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Background: Considering the importance of cardiac rehabilitation after coronary artery bypass grafting (CABG) and the development of acupuncture over the past few decades, the aim of this study was to evaluate the effects of acupuncture on patients' exercise tolerance, heart rate and blood pressure after CABG., Methods: Thirty-four patients with a history of recent CABG were recruited between 2019 and 2020 for this clinical trial and randomly divided into two groups receiving acupuncture plus cardiac rehabilitation (group A) and cardiac rehabilitation alone (group B). In both groups, exercise-based rehabilitation exercise was performed. Group A additionally received acupuncture at PC6, PC4, HT7 and GB20 bilaterally. Changes in blood pressure, heart rate and Borg scale score were evaluated before, during and after the course of the treatment., Results: Heart rate was significantly lower in group A compared to group B after completion of the course of the treatment (P = 0.022). However, there were no statistically significant differences between the two groups in systolic or diastolic blood pressure or Borg scale scores (P > 0.05). Nevertheless, the Borg scale scores showed a significant decrease within each group over time (P < 0.001), reflecting an improvement in the patients' ability to tolerate activity after cardiac rehabilitation with or without acupuncture., Conclusion: Acupuncture in combination with exercise-based cardiac rehabilitation was more effective at decreasing heart rate than cardiac rehabilitation alone after CABG. Both approaches appeared to be similarly effective at improving exercise tolerance. In this study, the addition of acupuncture at the aforementioned traditional acupuncture point locations to exercise-based cardiac rehabilitation did not affect blood pressure., Trial Registration Number: IRCT20171208037793N1 (Iranian Registry of Clinical Trials)., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objectives: This study aims to compare the effectiveness of intra-articular and peri-articular dextrose prolotherapy (DPT) in patients with knee osteoarthritis (KOA) without effusion., Patients and Methods: Between August 2018 and November 2018, a total of 51 participants including 27 cases (12 males, 15 females; mean age: 55.7±5.2 years; range, 38 to 70 years) in Group A and 24 cases (9 males, 15 females; mean age: 54.7±4.6 years; range, 38 to 70 years) in Group B were recruited. Group A received intra-articular DPT, while Group B received peri-articular DPT. Treatment was administered two times with two-week intervals. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford Knee Scale (OKS) questionnaires were filled at baseline, and four and eight weeks after first injection., Results: At four and eight weeks, the VAS, OKS, and WOMAC scores improved from baseline in both groups. There was no significant difference in the WOMAC and OKS scores between two methods. The VAS scores showed superiority of intra-articular method (p<0.05)., Conclusion: Both peri-articular and intra-articular DPT were effective in patients with KOA. There was no superiority in terms of functional improvement between two groups. However, intra-articular prolotherapy was more effective in decreasing pain in these patients., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish Society of Physical Medicine and Rehabilitation.)

