Background and objectives: Effective pain management is an important component of intraoperative and postsurgical care; it can prevent pain related clinical complications and improve the patient quality of life. This prospective, randomized, double-blind study was designed to evaluate analgesic efficacy of adding magnesium and midazolam to epidural bupivacaine in patients undergoing total knee replacement. Methods: 120 patients ASA I and II, undergoing total knee replacement surgery were enrolled to receive either bupivacaine 0.5 % or bupivacaine 0.5 % plus magnesium sulphate 50 mg as an initial bolus dose followed by a continuous infusion of 10 mg/h or bupivacaine 0.5 % plus midazolam 0.05 mg/kg as intraoperative epidural analgesia. Postoperatively, all patients were equipped with a patient-controlled epidural analgesia device. Heart rate, mean arterial pressure, oxygen saturation, respiratory rate, pain assessment using a visual analogue scale (VAS),sedation score, patients’ first analgesic requirement times and postoperative fentanyl consumption were recorded. Results: The intraoperative VAS was significantly less in magnesium and midazolam groups. Whereas, in the first postoperative hour, VAS was significantly less in magnesium group. The postoperative rescue analgesia as well as the PCEA fentanyl consumption was significantly reduced in magnesium group. Conclusion: Co-administration of epidural magnesium provides better intraoperative analgesia as well as analgesic-sparing effect on PCEA consumption without increasing the incidence of side-effects.

Jeune syndrome or asphyxiating thoracic dystrophy is a rare autosomal recessive skeletal dysplasia characterised by a small chest and short ribs which restrict the growth and expansion of the lungs often causing life threatening complications. The inheritance is autosomal recessive. A locus has been identified on chromosome 15q13 , while recently, mutations were found in the IFT80 gene, encoding an intraflagellar protein. Other symptoms may include shortened bones in the arms and legs, unusually shaped pelvic bones, and extra fingers and/or toes (polydactyly). It is estimated to occur in 1 per 100,000 – 130,000 live births. Children that survive the breathing and lung challenges of infancy, can later develop life-threatening kidney problems. Heart defects and a narrowing of the airway (subglottic stenosis) are also possible. Other, very less common features of Jeune syndrome include liver disease, pancreatic cysts, dental abnormalities, and an eye disease called retinal dystrophy that can lead to the loss of vision. We report a preterm neonate with Jeune syndrome.

Osteoporosis, a disorder of bone metabolism, is a significant health concern for the aging population. Depression has been recognized as an unrecognized risk factor for low bone mineral density (BMD), which increases the risk of osteopenia, osteoporosis, and fractures, especially in the elderly. The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with reduced BMD and an elevated risk of fractures. This literature review examines the link between depression and osteoporosis, emphasizing the need for close monitoring and early intervention in at-risk individuals. Identifying modifiable risk factors, including depression, could help reduce the public health burden of osteoporosis and its complications.

This report presents two cases of femoral neuropathy following femoral artery procedures, specifically stent placement and cardiac catheterization. Both patients experienced severe, debilitating pain radiating from the groin to the medial thigh and leg, which was refractory to multiple treatments and consultations with various healthcare professionals. Clinical diagnoses of femoral neuropathy were confirmed through physical examination and, in one case, electromyography and nerve conduction studies (EMG/NCV). Both patients showed significant pain relief after treatment with pregabalin. The first patient, a 65-year-old female, was completely pain-free after two months of therapy, and the second patient, a 78-year-old female, experienced full resolution of pain within a month. This case report highlights the importance of recognizing femoral neuropathic pain as a potential complication following femoral artery interventions. Early diagnosis and appropriate treatment with neuropathic pain medications, such as pregabalin, can significantly improve patient outcomes.

Aim: To analyse trends in admissions to an intellectual disability unit over a ten year period. Method: We carried out a retrospective review of medical case notes over two time periods (1999-2001 and 2009-2011). Data collected included patient demographics, reasons for admission, length of stay, delay in discharge and reasons for delay in discharge.Results: During the initial review there were 60 admissions to the unit, compared to 41 admissions during the later time period. During both periods challenging behaviour followed by psychotic disorder were the most common reasons for admission. Over this ten year period, more than half of the admissions were considered delayed discharges, most commonly due to social reasons (i.e. funding, appropriate placement).Conclusions: Specialist inpatient assessment and treatment units are a costly necessity. Reducing the average length of stay where possible can reduce the cost of a patient admission. However, this single agenda can lead to problems of pressured early discharge to placements which are unable to sustain the patients. Collaborative approaches together with those involved in community care is crucial to getting the right care at the right financial cost for this relatively small but very complex and vulnerable group of individuals.

