Efficacy of neural prolotherapy versus local corticosteroid soft tissue injection for treatment of chronic anserine bursitis: a prospective randomized clinical trial

Background Anserine bursitis is characterized by the presence of spontaneous pain with tenderness at the inferomedial aspect of the knee joint. Neural prolotherapy aims to relieve pain of a variety of chronic musculoskeletal disorders. The study aim was to explore the short-term efficacy of neural prolotherapy (subcutaneous perineural injection of dextrose 5% solution) versus local corticosteroid injection for pain relief and improvement of function in patients with chronic anserine bursitis. The enrolled patients were randomly assigned to receive neural prolotherapy (subcutaneous perineural injection of dextrose 5% solution) (neural prolotherapy group) or a single local soft tissue injection of corticosteroid (corticosteroid group). Outcome measures included Western Ontario McMasters Universities osteoarthritis index, assessment of overall anserine bursitis pain severity using the visual analogue scale, patient’s global assessment of anserine bursitis severity using the visual analogue scale, and clinical assessment for the presence of tenderness on the anserine bursa region. Patients were evaluated before injection and after intervention by 4 weeks. Results The study included 67 lower limbs from 43 patients with chronic anserine bursitis. No significant differences were found between both treatment groups regarding all assessed parameters at the start of the study. After 4 weeks, within-group analysis showed that there was a statistically significant improvement in Western Ontario McMasters Universities osteoarthritis index and its subscales (P ≤ 0.0001), overall anserine bursitis pain severity (P ≤ 0.0001), and patient’s global assessment of anserine bursitis severity (P ≤ 0.0001), as well as there was significant improvement regarding the presence of tenderness at the anserine bursa region in both groups in comparison to the preinjection assessment. At the postinjection assessment, between-group analysis showed that there were no significant differences regarding all assessed outcome parameters. All patients in both groups tolerated the injection procedure and were satisfied with the procedure. There was no significant difference between the two groups regarding patients’ satisfaction to the procedure results. Improvement was achieved in 86.4% of patients included in the neural prolotherapy group versus 95.2% of patients included in the corticosteroid group. Conclusions Neural prolotherapy was effective in relieving pain, improving local tenderness and function in patients with chronic anserine bursitis similar to local corticosteroid injection. Trial registration ClinicalTrials.gov, registration number: NCT04509440. Registered 12 August 2020—Retrospectively registered,

Assessment of nutritional status of hemodialysis patients by subjective global assessment score: a single centre study from Karachi, Pakistan

Objective: Despite being an important predictor of morbidity and mortality, routine screening for malnutrition in dialysis patients is not a common practice in Pakistan. Modified Subjective Global Assessment (SGA) is a convenient, inexpensive and practical method to assess nutritional status particularly in resource limited setup. Methods: This cross sectional study was conducted in The Kidney Center Post Graduate Training institute (TKC-PGTI). Patients on maintenance hemodialysis (MHD) were included through non-probability consecutive sampling. A one-time SGA score was calculated based on the history and physical examinations using modified SGA or Dialysis Malnutrition Score (DMS). Chi square test was applied to find association between variables, while to observe the amount of effect of factors on SGA score; binary logistic regression analysis was run. P value of ? 0.05 considered significant. Results: Mild-Moderately malnourished patients were the most frequent in our study 96(64%).None of patient had severe malnourishment. Females were 2.6 times more prone for malnourishment (p value=0.009). More than 5- years on hemodialysis also increased the risk of malnourishment by 12.5 times (p value <0.001). Overweight patients had 85 % less chance of being malnourished as compare to patients with normal weight (p value=0.004). Conclusion: Malnutrition is quite common in hemodialysis patients, which necessitates its regular assessment and monitoring. There is a need to assess the reasons of more malnourishment in female as compared to male. Similarly, the longer duration (> 5 years) on hemodialysis also need attention for prevention and cure of malnourishment. Continuous...

Reliability Assessment and Validation of the Skin Hyperpigmentation Index Compared to the Physician Global Assessment Score

<b><i>Background:</i></b> The skin hyperpigmentation index (SHI), a new objective method for measuring skin hyperpigmentation, needs validation. <b><i>Objective:</i></b> To gain evidence of the reliability and validity of the SHI. <b><i>Methods:</i></b> Fifteen raters were divided into 3 groups (5 dermatologists, 5 nondermatologist physicians, and 5 nonphysician clinicians). Each rated 5 pigmented mole lesions with mild-to-severe hyperpigmentation to determine intra- and interrater reliability. All raters photographed the lesions and rated them using the subjective Physician Global Assessment (PGA) score. The same photographs were then assessed based on automatic computer measurement software using the online SHI tool (https://shi.skinimageanalysis.com). <b><i>Results:</i></b> The SHI reliability was excellent for all intra- and interrater assessments, while most PGA assessments showed good intra- and interrater agreement. Between-group reliability was excellent for SHI, while moderate-to-good for PGA evaluations. Concordance between the SHI and PGA assessments was strong across all groups of assessors. <b><i>Conclusion:</i></b> There is evidence that the SHI is a reliable instrument for measuring skin hyperpigmentation, and can be used by nonexperienced clinicians.