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Objective: To establish the effectiveness of polyethylene skin wrap in prevention of neonatal hypothermia in preterm and low birth weight neonates. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pediatrics, Combined Military Hospital Quetta, from May 2015 to Apr 2017. Methodology: A total of 176 neonates were enrolled according to the inclusion and exclusion criteria, through non-probability consecutive sampling. Eighty eight newborns were randomly distributed to each of group “A” and “B” by lottery method. The intervention group “A” infants were wrapped in a polyethylene skin wrap from shoulders down while the control group “B” newborns were wrapped with conventional blankets. After shifting to neonatal intensive care unit, axillary temperatures were recorded with similar pediatric digital thermometers upon admission and after one hour and two hours following admission in the two groups. Results: The mean temperatures measured at one hour and two hours after admission showed significant statistical improvements in the intervention group as compared to the control group (<0.05). Conclusion: The use of polyethylene skin wrap in preterm and low birth weight neonates potentially offers a useful intervenetion in prevention of neonatal hypothermia.

Objective: To compare mean resting pain relief and passive external rotation improvement by Intra-articular Steroid versus intra-articular Platelet Rich Plasma injection in patients with adhesive capsulitis. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jan to Jun 2019. Methodology: A total of 60 patients were included in the study. Group-A and B received Intra-articular 40mg Triamcinolone Acetonide with 1 ml 1% Lignocaine and platelet-rich plasma injections in affected shoulders, respectively. Pain severity was assessed on the Numeric Rating Scale, and passive external rotation was assessed by goniometry at baseline, i.e., preintervention, six weeks and 12 weeks intervals. Results: In our study, the NRS scale for pain was 3.030.76 at six weeks and 1.230.77 at 12 weeks with PRP versus 5.070.87 at six weeks and 3.200.89 with Corticosteroids at 12 weeks post-intervention, with the p-value of <0.001 showing increased efficacy of PRP. While passive external rotation was 70.275.26 at six weeks and 82.304.84 at 12 weeks with PRP versus 61.35.28 at six weeks and 71.806.99 with corticosteroids at 12 weeks post-intervention, with the p-value of <0.001 showing increased efficacy of PRP. Conclusion: There was a significant improvement in mean resting pain relief and passive external rotation after platelet-rich plasma injection in the shoulder joint adhesive capsulitis compared to intra-articular Steroids.

ABSTRACT Objective: To compare platelet rich plasma against local steroid injection in patients with chronic plantar fasciitis in terms of mean pain and functional scores. Study Design: Quasi-experimental study. Place and Duration of study: Armed Forces Institute of Rehabilitation Medicine(AFIRM) Rawalpindi, from May 2016 to Apr 2018. Methodology: A total of 120 patients having chronic plantar fasciitis were included in the study and were split into 2 groups. The group “A”(n=60) patients were injected with a single dose of autologous platelet rich plasma. The group “B”(n=60) patients received a single dose of methylprednisolone added with a local anesthetic agent. Functional and symptomatic evaluation was done using the American foot and ankle score and the visual analog scale respectively at baseline and at 6 months follow-up. Results: Mean visual analogue score was 7.83 ± 0.99 at baseline and 3.43 ± 1.30 at 6 months follow-up in group “A” and 7.90 ± 1.06 and 4.97 ± 1.16, respectively, in group “B”(p<0.001). Mean American Foot and Ankle Score was 39.37 ± 5.93 at baseline and 88.73 ± 5.02 at 6 months follow-up in group “A” and 39.03 ± 5.97 and 80.30 ± 8.03, respectively, in group “B”(p<0.001). Changes in the scores of both the evaluation tools were significantly higher in the group “A”(p<0.001). Conclusion: Platelet rich plasma turns out to be more efficacious compared to steroid injection in terms of pain relief and functional outcome in the management of chronic plantar fasciitis in long term.