Background and Objective: Motor function plays a critical role in everyday activities, from basic self-care tasks to complex activities that require precision and dexterity. This study was conducted to investigate the effects of transcranial direct current stimulation (tDCS) on grip strength and hand dexterity in healthy individuals., Method: We conducted a double-blind randomized clinical trial with two groups of sham and active tDCS. The anode was fixed over the primary motor cortex area M1 on the C3 point. The primary outcome was hand grip strength measured by a dynamometer and the secondary outcomes were hand dexterity and assembly assessed by the Purdue Pegboard test. The tDCS program was administered at rest three and two times for the first and second week for a total of five sessions of 20 min each., Results: There was no significant improvement in the mean difference in grip strength between the sham (N = 27) and active (N = 27) tDCS groups (1.7 vs. 2.3, Mann-Whitney U test, P = 0.869, d = 0.02). Participants who received active tDCS showed subtle improvements in right-hand dexterity (0.6 vs. 1.3, U test P = 0.017, d = 0.33) and overall manual dexterity (1.4 vs. 3.2, U test P = 0.023, d = 0.31) compared with the sham group. Other comparisons for hand dexterity and assembly (motor coordination and fine skills during the manipulation of small objects) between the two groups were not significant. We did not find any adverse effects of sham or active tDCS., Conclusion: Our study showed a potential for clinical improvement in hand dexterity after five sessions of tDCS in healthy individuals., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Patients with chronic kidney disease, as a common disorder, usually necessitate the implementation of hemodialysis. Muscle cramps are one of the most disabling complications affecting their quality of life., Objectives: We aimed to investigate the efficacy of acupuncture as a safe alternative to the management of pain severity and frequency of calf cramps in dialysis patients compared to a control group., Methods: Fifty dialysis patients experiencing calf cramps who met the eligibility criteria were randomly allocated to two groups. Group A received routine management, including analgesic consumption, stretching exercises, and nine acupuncture sessions, including acupoints BL57, GV26, CV4, CV6, LV3, KI 1, LU7, LU9, and GB34. Group B underwent sham acupuncture therapy at locations other than the primary acupoints in addition to following the specified routine management. The pain severity was measured using the visual analog scale (VAS), and the daily frequency of calf cramps was evaluated at baseline and one month after treatment completion., Results: VAS scores and the frequency of calf cramps were improved one month after treatment completion in both groups. However, the improvement was significant in group A ( p < 0.001), while it was not statistically significant in group B ( p > 0.05). There was also a significant difference between both groups regarding reducing pain and the frequency of calf cramps, which showed the efficacy of acupuncture compared to the control group ( p < 0.0001)., Conclusion: Acupuncture can decrease pain and frequency of calf cramps in dialysis patients.

Introduction: Generalized joint hypermobility (GJH) can be the result of several hereditary connective tissue disorders, especially Ehlers-Danlos syndrome. Cerebrovascular manifestations are among the most common complications in this disorder, and understanding their extent can help better diagnosis and prevention of hazardous events. We investigated visual evoked potential (VEP) changes in patients with GJH and compared them with healthy individuals., Methods: Our case-control study included 90 patients who fulfilled the Beighton score (B score) for joint hypermobility and other 90 healthy participants. All of them went under VEP study, and the amplitude and latency of the evoked potential (P100) were compared to each other., Results: The Case group had significantly higher B score (7.18 ± 0.967 vs. 1.18 ± 0.712), P100 latency (110.23 ± 6.64 ms vs. 100.18 ± 4.273 ms), and amplitude (6.54 ± 1.26 mv vs. 6.50 ± 1.29 mv) compared with the Control group, but the difference was only significant regarding B score, and P100 latency (p-value <.0001). Moreover, both latency and amplitude of P100 had significantly positive correlations with the B score in the Case group (p-value <.0001), but such correlations were not found in the Control group (p-value = .059)., Conclusion: Our study could reveal VEP changes, especially significant P100 latency in GJH patients without previous neurologic or musculoskeletal disorders. Whether these changes are due to GJH itself or are predictive of inevitable neurologic disease or visual pathway involvement, particularly Multiple Sclerosis needs further investigation with longer follow-up periods., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: In renal transplant patients, bisphosphonates may prevent bone loss, but little is known about their effects on bone microarchitecture and geometrical hip parameters, as the key factors of bone stability. This study aimed to analyze the effect of zoledronic acid on the mentioned parameters in kidney transplant patients., Methods: In this double-blind, randomized trial, 33 patients were followed for six months after administering either 4mg of zoledronic acid or a placebo. Bone mineral density (BMD) measurement of the spine, hip, radius, and whole body was obtained, and trabecular bone score (TBS) was evaluated using the software. Geometric assessment at the proximal femur was performed by the HSA program., Results: Eighteen patients in the intervention group and 15 in the control group completed the study. The mean percentages of the changes in the BMD at the lumbar spine and whole body were significantly different between the placebo and intervention groups (-0.23% vs. 4.91% and -2.03% vs. 1.23%) (P < 0.05). Zoledronic acid appeared to enhance the subperiosteal diameter, endocortical diameter, and cross-sectional moment of inertia (CSMI) at the narrow neck in comparison with placebo (P < 0.05); however, no difference in TBS was observed between both groups (P > 0.05)., Conclusions: We concluded that a single administration of zoledronic acid might ameliorate bone loss at the lumbar spine and the whole body and maintain the subperiosteal diameter, endocortical diameter, and CSMI as parameters of bone strength at the narrow neck of the proximal femur after six months in renal-transplant recipients., Trial Registration: This study was registered in IRCT (ID: IRCT20181202041821N1) on 04-05-2019., (© 2023. The Author(s).)

