Outcome of Neuromuscular Electrodiagnostic Testing in Children

This study aimed to describe the spectrum of the results of neuromuscular electrodiagnostic investigations performed by age and pathology in paediatric patients. This retrospective observational study took place from January 2019 to December 2021. Electrodiagnostic records of paediatric patients (birth to 15 years) were referred to the electromyography (EMG) laboratory for EMG and nerve conduction study (NCS). Electrodiagnostic and demographic data were collected. Among these, 151 (56%) were males and 118 (44%) were females. Forty-four percent tests came out to be normal and 151(56%) tests revealed electrophysiological abnormality. Peripheral nerve neuropathy (n = 39, 14.5%), polyneuropathy (n = 35, 13%) and myopathy (n = 28, 10%) were the most common electrophysiological diagnoses. The electrodiagnostic test helps in differentiating the aetiologies, thus guiding the subsequent work-up logically in the paediatric population. Key Words: Brachial plexus neuropathies, Electromyography, Duchene muscular dystrophy, Neuromuscular junction disorders, Nerve conduction studies, Acute inflammatory demyelinating polyneuropathy, Rehabilitation, Electromyography, Hereditary sensory motor polyneuropathy.

The Analgesic Effect And Functional Improvement Produced by Radio-Frequency Ablation of Genicular Nerves in Patients with Advanced Knee Osteoarthritis

Objective: To study the efficacy of radiofrequency ablation for treating pain in patients with advanced knee osteoarthritis. Study Design: Quasi-experimental study. Place and Duration of Study: Pain Clinic of Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Sep 2019 to Feb 2020. Methodology: Patients of more than 50 years of age, with grade III and IV Kellgren-Lawrence grades of knee osteoarthritis and at least a score of 4 for three months on the numerical rating scale were included in the study. Measurements were taken on the numerical rating scale and Western Ontario and McMaster universities osteoarthritis index before and four weeks after fluoroscopy-guided radiofrequency ablation of three genicular nerves around the knee joint. . Results: Fifty patients (mean age: 62 ± 6.5 years) were included in the study. The median numerical rating scale scores before and after intervention were 9 (Interquartile range: 7-10) and 5 (Interquartile range: 2-8), respectively (p<0.001). The mean Western Ontario and McMaster universities osteoarthritis index scores before and after intervention were 76.7 ± 13.4 and 50.3 ± 18, respectively (p<0.001). No complications were reported. The reduction in numerical rating scale, Western Ontario and McMaster universities osteoarthritis index scores after the intervention were significantly better in females than in males (p=0.023 and p=0.012 respectively); however, no significant change was observed for the right and left knee or grades of knee osteoarthritis (p>0.05). Conclusion: Radiofrequency ablation of genicular nerves around the knee joint significantly improves pain, stiffness and body function in patients with advanced knee osteoarthritis .........................

FIRST REPORTED CASE OF MAJEED SYNDROME FROM PAKISTAN

Majeed syndrome, characterized by chronic recurrent multifocal osteomyelitis and congenital dyserythropoeitic anemia, is a rare disease reported in children. We report a case of Majeed Syndrome in a 9-year-old boy, born of consanguineous marriage reporting to us for treatment of anemia, requiring blood transfusion. He underwent below-knee-amputation due to unresolving recurrent osteomyelitis at multiple sites. There was history of pain insensitivity and fever during hot weather as well. His interleukin-6 levels were raised. This is the first case of Majeed Syndrome from Pakistan and first in the world with Hereditary Sensory Autonomic Neuropathy type 4 as an associated feature.

Efficacy of intra-articular autologous platelet rich plasma injection in primary knee osteoarthritis: A quasi-experimental study

OBJECTIVE

To observe the efficacy of platelet rich plasma on pain improvement in knee osteoarthritis patients and to explore the impact of various facotrs on pain reduction with such a treatment.

METHODS

The quasi-experimental study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from October 2017 to April 2018 and comprised patients with primary knee osteoarthritis. The sample was sub-grouped into "normal", "overweight" and "obese" on the basis of body mass index. Two age-based sub-groups were also formed at ≤ 60 years and >60 years. Three injections of calcium gluconate activated 2.5ml platelet rich plasma were given in the knees at an interval of two weeks each. The pain score was calculated using the numerical rating scale at the 6th week. Data was analysed using SPSS 20.

RESULTS

Of the 50 patients, 26(52%) were females and 24(48%) were males. The overall mean age was 59.6±9.6 years (range: 42-75 years), with 22(44%) aged ≤ 60 years. There were 21(42%) patients who were overweight, 7(14%) had normal weight and 22(44%) were obese. There was significant pain reduction post-treatment compared to the baseline (p<0.001). The reduction in pain was not significantly related to gender, age, knee osteoarthritis grade, or body mass index (p>0.05).

CONCLUSIONS

Platelet rich plasma significantly improved pain in knee osteoarthritis patients regradless of all age, gender, grade and body mass index.

Ultrasonographic evaluation of the ankle after unilateral traumatic lower limb amputations

BACKGROUND

Unilateral lower limb amputation can alter the tissue morphology leading to increase future risk of degenerative secondary disorders.

METHODS

Thirty-four consecutive male patients with unilateral lower limb amputations of different levels and 34 well matched male controls were included. To explore whether the ankles of traumatic lower limb amputees were undergoing morphological changes, three different tissue types i.e. talar cartilage, plantar fascia and Achilles tendon thicknesses in the intact limb of the lower limb amputee and healthy controls were measured by using ultrasound.

RESULTS

Plantar fascia was found to be thicker (p=0.013) and talar cartilage was thinner (p<0.001) on the intact sides of the patients than those of the controls. Achilles tendon thickness was found to be similar. In patients group, plantar fascia thickness was positively correlated with age (r=0.601, p<0.001), BMI (r=0.454, p=0.007) and durations of amputation (r=0.443, p=0.009) and prosthetic use (r=0.429, p=0.011). Achilles tendon thickness was positively correlated with durations of amputation (r=0.338, p=0.05) and prosthetic use (r=0.468, p=0.005). In controls group, talar cartilage thickness was negatively correlated with age (r=-0.640, p<0.001) and BMI (r=-0.401, p=0.019).

CONCLUSIONS

The talar cartilage seemed to be thinner and the plantar fascia to be thicker on the intact sides of the unilateral limb amputees.