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Ganesan Baranidharan,1,2 Beatrice Bretherton,1,3 Richard G Feltbower,4 Jake Timothy,5 Almas Latif Khan,6,7 Ashok Subramanian,8 Mushtaq Ahmed,9 Tracey A Crowther,1,10 Helen Radford,10,11 Harun Gupta,12 Muthusamy Chandramohan,13 Douglas P Beall,14 Timothy R Deer,15 Thomas Hedman16 1Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 2School of Medicine, University of Leeds, Leeds, UK; 3School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK; 4Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK; 5Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 6Department of Spine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 7Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK; 8Somerset Spinal Surgery Service, Musgrove Park Hospital, Taunton, UK; 9Department of Trauma and Orthopaedic Surgery, Dudley Group NHS Foundation Trust, Dudley, UK; 10Research & Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 11Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK; 12Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 13Radiology Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; 14Comprehensive Specialty Care, Edmond, OK, USA; 15The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 16Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USACorrespondence: Ganesan Baranidharan, Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Email g.baranidharan@nhs.netPurpose: An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented.Patients and Methods: Forty-eight participants were randomly assigned to IFD or decompression. Primary study endpoints included changes from baseline at 8-weeks, 6, 12 and 24-months follow-ups for leg pain (visual analogue scale, VAS), back pain (VAS), disability (Oswestry Disability Index, ODI), LSS physical function (Zurich Claudication Questionnaire), distance walked in five minutes and number of repetitions of sitting-to-standing in one minute. Secondary study endpoints included patient and clinician global impression of change, adverse events, reoperations, operating parameters, and fusion rate.Results: Both treatment groups demonstrated statistically significant improvements in mean leg pain, back pain, ODI disability, LSS physical function, walking distance and sitting-to-standing repetitions compared to baseline over 24 months. Mean reduction of ODI from baseline levels was between 35% and 56% for IFD (p< 0.002), and 49% to 55% for decompression (p< 0.001) for all follow-up time points. Mean reduction of IFD group leg pain was between 57% and 78% for all time points (p< 0.001), with 72% to 94% of participants having at least 30% reduction of leg pain from 8-weeks through 24-months. Walking distance for the IFD group increased from 66% to 94% and sitting-to-standing repetitions increased from 44% to 64% for all follow-up time points. Blood loss was 88% less in the IFD group (p=0.024) and operating time parameters strongly favoured IFD compared to decompression (p< 0.001). An 89% fusion rate was assessed in a subset of IFD participants. There were no intraoperative device issues or re-operations in the IFD group, and only one healed and non-symptomatic spinous process fracture observed within 24 months.Conclusion: Despite a low number of participants in the IFD group, the study demonstrated successful two-year safety and clinical outcomes for the IFD with significant operation-related advantages compared to surgical decompression.Keywords: lumbar spinal stenosis, surgical decompression, posterior lateral arthrodesis, patient reported outcomes, minimally invasive spine, interspinous fixation device

