Evaluation of Intraoperative pain occurrence and need for supplemental anesthesia during emergency dental care

Aims: This study aimed to evaluate the intraoperative pain (IOP) occurrence in situations of symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP). Materials and Methods: Patients who sought emergency care presenting a diagnosis of SIP or SAP were included. IOP was measured with a Visual Analogue Scale (VAS) after five minutes of local anesthesia, during access to the pulp chamber, root canal exploration and at the end of procedures. In cases where pain was reported during treatment, supplementary anesthesia was performed. Pain scores were recorded and analyzed using a generalized estimating equation model with posthoc comparisons. Results: 56 patients were included. 35 had a diagnosis of SIP; and 21 a diagnosis of SAP. Mean preoperative pain scores for SAP and SIP were 6.69 (±1.54) and 6.39 (±1.48), respectively (p>0.05). In patients with SIP, significant differences were observed between: preoperative scores and other time points; scores after five minutes of local anesthesia and other time points; scores during pulp chamber access and at the end of procedures; and scores during root canal exploration and at the end of procedures (p<0.05). In patients with SAP, significant differences were observed between preoperative pain scores with all other time points (p<0.05). Chi-square test indicated an association between diagnosis and the need for supplementary anesthesia (p<0.05). Conclusions: In conclusion, there is a strong relationship between reduction of moderate/severe pain after application of local anesthesia. The need for supplemental anesthesia is significantly associated to the diagnosis of symptomatic irreversible pulpitis.

Effects of Cochlear Implantation on Ipsilateral Tinnitus in Post-lingual Adault Recipients / 听力学及言语疾病杂志

Objective To study the changes of tinnitus after cochlear implantation in post-lingual adault recip-ients and analyze the factors that affect tinnitus.Methods A total of 47 postilingually-deafened adult subjects with tinnitus who underwent cochlear implantation at the Department of Otology,the first affiliated hospital of Zheng-zhou University,from January 2017 to December 2021.The subjects were evaluated using tinnitus handicap invento-ry(THI)and visual analogue scale(VAS)before cochlear implantation and 6 months after cochlear implant surger-y.Results Among 47 subjects who were eligible for this study,the THI scores were 36.94±13.337,14.48± 12.726,respectively,before CI and 6 months after cochlear implantation.The VAS scores were 5.13±1.676 be-fore and 2.34±1.903 after cochlear tmplantation.Statistical analysis showed significant differences in THI and VAS scores before and after cochlear implantation(P＜0.05).A total of 18 patients experienced complete tinnitus suppression,14 patients experienced alleviation of tinnitus,tinnitus remained unchanged in 13 patients,tinnitus worsened in 2 patients,and the overall efficiency was 66.0％(31/47).The tinnitus alleviation rate was signifant higher in the patients with tinnitus history of ≤5 years than the patients with tinnitus history of＞5 years(P＜0.05).There was a statistically significant difference in tinnitus alleviation between the patients with mild tinnitus and the patients with more than mild tinnitus before surgery(P＜0.001).Conclusion Cochlear implantation has an inhibitory effect on tinnitus in adults.Patients with shorter duration of the tinnitus and higher tinnitus handicap are more likely to experience tinnitus improvement after cochlear implantation.

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Validación del ClinESSDAI para Argentina / Validation of ClinESSDAI for Argentina

Introducción: recientemente, en Europa y en idioma inglés, se ha desarrollado el Clinical EULAR Sjögren's Syndrome Disease Activity Index (ClinESSDAI) para evaluar la actividad en pacientes con síndrome de Sjögren primario (SSp). Objetivos: validar el ClinESSDAI en pacientes con SSp en Argentina. Materiales y métodos: estudio de corte transversal. Se utilizó la versión en castellano del EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) validada en Argentina. Para evaluar la validez del constructo, se usó la escala visual análoga (EVA) desarrollada por un reumatólogo experto por dominio del ClinESSDAI y de la EVA global para el puntaje total del ClinESSDAI, mientras que otro profesional en la materia realizó el ESSDAI y ClinESSDAI. Para analizar la reproducibilidad, se estudió a un subgrupo de pacientes, sin mediar cambios en el tratamiento ni en la condición clínica, 10 días después de la evaluación basal. Todos los médicos examinaron a los pacientes desconociendo la evaluación de los demás colegas. Resultados: se incluyeron 47 pacientes con SSp. La correlación entre la EVA global y el ClinESSDAI fue muy buena (Rho 0,7), así como la correlación de la EVA y el ClinESSDAI de cada dominio. El coeficiente de correlación intraclase (CCI) entre el ESSDAI y el ClinESSDAI fue de 0,98. La reproducibilidad fue de 0,93. Conclusiones: el ClinESSDAI es una herramienta válida y reproducible en nuestra población, equiparable al ESSDAI.

