ABSTRACT
Abstract: Anxiety is the commonest anticipated problem of patients during the perioperative period. Preoperative anxiety can produce poor postoperative outcome and make the management and control of postoperative pain more difficult. Studies have demonstrated a strong relationship between anxiety and pain. Anxiety leads to elevated pain, likewise pain results in an increased level of anxiety. Therefore, it can be postulated that reducing the amount of anxiety experienced preoperatively with an anxiolytic will reduce the burden of pain experienced by patients postoperatively. This study assessed the clinical effect of preoperative anxiolysis with Lorazepam on postoperative pain perception in patients undergoing elective lower limb major orthopaedic surgeries under combined spinal epidural (CSE) anaesthesia. This was a prospective study of 122 patients who presented for surgeries at the University of Abuja Teaching Hospital, Nigeria. Patients were randomly assigned to receive either Lorazepam 2mg (n=56) or placebo (n=56) the night before surgery and 2h before scheduled surgery. Postoperative pain scores, analgesic requirements and satisfaction with pain control were evaluated during the first 24h following surgery.We found that patients who received Lorazepam reported a significantly lower pain score than placebo group during the first12h (p= 0.031) while morphine requirement was significantly greater in the placebo group than Lorazepam group (8.20±1.91mg vs 14.8 ±2.10mg; p= 0.036) and patients treated with anxiolytics showed a greater satisfaction with pain relief (p=0.0185). In summary, preoperative Lorazepam produced significant anxiolysis that led to reduced pain, lower analgesic consumption, and better satisfaction but with modest side effects.

ABSTRACT
Background: The argument on whether extracorporeal shock-wave therapy (ESWT) proves to be beneficial in short- term intervention in adults with plantar fasciitis. It is important and necessary to conduct a meta-analysis to make a comparatively more reliable and overall assessment about the outcomes of ESWT in the less than 6 months. Methods: we conducted A Systematic Review and meta-analysis of randomized control trials from MEDLINE, Embase and CINAHL database from 2000 to 2020. We included randomized trials which evaluated extracorporeal shock wave therapy used to treat plantar heel pain. Trials comparing extra corporeal shock wave therapy with placebo were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomized controlled trial, extracted data and assessed the methodological quality of each trial. Results: Four studies involving 645 patients were included. 3 RCTs (n=605) permitted a pooled estimate of effectiveness based on overall success rate and composite score of visual analogue scales for pain at the follow-up 1 (12 Weeks) .The pooled data showed no significant heterogeneity at three-month follow-up (p-value of chi-square = 0.61 P=0.74 and I2 = 0%). The ESWT group had a better success rate than the control group at three-month follow-up (OR = 2.26, 95% CI = 1.62-3.15, p < 0.00001). For reduction of pain the pooled data showed no significant heterogeneity (P Value of chi-Square 0.28 and I2 22% ) There were significant differences between the ESWT and control groups for all the follow-up visits (random-effect model, three trials, MD = 15.14, 95% CI = 13.86 to 16.42, P <0.00001 at three-month). Conclusion: A meta-analysis of data from three randomized-controlled trials that included a total of 605 patients was statistically significant in favour of extracorporeal shock wave therapy at follow-up 1(12 weeks).

ABSTRACT
Charcot osteoarthropathy is a debilitating disease associated with uncontrolled diabetes mellitus that has multiple orthopedic complications. Severe degenerative foot and ankle changes have been cited in the literature and remain a challenging pathology for treatment. A 61 year old female with severe Charcot osteoarthropathy to the left tibiotalar and subtalar joints treated successfully with a minimally invasive tibiotalocalcaneal hindfoot fusion nail construct. While multiple stabilization techniques exist to include cross screws, plates, and intramedullary devices, hindfoot nailing systems offer a technique with minimal periosteal stripping and soft tissue dissection. Tibiotalocalcaneal hindfoot fusion nails show promise to fast post-operative return to activities of daily living.

