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Home > A Randomized-Controlled Trial of Steroid Injection in the Management of Plantar Fasciitis at the Aga Khan University Hospital

A Randomized-Controlled Trial of Steroid Injection in the Management of Plantar Fasciitis at the Aga Khan University Hospital

Thesis Info

Author

Mohamed, Abdi H.

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2011

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728035004

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Background: Plantar fasciitis is a common painful condition often associated with significant morbidity. Its management varies among clinicians because no single treatment has strong scientific evidence to support its use to improve outcome. Patients present to clinicians with pain and disability but most patients with plantar fasciitis eventually improve over time irrespective of the modality of treatment provided. Steroid injections are one of the more commonly used modalities and the response to the treatment is varied and unpredictable. Objectives: The objective of this study was to compare the effects of two treatment options for plantar fasciitis: steroid injections with conservative treatment (analgesics, stretch exercises, and insoles) and conservative management alone. Design: A double blind randomized controlled trial to compare these two treatment options. Setting: The study was conducted between December 2010 and May 2011 at The Aga Khan University hospital and affiliated outreach centers. Methodology: Eighty eight patients with plantar fasciitis were randomized to two treatment arms, 47 to the steroid injection arm and 41 to the control arm. Both arms received standard conservative management. Visual analogue scales (VAS) and Foot Function Index (FFI) scores of the patients were recorded at study entry, at one month and at two months. Analysis: The change from baseline VAS scores and FFI scores were analyzed using Student’s t-test and chi square analysis. Results: The mean age of the overall study cohort was 42.9 years (SD 9.1). Forty two were male and 46 female. The majority (87%) were active individuals in occupations that required prolonged walking or standing. The mean Body Mass Index (BMI) was 31.7 and eleven (12.5%) of the study cohort had flatfoot. There was a significant reduction in mean pain scores, after one month and after two months in both the steroid and the control arms. The mean VAS scores at study entry were 8.6 (SD 1.4); 7.2 (SD 1.7) at one month and 6.6 (SD 1.7) at two months (P<0.001). The mean morning pain was 7.5 (SD 2.2) at enrollment; 6.2 (SD 1.9) at one month and 5.6 (SD 1.8) at two months (P<0.001). The mean FFI at study entry was 50.5 (SD 18.2). At one month and two months follow-up, the mean FFI scores were 43.4 (SD 16.2), and 41.4 (SD 15.3) respectively (P<0.001). There was no statistically significant difference in pain scores between patients who received steroid injections 7.36 (SD1.6) and those in the control arm 7.22 (SD
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مولانا حکیم سید محفوظ علی

مولانا حکیم سید محفوظ علی
افسوس ہے نومبر کی ۲؍ تاریخ کوہماری جماعت دیوبند کے ایک نامور رکن مولانا حکیم سیدمحفوظ علی صاحب نے کم وبیش ستر برس کی عمر میں دیوبند میں داعی اجل کولبیک کہااور رہ گزائے عالم آخرت ہوگئے۔ موصوف دارالعلوم دیوبند کے فارغ التحصیل تھے اور علوم عقلیہ ونقلیہ دونوں میں کسی میں کم اور کسی میں زیادہ پختہ استعداد رکھتے تھے۔ فراغت کے بعد کچھ دِنوں مدرسہ میں بحیثیت معین المدرسین چند ابتدائی کتابوں کادرس بھی دیا ۔مگر طبیعت میں فنِ طب کی طرف شدید میلان پیدا ہوا تو دلّی کے نامورطبیب حکیم عبدالوہاب عرف نابینا مرحوم کی خدمت میں چندسال رہ کر اس شوق کی تکمیل اس خلوص، محنت اورانہماک سے کی کہ علماً وعملاً ایک ممتاز صاحبِ فن اوراُستاد کے لائقِ فخر ومعتمد علیہ تلمیذ رشید بن گئے۔ اب دِلّی سے رُخصت ہوکر دیوبند میں ہی انہوں نے مطب جمایاتو چندہی مہینوں میں اُن کے حذاقتِ فن اوردستِ شفاء کی شہرت دُور دورتک پہنچ گئی۔ اور اُن کامطب مرجع خواص و عوام ہوگیا ۔فنّی کمال ومہارت کے علاوہ اخلاقی اعتبارسے بھی بڑے خلیق ومتواضع، خوش طبع وخندہ رو اور غیرت وخودداری کے ساتھ حد درجہ مخلص وبے لوث انسان تھے یہی وجہ ہے کہ جس توّجہ سے وہ مریضوں کا علاج کرتے تھے اُسی توّجہ اور خلوص سے طلباء کوطِب کادرس خالصۃً لوجہ اﷲ دیتے تھے۔
حضرت شاہ صاحب ؒ کے قریبی عزیز تھے۔اِس تعلق سے ہم خدام بارگاہ کے ساتھ غیر معمولی شفقت ومحبت اور التفات وتوجّہ کامعاملہ کرتے تھے۔ ان خدام میں میں سب سے کم عمربھی تھااور کم مایہ بھی،مگر اُن کاجوشِ التفات وکرم ان حدود کی پروا نہیں کرتا تھا۔ ہم اُن کواپنا مخدوم ومحترم مانتے تھے اور وہ ہمارے ساتھ بالکل عزیزوں کاسا برتاؤ کرتے تھے۔ گذشتہ اکتوبر کی ۲۸؍ تاریخ کوایک کمیٹی کی میٹنگ...