Background: Coronary artery bypass grafting (CABG) accounts for more than half of all adult cardiac surgeries worldwide. Post-operative chest pain is a common CABG complication and can cause significant discomfort., Objectives: Because taking large amounts of analgesics can have many side effects, we evaluated whether acupuncture effectively reduces pain and the use of analgesics by CABG patients., Methods: In this clinical trial, 30 patients who had recently undergone CABG were randomly allocated to two groups. For both groups, exercise therapy and routine analgesics were recommended. The intervention group underwent bilateral acupuncture in distinct acupoints, including the HT3, HT4, HT5, HT6, HT7, PC3, PC5, PC6, and PC7 for 10 daily sessions constantly. Visual analog scale (VAS) and analgesic use were evaluated in both groups at baseline and after completing the 10-day treatment., Results: Our analysis revealed significant decreases in the mean VAS scores in both the intervention and the control group, and that the reduction was more significant in the acupuncture group ( p < 0.001). Moreover, analgesic use was significantly lower in the acupuncture group when compared with the control group ( p < 0.001)., Conclusion: Our findings highlight acupuncture as an alternative method of controlling CABG-associated post-operative chest pain and reducing the use of analgesics, which might have many side effects.

Objectives: Many articles hypothesized the potential role of autonomic nervous system in the pathogenesis and outcome of COVID-19 infection. Several studies reported both central and peripheral nervous system involvement in COVID-19 as well. Up to our knowledge, there is no study evaluating whether this virus could invade the autonomic nervous system affecting its function adversely. Sympathetic skin response (SSR) has long been used as a method of evaluating the autonomic nervous system. Regarding the importance of the autonomic nervous system in hemostasis and wide consequences of COVID-19 infection, we designed this study to evaluate the autonomic nervous system function in patients recovered from COVID-19 compared with normal population who are not yet infected by this virus by the means of SSR., Methods: This case-control study included 70 patients surviving COVID-19 who met the inclusion and exclusion criteria that went under SSR. The data gathered were compared with those without the history of any symptoms attributable to COVID-19 during the pandemic., Results: There was a correlation between COVID-19 infection and abnormal SSR (p value < 0.0001) with the most effect on the latency prolongation of the action potential recorded from the median nerve at palms (effect size: right: 3.90, left: 3.69). Moreover, the greater severity of the disease correlated with more abnormality of parameters recorded by SSR technique., Conclusions: Abnormal SSR parameters could be a good indicator of autonomic nervous system involvement in patients with COVID-19 infection. It might be a predictor of disease severity, clinical outcomes and prognosis as well., (© 2022. The Author(s) under exclusive licence to Belgian Neurological Society.)

