Introduction:Patientcontrolled analgesia (PCA) is an interactive method of self drug administrationthat requires proper education to ensure safe and effective use. Morphine is the most popular opioid used for postoperative pain management using PCA; however it has many adverse effects. Nalbuphine, a mixed opioid agonist antagonist, is known to be safer than morphine. Ketorolac produce excellent analgesia when used alone or with opioids. Multimodal analgesicapproach using morphine or nalbuphine combined with ketorolac for PCA administration has not been compared before. The study aimed to compare the clinical efficacy, adverse effects of multimodal analgesia using PCA and the effect of patient education regarding PCA use on patients' outcomes. Patients and methods: AdultEgyptian patients ASA I and II whounderwent different surgical procedures were selected and randomized either to receive PCA of morphine or nalbuphine combined with ketorolac. Patients from each drug group were further randomly selected to receive additional preoperative PCA education beside the usual care for pain management. Visual analogue scale (VAS), hemodynamic parameters,adverse effects and patient satisfaction were compared between groups. Results: Of the total of 60 patients enrolled, 45 patients completed the study: 22 patients for morphine group(M) and 23 for nalbuphine group (N). VAS score was significantly lower in group(M)than group (N)at certain time points. Nalbuphineshowed a significant lower incidence of itching than morphine(P: 0.03*). Pain control and overall satisfactionswerebetter in the intervention groups (M2, N2) than in the control groups (M1, N1). Conclusion:Morphine coadministerd with ketorolac provides more potent analgesia than with nalbuphine. Preoperative patient education regarding PCA is crucial for proper postoperative pain control.
KEYWORDS:Patient education, Morphine, Nalbuphine, PCA, Postoperative Pain.

[1]. Manias, E., M. Botti, and T. Bucknall, Patients' decision-making strategies for managing postoperative pain.The Journal of pain, 7(6) 2006: p. 428-437.
[2]. Kehlet, H. and K. Holte, Effect of postoperative analgesia on surgical outcome.British journal of anaesthesia, 87(1) 2001: p. 62-72.
[3]. Walder, B., et al., Efficacy and safety of patient‐controlled opioid analgesia for acute postoperative pain.Acta Anaesthesiologica Scandinavica, 45(7) 2001: p. 795-804.
[4]. Hudcova, J., et al., Patient controlled intravenous opioid analgesia versus conventional opioid analgesia for postoperative pain control: A quantitative systematic review.Acute Pain, 7(3) 2005: p. 115-132.
[5]. Gal, T.J., C.A. DiFazio, and J. Moscicki, Analgesic and respiratory depressant activity of nalbuphine: a comparison with morphine.Anesthesiology, 57(5) 1982: p. 367-374.
[6]. Minai, F. and F. Khan, A comparison of morphine and nalbuphine for intraoperative and postoperative analgesia.JOURNAL-PAKISTAN MEDICAL ASSOCIATION, 53(9) 2003: p. 391-395.
[7]. Yeh, Y.-C., et al., Combination of opioid agonist and agonist–antagonist: patient-controlled analgesia requirement and adverse events among different-ratio morphine and nalbuphine admixtures for postoperative pain.British journal of anaesthesia, 101(4) 2008: p. 542-548.

The aqueous extract of Parsley ( Petroselinum crispum ) were investigated for anti-inflammatory, analgesic and antipyretic activity at the doses of 2 , 5 , and 10 g/kg, of body weight. The experimental paradigms used were carrageenan, dextran, histamine induced pedal edema and cotton pellet induced granuloma for anti-inflammatory activity, while hot plate and acetic acid induced writhing methods were used to assess analgesic activity. Yeast-induced hyperpyrexia was used to evaluate the antipyretic activity. In acute phase inflammation, a maximum inhibition 50.6% (P < 0.05), 51.1% (P < 0.05) and 52.3% (P < 0.05) were noted at the dose of 10 g/kg after 3 h of treatment with methanol extract of Parsley ( Petroselinum crispum ) in carrageenan, dextran and histamine induced pedal edema , respectively. In the chronic model (cotton pellet induced granuloma) , the parsley (10 g/kg) and standard drug (Indomethacin 10 mg/kg) showed decreased formation of granuloma tissue by 51.8% (P < 0.05) and 56.6% (P < 0.05) , respectively. The extract also produced significant (P < 0.01) analgesic activity in both paradigms. In addition, the aqueous extract of parsley potentiated the morphine and aspirin induced analgesia. A significant (P < 0.01) reduction in hyperpyrexia in rat was also produced by the extract. This study exhibits that methanol extracts of leaves of parsley possess anti-inflammatory, analgesic and antipyretic activities.
KEYWORDS:Parsley ( Petroselinum crispum ) , Anti-inflammatory, Analgesic, Antipyretic

