Steroid Treatment for Acute Spinal Cord Injury.pdf
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Steroid treatment for acute spinal cord injury (ASCI) has been studied extensively since the 1970s, but the evidence remains inconclusive. Early studies in cats found improved recovery with dexamethasone treatment. The 1985 NASCIS I trial found no difference with steroid treatment, but the 1992 NASCIS II trial found modest improved motor recovery when methylprednisolone was given within 8 hours. Subsequent trials found no benefit when treatment was given after 8 hours. While some meta-analyses found improved motor recovery, others and the most recent trials found no clear clinical benefits and increased risks of pneumonia and other complications. Current recommendations are that steroids are not a standard treatment but may be considered as an option if given
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Effectiveness of Mirror Therapy on Upper Extremity Functioni
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Rohini T. Chaudhari1, Seeta Devi2, Dipali Dumbre3
1MSc Nursing, 2Asst. Professor, 3Tutor, Symbiosis College of Nursing, Symbiosis International
(Deemed University), Pune
ABSTARCT
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As human, we move our bodies to explicit our wants,
needs, emotions, thoughts, and ideas. Basically, how
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well we engage with the world and make our full purpose
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completely, interact with the world, feel well physically
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Delirium in critically ill patients bogota043009
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Functioning among Stroke Patients
Rohini T. Chaudhari1, Seeta Devi2, Dipali Dumbre3
1MSc Nursing, 2Asst. Professor, 3Tutor, Symbiosis College of Nursing, Symbiosis International
(Deemed University), Pune
ABSTARCT
Background: The prevalence of stroke in the general population varies from 40 to 270 per 1000,000 in
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rehabilitation services. One of them Mirror therapy is a simple, inexpensive and most importantly patient
directed treatment that may improve hand function after stroke.
Objective: To assess the effectiveness of mirror therapy on upper extremity functioning among stroke
patients at selected neuro- rehabilitation centres
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days in a week for 4 weeks. Other side the control group has received only conventional therapy for 4 weeks,
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Conclusion: The findings of the study show that there is significant difference between the scores of
experimental and control group.
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well we engage with the world and make our full purpose
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This case series examines the use of medical shockwave therapy for 10 patients with chronic low back pain. Shockwave therapy involves using focused acoustic pulses to target deep tissue. After 3 sessions of 1000 pulses each over 3 weeks, 8 of the 9 patients showed excellent improvement in pain levels, functional disability, and reduced need for pain medication that was maintained at the 12 week follow up. This positive preliminary outcome supports further investigation of shockwave therapy as a potential disease-modifying treatment for chronic low back pain.
Radiation Therapy in Palliative Care Spring 2012
This document provides an overview of palliative radiation therapy for cancer patients. It discusses the fundamentals of how radiation works and advances that have allowed it to more effectively treat cancer. It then focuses on how palliative radiation can effectively relieve symptoms from bone metastases, lung cancer, bleeding, and other cancers in 1-3 fractions rather than longer courses of treatment. Studies show short fractionation schedules provide pain relief comparable to longer schedules with fewer side effects and greater convenience. The document provides guidance on discussing palliative radiation options with radiation oncologists to help simplify the process for hospice patients.
A prospective comparative study of three treatment
This study compared the effectiveness of three treatment modalities for idiopathic adhesive capsulitis of the shoulder: 1) conservative treatment including physical therapy, 2) intra-articular steroid injections plus physical therapy, and 3) arthroscopic capsular release plus physical therapy. The study found that arthroscopic capsular release resulted in significantly better improvement in external shoulder rotation compared to conservative treatment alone. However, overall functional outcomes as measured by a shoulder rating questionnaire were similar across groups. The study concluded that conservative treatment remains an effective first-line option for adhesive capsulitis, though arthroscopic release may provide faster recovery of external rotation.
Application of Pstim in Clinical Practice
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Pregabalin in chronic Post-thoracotomy Pain
Pregabalin is an effective and safe adjuvant for reducing chronic
post-thoracotomy pain, without significant side effects, in all age
groups and either gender. The pain relief becomes statistically
significant after three weeks of treatment and it continues till six
months. However, larger randomized and placebo-controlled trials
of longer durations are required to further validate these findings.
Does a standard outpatient physiotherapy regime improve the range of knee mot...
This study investigated whether a standard outpatient physiotherapy regime improved range of knee motion after primary total knee arthroplasty (TKA). 150 patients were randomly assigned to either receive 6 weeks of outpatient physiotherapy after TKA (Group A) or no outpatient physiotherapy (Group B). Range of motion measurements found that while Group A achieved greater flexion than Group B, the difference was not statistically significant. The study concluded that outpatient physiotherapy does not improve range of knee motion after primary TKA.
Delirium in critically ill patients bogota043009
The document discusses acute brain dysfunction, specifically delirium, in critically ill patients. Some key points:
- Delirium affects 60-80% of ICU patients and is underdiagnosed. It is linked to higher costs, longer hospital stays, and increased risk of death.
