MyrliMax® and Low Back Pain: A Multicentric, Observational, Post-Marketing Surveillance Study in Indian Patients Suffering from Chronic Low Back Pain of Various Pain Intensity.

Background: Chronic low back pain (LBP) is the most common musculoskeletal condition affecting a person's quality of life. Over the past decades, a lot of work was done in an attempt to reduce the negative impact of LBP, and help patients recover and maintain a better quality of life. Nevertheless, there is still a lot to be done to fully understand the problem of underlying chronic LBP and a wide gap that exist between basic science and applied rehabilitation research on LBP. Objectives: This was an open label, multicentric, observational, post-marketing surveillance study in a real-world setup designed to evaluate the efficacy and safety of MyrliMax® capsules containing standardised Commiphora myrrha gum resin extract in Indian subjects with chronic LBP varying in intensity. Materials and methods:This study included 204 subjects diagnosed with chronic LBP at the outpatient department of 20 centres under the supervision of a medical doctor. All subjects took MyrliMax® capsules twice daily for 20 days. Visual Analogue Scale (VAS) pain score, rescue medicine requirement, therapy satisfaction scores and safety parameters were assessed as per the schedule. Outcomes:Treatment with MyrliMax® capsules significantly (p<0.01) and progressively reduced the VAS score throughout treatment. A significant pain reduction was observed from the second visit. The mean VAS score was 6.58, 4.66, 2.99 and 1.88 on Day 0, Day 7, Day 14 and Day 20, respectively. A similar trend was also observed in subgroups based on gender and severity score. The need of rescue analgesics/NSAIDs was significantly reduced from the second week, indicating a potential of MyrliMax® capsules to increase the pain threshold. All physicians and patients were satisfied with the efficacy of MyrliMax® capsules assessed by physician's satisfaction score and patient's satisfaction score. There were no significant serious adverse events due to treatment during the study, which indicated that the treatment with MyrliMax® was well tolerated by subjects. Conclusion:MyrliMax® capsule is a potentially effective and safe therapy for pain reduction in patients suffering from chronic LBP. MyrliMax® capsules can be used to reduce pain in NSAIDs intolerant subjects suffering from chronic LBP.

Spontaneous extradural hematoma: a rare entity.

Spontaneous onset extradural hematoma (EDH) is a very rare entity and has been seen mostly to be associated with adjacent infective pathologies, dural vascular malformations, extradural metastasis, or coagulopathies. We report a series of two such cases and review the literature. One case presented with spontaneous EDH that was managed conservatively and was diagnosed to have chronic kidney disease later; the other had deranged coagulation profile and liver function secondary to drug induced hepatitis and was operated. Both patients were discharged in a stable condition and were improving on follow up.

Use of 3D printer model to study vertebral artery anatomy and variations in developmental craniovertebral junction anomalies and as a preoperative tool-an institutional experience.

BACKGROUND: Spinal instrumentation using rods and screws have become procedure of choice for posterior fixation. Vertebral artery anatomy is highly variable in this region posing challenges during surgery. Our study used 3D printer model to understand the anatomy and variations in vertebral artery in live patients thereby providing an accurate idea about vertebral artery injury risk in these patients preoperatively and to rehearse the whole procedure. METHODS: Ten patients of developmental craniovertebral junction (CVJ) anomalies who were planned for operative intervention in the Department of Neurosurgery at SMS Hospital from February 2016 to December 2016 were analysed using a 3D printer model. RESULTS: Out of twenty vertebral arteries studied in ten patients, two were hypoplastic and out of these one could not be appreciated on 3D printer model. Out of remaining nineteen, thirteen arteries were found to lie outside the joint, three were in lateral third, one traversed the middle third of joint and one lied in medial third. In one patient, the vertebral artery was stretched and it traversed horizontally over the joint. Out of ten patients studied, nine were having occipitalised atlas and so entry of these vertebral arteries into cranium were classified as given by Wang et al. into four types. CONCLUSIONS: By our study, 3D printer model was extremely helpful in analyzing joints and vertebral artery preoperatively and making the surgeon acquainted about the placement and trajectory of the screws accordingly. In our opinion, these models should be included as a basic investigation tool in these patients.

Posterior polymorphous dystrophy associated with nonkeratoconic steep corneal curvatures.

