Suranjan Bhattacharji

Functional Independence Score in Haemophilia: a new performance-based instrument to measure disability

Summary.  Morbidity in haemophilia has been described predominantly in terms of musculoskeletal dysfunction and assessed by the clinical and radiological joint scores. These scores document changes in a particular joint, but do not reflect the impact of these changes on the individual in terms of his overall musculoskeletal function. Several self‐assessment instruments have been used to measure musculoskeletal function but none have been specifically validated for use in haemophilia. In order to objectively assess musculoskeletal function of patients with haemophilia, we developed Functional Independence Score in Hemophilia (FISH), a performance‐based instrument. FISH measures the patients independence in performing seven activities under three categories: self‐care (grooming and eating, bathing and dressing), transfers (chair and floor) and mobility (walking and step climbing). Each function is graded from 1 to 4 depending on the amount of assistance needed in performing the function. We evaluated 35 patients who were over 10 years old and had had at least three major bleeds per year. All subjects were scored for clinical (World Federation of Hemophilia, WFH score) and radiological changes (Petterssons score). Functional independence of the patient was assessed using the Stanford Health Assessment Questionnaire (HAQ) and the FISH. Correlation of the FISH score was modest with both the WFH clinical score (r = −0.68) and the radiological score (r = −0.44). While there was good correlation between FISH and HAQ (r = −0.90), FISH had better internal consistency than HAQ (Cronbachs α 0.83 vs. 0.66). FISH appears to be a promising disease‐specific instrument for assessing overall musculoskeletal function in haemophilia. It requires evaluation in different patient populations.

Depression in individuals with spinal cord injury: methodological issues

The methodological problems in research related to depression in individuals with spinal cord injury (SCI) are examined. These include relation to normal emotional reactions following injury, the use of physical and vegetative symptoms in the diagnosis of depression, the utilisation of rating scales primarily designed for use in psychiatric populations, the heterogeneity of patients with SCI, the role of preexisting psychiatric morbidity, the selection of controls for comparison and the necessity for multivariate statistical approaches to analysis. The issues and possible solutions are discussed.

Psychological wellbeing among carers of people with spinal cord injury: a preliminary investigation from South India

Study design: A cross-sectional study that assessed people with spinal cord injury (SCI) and their carers who attended the 3-day health care program.Objectives: The study examined the nature and prevalence of the factors associated with psychological morbidity among carers of people with SCI.Setting: A community reintegrated population of persons with SCI and their carers attended the 3-day program in the Department of Physical Medicine and Rehabilitation, Christian Medical College Hospitals, Vellore, South India.Methods: Thirty-eight people with SCI and their carers participated in this cross-sectional study.Results: Thirty (78.9%) carers of people with SCI were psychologically distressed. While carers were distressed, they were not significantly depressed. Educational level of carers and suicidal behavior of people with SCI were significantly associated with psychological distress.Conclusion: The findings of this study suggest that health care workers should have a high index of suspicion of psychological morbidity, in carers of people with SCI. Identification of risk factors may lead to useful target interventions.Sponsorship: Nil.

Malignant secondary deposit in the iliac crest masquerading as meralgia paresthetica

Meralgia paresthetica is an entrapment neuropathy from compression of lateral femoral cutaneous nerve of the thigh as it passes under the inguinal ligament. The entrapment produces pain, paresthesia, and sensory loss over the anterolateral aspect of the thigh, without motor loss. The etiology of this condition is often obscure and the pathogenesis is thought to be an entrapment of this nerve at the inguinal ligament where it pierces the fascia to reach the skin. Rarely, retroperitoneal lymphomas or other neoplasms can mimic symptoms of meralgia paresthetica. We report a case of a 60-year-old man who presented with clinical features of meralgia paresthetica. On investigation, he was found to have a secondary malignant deposit in the iliac crest from an adenocarcinoma of the lung. This neuropathy, although often caused by a benign lesion, can at times be the presenting symptom of a malignancy.

Motor recovery following olfactory ensheathing cell transplantation in rats with spinal cord injury

BACKGROUND Olfactory ensheathing cells (OEC) are considered to be the most suitable cells for transplantation therapy in the central nervous system (CNS) because of their unique ability to help axonal regrowth and remyelination in the CNS. However, there are conflicting reports about the success rates with OEC. AIM This study was undertaken to evaluate the therapeutic effect of OEC in rat models using different cell dosages. MATERIAL AND METHODS OECs harvested from the olfactory mucosa of adult white Albino rats were cultured. Spinal cord injury (SCI) was inflicted at the lower thoracic segment in a control and test group of rats. Two weeks later, OECs were delivered in and around the injured spinal cord segment of the test group of the rats. The outcome in terms of locomotor recovery of limb muscles was assessed on a standard rating scale and by recording the motor-evoked potentials from the muscles during transcranial electrical stimulation. Finally, the animals were sacrificed to assess the structural repair by light microscopy. STATISTICAL ANALYSIS Wilcoxon signed rank test and Mann-Whitney U-test were used to compare the data in the control and the test group of animals. A P value of <0.05 was considered significant. RESULTS The study showed a moderate but significant recovery of the injured rats after OEC transplantation (P=0.005). CONCLUSION Transplantation of OECs along with olfactory nerve fibroblasts improved the motor recovery in rat models with SCI.