ABSTRACT
Tightness of hamstring muscle is closely linked with movement dysfunction at the lumbar spine, pelvis and lower limbs coupled with low back pain. In the present study, purposively selected 50 collegiate students having asymptomatic hamstring tightness aged 18-26 years from Guru Nanak Dev University, Amritsar, participated in two intervention groups, i.e. Mulligans bent leg raise (BLR) and muscle energy technique (MET). To evaluate the hamstring flexibility, active knee extension test, finger to floor test and sit and reach test of both right and left legs of all the subjects were measured at baseline and after 4th week of intervention. The results indicated significant improvement (p<0.001) in hamstring flexibility in asymptomatic students after the intervention using both Mulligans BLR and MET. After the 4th week intervention, when comparisons were made between these two groups, significant difference (p˂0.05) was found only in active knee extension test of right leg. It could be concluded that both Mulligans BLR and MET were effective in improving the hamstring muscle flexibility in individuals with asymptomatic hamstring muscle tightness. However, MET showed significantly more improvement after 4 weeks of intervention on hamstring flexibility in terms of active knee extension test of right leg as compared to Mulligans BLR technique

ABSTRACT
Introduction:- Tibio-talar arthrodesis remains the surgical procedure used most frequently for post-traumatic arthritis after conservative measures have been exhausted. Minimal invasive ankle arthrodesis with arthroscopic assistance have advantages over conventional one. Methods: - An evaluation of prospectively case series study done on 32 patients that underwent arthroscopic ankle arthrodesis in 2015-19. Clinical assessment was done foot and ankle disability index and visual analog scale score for pain. Radiological assessment was done by serial x rays. All patients underwent arthroscopic assisted ankle arthrodesis. Regular follow-ups were taken till one year. Results: - All cases showed radiological evidence of fusion at 3 months. After a mean 6 months follow up there was significant improvement in terms of foot and ankle disability index and visual analog scale in terms of pain. Conclusions: - Arthroscopic assisted ankle arthrodesis is a effective way to treat ankle arthritis where conservative management has failed.

ABSTRACT
Plantar fasciitis is a common foot complication. It is a disorder of the connective tissue which supports the arch of the foot. It causes pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. The present study deals with purposively selected 50 patients with plantar fasciitis aged 25-45 years from Physiotherapy Center of Guru Nanak Dev University, Amritsar, Punjab, India. The subjects were randomly allocated into two groups, calf stretching and Achilles tendon stretching for 4 weeks interventions. To evaluate the pain and foot function disability of the patients, visual analogue scale (VAS) and foot function index (FFI) were assessed from all the subjects in pre- and post-intervention stages. The results indicated significant reduction (p<0.001) in VAS and FFI in patients with Plantar fasciitis after 4-week interventions using both calf stretching and Achilles tendon stretching. The patients treated with Achilles tendon stretching had more significant (p<0.001) reduction both in VSA and FFI than the patients treated with calf stretching. In conclusion it could be stated that Patients who reported significant relief from symptoms at the end of 4-week interventions with Achilles tendon stretching were double that of the calf stretching.

ABSTRACT
Background: Lung reactions to exposure to dust, gases, and fumes at work places have been studied in different populations. The emission level of pollutants that emit particulate matter less than 10 micrometers in size (PM 10) has been found very high in Ahmedabad. Processes in the foundry production involve the potential hazards for inhalation exposures that may lead to respiratory diseases, metabolic disorders of trace elements. However, the dependence of lung dysfunction on the metal toxicity is unclear. The aim of this study was to assess the parenting stress levels in parents of children who have cerebral palsy as compared to parents of normal children. Further objectives were to ascertain variables predictive of parenting stress levels. Methods: A Cross-Sectional comparative study was conducted on foundry workers from naroda Ahmedabad and normal subjects from V.S hospital campus, Ahmedabad.. A total of 20 foundry workers underwent pulmonary function testing. Their spirometry parameters were compared with 20 ages-matched, healthy controls. Results: A significant reduction (P < 0.001) was found in the spirometry parameters, such as, forced expiratory volume in the first second (FEV1), FEV1/FVC (%), MVV in foundry workers, as compared to the controls. The mean values of FEV1/FVC (%) were significantly increased (P < 0.001). Conclusions: The results of this study confirm that Iron foundry workers were found to have a lower lung function than normal subjects.