A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient's mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Burn victims are reported to have more possibility of bone loss in acute phase of injury partly due to sympathetic dysfunction and catecholamine increase beside other hypermetabolic responses. These patients are also prone to autonomic neuropathy and sympathetic skin response (SSR) impairment. We aim to investigate the correlation between SSR in the acute phase and bone mineral density (BMD) parameters in electrical burn patients and determine whether the SSR parameter in initial weeks of the event is a good predictor of bone loss in long term., Materials and Methods: Sixty two individuals exposed to low voltage(<1000 V) electrical current were invited to a cohort study. The SSR was recorded from their four limbs in 2-5 weeks after injury. Then, dual X-ray absorptiometry (DXA) was done to measure their BMD, T-score and Z -score, 9-12 months later. The correlation between SSR parameters in acute phase and DXA indexes was evaluated using Spearman test. A Roc curve was charted to point out a cut-off value for SSR amplitude and latency in respect to T-score to predict the subsequent bone loss., Result: All the patients were male with a mean age of 34.09 years. Biphasic SSR parameters showed a significant correlation with lumbar BMD in a confidence interval of 99.9%. SSR amplitude threshold of 293.75 μV and latency of 2.15 s had a 100% sensitivity and 94% and 83% specificity respectively for predicting the bone loss (T-score<-1) in long term. The area under Roc curve was 0.94 and 0.99 in terms of SSR amplitude and latency., Conclusion: SSR recorded in the first few weeks after electrical injury is a good predictor of bone loss in long term, so we recommend this test as a guide for screening the patients at risk for osteoporosis in electrical burn and formulating the preventive measurements., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Often discovered late during the clinical course of burns, bone loss is widely accepted by clinicians as a de facto consequence of burn. Literature on this bone loss is limited and contradictory in details. More insight into the prevalence and magnitude of bone loss may facilitate its prevention. To this end, over a period of two years, we gathered a test group of 34 male patients with at least six-month-old thermal burns and a control group of 50 male members of similar age and geographical background as our test group. All members with any history of metabolic or endocrine disease or ICU admission were excluded from both groups. Using dual energy X-ray absorptiometry (DXA), we measured bone mineral density (BMD), Z-score and T-score in lumbar vertebra, femoral neck, and total femur and compared the results between the two groups. T-test of density scores against total body surface area of burns was performed. We found that the average T-scores, Z-scores and BMDs in the test group were significantly smaller than the averages in the control group (P<0.001); and in the test and the control group, 25.7% and 0% of subjects respectively, had osteoporotic lumbar T-scores. Total femur and femoral neck T-scores exhibited a significant similar pattern with smaller differences across the two groups. The density scores also showed a significant reverse relationship to the total body surface area (TBSA) of burn (P<0.003). Our results indicate that thermal burn victims have lower bone density and higher prevalence of osteoporosis than their healthy counterparts and that this difference is significant enough to justify screening in these patients which requires further longitudinal studies to institute., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: Risk factors associated with Carpal Tunnel Syndrome include repetitive use of hand and wrist, advanced age, obesity, pregnancy, diabetes mellitus and thyroid disease. Decompression of the median nerve is the last treatment of choice usually indicated when negative results to conservative treatments remain for three months. In this study, we aimed to find out whether hypothyroid patients would respond to CTS surgical decompression differently in comparison to healthy individuals., Methods: This case control study was conducted on patients with CTS in need of surgical release who were refered to Shahid Faghihi hospital, International Branch of Shiraz University of Medical Sciences, Shiraz, Iran from January 2013 to January 2015. Twenty-five hypothyroid and 22 euthyroid patients were recruited. Hypothyroidism was diagnosed based on clinical symptoms and serum TSH level. All patients were followed for three weeks after surgery and a Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was completed for them pre and post operation. An electrophysiological study was performed during the same follow up period. Statistical analysis was performed using SPSS version 16., Results: The CTS grade reported by electrophysiological study, decreased significantly 3 weeks after operation in comparison with preoperative grades (p<0.001). A significant decrease was observed in the immediate postoperative BCTQ scores compared to preoperative (p<0.001). Also a decrease was detected in the three weeks of postoperative follow up compared to immediate postoperative BCTQ scores (p<0.001) and preoperative BCTQ scores (p<0.001). Postoperative BCTQ scores of euthyroid patients decreased more in comparison to hypothyroid patients (p<0.001)., Conclusion: It seems that, hypothyroidism has an effect on postoperative outcome of carpal tunnel release., Competing Interests: There is no conflict of interest to be declared.