PURPOSE: To report a case series of eyes with posterior polymorphous corneal dystrophy and steep nonkeratoconic corneas. METHODS: Retrospective, descriptive, nonrandomized case series. RESULTS: Thirty-five eyes of 18 patients (14 cases from 6 families and 4 isolated cases) with diffuse posterior polymorphous corneal dystrophy had mean topographic simulated keratometry readings of 52.21 diopters (D), with a range of 46.47 D to 59.86 D and an SD of 3.69 D, with no slit-lamp or topographic findings suggestive of keratoconus. CONCLUSIONS: The patients in this series demonstrate diffuse posterior polymorphous corneal dystrophy and nonkeratoconic steep corneas.

Subconjunctival/perilesional recombinant interferon α2b for ocular surface squamous neoplasia: a 10-year review.

PURPOSE: To evaluate the biologic effect of subconjunctival recombinant interferon α2b (IFNα2b) for the treatment of ocular surface squamous neoplasia (OSSN). DESIGN: Retrospective study. PARTICIPANTS: Patients with primary or recurrent OSSN treated with subconjunctival injections of recombinant IFNα2b were studied retrospectively. INTERVENTION: Patients were given perilesional subconjunctival injections of 3 million international units in 0.5 ml of IFNα2b (Intron; Schering-Plough, Kenilworth, NJ) until tumor resolution. MAIN OUTCOME MEASURES: Patients were followed up clinically and photographically for evidence of tumor resolution and were monitored for evidence of tumor recurrence. RESULTS: The authors present a series of 15 eyes (14 patients) that were treated with perilesional, subconjunctival, recombinant IFNα2b. Clinical resolution of the tumor occurred in 13 of 15 eyes. The median time to resolution was 1.4 months (range, 0.6-5.7). In the time of follow-up after lesion resolution (median, 55 months), only 1 of the 15 eyes in the study exhibited disease recurrence, and this occurred 4 months after clinical resolution. CONCLUSIONS: Perilesional subconjunctival recombinant IFNα2b may be a viable medical alternative for the treatment of OSSN. Future studies will be needed to evaluate the ideal treatment regimen of IFNα2b.

Endophthalmitis after open globe injury: microbiologic spectrum and susceptibilities of isolates.

PURPOSE: To present the microbiologic spectrum and susceptibilities of isolates in posttraumatic endophthalmitis, and to provide a review of the literature. DESIGN: Retrospective consecutive case series. METHODS: A review of 1182 consecutive open globe injuries was performed, identifying 10 patients with culture-proven endophthalmitis. RESULTS: Thirteen organisms were isolated from 10 eyes with posttraumatic endophthalmitis. Isolated organisms included Streptococcus species (46.2%), coagulase-negative Staphylococcus (23.1%), and Bacillus cereus (15.4%). All organisms tested were susceptible to vancomycin and tobramycin. The most commonly isolated organisms from an aggregate posttraumatic endophthalmitis pool of 372 cases obtained by literature-based meta-analysis were coagulase-negative Staphylococcus (21.5%) and Bacillus cereus (18.5%). CONCLUSION: We report a high prevalence of gram-positive pathogens and a notable prevalence of Bacillus cereus in posttraumatic endophthalmitis. Susceptibility results suggest that posttraumatic endophthalmitis isolates are generally susceptible to vancomycin and tobramycin.

Seeking help for sexual function complaints: what gynecologists need to know about the female patient's experience.

OBJECTIVE: To further explore the patient experience of seeking help for a sexual function complaint. DESIGN: Survey administered on a Web-based instrument. SETTING: Healthy volunteers visiting an online Website. PATIENT(S): The majority of participants were married (73%), Caucasian (88%), and premenopausal (67%). Most commonly reported sexual complaints included low desire (77%), low arousal (62%), and difficulty achieving orgasm (56%). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patient experience survey on a women's sexual health website. RESULT(S): Although 40% of the women reported that they did not seek help from a physician for sexual function complaints, 54% reported that they would like to. Although only a minority of the women internalized their experience with extremely negative emotions like shame, devaluation, or disgust, the experience was not a particularly emotionally positive one along the lines of relief, optimism, or confidence, and a great deal of frustration and anxiety about treatment was reported. CONCLUSION(S): The extent to which health professionals currently receive exposure to training in human sexuality as well as the way in which female sexual complaints are handled in the medical setting remain ambiguous. The inflow of patients with sexual function complaints only will increase, and it is time for physicians to start to acknowledge women's sexuality with the same importance their patients do.