Moral Reforms in a Community: Modus Operandi in the Light of Sīrah

It’s always the people who define the status of a society. If the people of a society are civilized, the society will be called an ideal society. Moral reforms and behavioural therapy of individuals of the society are basic factors to establish an ideal society. Such an ideal society was established by Prophet Muḥammad (P.B.U.H) in Madina where he laid the foundations of brotherhood and equality among citizens of that state. He showed tolerance towards people belonging to different religions by protecting all their human rights and by providing indiscriminate and quick justice. He not only made the social institutions strong but also developed a history of human civilization. We simply need to work on our moral values and behaviours. We should study the daily life of Muḥammad (P.B.U.H) and mould our lives according to that. Dire need of the modern world is the rectification of human behavior in the light of the ideal life of Muḥammad (P.B.U.H). It will give an opportunity to breathe the same spirit into the contemporary social attitudes so that our society may become peaceful.

Assessment of Heavy Metals Induced Genotoxicity in the Fish by Using Single Cell Gel Electrophoresis

A research work on the assessment of heavy metals induced genotoxicity in the fish by using single cell gel electrophoresis was carried out in two phases (1) acute toxicity of metals to the fish (2) genotoxic impacts of heavy metals on the fish. Acute toxicity of aluminium, arsenic, manganese, Mn+Al, Mn+As, Al+As and Mn+Al+As mixtures (MM) was calculated in respect of 96-h LC50 and the lethal concentrations for the three species of fish viz. Labeo rohita, Cyprinus carpio and Oreochromis niloticus at constant levels of water temperature (26°C), pH (7.60) and hardness (240mgL-1) with three replications for each treatment. Accumulation of the metals in body organs viz. liver, gill, kidney, heart, muscle, intestine, bone, fin and skin of the three fish species was also determined at 96-h LC50 and the lethal concentration exposures. During second phase, the three species of fish were exposed, separately, to 1/2, 1/3, 1/4 and 1/5th of their respective 96-hr LC50, for eight weeks at controlled laboratory conditions. During 8 week exposure, each fish species was analyzed, periodically, for their peripheral erythrocyte DNA damage concerning percentage of damaged cells, cumulative comets tail lengths and the genetic damage index (GDI). After chronic exposure of individual metals/MM, the organs viz. liver, gills, kidney, heart, muscles, intestine, bones, fins, skin and blood of each fish species were examined for the accumulation of their specific metals. During both acute toxicity and genotoxicity trials, the physico-chemical characteristics of water were analyzed on 12 hourly basis for each test concentration. Probit analysis method was used to determine the acute toxicity of metals with 95% confidence intervals. Analysis of variance and Tukey’s tests were applied to determine statistical differences existing among various variables. Regression and correlations among selected variables were also computed. Among individual metals, arsenic was significantly increased toxic to fish, following aluminium and manganese. The three species of fish showed significantly higher sensitivity towards tertiary mixture of Mn+Al+As, followed by As, Al+As, Mn+Al, Al and Mn. Significantly variable tendencies of three fish species for their tolerance limits against individual metals and metals mixture were accredited to physiological variances and their species-specific manner to interact with metals of different nature. This also predicts differential abilities of three fish species to produce metallothionein to normalize the metal load through depuration from the body and protect it against their detrimental effects while living in metals contaminated waters. Among three fish species, Labeo rohita appeared significantly more sensitive