Bilateral stress fractures of femoral neck in non-athletes: a report of four cases

Femoral neck stress fractures (FNSFs) are rare,constituting only 5％ of all stress fractures in young adults.These fractures are usually seen in athletes,military recruits and patients with underlying m...     

Chronic pain and its impact on quality of life following a traumatic rib fracture

Purpose

Traumatic rib fractures account for 7–40?% of trauma admissions and most of them heal spontaneously and do not contribute to disability. The prevalence of chronic pain and its impact on quality of life following a traumatic rib fracture has not been studied adequately.

Methods

A retrospective review of electronic medical records of all the traumatic rib fracture admissions from January 2007 to December 2008 was conducted. This was followed up with a brief telephonic survey of the following questions: (1) Do you have pain following the trauma? (2) If YES, how severe is your pain from a score of zero to ten? (3) Does the pain affect your life style? (4) Does the pain affect your work? (5) Do you need to take regular pain medications?

Results

One hundred and two patients responded to the survey and 23 patients (22.5?%) complained of chronic persistent pain. In patients with pain, six patients (26?%) had chronic pain that required regular use of analgesics, eight patients (35?%) complained of impairment of work life, and three patients (13?%) complained of impairment of personal quality of life. Chronic pain was not related to age, number of ribs fractured, flail chest, hemothorax and/or pneumothorax, chest tube insertion, or Injury Severity Score (ISS).

Conclusion

This study confirms the high incidence of chronic pain after a traumatic rib fracture. While the majority of the patients can manage this pain without interference of their quality of life, a few do suffer from life style/work interference and may have to resort to regular analgesic usage.     

Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease

Chorea is a neurological adverse effect of oral contraceptive pills (OCPs). The onset of chorea following OCPs usage varies widely from few weeks to several years. We report a rare case of chorea which developed within a week of starting OCPs in an adolescent girl with polycystic ovarian disease.KEY WORDS: Chorea, oral contraceptive pills, polycystic ovarian disease     

Effect of Azelastine Nasal Spray on Histamine-and Allergen-Induced Skin Wheal Response in Patients with Allergic Rhinitis

Effect of azelastine nasal spray on histamine-and allergen-induced skin test response in patients suffering with allergic rhinitis was evaluated. Baseline cutaneous response to histamine and 18 common allergen extracts were recorded by skin prick tests on 10 patients. The patients were then advised to take azelastine nasal spray (1 spray per nostril, twice daily; 0.28 mg/dose). This pediatric dose is reported to be effective also in adults (age ≥ 12 years) with improved tolerability as compared with usually recommended adult dose of 2 sprays per nostril twice daily. Skin tests were repeated 2 and 6 hours after single dose, as well as after 6 days of continuous treatment. We did not find any significant difference in skin wheal response with single dose and 6 days' treatment of azelastine nasal spray (p > 0.05). It is concluded that diagnostic allergen skin tests may be performed on patients undergoing azelastine nasal spray treatment (0.28 mg/dose, twice a day) during their symptomatic period.     

Sphingomyelin metabolism in erythrocyte membrane in asthma

Background. Sphingomyelin (SM), a major lipid constituent of outer leaflet of plasma membranes, with cholesterol, constitutes microdomains, which are termed as lipid rafts. These rafts provide support to proteins, receptors, enzymes, and so on and organize and orient them to conduct cellular functions including transmembrane signaling to substances in external milieu. The SM contents are regulated by its metabolism, changes in which may affect the composition of lipid rafts and cell response to the triggers of asthma which may lead to the pathophysiology. For studying changes in membranes, erythrocytes, which contain lipid rafts, are considered to be the best cell type. Hence, this study was conducted on plasma membrane of erythrocytes of asthmatic patients. Objective. The objective is to understand the changes in SM metabolism in asthma. Methods. The study included 50 subjects (25 asthmatics and 25 healthy subjects). Erythrocytes were isolated from the peripheral blood and membrane prepared. This was followed by determination of total cholesterol, phospholipids, SM, and sphingomyelinase activity. P < .05 was considered significant. Results and conclusions In asthmatics, there was a significant decrease in cholesterol contents (p < .05), decrease in total phospholipid contents (p < .005), increase in SM (p < .01), decrease in cholesterol: SM ratio (p < .001) and increase in sphingomyelinase activity (p < .001) in erythrocyte membranes. We conclude that in asthma, the increase in SM contents is associated with increased sphingomyelinase activity which shows an imbalance in SM metabolism, directed toward its accumulation. The ratio of cholesterol to SM, critical for maintenance of lipid rafts, was significantly lower in asthmatics. This indicates changes in structure of lipid rafts which may lead to the pathophysiology and development of asthma. Regulation of SM metabolism may help in disease regulation and its control.     

Tropical eosinophilia: clinical and physiological response to diethylcarbamazine

Fifty patients with tropical eosinophilia were studied clinically and physiologically, before and after a standard 3-week course of diethylcarbamazine. Before treatment the main physiological abnormality was a reduction in the carbon monoxide transfer factor. One month after the start of treatment most patients had shown a marked symptomatic improvement, but peripheral blood eosinophilia persisted in 52%, radiographic abnormalities in 44%, cough in 22% and chest signs in 8%. Significant improvement was noted in almost all aspects of lung function including blood gases, but the mean values for forced expiratory volume in one second, forced vital capacity, transfer factor and transfer coefficient continued to be significantly lower than predicted values. This study demonstrates the incomplete reversal of clinical, haematological, radiological and physiological changes in tropical eosinophilia one month after starting a 3-week course of diethylcarbamazine.