Introduction: Several studies have shown the importance of the sympathetic nervous system in bone metabolism. There is an evidence of sympathetic skin response (SSR) impairment in electrical burn patients up to 2 years after their injuries. The acute phase of burn is accompanied by increased bone resorption. Whether the prolonged dysfunction of sympathetic nervous system may result in bone metabolism derangement even after the acute phase of electrical burn is the inspiring question for this study. And we tried to find correlation between SSR abnormality and areal bone mineral density (BMD) in electrical burn patients 6 months or more after the incidents., Methods and Materials: 42 electrical burn patients (≥6 months prior to study) who did not have a known joint or bone disease, history of neuropathy (central or peripheral), diabetes mellitus or consumption of any drug affecting the autonomic nervous system or evidence of neuropathy in nerve conduction study were recruited. We also gathered a control group of 50 healthy subjects (without electrical burn or the exclusion criteria). They went under dual energy X-ray absorptiometry and SSR study. Data were analyzed statistically with SPSS 16.0 making use of independent t-test and Pearson correlation coefficient. P<0.05 was considered significant statistically., Results: Areal BMD was significantly lower in electrical burn patients than control group (P<0.001). SSR latency was significantly prolonged and its amplitude was significantly reduced in burn patients compared to control group (P<0.001). In burn patients there was an inverse correlation of areal BMD of lumbar vertebrae, left femur neck and total femur with SSR latency and a direct correlation of areal BMD with SSR amplitude. In control group there was just direct correlation of areal BMD of lumbar vertebrae and left femur neck with SSR amplitude., Conclusion: Electrical burn patients are at risk of reduced areal BMD long after their injuries. Sympathetic derangement and impaired SSR are correlated with reduction in areal BMD in these patients., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

It is more than a decade since scientists are making use of sympathetic skin response (SSR) as a clinical and research method to evaluate sympathetic nervous system. A major portion of the efferent pathway of this response is composed of non-myelinated nerves. Thus, the latency of the response may be significantly different in normal individuals with different height and limb lengths. This study was designed to investigate the effect of these parameters on the SSR results. We measured the height and limb length of 65 normal individuals with different heights (divided into 3 groups of height ≤150 cm, 150-170 cm, and ≥170 cm). The participants had neither peripheral nor central neuropathy. They also had none of the exclusion criteria. Then, they underwent SSR testing of both palms and soles. The correlation between the height and limb length in relation to SSR parameters (latency and amplitude) was analyzed statistically by Pearson's correlation. No significant correlation was detected between the height and limb length and the SSR amplitude. However, the results showed significant correlation between SSR latency recorded from all four sites (both palms and soles) and the height of participants. Furthermore, there was a significant correlation between SSR latency recorded from any limb and the length of that limb. Regarding the significant effect of the height and limb length on the SSR latency, both the height and limb length should be considered when interpreting the results of SSR.

