Chronic tympanic membrane (TM) perforation is a common problem worldwide. Recent reports have shown epidermal growth factor (EGF) to stimulate healing in approximately 80% of chronic TM perforations in chinchillas when applied in three doses over 1 week. The objective of this controlled study is to evaluate the efficacy of long-term EGF in the closure of TM perforations. Chronic chinchilla TM perforations were treated with EGF for up to 6 weeks. One hundred percent (17 of 17) of treatment group perforations completely healed. However, two new findings with this long dosing scheme were reperforation on long-term follow-up and three TMs with cholesteatomas. It is likely that reperforation was due to a progressive thinning seen with prolonged EGF application. Long-term EGF use is not recommended for the treatment of TM perforations because of possible wound healing impairment and possible cholesteatoma induction.

This study aimed to investigate the effects of an incorrectly positioned tracheostomy tube on flow resistance. A laboratory-based model of the trachea was used with both cuffed and uncuffed tracheostomy tubes inserted to variable depths. With a constant metered flow through the model, the pressure for given depths of insertion was recorded. The model was then re-run to test the effect of different flow rates on the system. A total of 468 individual results were grouped and statistically analysed. They showed that both over-and under-insertion increase the pressure within the circuit and that a cuffed tracheostomy tube offers a degree of protection against this. These results were statistically significant with P < 0.05 demonstrating that incorrect positioning has a greater resistance to flow. These results provide an essential scientific basis for further work to assess the clinical significance of incorrect positioning as well as suggesting the need to monitor tube position.

The capacity to experience pain is valuable for survival; however, the development of neuropathic pain is maladaptive and may be the result of a variety of underlying clinical diagnoses. Neuropathic pain has a significant impact on the patient's quality of life, function and psychological well-being and creates a personal and societal financial burden. It is an important issue within primary care that is often underdiagnosed and undertreated. It is essential to have a systematic approach to the assessment of these patients with neuropathic pain within primary care. The patient and clinician should develop an individual management strategy involving behavioural and psychological support, functional rehabilitation and pharmacological therapy with the aim of optimising quality of life. This article aims to summarise the background to neuropathic pain, the common presentations within primary care and the current treatment options available.

Aim: To compare the frequency of absence of pain with injection paracetamol versus placebo given before injection rocuronium in patients undergoing elective procedures Study design: Randomized Controlled Trial Place and duration of study: Dept of Anaesthesia, Civil Hospital, Karachi from 15th January to 14th July 2017. Methodology: One hundred and two patients aged 25-75 years of either gender undergoing elective surgery were enrolled. The lottery method was used to divide the patients into two equal groups. Paracetamol (5 mL, 10 mg/mL) or normal saline (5 mL) were used as pretreatment solutions. When the tourniquet was removed after 2 minutes, the rocuronium at 1% concentration was injected throughout the 10 second’s period. Patients were then advised and asked to rate their pain on the hand's dorsum using VAS. Results: Mean age of the patients was 44.11±7.75 years. Mean pain score was 1.49±1.38. Significant difference was observed in the mean pain score in between paracetamol and placebo group (p-value <0.001). Overall absence of pain was found in 49 (40.8%). Absence of pain was found to be higher 34 (69.4%) in paracetamol group as compared to placebo group (p-value <0.001). Conclusion: Frequency of absence of pain found lower in patients undergoing elective procedures with injection paracetamol versus placebo given before injection rocuronium. Keywords: Injection rocuronium, Elective procedures, Injection paracetamol, Absence of pain