Peppering versus Single Injection Technique in Tennis Elbow - A Prospective Comparative Study.

Introduction: Lateral epicondylitis is a common condition causing severe incapacitating pain. Several methods of treatment have been approached for its management. In our study we aim to compare the results of injecting steroid and lignocaine mixture via single injection and peppered injection technique and analyse the outcome in each category. Materials and methods: A prospective randomised study comprising of 25 patients in each group (single vs peppered group) were included in the study after satisfying inclusion and exclusion criteria. Outcome of the treatment was measured in the form of Patient Related Tennis Elbow Evaluation (PRTEE) Questionnaire, Visual analogue score (VAS) and tenderness grading at two weeks, six weeks and six months after injection. Results: Results of our study showed that the mean PRTEE score was 22.36, 18.40 and 14.16 at 2 weeks, 6 weeks and 6 months following peppered injection as compared to 28.96, 21.84 and 25.32 in the single injection group (p value <0.05). VAS score at 2 weeks, 6 weeks and 6 months after the peppered injection was found to be 2.72, 1.72 and 1.36 and in the single injection group was 2.96, 1.92 and 2.72 at 2weeks, 6 weeks and 6 months, respectively (p value <0.05). On comparison of the 2 groups, there was a significant reduction of VAS scores at 6 months post-injection (p value <0.05) and PRTEE score at 6 weeks, 6 months in peppered injection group. Conclusion: The effects of peppered injection technique is seen to be advantageous over the single injection technique in the management of chronic lateral epicondylitis.

Peppering versus Single Injection Technique in Tennis Elbow - A Prospective Comparative Study

@#Introduction: Lateral epicondylitis is a common condition causing severe incapacitating pain. Several methods of treatment have been approached for its management. In our study we aim to compare the results of injecting steroid and lignocaine mixture via single injection and peppered injection technique and analyse the outcome in each category. Materials and methods: A prospective randomised study comprising of 25 patients in each group (single vs peppered group) were included in the study after satisfying inclusion and exclusion criteria. Outcome of the treatment was measured in the form of Patient Related Tennis Elbow Evaluation (PRTEE) Questionnaire, Visual analogue score (VAS) and tenderness grading at two weeks, six weeks and six months after injection. Results: Results of our study showed that the mean PRTEE score was 22.36, 18.40 and 14.16 at 2 weeks, 6 weeks and 6 months following peppered injection as compared to 28.96, 21.84 and 25.32 in the single injection group (p value <0.05). VAS score at 2 weeks, 6 weeks and 6 months after the peppered injection was found to be 2.72, 1.72 and 1.36 and in the single injection group was 2.96, 1.92 and 2.72 at 2weeks, 6 weeks and 6 months, respectively (p value <0.05). On comparison of the 2 groups, there was a significant reduction of VAS scores at 6 months post-injection (p value <0.05) and PRTEE score at 6 weeks, 6 months in peppered injection group. Conclusion: The effects of peppered injection technique is seen to be advantageous over the single injection technique in the management of chronic lateral epicondylitis.

C. elegans EGL-9 and mammalian homologs define a family of dioxygenases that regulate HIF by prolyl hydroxylation.

HIF is a transcriptional complex that plays a central role in mammalian oxygen homeostasis. Recent studies have defined posttranslational modification by prolyl hydroxylation as a key regulatory event that targets HIF-alpha subunits for proteasomal destruction via the von Hippel-Lindau ubiquitylation complex. Here, we define a conserved HIF-VHL-prolyl hydroxylase pathway in C. elegans, and use a genetic approach to identify EGL-9 as a dioxygenase that regulates HIF by prolyl hydroxylation. In mammalian cells, we show that the HIF-prolyl hydroxylases are represented by a series of isoforms bearing a conserved 2-histidine-1-carboxylate iron coordination motif at the catalytic site. Direct modulation of recombinant enzyme activity by graded hypoxia, iron chelation, and cobaltous ions mirrors the characteristics of HIF induction in vivo, fulfilling requirements for these enzymes being oxygen sensors that regulate HIF.

Mutagenesis studies on the iron binding ligands of clavaminic acid synthase.

Mutagenesis studies on conserved histidine residues identified as possible metal binding ligands in clavaminic acid synthase isozyme 2 were consistent with His-145 and His-280 acting as iron ligands, in support of crystallographic and previous mutagenesis studies. Mutagenesis of the four cysteines and a glutamine residue, conserved in both clavaminic acid synthase isozymes 1 and 2, demonstrated that none of these residues is essential for activity.

PaaSiCats: novel polyamino acid catalysts.

The abilities of five polyamino acids (Paa's) to catalyse the asymmetric epoxidation of enones 1-7 under three sets of reaction conditions were compared: polyneo-pentylglycine and polyleucine showed distinct advantages in most circumstances. All five polymers were adsorbed onto silica and from this further study, immobilised polyneo-pentylglycine (PLNSi) and polyleucine (PLLSi) were shown to be the catalysts of choice for the asymmetric epoxidation of less-reactive alpha,beta-unsaturated ketones.

Compassion not coercion.

PIP: In this article, law professor Amita Dhanda argues for the recasting of India's AIDS Prevention Bill of 1989, a coercive piece of legislation that only serves to stigmatize those infected with the disease. The AIDS Prevention Bill subjects member of high-risk groups (prostitutes, drug addicts, and professional blood donors) to compulsory testing and segregation. Not only does this law infringe on human rights and privacy, its high cost and the amount of resources required make it impossible execute. Also, it is difficult to adequately classify the high-risk groups. While prostitutes in red light districts might be singled out, promiscuous behavior elsewhere goes unchecked. Furthermore, the coercive and stigmatizing elements of the bill end up driving AIDS-infected individual underground. Dhanda suggests a recasting of the bill into a noncoercive measure of legal regulation. Currently, informed responsible behavior is the best AIDS preventive strategy. But in order to make it possible for people to act responsibly, human rights need to be recognized. Therefore, the law should acknowledge this, allowing for confidential testing, informed consent, and protection against discrimination. The law can also take the form of regulatory measures such as those used to prevent the adulteration of food and drugs. This regulations should aim at ensuring that blood supplied are not infected and that manufacturers and dealers in blood follow are held liable for unsafe products. Instead of stigmatizing groups of individuals, the law should require the modification of unsafe practices.^ieng

Pseudomonas infection of the symphysis pubis in a heroin user: a case report.

This article reports a case of Pseudomonas aeruginosa infection of the symphysis pubis in a heroin user. Cultures showed the organism to be sensitive to gentamicin, and cure was effected after the use of intravenous gentamicin therapy and operative curetting of joint debris and affected bone. The patient remained asymptomatic at the nine-month followup.