Mayank Gupta,1,&ast; Anand S Patil,2,&ast; Ahish Chitneni,3 Michael E Schatman,4 Hemant Kalia,5 Timothy R Deer,6 Dawood Sayed,7 Amol Soin,8 Ganesan Baranidharan,9 Peter Staats,10 Leonardo Kapural,11 Phani Ashok Attaluri,12 Paul Verrills,13 Sudhir Diwan,14 Danielle Levin,4 Nimisha Halder,15 Alaa A Abd-Elsayed16 1Kansas Pain Management & Neuroscience Research Center, LLC, Overland Park, KS, USA; 2St. Luke’s Rehabilitation Medical Center, Spokane, WA, USA; 3Newyork-Presbyterian, New York, NY, USA; 4Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 5Rochester Regional Health System, Rochester, NY, USA; 6The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 7The University of Kansas Health System, Kansas City, KS, USA; 8The Ohio Pain Clinic, Dayton, OH, USA; 9Leeds Teaching Hospitals NHS Trust, Leeds, UK; 10National Spine & Pain Centers, Frederick, MD, USA; 11Carolinas Pain Institute, Winston-Salem, NC, USA; 12Olathe Health, Olathe, KS, USA; 13Metro Pain Group, Clayton, VIC, Australia; 14Manhattan Spine & Pain, New York, NY, USA; 15Kansas City University, Kansas City, MO, USA; 16UW Health Pain Services, University of Wisconsin-Madison, Madison, WI, USA&ast;These authors contributed equally to this workCorrespondence: Mayank Gupta, Kansas Pain Management & Neuroscience Research Center, LLC, Overland Park, KS, USA, Email mayank.g@kansaspainmanagement.comAbstract: In this article, we propose a new diagnostic paradigm known as Chronic Abdominal Discomfort Syndrome (CADS). Patient’s presentation centers around chronic abdominal pain not explained by acute pathology with or without accompanying dyspepsia, bloating, nausea and vomiting among other symptoms. The pathophysiology is noted to be neurogenic, possibly stemming from visceral sympathetic nerves or abdominal wall afferent nerves. Diagnosis is supported by signs or symptoms traversing clinical, diagnostic and functional criteria. Included is a tool which can assist clinicians in diagnosing patients with CADS per those domains. We hope to facilitate primary care physicians’ and gastroenterologists’ utilization of our criteria to provide guidance for selecting which patients may benefit from further interventions or evaluation by a pain physician. The pain physician may then offer interventions to provide the patient with relief.Keywords: CADS, chronic abdominal pain, neurogenic abdominal pain, chronic abdominal discomfort

Muhammad Laklouk,1 Ganesan Baranidharan2 1Department of Anaesthesia, Bradford Teaching Hospitals NHS Foundation Trust, 2Leeds Pain and Neuromodulation Centre, Leeds Teaching Hospitals NHS Trust, Seacroft Hospital, Leeds, UK Abstract: Capsaicin is a naturally occurring irritant active ingredient found in hot peppers. It is a ligand for transient receptor potential channel vanilloid receptors, which are found in nociceptive nerve terminals in the skin. Initial exposure to topical capsaicin leads to excitation of these receptors, release of vasoactive mediators, erythema, intense burning, pain, and thereafter desensitization of sensory neurons resulting in inhibition of pain transmission. Capsaicin 8% has been licensed for the treatment of postherpetic neuralgia pain in recent years. A single application of high-concentration capsaicin for 60 minutes for postherpetic neuralgia has been robustly evaluated. Capsaicin 8% patches are applied to the most painful areas of healthy skin and allowed to remain for 60 minutes. Treatment can be repeated every 90 days if the pain persists or returns. The patches are usually applied in specialist pain clinics where patients can be pretreated and monitored. Health care staff need to take certain precautions before administering these patches to avoid unintentional contact. Common adverse effects of the capsaicin 8% patch are transient mild-to-moderate self-limiting application-site burning, pain, erythema, pruritus, papules, swelling, dryness, and hypertension. To manage local pain from capsaicin application, the skin is pretreated with a local anesthetic such as topical lidocaine or an oral analgesic such as oxycodone for up to 5 days. A transient increase in pain is usually seen within 48 hours of patch application before the pain-relieving effect starts. Systemic absorption is minimal and clinically insignificant. The nature of administration and relatively high cost of capsaicin patches can significantly limit their use to a small number of patients with severe refractory symptoms. This review highlights recent evidence related to the use and effectiveness of the 8% capsaicin patch for Postherpetic Neuralgia and discusses its safety and side-effect profiles. Keywords: capsaicin, efficacy, safety, tolerability, high-dose patch, postherpetic neuralgia