Introduction: the Clinical EULAR Sjögren's Syndrome Disease Activity Index (ClinESSDAI) has recently been developed in Europe and in the English language to evaluate activity in patients with primary Sjögren's syndrome (pSS). Objectives: validate the ClinESSDAI in patients pSS in Argentina. Materials and methods: a cross-sectional study. The Spanish version of the ESSDAI, validated in Argentina, was used. To evaluate construct validity, the Visual Analog Scale (VAS) was used, performed by an expert rheumatologist per ClinESSDAI domain, and the global VAS was used for the total score of the ClinESSDAI, while another professional performed the ESSDAI and ClinESSDAI. To evaluate reproducibility, a subgroup of patients was evaluated without changes in treatment or clinical condition 10 days after the baseline evaluation. All physicians were blind to each other's evaluation. Results: 47 patients with pSS were included. The correlation between global VAS and ClinESSDAI was very good (Rho 0.7), as well as the correlation of the VAS and ClinESSDAI of each domain. The intraclass correlation coefficient (ICC) between ESSDAI and ClinESSDAI was 0.98. The reproducibility was 0.93. Conclusions: the ClinESSDAI is a valid and reproducible tool in our population, comparable to the ESSDAI.

Tratamiento de la hipersensibilidad dentinaria primaria: Revisión exploratoria / Treatment of primary dentin hypersensitivity: A scoping review

RESUMEN Objetivos: Identificar la evidencia del manejo de la hipersensibilidad dentinaria (HD) primaria utilizando diferentes tratamientos, como agentes tópicos, cirugía o láser. Materiales y métodos: Se realizó una búsqueda sistemática con los términos MeSH relacionados con el tema de investigación mediante un único algoritmo de búsqueda exhaustiva de la literatura en las bases de datos computarizadas de MEDLINE, Registro Cochrane de Ensayos Clínicos Controlados, Ovid y Scopus. Sólo se incluyeron ensayos clínicos controlados aleatorizados que incluyeran pacientes con HD asociada a dentina sensible con túbulos abiertos en dentición permanente y que realizaran tratamientos para la HD con terapia láser, tratamientos quirúrgicos o terapia tópica, evaluando el nivel de dolor con la Escala Visual Análoga (EVA). Resultados: Se seleccionaron 34 artículos. Se encontró que entre alternativas de tratamiento para disminuir la HD primaria, los agentes tópicos y el empleo de laser son intervenciones que mejoran significativamente la respuesta dolorosa, sin embargo, se obtuvo mejores resultados al emplear ambas técnicas de manera combinada. Conclusiones: Los resultados de este estudio permiten concluir que existe evidencia de la eficacia para manejar la HD primaria mediante intervenciones con terapia láser y agentes tópicos. Este trabajo abre un nuevo camino hacia futuras investigaciones que evalúen los efectos a largo plazo de este tipo de intervenciones y de los efectos adversos derivados de los mismos.

ABSTRACT Objectives: To identify the evidence of primary dentin hypersensitivity (DH) management using different treatments such as topical agents, surgery, or laser. Materials and methods: A systematic search was performed with the MeSH terms related to the research topic using a single comprehensive literature search algorithm in the computerized databases of MEDLINE, Cochrane Register of Controlled Clinical Trials, OVID, and Scopus. We only included randomized controlled clinical trials that included patients with HD associated with sensitive dentin with open tubules in the permanent dentition and who underwent HD treatments with laser therapy, surgical treatments, or topical therapy, evaluating the level of pain with the Visual Analogue Scale (VAS). Results: 34 articles were selected. It was found that among treatment alternatives to reduce primary HD, topical agents and the use of laser are interventions that significantly improve the pain response, however, better results were obtained when using both techniques in combination. Conclusions: The results of this study allow us to conclude that there is evidence of the efficacy of managing primary HD through interventions with laser therapy and topical agents. This work opens a new path towards future research that evaluates the long-term effects of this type of intervention and its adverse effects.