- Survivors often experience long-term cognitive impairment equivalent to mild/moderate dementia.
- Sedatives like benzodiazepines and opioids are risk factors for delirium. Protocols aiming to reduce exposure can help prevent delirium.
- Studies found the alpha-2 agonist dexmedetomidine reduced delirium and cognitive dysfunction compared to lorazepam. Antipsychotics may help
Safety and Efficacy of Low Dose versus Standard Dose of Alteplase for Stroke ...
Safety and Efficacy of Low Dose versus Standard Dose of Alteplase for Stroke ...Institute for Clinical Research (ICR)
Safety and Efficacy of Low Dose versus Standard Dose of Alteplase for Stroke Thrombolysis in Hospital Sultanah Nur Zahirah (HSNZ)
Presentation Slides by Ms Mahfuzah Ishak, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348496
E-Poster: https://zenodo.org/record/5348723EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
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Effectiveness of Mirror Therapy on Upper Extremity Functioni
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Medical shockwaves for chronic low back pain - a case series
Medical shockwaves for chronic low back pain - a case series
A prospective comparative study of three treatment
A prospective comparative study of three treatment
Does a standard outpatient physiotherapy regime improve the range of knee mot...
Does a standard outpatient physiotherapy regime improve the range of knee mot...
Safety and Efficacy of Low Dose versus Standard Dose of Alteplase for Stroke ...
Safety and Efficacy of Low Dose versus Standard Dose of Alteplase for Stroke ...
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...
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1. Shock is defined as cellular hypoxia due to reduced oxygen delivery, increased oxygen consumption, or inadequate utilization and can progress from cellular to systemic effects if unchecked.
2. Shock is classified based on pathophysiology into hypovolemic, cardiogenic, obstructive, distributive, and neurogenic types.
3. The document provides an overview of the pathogenesis, classification, treatment goals and strategies for each shock type to guide clinical management.
Breast Cancer Treatment.pdf
This document discusses current treatment options for breast cancer, including both non-metastatic and metastatic disease. For non-metastatic cancer, local therapy involves surgical resection and lymph node removal, while systemic therapy includes pre-operative, postoperative, or both chemotherapy and endocrine therapy based on molecular subtype. Metastatic breast cancer focuses on prolonging life and palliating symptoms using the same systemic therapies. The document then covers specific topics like nipple discharge, cystic lesions, rare tumors, DCIS, mastectomy, breast-conserving therapy, and systemic therapies.
Emergency Management of Hip Dislocations & Pelvic Fractures.pdf
Hip dislocations and pelvic fractures are common injuries seen in emergency departments. Hip dislocations, which are usually posterior, require prompt closed or open reduction to prevent osteonecrosis of the femoral head. Pelvic fractures are classified using the Young-Burgess system and range from stable patterns to more unstable anterior-posterior compression or lateral compression injuries which may lead to life-threatening hemorrhage. Clinical assessment focuses on signs of bleeding, neurovascular injury, or instability while radiological evaluation aids classification and guides management, which may involve hemorrhage control techniques, external or internal fixation, or angiography in unstable or bleeding patterns. Complications include bleeding, infection, instability, and nerve injuries requiring multidisciplinary care and early
Abdominal Compartment Syndrome.pdf
This document outlines a presentation on abdominal compartment syndrome (ACS) and intra-abdominal hypertension (IAH). It includes two case reports of patients who developed ACS after abdominal surgery or ingesting bleach. It defines ACS and IAH, describes how to grade and diagnose them, and outlines their epidemiology, etiology, pathophysiology, and management, including conservative measures and decompressive surgery if needed. Complications of decompressive laparotomy like enteroatmospheric fistulas are also discussed.
Peripheral Arterial Disease
Peripheral arterial disease (PAD) is the obstruction or deterioration of arteries other than those supplying the heart and brain. PAD prevalence increases with age and is more common in Black individuals compared to Whites. A study in Ghana found higher PAD prevalence in Ghanaians living in Ghana compared to migrant Ghanaians in Europe. Risk factors for PAD include smoking, hypertension, diabetes, hyperlipidemia, and renal insufficiency. Treatment involves lifestyle modifications, medications, and revascularization procedures like angioplasty, stenting, or bypass surgery depending on the severity and location of arterial blockages. Amputations may be required for gangrenous or critically ischemic limbs.
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This document discusses local anaesthesia techniques for common penile procedures. It describes relevant anatomy and different nerve block techniques like the dorsal penile nerve block and intracorpus spongiosal block. It also discusses a transillumination-guided urethral block technique for anterior urethral strictures that has been successfully used in 55 cases without needing additional sedation. The document emphasizes considering local anaesthesia as an option for penile procedures and calculating safe doses to minimize risks.