Re-examining the psychology of spinal cord injury: a meaning centered approach from a cultural perspective

Objectives: To examine the impact of SCI from a non-Western cultural perspective.Setting: India.Methods: A philosophical approach.Conclusion: Management of the individual with spinal cord injury needs to take in to account the individuals beliefs and cultural context.Spinal Cord (2001) 39, 323–326.

Glucose intolerance and dyslipidaemias in persons with paraplegia and tetraplegia in South India

Glucose intolerance and dyslipidaemias have been reported among paraplegics and tetraplegics. In this study we determined the lipid profiles and the glucose tolerance in a group of 48 persons with spinal cord lesions who had been rehabilitated in our Department of Physical Medicine and Rehabilitation. This non-randomised, descriptive study was conducted as part of the annual medical follow-up of these individuals. Hypertension was observed in only 6% of the subjects. Fasting hyperglycemia was observed in 19% and glucose intolerance in 23% of the subjects. Total cholesterol was abnormal in 2%, but 58% had low levels of high density lipoprotein (HDL). 10% of the subjects had raised low density lipoprotein (LDL) levels. The cardioprotective HDL fraction may remain very low even while the total cholesterol level is within normal limits, and unless a lipid profile estimation is done, this group of individuals who are at cardiovascular risk may remain undetected. We conclude that glucose intolerance and dyslipidaemias are common among paraplegic and tetraplegic individuals, and these metabolic derangements may contribute to increased cardiovascular morbidity.

The Effectiveness of Intravesical Oxybutynin, Propantheline, and Capsaicin in the Management of Neuropathic Bladder following Spinal Cord Injury

The objective of this study was to compare the therapeutic response of intravesical oxybutynin, propantheline, and capsaicin in the treatment of neurogenic detrusor overactivity. Carried out in the Department of Physical Medicine and Rehabilitation at a university teaching hospital in India, patients acted as their own controls. Oxybutynin 5 mg in solution or propantheline 15 mg in solution and capsaicin were instilled intravesically in each patient. Urodynamic studies were done before and after the intravesical instillation of each drug. The nonparametric tests were used for statistical analysis. The efficacy of intravesical capsaicin in the treatment of neurogenic detrusor overactivity was statistically significant for reflex volume (RV) (p = 0.018), cystometric capacity (CC) (p = 0.0440), leak volume (LV) (p = 0.000), and leak frequency (LF) (p = 0.009). The Kruskal-Wallis test for paired sample comparing pre- and post-LV and LF for intravesical capsaicin was significant at 2nd week (p = 0.002 and 0.054, respectively). There was a significant difference in therapeutic response between intravesical oxybutynin, propantheline, and capsaicin in the treatment of detrusor overactivity for LV and LF at 2nd week (p = 0.017 and 0.003, respectively). When comparing responses of oxybutynin and propantheline, more subjects demonstrated improvement with intravesical propantheline than oxybutynin for RV, detrusor leak point pressure (LPP), clean intermittent catheterization volume (CICV), and LV. This study suggests that intravesical agents may be used as effective adjuvants in the management of incontinence due to neurogenic detrusor overactivity following spinal cord injury.

Aspirin in chloroform as an effective adjuvant in the management of chronic neurogenic pain

OBJECTIVE To evaluate the effectiveness of topical application of aspirin in chloroform as an adjuvant in the management of chronic neurogenic pain. DESIGN Intervention study, nonrandomized before-and-after trial. SETTING A department of physical medicine and rehabilitation in a tertiary-care university teaching hospital. PARTICIPANTS Fifteen adults who presented with severe, chronic neurogenic pain in whom, conventional methods of treatment were unsuccessful in alleviating the pain. INTERVENTION A solution of aspirin (acetyl salicylic acid) in chloroform was applied over the painful areas. MAIN OUTCOME MEASURES A numerical scale from 0 to 100 was used to measure the severity of pain. RESULTS Seventy-four percent of patients showed a good response, 13% had fair response, and in 13% there was no response. CONCLUSION Aspirin in chloroform solution is a simple and effective adjuvant in the management of chronic neurogenic pain.

Perceptions of patients with spinal cord injury on future research in South India

Purpose – The purpose of this paper is to evaluate the perceptions of research priorities as expressed by people with spinal cord injury (SCI).Design/methodology/approach – A descriptive study based on feedback from patients, rehabilitated following SCI was conducted in order to explore their felt needs for further research. A questionnaire was sent to 225 people who were rehabilitated following SCI. They were asked to indicate three priorities for further research on disability related issues. The questionnaire had a list of issues on different facets of disability following SCI. In total, 62 patients responded to the questionnaire.Findings – Research on urinary incontinence was stated to have the highest priority among these different groups according to their age, marital status, duration of disability, and employment status. Rehabilitated patients of all age groups, irrespective of marital or employment status or duration of disability, indicated that further research is to be done on urinary incontin...