Drug utilization pattern of analgesics after a surgical procedure in a tertiary care hospital: a prospective observational single centre cohort study

Background: the study aimed to understand the prescription pattern of analgesics used in the post-operative period after a general surgical procedure in a tertiary care hospital in India and estimate the severity of post-operative pain up to 48 hours. Such a study was not done in this institute of recent hence it was carried out. Methods: 266 adults of either gender were recruited and prescription pattern analyzed over a period of 1 year beginning January 2021 to December 2021 from the post-operative general surgery wards of a tertiary care hospital in India. Patient interview and records were used to collect data. Follow ups at 4, 24 and 48 hours were undertaken to assess pain according to the visual analogue scale (VAS) that was analyzed using the Friedman’s test followed by the post hoc Dunn’s test. Results: an average of 1.52±0.58 analgesics were prescribed per patient. Paracetamol was most commonly used followed by tramadol and diclofenac. All analgesics prescribed were a part of the national list of essential medicines. Effective pain management is feasible as seen by the significant (p<0.0001) reduction in average pain score from 4.75±1.35 to 3.05±1.18 at 24 hours and further to 2.16±1.04 at 48 hours. Conclusions: Use of analgesics prescribed from a standardized list is effective in majority of patients.

Correlation between Bath Ankylosing Spondylitis Disease Activity Index Score and body mass index in the patients suffering with ankylosing spondylitis

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial spine that can manifest with various clinical signs and symptoms. Chronic back pain and progressive spinal stiffness are the most common features of this disease. It is an autoimmune disease which also leads to the involvement of skeletal, cardiac, nervous tissues, and other systemic organs. Aim and Objectives: This study was conducted to assess the correlation between the Bath AS Disease Activity Index (BASDAI) score/visual analog scale (VAS) and various age groups in the patients suffering with AS using standard questionnaire. Materials and Methods: Forty-eight AS patients having BASDAI scores of ?4 were included in this study. The height and weight were taken and responses to the standard questionnaire were recorded. BASDAI Score, body mass index (BMI), and VAS were computed. The patients with history of chronic diseases such as hyper/hypothyroidism, diabetes mellitus, and hypertension or the use of any medication such as ?/? blockers, calcium channel blockers, and antiepileptics were excluded from the study. Results: The patients were divided into six different age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years. The mean ± SEM values of the BASDAI score in various age groups were 6.8 ± 0.34, 6.3 ± 0.33, 6.2 ± 0.26, 7.1 ± 0.41, 6.5 ± 0.30, and 5.8 ± 0.48, respectively. The mean ± SEM values of VAS are shown in relation to the various age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years and the values were 6.88 ± 0.312, 6.58 ± 0.22, 6.55 ± 0.66, 6.00 ± 0.23, 6.72 ± 0.25, and 6.0 ± 0.50, respectively. Conclusion: This study indicates that in the young age group, patients BASDAI score is higher and BMI is lower, and in the older age group, patients BASDAI score is lower and BMI is higher than each other indicating higher disease activity in the younger patients than older patients. An inverse correlation between VAS and age further substantiates our previous finding.

Effects of Electrohydraulic Therapy of Shock Waves on Pain and Lymphedema Measurement Post-Radical Mastectomy

