ObjectiveAnticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan.MethodsThis was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18–65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ≥4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale–Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs.ResultsOf the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P<0.001). The mean (± SD) pain severity score decreased from 5.8±2.0 at baseline to 3.6±2.2 at week 12 (P<0.001). There was a decrease of ≥30% in the pain severity score between visits. The mean (± SD) QoL scale score improved from 5.9±1.6 at baseline to 8.0±1.7 at week 12. A total of ten (2.2%) patients reported AEs during the study period. No patient discontinued the study due to AEs.ConclusionIn this real-life experience study, carbamazepine, when prescribed for 12 weeks to adult diabetic patients suffering from neuropathic pain, showed pain-relief effect, with reduced mean pain severity and mean pain interference scores and with improved QoL and good tolerability profile.

Informed consent implies that the person undergoing an intervention thoroughly understands its pros and cons. We conducted a randomized control trial to evaluate patients’ recall of complications after day case hand surgery and how this can be influenced by age and/or socioeconomic factors. Patients’ wishes on the extent and type of provided information were also evaluated. A total of 124 cases were recruited. Ten cases were excluded because they presented for follow up more than 2 weeks after surgery. The other patients were randomized into 2 groups: the first one (48) received only verbal information, while the second one (66) also received written information sheets. No statistically significant difference was noted in the recall between the two groups. No difference among gender, age or socioeconomic status was noted. Most patients preferred both written and verbal information. Preference for knowledge of rates of complications increased when surgery was dangerous. Our results don’t show any significant difference in patients’ recall depending on the type of consenting method. Nevertheless, we still propose that patients should receive as much information as possible before undergoing any intervention.

Introduction: Medical case notes are the only lasting interpretation of a patient-physician interaction and are important for good quality patient care. Accurate, legible and contemporaneous note-keeping is important however it can be substandard. This can lead to errors in handover of patients and to medicolegal vulnerability. We present a comprehensive auditing tool for Trauma & Orthopaedics medical case notes and our experience in using it over the last 12 months. Patients and Methods: The TONK score was developed from a pre-existing system with some additions for Trauma & Orthopaedic case notes, with the incorporation of a legibility scoring system. An initial audit was carried out evaluating the case notes for each team against the TONK score. In order to evaluate the reproducibility of this score, we employed the Cohen’s Kappa coefficient and noted substantial agreement. The individual team scores were analysed and the audit cycle completed four months later with the provision of feedback. Results: Our first audit revealed a mean of 81 with a range from 70 to 90. Subsequent audits over the next two quarters revealed mean scores in excess of 90. Significant improvement has been noted in all areas of documentation and it has been decided to conduct this audit every six months in our department. Conclusions: The TONK score is an easy, quick and reproducible tool, which aims to eliminate the weaknesses in Trauma & Orthopaedic medical note-keeping. It emphasises the medicolegal importance of accurate medical note-keeping to doctors at all levels of training.

Simultaneous distal radius and carpus fractures are uncommon. They can be missed because of a diffused clinical picture and an inexperienced clinician reviewing the patient and radiographs. A 64-year-old woman presented to the emergency department (ED) with a clinically deformed left wrist after a fall. Plain radiographs were interpreted as a distal radius intra-articular fracture with volar angulation, both by the ED physician and the first on call for trauma and orthopaedics (T&O). Review of the radiographs in the trauma meeting revealed the possibility of an additional undisplaced lunate fracture. A computed tomography scan confirmed the distal radius fracture in addition to an undisplaced fracture of the lunate. Because of the unstable nature of the distal radius fracture, open reduction and internal fixation was performed. As the lunate fracture was undisplaced, it was managed conservatively. The patient was discharged home the next day and has been doing well at follow-up.

Objective: The purpose of this study was to determine the frequency of atticoantral/unsafe chronic suppurative otitis media in patients with chronic ear discharge. Materials and Methods: This Cross-sectional study was conducted in the department of ENT and Head and Neck Surgery, Hayatabad Medical Complex and Department of ENT, Naseerullah Khan Babar memorial Hospital, Peshawar from August 2018 to February 2019. In this study 199 patients were enrolled with consecutive sampling. Detailed demographic data like history and physical examination were taken from patients. All patients were subjected to detailed otoscopic examination and pure tone audiometery by a consultant. A detailed performa was designed in which all information of the patients like name, age, gender, duration of symptoms and CSOM were recorded by SPSS analysis. Results: With a standard deviation of ± 10.334, the average age of participants in this study was 29 years. There were more males than women among the patients present, with 60% of them being men. Twelve percent of patients with chronic discharge developed CSOM, compared to 90% of those who didn't have the condition at all. Conclusion: Our study shows that individuals who come with persistent ear drainage frequently have hazardous ears.