Pain Management in Oncology
This document discusses pain management in oncology. It begins by outlining the objectives of understanding cancer pain management principles, categorizing pain, optimizing analgesia, using adjuvant analgesics, and recognizing when interventional therapies could help. It then provides background on cancer prevalence in Ghana and the high rates of pain in cancer patients. The rest of the document details approaches to assessing and treating cancer pain, including pharmacological and non-pharmacological options. It emphasizes a stepwise approach using the WHO analgesic ladder and treating the specific cause and type of cancer pain.
Organophosphate Poisoning
Keynote Presentation given to medical staff of the West Africa Rescue Association affiliated with International SOS, on management of organophosphate poisoning.
Dermatomyositis
A middle-aged woman presented with generalized weakness, rashes, and sores. On examination, she had hyperpigmentation, edema, and rashes on her buttocks and groin. Tests found elevated muscle enzymes. She was diagnosed with dermatomyositis and admitted for IV fluids and steroids. Her symptoms worsened, and she developed difficulty raising her arms, confirming the diagnosis of dermatomyositis. She was started on immunosuppressants and referred for palliative care.
Systemic Lupus Erythematosus - Case Management and Literature Review
A middle-aged woman presented with generalized weakness, dizziness and was found to have pancytopenia. Physical exam revealed signs of systemic lupus erythematosus including malar rash, oral ulcers, arthritis and hyperpigmented skin lesions. Laboratory tests confirmed pancytopenia and elevated inflammatory markers. A working diagnosis of SLE with pancytopenic anemia was made. She was started on steroids and other treatments. Further workup of her labs and signs are consistent with SLE. SLE is an autoimmune disease that commonly affects women and can involve multiple organ systems.
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Learning objectives:
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2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
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Steroid Treatment for Acute Spinal Cord Injury.pdf
- 1. Steroid Treatment for ASCI Fiifi Brakatu
- 2. How Did We Get Here?
- 3. 1972 n= 82 Control (no injury) = 8 Cats with 150 GCF ASCI (untreated) = 33 Grp treated with IM steroids = 41 Cats treated with dexamethasone before or up to 24 h after cord injury have significandy better recovery and less histological abnormality in the spinal cord than untreated cats, but the course of post-traumatic edema is similar.
- 4. 1974 They demonstrated that K+ loss from cord happens in ASCI Definite effect on Dexamethasone on D3 and statistically significant on D6 (p<0.01)
- 5. National Acute Spinal Cord Injury Studies (NASCIS) I Trial - 1985 No significant difference was observed in neurological recovery of motor function, pinprick response, or touch sensation 1 year after injury between the two treatment groups Lack of a steroid treatment effect. Multicenter Double-blind RCT Compared 1g Dexa daily x 10days with 100mg Dexa x 10days CFR - 10.7%
- 6. NASCIS II Trial - 1992 At 1yr - No significant difference in neurologic function Those treated with methylprednisolone within 8hrs had a modest improvement in motor recovery compared to placebo (p = 0.03) Wound infections were more common in methylprednisolone group Compared Methylprednisolone (30mg/kg IV ff 5.4g/kg/hr over 23hrs) with Naloxone and placebo in 427 TSCI patients
- 7. NASCIS III Trial - 1998 Patients treated within 3hrs had no diff in neurologic outcomes at 1yr For patients treated btn 3-8h, 48hrs of MP was associated with greater motor but not functional recovery Longer MP infusions = more cases of severe pneumonia and severe sepsis Mortality was similar in all treatment groups n=499 MP(x48h) vs MP(x24h) vs TM(a potent lipid peroxidation inhibitor; x 48h) All 499 received bolus of 30mg/kg and Rx within 8hrs
- 8. Metanalysis - Only 3 RCTS! - 2012 NASCIS II trial + 2 other smaller trials (one positive and one negative) Improved motor recovery (Not functional recovery!)
- 9. Surgical Timing in Acute Spinal Cord Injury (STACIS) Trial - 2012 to 2019 Nonrandomized prospective cohort study 6 North American Centers; 7yr study n=411 Patients who suffered a complication were less likely to have received glucocorticoid therapy (p=0.01), higher ASIA scores and more comorbidities Limitations - Generalizability of model and suitability for clinical use remains unproven.
- 10. Societal Recommendations STEROIDS NOT RECOMMENDED FOR ASCI! STEROIDS ARE A TREATMENT OPTION NOT A TREATMENT STANDARD
- 11. Meta-analysis - 2020 12 studies including 5RCTs and 7 observational studies No statistically significant increased risk of GI bleeding, Decubitus ulcers, SSIs, Sepsis, Atelectasis, VTEs, UTIs or mortality MP within first 8h failed to show a statistically significant short term or long term improvement in overall motor or neurological scores compared to controls who did not take MP. Increased risk of pneumonia and hyperglycaemia among those who took MP.
- 12. NO CLINICAL EVIDENCE EXISTS TO DEFINITELY RECOMMEND THE USE OF STEROID THERAPY
- 13. THANK YOU