Background: Osteoporosis is a common disease characterized by reduction in bone mass, due to depletion of calcium and bone protein. A pivotal role of the sympathetic nervous system in bone remodeling has been considered. On the other hand, elevated central sympathetic activation in postmenopausal women is involved in the creation of vasomotor symptoms. Also, sympathetic skin response (SSR) has been performed for evaluation of the peripheral and central autonomic nervous system dysfunctions. Therefore, to determine the association of the autonomic nervous system and osteoporosis, we evaluated the correlation between the bone mineral density (BMD) with the frequency of vasomotor symptoms and also sympathetic skin responses., Methods: This is a cross-sectional study in which thirty-three postmenopausal osteoporosis women, as the case group, and 31 age-matched postmenopausal women with normal BMD, as the control group, were included in our study. To evaluate the autonomic function, we assessed the frequency of vasomotor symptoms with a questionnaire and performed SSR test for the two groups. According to the parametrical or the nonparametrical distribution of the data, Independent Samples t-test or Mann Whitney test, respectively, were used to compare group differences., Results: The onset latencies of SSR recorded from both hands and feet were significantly prolonged in the case group compared with the control group (P<0.001). Amplitudes of SSR in the case group were significantly less than those of the control group (P<0.001). The postmenopausal osteoporotic women reported a significantly higher frequency of hot flashes and night sweats when compared with non-osteoporotic women (P<0.001)., Conclusion: The higher frequency of vasomotor symptoms and impaired sympathetic skin responses in postmenopausal osteoporotic women suggests a role of autonomic dysfunction in osteoporosis.

Background: Sensory, motor, and autonomic neuropathy has been reported after electrical injury. Besides subclinical involvement of the sympathetic nervous system during the 1st year post injury, late clinical manifestations of this involvement have been reported sporadically. This study was designed to investigate how the clinical and electrodiagnostic manifestations of sympathetic involvement would change with time in electricity victims., Methods and Materials: Sixty electrically burnt patients were followed for 22 months with sympathetic skin response (SSR) and autonomic system derangement symptom surveillance., Results: Thirty-one patients reported autonomic derangement symptoms during the 2nd year post injury. SSR latency prolongation showed direct negative correlation with time; but SSR amplitude was decreased in all cases irrespective of the time laps. Symptomatic patients showed significantly lower SSR amplitudes compared to asymptomatic ones. This was true for the pre-symptom SSR test results too., Conclusion: SSR amplitude can be used as a predictive test for the symptoms of autonomic derangement to occur post electrical injury., (Copyright © 2013. Published by Elsevier Ltd.)

Takotsubo cardiomyopathy (TCM), otherwise cardiomyopathy,apical ballooning syndrome or broken heart syndrome is a reversible cardiomyopathy, predominantly occurs in post-menopausal women and commonly due to emotional or physical stress. Typically, patients present with chest pain and ST elevation or T wave inversion on their electrocardiogram mimicking acute coronary syndrome, but with normal or non-flow limiting coronary artery disease. Acute dyspnoea, hypotension and even cardiogenic shock may be the presenting feature of this condition. The wall motion abnormalities typically involve akinesia of the apex of the left ventricle with hyperkinesia of the base of the heart. Atypical forms of TCM have also recently been described. An urgent left ventriculogram or echocardiogram is the key investigation to identify this syndrome. Characteristically, there is only a limited release of cardiac enzymes disproportionate to the extent of regional wall motion abnormality. Transient right ventricular dysfunction may occur and is associated with more complications, longer hospitalisation and worse left ventricular systolic dysfunction. Recently, cardiac MRI has been increasingly used to diagnose this condition and to differentiate from acute coronary syndrome in those who have abnormal coronary arteries. Treatment is often supportive, however beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocking agent are being used in routine clinical practice. The syndrome is usually spontaneously reversible and cardiovascular function returns to normal after a few weeks. This review article will elaborate on the pathophysiology, clinical features including the variant forms, latest diagnostic tools, management and prognosis of this condition.

Objectives: Sympathetic skin response (SSR) is a test for evaluation of the sympathetic sweat gland pathways, and it has been used to study the central sympathetic pathways in spinal cord injury (SCI). This study aimed to assess the autonomic pathways according to normal or abnormal SSR in urinary incontinence patients due to incomplete spinal cord injury., Materials and Methods: Suprapubic, palmar, and plantar SSR to the peripheral nerve electrical stimulation were recorded in 16 urinary incontinence patients with incomplete spinal cord injury at various neurological levels and in 30 healthy control subjects., Results: All the recordings of SSR from the incomplete SCI patients with urinary incontinence as compared with their counterparts in the control group showed significantly reduced amplitudes with more prominent reduction in the suprapubic area recording site (P value < 0.0004). SSR with significantly prolonged latencies were recorded from palm and plantar areas in response to suprapubic area and tibial N stimuli, respectively (P value < 0.02). In this study, a significantly higher stimulus intensity (P value < 0.01) was needed to elicit SSR in the cases compared with the control group., Conclusion: This study showed abnormal SSR in urinary incontinence patients due to incomplete SCI. In addition, for the first time we have described recording of abnormal SSR from the suprapubic area as another way to show bladder sympathetic system involvement.

