Background: The need for case-based learning in basic subjects is being recognized world over. Early clinical illustrations and actual clinical exposure enable students to associate basic science and real patient situations, probably increasing their retention of knowledge. The study was conducted to introduce an alternate method of teaching-learning in pharmacology in a large classroom setting to integrate pharmacology into clinical setting for better learning and understanding of the subject. Methods: Ninety-four students of second professional MBBS of a medical college in Punjab were divided into 2 groups and were taught a 2-hour topic in pharmacology using case-based learning (CBL) method and didactic lecture (DL) method using a crossover design. Their attendance and written test score at the end of teaching session were compared. Feedback from students and faculty was taken by prestructured questionnaires. Results: There was an increase in students’ attendance ( P = .008) in CBL sessions but insignificant difference in their performance ( P = .98) in the tests. Most (84%) of the students felt that CBL is a better method of teaching-learning than traditional DL. The teaching faculty felt that the students looked more interested and were themselves more motivated for the newer method of teaching. Conclusions: Case-based learning led to improvement in student motivation, satisfaction, and engagement. Most students and faculty accepted that CBL was an effective learning tool for pharmacology teaching in a large group setting and supported the incorporation of CBL into traditional DL teaching.

Background: Tourniquet use has been advocated for better visualization of the surgical field as it exsanguinates most of the blood from the limbs to the central compartment. On the contrary, its use may increase postoperative pain and recovery of quadriceps function, thereby increasing the length of stay (LOS). The study aims to assess short-term outcomes of total knee arthroplasty (TKA) performed with and without a tourniquet.Methodology: Eighty-six patients scheduled for TKA either with or without a tourniquet were selected and divided into two groups using simple random sampling. Knee replacements were performed with a tourniquet in group I and without a tourniquet in group II. In all cases, blood loss was estimated. A visual analog scale (VAS) was used for the assessment of postoperative pain. In the study, range of motion (ROM) and quadriceps lag were also assessed on postoperative day 2 and discharge.Results: There were 23 (26.7%) males and 20 (23.2%) females in group I and 28 (32.5%) males and 15 (17.4%) females in group II (p = 0.07). On comparing mean age and body mass index (BMI), statistically insignificant results were obtained. In group I and group II, a statistically significant difference was obtained in the estimation of mean total blood loss as 780.4 ± 152.49 and 1146.2 ± 193.14 ml, respectively (p = 0.02). Neither on postoperative day 2 nor at the time of discharge, no significant results were obtained in observing the ROM at the knee joint and quadriceps lag.Conclusion: It was found that tourniquet use is associated with lower blood loss and similar postoperative pain, ROM, quadriceps lag, and LOS.

Purpose. To evaluate the outcome after closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for displaced supracondylar humeral fractures. Methods. 39 boys and 11 girls aged 2 to 12 (mean, 7.27) years underwent closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for posteromedially (n=28), posterolaterally (n=7), or posteriorly (n=15) displaced extension-type supracondylar humeral fractures (Gartland types II and III). Results. Compared with the uninjured elbows, the injured elbows had a mean loss of flexion of 4.52° (p<0.001), a mean loss of extension of 1.7° (p=0.008), and mean change in carrying angle of 3.47° (p<0.001). According to the Flynn grading system, outcome was excellent in 35 patients, good in 9, fair in 2, and poor in 4. Outcome did not differ significantly between patients aged 2 to 4, 5 to 8, and 9 to 12 years or between those operated on within 24 hours of injury and those operated on 2 to 5 days after injury. One patient developed superficial pin tract infection, and 2 patients developed cubitus varus deformity. No patient sustained iatrogenic nerve injury. Conclusion. Transolecranon vertical and lateral Kirschner wire fixation is a viable option for displaced supracondylar humeral fractures in children, especially when there is massive swelling.

Background: Lateral epicondylitis (Tennis elbow) is due to degeneration in common origin of extensor group of muscles of forearm. The objective of our study was assessment of efficacy of activated platelet rich plasma and local corticosteroid injection for the treatment of lateral epicondylitis. Methods: 50 patients with chronic lateral epicondylitis were included in the study and randomised into 2 groups. Group 1 was treated with a single injection of 2 ml of autologous platelet rich plasma (4.8 times of plasma) with 1 ml of calcium chloride as activator and group 2 patients were infiltrated with 2 ml of local corticosteroid (methylprednisolone acetate 80 mg) mixed with 1 ml of 2 % lignocaine, followed by elbow strap, stretching and strengthening exercises along with oral non-steroidal anti-inflammatory drugs for both groups. Pain and functional outcomes were assessed using visual analogue scale (VAS) and NIRSCHL staging at 0, 1, 3, 6, weeks and 4 months and 8 months. Results: Pain variables including VAS and NIRSCHL scores improved significantly in both groups at short and intermediate duration, but long-term activated platelet rich plasma showed better improvement in regard to pain severity, functional outcome and recurrence rates. Conclusion: Both platelet rich plasma and local corticosteroid injection are effective to treat chronic lateral epicondylitis., But platelet rich plasma is better in both short-term and long-term follow-up in tennis elbow with no post injection exacerbation of pain in PRP cases.

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