Background: Lymphedema post-mastectomy remains a challenging problem. This study aimed to investigate the efficacy of shock wave electrohydraulic treatment (ESWT) for patients with pain and lymphedema. Methods: Thirty patients (30 women) with pain & lymphedema post-radical mastectomy were evaluated to participate in this Clinical trial. They were recruited from the Minia Cancer Institute- Minia University and Deraya University outpatient clinics. Their ages varied between the ages of 40 and 50 years. They were divided into two groups. Group (1) 'Group of studies': 15 patients seeking ESWT in addition to conventional medical care. Group (2) 'Control group': 15 people seeking conventional medical care only. Patients of the study group (1) were treated with a number of impulses, at least 500 shocks at E2 at 4Hz (equivalent to 0.11mJ/mm square energy). Treatment sessions were delivered twice weekly for six treatments (3 weeks). The assessment used a Visual analogue scale (VAS) for pain and arm circumference midway between the shoulder and elbow for lymphedema measurement.Results: showed that (ESWT) on pain and lymphedema measurement post-radical mastectomy effectively decreased pain as evidenced by the highly significant decreases in the visual analogue scale. These results revealed a substantial VAS reduction (P<0.0001). Effects of the ESWT on lymphedema measurement via the arm circumference measurement at the point where the shoulder and the elbow meet post-radical mastectomy were investigated. These results revealed a notable reduction in the mean value of the arm circumference measurement (ACM) (P<0.0001). Conclusion: The significant reductions in VAS and assessment of the ACM arm range show that the ESWT, in addition to conventional therapy, significantly impacted upper limb structural components following radical mastectomy.

Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study

Abstract Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

A prospective, randomised, open label study to compare efficacy and safety of hydroxychloroquine and teneligliptin in patients of type 2 diabetes mellitus refractory to concomitant metformin and glimepiride

Background: Diabetes mellitus is chronic, metabolic disease characterized by hyperglycemia, which over time causes both microvascular and macrovascular complications. If HbA1c target is not achieved with dual therapy then 3rd drug is added. Aims of present study were to compare efficacy and safety of Hydroxychloroquine (HCQ) and Teneligliptin in patients of T2DM who are refractory to concomitant Metformin and Glimepiride. Methods: It was interventional, randomized, prospective, parallel and open-label study. Patients were randomly divided into 2 groups either HCQ 400mg OD or Teneligliptin 20mg OD were added to their current treatment using Metformin 1gm BD and Glimepiride 4 mg OD as 3rd drug. Follow up was done every 15 days for 12 weeks and underwent assessment of glycaemic parameters (FBS, PPG, HbA1c), LFT, RFT, CBC, ADRs and VAS in addition to anthropometric parameters. Results: After 12 weeks of treatment, HCQ group showed statistically (p<0.05) better improvement in BMI than Teneligliptin group. Both groups showed comparable improvement (p>0.05) from baseline in FBS, HbA1c, PPG and VAS score. In HCQ group there was significant number (p<0.05) of patients who achieved target glycaemic control (HbA1c ?7.5%) i.e., 56.6%, compared to 37% with Teneligliptin group. Both groups had comparable (p>0.05) safety profile with no serious adverse effects and no significant change (p>0.05) in hepatic, renal and complete blood profiles. Conclusions: On the basis of effects of HCQ on the glycaemic parameters and BMI, HCQ may be preferred over Teneligliptin in patients of T2DM who are refractory to concomitant Metformin and Glimepiride.

Comparative study of atienuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Introduction: Needle prick pain is a distressing event for a pa?ent receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally trauma?zing for many pa?ents. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the prac?ce of giving injec?ons of local anaesthe?c or local applica?on of EMLA cream or patch at the site of spinal puncture beforehand for anaesthe?zing the skin and subcutaneous ?ssues. Methods: A prospec?ve cohort study was done. Those enrolled pa?ents were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed pa?ents either EMLA cream or regular standard lignocaine infiltra?on anaesthesia and labelled them as Group E and Group L respec?vely. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 pa?ents were enrolled in the study33 in Group E and 31 in Group L. Both groups had an almost similar number of pa?ents who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E pa?ents compared to that in Group L, p<0.001. The mul?variate analysis had similar findings a?er controlling confounding factors in mul?ple regression analysis. Conclusion: Local 2% lignocaine injec?on achieved significantly more pain reduc?on during spinal needle inser?on compared to the applica?on of an EMLA patch before spinal anaesthesia.

