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Background: Inadequate pain relief during the early post-operative stages following arthroscopic shoulder procedures may lead to patients having poor functional and satisfaction outcomes. The goal of our study is to evaluate the effect of Eperisone in patients undergoing arthroscopic rotator cuff repair, with regards to post-operative pain and functional outcomes. Methods: All patients who underwent arthroscopic rotator cuff repair between January to September 2022 were assessed. Patients eligible for the prospective study were separated based on their analgesia regimes. Group 1 received baseline analgesia (Paracetamol and Arcoxia). Group 2 patients had Eperisone prescribed as an additional adjunct. For breakthrough pain, oral tramadol was administered. Outcome measures inclusive of: Visual Analog Scale (VAS) pain score, morphine milligram equivalent (MME) values, University of California Los Angeles (UCLA) shoulder score and range of motion measurements were collated. Results: 40 patients were included in our study, of which 17 patients were in group 1 and 23 patients were in Eperisone group. There were no statistical difference in pain scores, UCLA scores and ROM in the first six weeks following surgery, between the control group and Eperisone group. The average amount of breakthrough opioid usage based on MME were slightly lower in the Eperisone group in the first two weeks, however this was not statistically significant. Conclusion: Addition of muscle relaxants such as Eperisone to post-operative analgesia regime did not significantly lead to improvement of pain scores or early functional outcome, in patients undergoing arthroscopic rotator cuff repair. However, Eperisone could still be offered on a case-by-case basis.

Lithium remains an effective option in the treatment of bipolar disorder (BD). Thus, we aim to characterize the pharmaco-epidemiological patterns of lithium use internationally over time and elucidate clinical correlates associated with BD using a scoping review, which was conducted using the methodological framework by Arksey and O’Malley (2005). We searched several databases for studies that examined the prescriptions for lithium and clinical associations in BD from inception until December 2023. This review included 55 articles from 1967 to 2023, which collected data from North America (n = 24, 43.6%), Europe (n = 20, 36.4%), and Asia (n = 11, 20.0%). The overall prescription rates ranged from 3.3% to 84% (33.4% before and 30.6% after the median year cutoffs). Over time, there was a decline in lithium use in North America (27.7% before 2010 to 17.1% after 2010) and Europe (36.7% before 2003 to 35.7% after 2003), and a mild increase in Asia (25.0% before 2003 to 26.2% after 2003). Lithium use was associated with specific demographic (e.g., age, male gender) and clinical factors (e.g., lower suicide risk). Overall, we found a trend of declining lithium use internationally, particularly in the West. Specific clinical correlates can support clinical decision-making for continued lithium use.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with significant morbidity. Current treatment approaches consist of a mixture of pharmacological and psychological approaches. The emergence of digital technology, and mobile gaming applications, represents a promising novel method in potentially augmenting existing interventions for ADHD. In this review, we will map out the use of mobile gaming applications in the management of ADHD and evaluate the effectiveness of these technologies and any areas for future research. Four electronic databases were searched for relevant articles. All articles were screened for abstract and full text by two independent reviewers, and data extracted onto a common data extraction sheet. The data was narratively synthesized and reported in line with the PRISMA-ScR guidelines. A total of 19 studies were included. Studies mostly evaluated the effectiveness of games on male children with ADHD. Most games were focused on the treatment of ADHD, while a minority were focused on the diagnosis and monitoring of ADHD. Some of the common gaming mechanisms employed in games included having participants responding to cures, remembering details, and making associations between different entities. The studies generally showed an improvement in performance of children as they played the games, but evidence for the effectiveness of these modalities remains scarce and mixed. While it is exciting that there is such a wide variety of games available currently in the diagnosis, treatment, and monitoring of ADHD, many of the games lack clinical evidence to prove their effectiveness. Furthermore, most studies contain several limitations including small sample size, limited ages of participants, lack of control group, and lack of comprehensive outcomes. To promote the application of these games to clinical practice, robust clinical trials, collaboration between stakeholders and using a comprehensive set of outcome measurements is essential.