[1]. Sosa, S.; Balic , M.J. ; Arvigo, R.; Esposito, R.G.; Pizza , C.; Altinier, G. et al. A Screening of the topical Anti-inflammatory activity of some Central American plants.. J Ethanopharmacol . 2002.Vol.8 .Pp:211-215.
[2]. Kayaalp , S.O. Medical pharmacology in terms of rational treatment (Rasyonel tedavi yonunden tibbi farmakoloji), Ankara: Ha-cettepe-Tas Ltd.Sti. 1998 . Pp:264-268.
[3]. Mimica-Dukić , N . ; Popović, M. Apiaceae Species. A promising sources of pharmacologically active compounds and Petrosellinum crispum, Apium greveolens and Pastinaca sativa . Phytopharmacology and Therapeutic Values . 2007. Vol. 21. Pp: 132-133.
[4]. Ozsoy-Sacan, O. ; Yanarday, R.; Orak, H .; Ozagy, Y.; Yaral, A ; and unali, T . Effect of parsley ( Protoselium crispun ) extract versus glibornuride on the liver of streptozotocin-induced diabetic rats . J Ethnopharmacol. March 2006. Vol.8. Pp: 104(1-2):175-81 .
[5]. Bolkent, S .; Yanadrag, R .; Ozsay-Sacan, O .; and Karabulunt –Bulan, O. Effects of parsley (Petroselium crispum ) on the liver of diabetic rats : a morphological and biochemical study . Phytother Res Dec. 2004.. Vol. 18(12). Pp: 996-9 .
[6]. Yanaerdag, R.; Bolkent, S .; Tabakoglu-Ognz, A .; and Ozsoy-Sacan, O . Effects of Petroselium crispum extract on pancreatic B-cells and blood glucose of streptozotocin – induced diabetic rats . Biol Pharm Bull . Aug; 2003.Vol. 26(8). Pp: 1206-10 .

Smoking is prevalent among Nigerians. This study identified the smokers and related factors among Amassoma Community in South-South Nigeria. Questionnaires were administered randomly within the community to 260 consenting respondents; Data was analyzed with SPSS version 20. Respondents were Males (73.6%), aged 18-45 years (77.5%), single (45.7%), married (37.8%); with secondary/tertiary education (68.1%); Civil Servants (13.4%) ); Students (26%); Drivers (12.2%); Christian (72.4%) and Ijaw tribe (54.7%).64.6%.had ever smoked at prevalent initiation age of 16-25 years (74.5%); current smokers were 86.0%; 97.2% also took alcohol; 43.3% always smoked for relaxation; 48.9% always smoked to have fun with their friends; 58.20% sometimes smoked in order to fit into the social circle; Gender, Age group and Education were associated with past (p<0.05) but not with present (p>0.05) smoking history; marital status and average annual income had no correlation with both past and present history of smoking (p>0.05). Smoking cessation outreaches should target the identified vulnerable groups in order to substantially lower the smoking prevalence in this community.

[1] Joan C, Marjorie R, Geofrey A, Sabella JK, Scholastica K and Simon MK. The Extent of Influence of Factors on Cigarette Smoking Among Teenagers in Baguio City: A Cross-Sectional Study. Journal of Natural Sciences. 3; 2013: 2224-3186.
[2] Klein H, Sterk CE and Elifson KW. Initial smoking experiences and current smoking behaviours and perceptions among current smokers. Journal of Addiction. 2013; 2013, Article ID 481797, 9 pages. http://dx.doi.org/10.1155/2013/491797
[3] Jha P and Peto R. Global Effects of Smoking, of Quitting, and of Taxing Tobacco. Engl J Med. 370; 2014: 60-8
[4] Khurshid F and Ansari U. Causes of smoking Habit Among the teenagers. Interdisciplinary journal of contemporary research in business.3 (9); 2012: 848.
[5] Berman M, Crane R, Seiber E and Munur M. Estimating the cost of a smoking employee. J. Tob Control 10; 2012:1136-050888.
[6] Araoye MO. Research methodology with statistics for health and social sciences; Ilorin: Nathadex Publishers. 2003: 117-118