Aim: To analyse trends in admissions to an intellectual disability unit over a ten year period. Method: We carried out a retrospective review of medical case notes over two time periods (1999-2001 and 2009-2011). Data collected included patient demographics, reasons for admission, length of stay, delay in discharge and reasons for delay in discharge.Results: During the initial review there were 60 admissions to the unit, compared to 41 admissions during the later time period. During both periods challenging behaviour followed by psychotic disorder were the most common reasons for admission. Over this ten year period, more than half of the admissions were considered delayed discharges, most commonly due to social reasons (i.e. funding, appropriate placement).Conclusions: Specialist inpatient assessment and treatment units are a costly necessity. Reducing the average length of stay where possible can reduce the cost of a patient admission. However, this single agenda can lead to problems of pressured early discharge to placements which are unable to sustain the patients. Collaborative approaches together with those involved in community care is crucial to getting the right care at the right financial cost for this relatively small but very complex and vulnerable group of individuals.

Persistent genital arousal disorder (PGAD), also known as persistent sexual arousal syndrome (PSAS) or restless genital syndrome (ReGS), is a recently recognized sexual health condition characterized by spontaneous and intrusive feelings of genital arousal in the absence of sexual thoughts or stimuli. PGAD is not included in DSM IV or ICD 10. Although predominantly reported in women, cases in men are rare. This case report describes a 54-year-old male with PGAD who presented with constant physical arousal and distressing symptoms of spontaneous genital sensations, exacerbated by anxiety and partially relieved by ejaculation. Despite a full urological and neurological workup, no organic cause was identified. Treatment with diazepam and pregabalin resulted in significant symptom relief. This case supports the hypothesis that PGAD may have both physical and psychological components, possibly as a psychosomatic condition affecting the peripheral nerves of the genito-urinary system. Further research is needed to explore the pathophysiology and management of PGAD.

When associated with Multiple Sclerosis (MS), Trigeminal Neuralgia (TN) is often bilateral and more refractory to treatment. Carbamazepine is the first line of treatment for TN, however, common side effects of carbamazepine such as hyponatremia occasionally limit its use. We report the case of a 62 year old female patient with a well controlled MS associated TN using carbamazepine. This drug needed to be discontinued because of recurrent symptomatic hyponatremia. Several agents including topiramate, gabapentine and amitriptyline were tried but none had any beneficial effect on TN. A small dose of eslicarbazepine (400 mg daily) provided excellent control of the TN pain on one hand and did not affect the plasma sodium levels on the other hand.Eslicarbazepine main advantage is providing the same effects of carbamazepine or oxcarbazepine but with an incidence of hyponatremia of less than 1%. It is much safer to use when the risk of hyponatremia is increased. To our knowledge, this is the first case that reports the use of eslicarbazepine in one of the several indications of carbamazepine such as pain and mental health problems. Eslicarbazepine use in epilepsy was reported extensively.We feel that a therapeutic trial of eslicarbazepine is justified when either carbamazepine or oxcarbazepine have to be discontinued because of hyponatremia despite their efficacy.

Aim: To assess the pattern of new cases referred to fracture clinic at a large paediatric university teaching hospital.Materials and Methods: The study was carried out over a four-week period in May and June of 2010. A total of 864 patients were seen during this period, which included 310 new cases and 554 follow up cases. The radiographs and reports were analysed to collect the data. Results: Two hundred and ninety two new cases were analysed as 18 cases did not have radiographs available. One hundred and one (34%) cases did not have any fractures and 14 (5%) were suspected fractures. Fractures of the distal radius and ulna were the predominant cases (23%) followed by hand fractures (15%).Conclusion: Significant number of patients (34%) did not have fractures. Considerable amount of time can be saved especially in a busy fracture clinic if protocols are developed to manage new referrals.

Background: Vaginal infections are common among women of reproductive age. They can be caused by sexually transmitted microorganisms or by some disorder resulting in the proliferation of endogenous microbiota. Among the more frequent microorganisms are the protozoan Trichomonas vaginalis (T. vaginalis) and Candida albicans (C. albicans). Aim of this study to find out the Prevalence of Trichomonas vaginalis & Candidia species (primary) and socio-demographic profile and different clinical presentations (secondary) in women of Reproductive Age Group with vaginal discharge. Methods: Total 140 sexually active females age group of 18- 45 yrs with meeting the eliglibility criteria complain of vaginal discharge. High vaginal swabs (HVS) were collected from the patients and processed for microscopy and culture. Comparative study was done by using chi-square test. Result: The prevalence of Candida species and Trichomonas vaginalis is calculated to be 27.8% and 4.3% respectively. Total 67% belong to rural population in candiasis where 83% belong to urban population in Trichomoniasis. Maximum number (77%) in Candiasis and all cases (100%) in Trichomoniasis were belonging to low socio economic status. Multiparous women were more prone for both candiasis and trichomoniasis infection. In both infections, majority were using OCP as contraceptive measure. Total 43%patients were having symptoms of vaginal discharge + pruritus + dysuria in candiasis and 66% patients were having vaginal discharge only in Trichomoniasis. Around 54% of total candidiasis was Diabetic which is highly significant. Conclusion: The prevalence of Candiasis and Trichomoniasis in my study is 27.8% and 4.3% respectively. Diabetes mellitus is imposed as a major risk factor for Candida species infection.