Postoperative Comfort Score after Septoplasty among Patients Undergoing Nasal Packing versus Suturing of the Septal Flap by Modified Technique without Packing : A Randomized Controlled Trial

Background : Septal surgery is one of the most common surgical procedures performed by an Otorhinolaryngeal surgeon since ancient times. Various modifications in the approach, changing concept of conserving septal cartilage, use of an endoscope and good antibiotics to control postoperative infection have played a key role in controlling the complication rates but still, one thing which is mostly practiced worldwide is nasal packing in the postoperative period which is a nightmare for many patients, as the pain threshold varies from patient to patient. It also causes dryness of mouth, throat irritation, facial heaviness, headache, excessive watering from eyes, aural fullness. There is a lack of proper evidence to prove whether nasal packing really decreases postoperative hemorrhage as the incision is properly approximated and sutured. The main reason for nasal packing was an approximation of nasal septal flap thereby reducing the chances of septal Haematoma and stabilization of septal flap in the midline. The present study has been taken to study and compare postoperative nasal packing and modified quilting suture of the septal flap without the nasal pack. Material and Methods : This one-year prospective comparative study was conducted on 149 patients who underwent septoplasty with 3 months follow-up. One group had Postoperative nasal packing and the other had only modified septal flap suturing without the nasal pack. Results : Out of the total of 149 patients, 88 underwent nasal packing in the postoperative period and 61 patients had undergone suture of the nasal septal flap without nasal packing. A statistically significant value of VAS score was found in the non-packing group of 61 patients, where the average postoperative VAS score was 1.46 against 3.7 among the packing group of 88 patients. An unpaired t-test was applied and a value of 15.431 was obtained with a pvalue less than 0.001. No cases presented with septal perforation in the postoperative period in patients without a nasal pack and there were 2 cases (2.2%) of septal perforation in the nasal packing group. There was no significant bleeding in the postoperative period in both groups of patients. Conclusion : Stabilization of the nasal septal flap by modified quilting technique is better option after septoplasty with good comfort score.

A comparative study between single dose intralesional autologous blood and corticosteroid injection in chronic plantar fasciitis-a short term follow-up study

Background: Plantar fasciitis was initially thought to be an acute inflammatory disease, but histology findings show that it is a chronic degenerative process leading to pain at the calcaneal insertion without any inflammation. The diagnosis of plantar fasciitis is mainly based on clinical symptoms, like heel pain and tightness, and diagnostic imaging is not routinely required. Injection of autologous blood can help stimulate a healing response in chronic tendon disorders. Methods: Radiological imaging of the affected foot in lateral view will be taken. 30 patients will be treated with 2 ml of autologous blood with 1 ml lidocaine and another 30 patients with 2 ml of triamcinolone acetonide with 1 ml lidocaine. The main outcomes measured are subjective based on the visual analog scale done pre-injection, 2 weeks, 4 weeks and 12 weeks post injection. Final outcome was measured based on the pain and activity level at 3 months. Results: The corticosteroid group showed an early sharp and then more gradual improvement in pain scores, but autologous blood group had a steady gradual drop in pain. Conclusions: Autologous whole blood and corticosteroid local injection can both be considered as effective methods in the treatment of chronic plantar fasciitis.

Therapeutic Effect of a Polyherbal Unani formulation in Sayalan al-Rahim (Abnormal vaginal discharge) - A clinical study

Sayalan al-Rahim (abnormal vaginal discharge) is one of the very common female complaints encountered in daily practice. It is an important public health problem in India and can occur mostly due to sexually and non-sexually transmitted infections. A clinical trial was conducted in the Department of Ilmul Qabalat wa Amraze Niswan, NIUM, Bengaluru. 30 patients of Sayalan al-Rahim were included in the study after obtaining their informed consents. All the patients were clinically assessed and diagnosed on the basis of thorough history, presence of abnormal vaginal discharge and other associated symptoms. Then, polyherbal Unani formulation was administered orally 5 gm twice daily with water from 5th day of menses for 21 days. The severity of disease and efficacy of treatment was assessed on the basis of subjective and objective parameters. Clinical improvement of 70% in Sayalan al-Rahim was observed. Mean ± SD of vaginal discharge before and after treatment was 2.87 ± 0.35 and 0.37 ± 0.61, VSS scale before and after treatment was 23.53 ± 3.49 and 10.33 ± 4.05 and VAS scale for LBA and LAP before and after treatment were 6.37 ± 2.36 to 2.37 ± 1.87 and 2.43 ± 1.96 to 0.03 ± 0.18, respectively with p=< 0.001** considered strongly significant. Polyherbal unani formulation was found safe and effective in improving the sign and symptoms of Sayalan al-Rahim. It was concluded that polyherbal Unani formulation can be used safely and effectively for the treatment of Sayalan al-Rahim.