Abstract: Background: Uveitic glaucoma (UG) due to disease and /or therapeutics is an important reason for reduced vision. Different therapeutic regimen employed in uveitis can alter the course of UG. Purpose: Evaluation of prevalence of UG with different commonly used therapy. Study design: Randomised prospective hospital based study Study Period: 2007-2012 Methods: Baseline IOP; Field and optic nerve head photographs were recorded. Three groups were randomised: 1.topical steroid 2.Systemic steroid +gr 1, 3.Topical synthetic steroids, cycloplegic and periorbital triamcinolone injection. Outcome measure: IOP more than 22 mm/4 mm increase from baseline is marker.

Results: 1254 cases of uveitis with 82 cases of uveitic glaucoma were included .Prevalence:63 per100000, 70% in anterior uveitis. During treatment, UG was maximum (80%) in first group and least (5%) with synthetic steroid combined with periorbital triamcinolone. Multi variate analysis shows synthetic steroid and periorbital triamcinolone has least association with UG. Macular oedema was more in UG which improved with low dose acetazolamide.25% cases had progressive visual field loss.

Conclusion: UG is an underappreciated visual threat in uveitis which can be modulated effectively with newer steroids and low dose acetazolamide.

[1] Allingham RR, Damji K, Freedman S, et al. Steroid induced glaucoma, in Allingham RR, Damji K, Freedman S, et al (eds). Shields Textbook of Glaucoma. Baltimore, MD,
[2] Allingham RR. Glaucoma due to intraocular inflammation,in Epstein DL, Schuman JS (eds). Chandler and Grant's glaucoma. Baltimore, MD, Williams and Willkins; ed 4. 1997, pp 376—94
[3] Boyle JW, Netland PA, Salim S, et al. Uveitic glaucoma: pathophysiology and management. EyeNet. 2008;12:39—41
[4] Heinz C, Koch JM, Zurek-Imhoff B, et al. Prevalence of uveitic secondary glaucoma and success of nonsurgical treatment in adults and children in a tertiary referral center.OculImmunolInflamm. 2009;17:243—8
[5] Herbert HM, Viswanathan A, Jackson H, et al. Risk factors for elevated intraocular pressure in uveitis. J Glaucoma,2004;13:96—9

To investigate the effects of D-002 (beeswax alcohols) on esophagitis induced by chronic gastroesophageal reflux (c-GER) in rats. Rats were randomized into a sham and five groups subjected to c-GER: a positive vehicle control, three D-002 (50, 100 and 200 mg/kg), and one omeprazole (20 mg/kg) group, all treated orally for seven days. cGER was induced by ligation of the junction between the forestomach and the duodenal side of the pylorus. Esophageal lesions index (ELI), esophageal malondialdehyde (MDA) and sulfhydril groups (SHG) concentrations were assessed. The positive control group exhibited macroscopically signs of esophageal injury assessed in term of ELI, which was significantly higher than in the negative control. D-002 (50, 100 and 200 mg/kg) reduced the ELI, showing 30.5, 72.9 and 76.4% protection, respectively; and also significantly attenuated the increased MDA (37.4, 63.6 and 94.2%, respectively) and SHG (16.6, 41.6 and 72.9%, respectively) esophageal concentrations versus the positive control. Omeprazole decreased the ELI (80.2%), MDA (99.3%) and SH (85.4%) esophageal concentrations. As conclusions, this study suggest that repeated oral administration with D-002 protects against reflux esophagitis and decreases esophageal lipid peroxidation and protein oxidation markers in rats with c-GER.

Key words: D-002, beeswax alcohols, esophagitis, chronic gastroesophageal reflux (cGER), oxidative stress, rats.

[1] A.F. Peery, E.S. Dellon, J. Lund, et al, Burden of gastrointestinal disease in the United States: 2012 update, Gastroenterology, 143, 2012, 1179-1187.