Background: Lymphoma is considered to be the most common hematopoietic tumor in dogs (83%) having an overall cure rate of less than five percent. Although many chemotherapy protocols have been suggested, doxorubicin based combination protocols are widely associated with long disease free interval and improved duration of survival. Six dogs presented to Madras Veterinary College Teaching Hospital with clinical signs suggestive of lymphoma were taken up for this study. Methods: The dogs were subjected to detailed clinical examination and dermatological examination. Fine needle aspiration cytology (FNAC) samples were taken from the lymph nodes in cases of multicentric lymphoma and from cutaneous nodules in cases of cutaneous lymphoma. Tru-cut biopsy and impression smears were collected from the cutaneous nodules. The FNAC and impression smears revealed pleomorphic lymphocytes suggestive of lymphoma. Ultrasonographic examination of all dog revealed the enlargement of mesenteric lymph nodes and spotted appearance of spleen. Treatment with multi-agent chemotherapeutic protocol (University of Wisconsin - Madison, Lymphoma CHOP - 19 protocol) was initiated after confirmative diagnosis. Result: Remissions in clinical signs were noticed within a week of therapy and no evidence of peripheral lymph node enlargement could be appreciated after three weeks of therapy. The diagnostic and management plans were presented and discussed. [ABSTRACT FROM AUTHOR]

Background: To evaluate the platelet storage lesion (PSL) markers and extended storage time for SSP+ added canine platelet concentrates (CPC) beyond five days at 22C. Fresh canine CPC undergo certain metabolic and morphologic changes during storage. Estimation of PSL markers helps us better understand quality of the canine PC and to estimate the efficacy of SSP+ in increasing the life span of stored CPC. Methods: CPC was prepared from 350 ml of whole blood, collected from 6 apparently healthy donor dogs by buffy coat method in a quadruple bag closed system. CPC was divided into four aliquots of 15 ml each with one control and three test groups with SSP+ additive solution in different concentrations (65%, 75%, 85%). The in vitro PSL markers including swirling, pH, glucose, lactate, bicarbonate, pO2, pCO2, platelet concentration, MPV and PDW were evaluated on day 1, 5, 9 and 13 of storage. Result: The results were analysed by Two-way ANOVA wherein swirling, pH, glucose, lactate, bicarbonate, pO2, pCO2, platelet concentration, MPV showed significant difference (p<0.01) between the groups. Interaction between the additive concentrations and the days of storage revealed a pH on day 9 for 65% SSP+ to be similar to day 5 for plasma stored CPC while swirling, lactate and bicarbonate were also better maintained for 65% SSP+ PAS added CPC till day 9. Addition of 65% SSP+ PAS to CPC evidenced increased shelf life up to 9 days at 22C under agitation without significant deterioration in product quality. [ABSTRACT FROM AUTHOR]

A 6 year Gelding was presented to Madras Veterinary College (MVC) teaching hospital large animal unit for skin injuries with erythematous skin lesions since a month. The skin scraping revealed Demodex equi. The horse was treated with Inj. Ivermectin @ 200 mcg/Kg bw IM. The skin scraping was negative 2 weeks post treatment and the skin lesions resolved completely. [ABSTRACT FROM AUTHOR]

The present communication puts on record a case of cavernous haemangioma in the chest region of a three-year-old male dog of Rajapalayam breed. [ABSTRACT FROM AUTHOR]

Two Jersey crossbred cows were presented in lateral recumbency and severe signs of Organo phosphorus compound (OPC) toxicity. Physical examination revealed bradycardia, nystagmus, hypersalivation, lacrimation, respiratory distress, tetany, grunting, pupillary constriction, frequent urination, muscle weakness, fever, severe dehydration suggestive of OPC poisoning. Atropine sulphate @ 0.5 mg/kg body weight, i.e. 200 ml for each cow, initially half the dose with normal saline intravenous and half the dose subcutaneous was administered. Further! stomach tube intubation to relieve bloat and oxygen therapy to compensate hypoxia was given for both recumbent cows. An uneventful recovery was observed within 20 minutes of antidote administration. [ABSTRACT FROM AUTHOR]