The complexation reaction of cephalosporins namely cefotaxime (CTX), cefuroxime (CRX), and cefazolin (CEFAZ) with palladium (II) ions have been studied in water and DMF in 25 °C by the spectrophotometric methods. The method is based on the formation of yellow to yellowish brown complex between palladium (II) chloride and the investigated cephalosporins in the presence of sodium lauryl sulfate (SLS) as surfactant. The complexation process was optimized in terms of pH, temperature and contact time. The stoichiometry of all the complexes was found to be 2:1 (metal ion/ligand) for CTX, CRX, and 1:2 for CEFAZ. The stoichiometry of palladium (II)-cephalosporins was estimated by mole ratio and continuous variation methods and emphasized by the KINFIT program. These drugs could be determined by measuring the absorbance of each complex at its specific λmax. The results obtained are in good agreement with those obtained using the official methods. The proposed method was successfully applied for the determination of these compounds in their dosage forms., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Electrical burn has been reported to be highly associated with peripheral neuropathy. This study was designed to evaluate the sympathetic skin response (SSR) of electrical burn patients to determine whether the sympathetic nervous system is involved in these patients., Materials and Methods: The sympathetic skin response of 28 patients, suffering from electrical burn injury (divided into two groups of high voltage and low voltage exposure) was compared with that of 28 matched subjects, who had never experienced electrical burn. Bilateral palmar and plantar latency and amplitude of SSR were recorded in response to Median and Tibial nerve electrical stimulation., Results: SSR in all recording sites of the electrical burn patients compared showed significantly more prolonged latencies and reduced amplitudes, with their counterparts in the control group with no significant difference between the high voltage and low voltage electrical burns. There was no significant difference in SSR latency, between the entry and exit sites of the electrical current. The SSR amplitude however, showed more reduction in right hand than the left one, in whom the electrical current had entered the body from the right hand. The time lapse between the electrical burn and the SSR study was shown to play no role in the results., Discussion: Increased SSR latency in electrical burn injury may be a sign of autonomic nervous system involvement, through systemic responses to electrical burn., (Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.)

Background: An adverse event (AE) is defined as an unintended injury or complication caused by healthcare management rather than the disease process that may prolong admission and lead to disability or death. This study retrospectively assessed all reported general surgery-related AEs in a district general hospital in the south-east of England., Methods: All general surgical AEs arising from adult inpatient admissions between 2002 and 2007, that had been reported to the risk management team, following completion of the standard 'Adverse Incident Report Form', were retrospectively reviewed., Results: There were 24,185 general surgical admissions over the period of the study; 461 AEs were reported (1.9% mean annual incident rate; 95% CI, 1.3%-2.5%). The majority (85%) were near miss or no injury events (category I and II) while serious/serious near-miss incidents accounted for just 2% of events. Communicative or administrative problems were implicated in 54% of cases while 12% arose from theatre/surgery-related failure. Of 58 medico-legal claims (0.24% of admissions) that were made, 16 (27.5%) progressed to the law courts for formal settlement., Conclusion: The reported annual AE incident rate of approximately 2% is well below the national average: this may be due to pre-selection of general surgery-related AEs or represent under-reporting of incidents. The vast majority of AEs were related to administrative and communicative error. These areas must be addressed if patient safety and outcome is to be significantly improved., (Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.)