[2] G. Boeckxstaens, H.B. El-Serag, A.J. Smout, P.J. Kahrilas, Symptomatic reflux disease: the present, the past and the future, Gut, 7, 2014, doi: 10.1136/gutjnl-2013-306393.

[3] Y.W. Wu, P.H. Tseng, Y.C. Lee, et al, Association of esophageal inflammation, obesity and gastroesophageal reflux disease: From FDG PET/CT Perspective, PLoS One, 9(3), 2014, e920012014, doi: 10.1371/journal.pone.0092001. eCollection 2014
[4] J.H. Rubenstein, J.W. Chen, Epidemiology of gastroesophageal reflux disease, Gastroenterol Clin North Am, 43, 2014, 1-14. [5] N.J. Shaheen, J.E, Richter, Barrett's oesophagus, Lancet, 373, 2009, 850–861.
[6] G.N. Tytgat, Recent developments in gastroesophageal reflux disease and Barrett's esophagus: ANNO 2012, J Dig Dis, 13, 2012, 291-295.
[7] K. Tsuboi, M. Hoshino, A. Sundaram, F. Yano, S.K. Mittal, Role of the lower esophageal sphincter on esophageal acid exposure - a review of over 2000 patients, Trop Gastroenterol, 33, 2012,107-111.
[8] K. Nagahama, M. Yamoto, H. Nishio, K. Takeuchi, Essential role of pepsin in pathogenesis of acid reflux esophagitis in rats, Dig Dis Sci, 51, 2006, 303-306.

Background: Road traffic accidents (RTAs) are an emerging public health problem. It is estimated that more than 5 million people between 17-40 years of age die annually as a result of RTAs worldwide. Currently, RTA is the tenth leading cause of disease burden in the developing countries, especially in the Sub-Saharan African countries. The objective of the study was to analyze the proportion of accidents by vehicle, as well as investigate group of people vulnerable to RTA.

Methods: This was a survey done in Kisii Central District. We interviewed 30 people undergoing treatment at Kisii General Hospital due to RTA injuries and a group of 15 traffic police officers. Fifth-one motor vehicle drivers and 297 non-motorist road users were also interviewed. Results: Pedestrians were 65.7% males while, drivers were 90.2% males. Vehicles involved in RTAs were matatus thus vans and mini buses (73.4%), buses (13.3%) and private vehicles (13.3%). Contributory factors included human errors (59.6%); bad roads (19.5%); defective vehicles (29.9%). Antecedent factors associated with RTAs included over-speeding, overloading and laxed policing.

Discussion: RTAs continue to cause avoidable injuries, disabilities and mortality. We show that antecedent factors to RTAs are modifiable through training, improved road design and maintenance, motor vehicle repairs and proper policing.

Keywords: Road Traffic Accidents, Road Traffic Injuries, Matatus Vehicles

[1] Andrew, C.N, Kobusingye, O.C, and Lett, R. (1999). Road Traffic Accident Injuries in Kampala. East African Medical Journal, 76:189-197.
[2] Asogwa, S.E. (1992). Road Traffic Accidents in Nigeria. A review and reappraisal. Accident Analysis Preview, 24: 149-155.
[3] Assum, T. (1998). Road Safety in Africa: Appraisal of Road Safety Initiatives in five African countries, The World Economic Commission for Africa.
[4] Atinga, J.E. (1990). Unique features of truck proneness to accidents: proceedings of the 18th Annual Scientific Conference, KMA—Nakuru, Medicus, 9(7): 11-19.
[5] Automobile Association Road Safety Report. (1990). An absence of manners; Nairobi, Automobile Association, 1990.
[6] Ayuthya, R. and Bohning. (1997). Risk factors for road traffic accidents in Bangkok metropolis. A case reference study, South East Asia. Journal of Tropical Medicine and Public Health, 28(4): 881-885.

Uthiravathasuronitham, a vatha disease described by Sage Yugi can be correlated to Rheumatoid arthritis. A 53 year old lady diagnosed as Uthiravathasuronitham was treated with Siddha medicines Karpoora Chindhamani Mathirai and MannennaiKalavaiThylam. A single case study of Uthiravathasuronitham is detailed in this article.The patient presented with pain and swelling in minor joints of hand, wrist, ankle, shoulder joints and morning stiffness. The RA factor, CRP was positive at the time of enrollment. She was admitted in the IPD of Sirappu Maruthuvam Department of National Institute of Siddha for 45 days. The treatment outcome was encouraging. Hence further clinical studies can be carried out.

