LIGNOCAINE INFUSION FOR NEUROPATHIC ITCH IN PATIENT WITH NEUROFIBROMATOSIS Neurofibromatosis (NF) is an autosomal dominant neurocutaneous disorder. The itchiness suffered by patients with NF is possibly caused by mast cells. However, transient receptor potential ankyrin 1 (TrpA1) and transient receptor potential vanilloid 1 (TrpV1) have been recently discovered as mediators of itchiness and pain in patients with NF. We reported a patient with NF, afflicted by neuropathic pain and itch, despite despite receiving conservative treatment. Herein, we provided the patient lignocaine infusion, which improved her pain and itch score by 50%. Additionally, her sleep quality, ability to perform housework and engagement in leisure activities were improved. This case report highlights the therapeutic value of lignocaine infusion when conservative treatment is ineffective for chronic neuropathic itch in patients with neurofibromatosis through suppressing TrpA1 and TrpV1.

ADDUCTOR CANAL AND SUPERIOR LATERAL GENICULAR NERVE INJECTIONS FOR GRADE 4 KNEE OSTEOARTHRITIS: A CASE REPORT This case report showcases the successful use of a combination of adductor canal (AC) and superior lateral genicular nerve (SLGN) injections in a patient with refractory knee pain caused by knee osteoarthritis (OA). A 73-year-old man with Kellgren and Lawrence (KL) Grade 3-4 of bilateral knee OA experienced debilitating chronic right knee pain and declined surgery intervention. He reported significant pain relief, which improved his ability to walk, after receiving a combination of AC and SLGN injections with a mixture of local anesthetic and steroids. This followed the unsuccessful provision of multiple analgesics and intraarticular injections. The pain-relieving effects persisted until his 2-month follow-up. Repeated injections were performed 4 months after his initial intervention, with the analgesic effect lasting for another 2 months. This case report suggests that the combination of AC and SLGN injections could be a viable treatment for patients with knee OA KL Grade 4 who are not candidates for surgery.

Objective: The aim of this study was to investigate scuba diving induced exercise response in novice divers as required in open water scuba diving certification. Methods: Maximal cardiopulmonary exercise test (CPET) was performed in 30 novice divers before and within 24 hours after a standard scuba diving open water certification diving protocol of four open water dives. Results: A significant increase in maximal oxygen consumption (VO2max) in mL·kg-1·min-1 after scuba diving training [25.84 (6.0) vs. 27.04 (7.0)] (p<0.05) suggestive of an increase in exercise performance. Ventilatory drive (VE/VCO2) also showed a significant increase 27.95 (2.7) vs. 30.07 (5.3). Ventilatory anaerobic threshold (VAT), blood pressure and lung function parameters showed no significant differences with open water scuba diving certification training. Conclusion In novice divers, repeated training exposure during open water scuba diving certification results in increased cardiorespiratory fitness. Although further corroborating studies are needed, this would suggest that recreational scuba diving may be an option for exercise promotion in the future.
Diving ; Diving and Hyperbaric Medicine ; Oxygen Consumption ; Exercise

secondary medical impairment following spinal cord injury(SCI). Ultrasound (US) of the kidneys, ureters and bladder(KUB) has been recommended as a useful, non-invasivesurveillance method with good diagnostic sensitivity. Thisstudy aims to understand US diagnosed NB complicationsand identify its associated factors.Methods: We enrolled all patients referred for SCIrehabilitation from 2012 to 2015 that fulfilled our studycriteria. Data that were retrospectively reviewed includeddemographic and clinical characteristic data; and US KUBsurveillance studies.Results: Out of 136 electronic medical records reviewed, 110fulfilled the study criteria. The prevalence of NB in our studypopulation was 80.9%. We found 22(20%) of the patientsshowed evidence of US diagnosed NB complications withthe mean detection of 9.61±7.91 months following initial SCI.The reported NB complications were specific morphologicalchanges in the bladder wall 8(36.4%); followed byunilateral/bilateral hydronephrosis 7(31.8%); bladder and/orrenal calculi 5(22.7%); and mixed complication 2(9.1%)respectively. Half of the patients with NB complications hadurodynamic diagnosis of neurogenic detrusor overactivitywith/without evidence of detrusor sphincter dyssynergia.We found co-existing neurogenic bowel, presence ofspasticity and mode of bladder management weresignificantly associated factors with US diagnosed NBcomplications (p<0.05), while spasticity was its predictorwith adjusted Odds Ratio value of 3.93 (1.14, 13.56).Conclusion: NB is a common secondary medical impairmentin our SCI population. A proportion of them had USdiagnosed NB complications. Co-existing neurogenic bowel,presence of spasticity and mode of bladder managementwere its associated factors; while spasticity was itspredictor.