of 14 patients operated, it was found that the average amount of drain in the patients in case group was 628 ± 234 millilitre (ml) which was significantly lower than the control group 1028 ± 183 ml (p<0.05). Though there was a difference in the amount of drain output, there was no significant change in the postoperative haemoglobin level in both the groups (p = 0.381). Conclusion: Tranexamic acid, an antifibrinolytic agent, can be effective to reduce blood loss in patients who undergo major surgeries like total knee arthroplasty.
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