Keywords: Uthiravathasuronitham, Rheumatoid arthritis, Siddha, Case study, Karpoora Chindhamani Mathirai, Mannennai Kalavai Thylam.

[1] Paul B. Beeson and Walsh Mc Dermott, Textbook of Medicine(14thEd, 1975, W.B.Saunderscompany,Phildelphia),142.
[2] T.V.SambasivamPillai, Tamil-English dictionary Vol:1(1st Ed, 1931. The research Institute of Siddhars Science, Chennai), 1110.
[3] HakeemP.M.AbdullaSayub, AnubogaVaidhyaNavaneedham, Part -4(1st Ed Oct 1995, Thamarainoolagam, Chennai),106.
[4] Kannuswamy Pillai, PatharthaGunaVillakam-Thathu, JeevaVargam(Revised 4thEd,2006, B.Rathinanayakar and sons, Chennai)
[5] Clinical manual for nursing practice (National Institute of Health Warren Grant Magnuson Clinical Centre)
[6] Shanmugavelu M, Siddha MaruthuvaNoinaadlNoiMuthalNaadalThiratu, (1stEd 1967, Sep 2006,Department of Indian medicine and Homoeopathy),363.
[7] Wang JF etal ,Five new phorbol esters with cytotoxic and selective anti-inflammatory activities from Croton tiglium, Bioorg Med Chem Lett, 25(9):May 12015, 1986-9.

Malaria is a major health problem in India with 1.04 million cases reported in 2012 leading to 504 deaths. The clinical spectrum depends on the infecting species, level of parasitemia and the immune status of the host. Malaria pathogenesis is based on extensive changes in hematological and biochemical parameters. The objective of this study was to study the clinical features, hematological and biochemical parameters in malaria patients and correlate them with the parasitic index (PI). Material and methods: We conducted a study on 300 malaria patients. The frequency of various symptoms and signs of malaria caused by various plasmodium species were determined. The degree of anemia, WBC count, platelet count serum bilirubin, liver enzymes and serum creatinine levels were studied and their variation depending on the parasitic index was documented. Results: 197 patients had vivax malaria, 76 patients had falciparum malaria and 27 patients had mixed infection. 171 patients had a PI of less than 2%, 100 patients had PI between 2 to 5%, 23 patients had PI between 5 to 10% and only 6 patients had PI of more than 10%. 72.3% of patients had thrombocytopenia, 46.66% had anaemia, 25% had increased bilirubin 29.66% showed increased liver enzymes and 7.66% had increased creatinine levels. Conclusion: There was a correlation between degree of parasitemia and severity of malaria in majority of cases. Derangements in hematological and biochemical parameters were more frequently seen in patients with higher PI. Hence PI can be used as an indicator by the clinician to know the severity of infection and plan appropriate treatment.

Keywords: Malaria, Parasitic index, Anemia, thrombocytopenia, Hyperbilirubinemia, Severity.

[1] World Malaria Report,Geneva Switzerland: WHO Press;2009
[2] World Health Organization,Universal Access to Malaria Diagnostic Testing: an Operational Manual,WHO,Geneva Switzerland,2011.
[3] World Health Organization: Severe falciparum malaria. Trans R Soc Trop Med Hyg 2000,94(suppl1):S1-90.
[4] Warhurst D C, Williams J E. Laboratory Diagnosis of Malaria. J ClinPathol 1996;49:533-8.
[5] Hansheid, T. 1999. Diagnosis of malaria: A review of alternatives to conventional microscopy. Clin. Lab. Haematol. 21:235-45.
[6] Wilkinson, R.J., J.L. Brown, G. Pasvol, P.L. Chiodini, and R.N. Davidson. 1994. Severe falciparum malaria: predicting the effect of exchange transfusion. Q.J. Med. 87:553-7.
[7] Kumar A, Valecha N, Jain T, Dash AP. Burden of Malaria in India: Retrospective and Prospective View. Am J Trop Med Hyg.2007;77(6):69-78.