Objective: To compare the outcome of intra-articular hyaluronic acid injection with oral non-steroidal anti-inflammatory drugs in knee osteoarthritis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient orthopedics department of Combined Military Hospital, Rawalpindi from February 2015 to July 2016. Patients and Methods: A total of 60 patients with knee osteoarthritis were enrolled as per inclusion and exclusion criteria by non-probability consecutive sampling. Thirty patients were assigned to group “A” and were given intra-articular injection of hyaluronic acid 20 mg (2 ml) into the knee joint aseptically for five consecutive weeks. Group “B”, having thirty patients, was given oral non-steroidal anti-inflammatory drug Celecoxib 200mg/Naproxen 500mg twice daily after meals for twelve weeks. Outcome measure was mean pain score using visual analogue scale at twelve week follow-up. Results: Statistically significant improvement in mean pain score on visual analogue scale at twelve week follow-up was found in patients of group “A”, with improvement in score from 7.2 ± 0.92 at the start of the study to 5.6 ± 1.23 at twelve week follow-up (p<0.001). No statistically significant results were obtained in patients with group “B” having pain score on visual analogue scale of 7.4 ± 0.94 at the start of the study to 7.3 ± 0.95 at twelve week follow-up (p= 0.373). Conclusion: The use of intra-articular injection of hyaluronic acid in knee osteoarthritis potentially offers a significantly greater clinical improvement in terms of pain relief, especially in radiological grades 1 to 3. Non-steroidal anti-inflammatory drugs, on the other hand, are of lower comparative efficacy in the treatment of knee osteoarthritis pain.

Objective: To determine mean bone mineral density in patients with chronic low back pain presenting at Armed Forces Institute of Rehabilitation Medicine Rawalpindi based on dual energy x-ray absorptiometry studies.Study Design: Cross sectional study.Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi from Apr 2015 to Mar 2016.Patients and Methods: Two hundred and forty patients having low back pain of more than 6 months duration fulfilling the inclusion criteria were included both from indoor and outdoor departments through non-probability consecutive sampling. Bone mineral density was measured at lumbar spine by dual energy x-ray absorptiometry studies by the same technical staff using the same equipment. A written informed consent was taken from each patient. Data were collected and recorded on specialized proforma by the principal investigator.Results: Spine BMD on DXA scan ranged from 0.90 to 0.98 g/cm2 with a mean of 0.95 ± 0.02 as shown in. When stratified, the mean BMD decreased significantly with increasing age and severity of LBP; 20-30 years vs. 31-40 years (0.95 ± 0.01 vs. 0.92 ± 0.02; p=0.001). However, there was no significant difference in mean BMD across genders; male vs. female (0.94 ± 0.01 vs. 0.94 ± 0.02; p=0.680). Similarly there was no significant difference in mean BMD across various durations of low back pain; 7-10 vs. 11-14 months (0.94 ± 0.03 vs. 0.93 ± 0.01; p=0.617).Conclusion: The mean bone mineral density at spine was found to be lower in patients with chronic low back pain. It was significantly lower in older patients and those with severe low back pain. However, it didn't change significantly with various durations of low back pain or gender.

Objective: To compare the intra-articular corticosteroid versus physiotherapy in the management of adhesive capsulitis in terms of mean pain score.Study Design: Randomized controlled trial.Place and Duration of Study: Outpatient department, at Armed Forces Institute of Rehabilitation Medicine, from Jul 2013 to Jul 2015.Material and Methods: A total of 90 patients with adhesive capsulitis were enrolled as per inclusion criteria by non probability consecutive sampling. Forty five patients were assigned to group \"A\" and were given intra-articular injection of triamcinolone 40mg (2ml) and bupivacain 2ml into the shoulder joint. Group \"B\", having forty five patients received eight session of physiotherapy on alternate day. Outcome measure included mean pain score using visual analogue scale at six week follow-up.Results: Statistically significant improvement in pain score on visual analogue scale was found in patients with group \"A\", with improvement in score from 7.2 ± 0.91 at the start of the study to 5.6 ± 0.18 at six week follow-up (p<0.001). Whereas no statistically significant results were obtained in patients with group \"B\" having pain score on visual analogue scale of 7.4 ± 0.14 at the start of the study to 7.3 ± 0.14 at six week follow-up (p=0.54).Conclusion: The use of intra-articular corticosteroid injection in shoulder joint potentially offers a significantly greater clinical improvement in pain relief over the use of supervised physiotherapy in the management of patients suffering from adhesive capsulitis.