to the toxicity of both individual metals and metals mixtures while Oreochromis niloticus showed significantly least sensitivity. The toxic effects of metals mixtures on the fish appeared significantly more severe as compared to the individual metals, depending upon the specific composition of metals in a mixture, concentration and duration of exposure. However, exposure of manganese, aluminum and arsenic in a mixture form presented additive effects towards sensitivity of all the three species of fish. Exposure of the fish to individual metals and MMs caused significantly variable accumulation of metals into their bodies at 96-hr LC50 and the lethal concentrations. However, manganese accumulation was significantly higher while As exhibited significantly least potential of amassing in all three species of fish. Overall abilities of the three species of fish to amass metals into their body followed the specific order: Oreochromis niloticus > Cyrinus carpio > Labeo XIX rohita with statistically significant variations. Fish organs showed significantly variable ability to accumulate metals also. In general, kidney, liver and gills appeared active organs to bioaccumulate metals while skin, intestine, fins, bone and muscles showed the least tendency to amass metals. In general, the bioaccumulation of metals in the body organs of the three species of fish followed a particular order: kidneys > liver > gill > heart > blood > skin > intestine > fins > bones > muscle. The chronic exposure of Al caused significantly greater accumulation in body organs of fish while arsenic amassing was significantly least. The three species of fish viz. Labeo rohita, Cyrinus carpio and Oreochromis niloticus exhibited significantly variable sensitivity towards different concentrations of metals/MMs at 1/2th, 1/3rd, 1/4th and 1/5th of LC50 (concentrations) to cause DNA damage into their peripheral blood erythrocytes, measured with respect to damage cells (%), GDI and cumulative comets tail lengths during 56 days chronic exposure period. The exposure of Mn+Al+As mixture induced significantly greater damage to fish erythrocyte nuclei in terms of average percentage of damaged cells (37.83±1.35%), genetic damage index (1.32±0.05) and cumulative tail length of comets (145.37±4.64μm) while manganese exposure exhibited significantly lower damage as 17.85±0.93%, 0.88±0.04 and 68.95±1.87μm, respectively. The overall sensitivities of three fish species to individual metals and MMs, to induce DNA damage, followed the order: Labeo rohita > Cyrinus carpio > Oreochromis niloticus. The exposure of metals/MMs at 1/2th of LC50 induced significantly higher DNA damage to nuclei in the peripheral erythrocytes of the three species of fish. Moreover, DNA damage increased concomitantly with the increase in both exposure duration and the concentration of metallic ions indicating ROS generation and also the inhibition of the DNA repair that would cause genomic instability and oxidation stress in the fish as metals can also act through redox cycle to induce ROS which possibly cause DNA strand breakage and hence Mn+Al+As mixture appeared significantly more toxic than the other metals/MMs studied during this investigation. The difference in genotoxicity, caused by various metals in three fish species, was dependent upon the extent of metals accumulation in the fish body. Three fish species showed concentration and duration dependent (p<0.05) linear increase in DNA damage under exposure of both individual metals and metals mixture that followed the order: Labeo rohita > Cyrinus carpio > Oreochromis niloticus. The extent of DNA damage in the fish body showed significantly direct dependence on metal species and its exposure duration. Therefore,comet assay appeared as a sensitive technique for the detection of DNA damage in peripheral blood erythrocytes of the Labeo rohita, Cyrinus carpio and Oreochromis niloticus that can serve as biological indicators of metal''s pollution in aquatic ecosystems of Pakistan.