International Journal of Neurology and Neurosurgery

Infections remain the important complication in surgery despite high knowledge about prevention and technological advances in modern surgery. During the last few decades several such technological advances were implemented to reduce the infection post-operatively in patients who have undergone clean surgeries like hernia, breast, thyroid. In this study we have included recurrent appendicitis cases, though is not a clean surgical case., Even when the sterile techniques are adhered to, surgical procedures can introduce bacteria and other microbes in the blood, which can colonize and infect different parts of the body. Due to this infection, often the outcome of the procedure is in question and even the patient’s life is at risk., Antibiotics can be effective in reducing the occurance of such infections. The antibiotics antimicrobial use for clean cases is a subject of controversy. Only antibiotics with good tolerability must be used. Pre-operative antibiotics are preferred as they do not penetrate the wound effectively when administered post operatively., In such a controversy about antibiotic use we have conducted a study without using any antibiotics pre-operatively as well as post-operatively unless there were signs of infection.   

Key words: Antibiotics, Wound infection.

Diabetes is a global epidemic and one of the most leading complications of diabetes is peripheral europathy. Recent research and clinical practice focus is on symptomatic or painful diabetic peripheral neuropathy (PDPN). The objective of this review is to throw light on commonly used and well-established drugs and pharmacotherapy options in PDPN patients. The various drugs reported in controlled clinical trials in MEDLINE were searched independently and 118 suitable trials were identified. The selected studies are grouped under each drug and the drugs are described in alphabetical order in the review. The pharmacotherapy for PDPN patients includes Duloxetine (24 studies), Pregabalin (10 studies), capsaicin 6 studies), Oxcarbazepine (6 studies) and so on. The total number of drugs reviewed under pharmacotherapy for PDPN was 44. The review would facilitate clinicians and stakeholders to understand the established drug therapy options for symptomatic management of patients with painful diabetic peripheral neuropathy, and also facilitate researchers to develop better drugs in future.   

Key words: drug therapy, diabetic neuropathy, neuropathic pain, management. 

Background: Habituation of P300 in the migraineurs has been studied in a number of studies, but not very often in tension type headache patients. Moreover, most of the studies have used only single montage. This study assesses the habituation in migraineurs and tension type headache subjects during inter-ictal period with the help of three scalp montages., Aims and objectives: To find out if the habituation of P3 differ between the migraineurs, tension type headache subjects and controls during inter-ictal period., Methods: Study sample comprised of three groups - migraineurs, tension type headache subjects as well as a healthy control group. Fifty subjects in each group were included after screening for the respective inclusion criteria and exclusion criteria. None of the subjects were blood relatives of each other. Habituation of P3 was assessed using the frontal, central and parietal electrodes using odd-ball paradigm for target stimuli., Statistical Analysis: Data was analyzed with the help of SPSS V11.0 for Windows. Paired sample test and one way ANOVA with post-hoc tukey (wherever required) were performed., Results: P3 did not show habituation or the potentiation after successive trials in any of the group. Similarly, amplitude or latency of any of these waves was not significantly different among groups. These results were consistent among all the three scalp montages., Conclusion: In between the headache episodes, event related potentials do not habituate or potentiate, thus confirming the true episodic nature of the headache episodes.

Key Words: Migraine, tension type headache, habituation, P300

Background and purpose: Neurodynamics is the concept based on a close interaction of mechanics and physiology of the nervous system which is to be considered while assessing and treating patients via nervous system mobilization and manual therapy. Neurodynamic assessment includes neurodynamic testing and nerve trunk palpation. Diabetes was shown to affect neural microcirculatory networks and neural connective tissue sheaths which may affect neurodynamic properties. The purpose of this study was to compare the neurodynamic findings in diabetic subjects, painless neuropathy and painful neuropathy with normal asymptomatic subjects.,Materials and methods: The study was an observer-blinded cross-sectional study on 164 subjects (98 male, 66 female) of mean age ± years. Type-2 diabetes mellitus was diagnosed with fasting blood glucose levels and glycosylated haemoglobin. Peripheral neuropathy with VPT > 25 volts in bilateral feet; neuropathic pain identified on neuropathic pain questionnaire (NPQ) with NPQ score d” 0 implied painless and > 0 implied painful neuropathy. The tester administered neurodynamic testing and nerve trunk palpation to bilateral lower limb nerves. The outcomes of pain, resistance and range of motion for neurodynamic test and presence/ absence of mechanical allodynia on nerve trunk palpation were documented. Prevalence of neurodynamics among the study population was assessed for sciatic, tibial and common peroneal nerves., Data analysis and results: Prevalence data was analyzed descriptively using percentiles and compared using Chi-square test. One-way analysis of variance was used for comparing neurodynamic test findings across the nerve-groups at 95% confidence interval using SPSS 12.0.1 for Windows. Post-hoc analysis was done using Bonferonni test. Secondary analysis was done using paired t-test for to evaluate interaction of range of motion with study group. The PDPN group had the greatest abnormalities in neurodynamic examination findings compared to diabetic group. The painless neuropathy group was similar to normal group in their findings. Sciatic and tibial nerve was involved together in neurodynamic testing and all three nerves were sensitive to nerve trunk palpation in PDPN group.,Conclusion:Abnormal neurodynamic findings in PDPN patients were demonstrated in terms of positive sciatic and tibial neurodynamic tests and by nerve trunk palpation for all three nerves. PDPN group had greater abnormalities in neurodynamics than diabetic subjects studied.

Key words: Neurodynamic testing, mechanosensitivity, diabetic neuropathy, manual therapy, nerve trunk palpation.