Analysis on Characteristics of Plantar Pressure and Balance in Patients with Chronic Nonspecific Low Back Pain / 医用生物力学

Objective To explore the difference of balance ability between patients with chronic nonspecific low back pain ( CNLBP) and healthy individuals, and the correlation between patients’ pain symptoms, lumbar flexibility, abdominal muscle endurance, overall function, quality of life and fear of avoidance with balance ability, so as to guide clinical rehabilitation evaluation. Methods A total of 34 patients with CNLBP were selected as the experimental group, and 34 healthy volunteers without history of low back pain were selected as control group. The plantar pressure measurement system was used to collect the ratio of forefoot to hindfoot pressure, pathlength ( L) of plantar center of pressure ( COP), displacement length in anteroposterior direction ( LAP ), displacement length in mediolateral direction (LML ), mean velocity (v), displacement velocity in anteroposterior direction (vAP ), displacement velocity in mediolateral direction (V-ML) and elliptical swing area (S). In addition,the experimental group was assessed by the visual analogue scale (VAS), the finger floor distance (FFD), the number of sit-ups in 1 minute, the Oswestry disability index (ODI), the 36-item short form survey (SF-36) and the fear avoidance beliefs questionnaire (FABQ), and correlated with plantar pressure parameters. Results All plantar pressure parameters were significantly different between the two groups ( P < 0. 05). The the ratio of forefoot to hindfoot pressure in experimental group was significantly lower than that in control group (P<0. 05), and the parameters L, LAP , LML , v, vAP , vML and S were significantly higher than those of control group (P<0. 05). With eyes open or closed, the VAS score of experimental group was positively correlated with L, LAP , LML(P<0. 05), and FFD and FABQ scores were positively correlated with L and LML , respectively (P< 0. 05). With eyes open, ODI was positively correlated with L, LAP and LML (P< 0. 05), and SF-36 score was negatively correlated with L and LML(P<0. 05). With eyes closed, the number of 1-min sit-ups was negatively correlated with LAP and S (P<0. 05), ODI was positively correlated with L and LML(P<0. 05), and the SF-36 score was negatively correlated with L (P<0. 05). Conclusions The static balance ability of patients with CNLBP is decreased, and it is correlated with pain symptoms, lumbar function, quality of life and psychological status. The result can provide references for the assessment of functional activities.

Transcutaneous electrical acupoint stimulation combined with electroacupuncture for rapid recovery after abdominal surgery: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with electroacupuncture (EA) on rehabilitation after abdominal surgery.@*METHODS@#A total of 320 patients undergoing abdominal surgery were randomly divided into a combination group (80 cases), a TEAS group (80 cases, 1 case discontinued), an EA group (80 cases, 1 case discontinued) and a control group (80 cases, 1 case discontinued). The patients in the control group received enhance recovery after surgery (ERAS) standardized perioperative management. On the basis of the treatment in the control group, the TEAS group was treated with TEAS at Liangmen (ST 21) and Daheng (SP 15); the EA group was treated with EA at Neiguan (PC 6), Hegu (LI 4), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39); the combination group was treated with TEAS combined with EA, with continuous wave, 2-5 Hz in frequency, and the intensity was tolerable to the patients, 30 min each time, once a day, from the first day after surgery, until the anus resumed spontaneous defecation and the oral intake of solid food was tolerated. The gastrointestinal-2 (GI-2) time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time, time of first get out of bed and hospital stay were observed in all the groups; the pain visual analogue scale (VAS) score and incidence rates of nausea and vomiting 1, 2, 3 days after surgery were compared in all the groups; after treatment, the acceptability of each treatment was evaluated by patients in each group.@*RESULTS@#Compared with the control group, the GI-2 time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time were shortened (P<0.05), the VAS scores 2, 3 days after surgery were decreased (P<0.05) in the combination group, the TEAS group and the EA group; those in the combination group were shorter and lower than the TEAS group and the EA group (P<0.05). Compared with the control group, the time of hospital stay in the combination group, the TEAS group and the EA group were shortened (P<0.05), and that in the combination group was shorter than the TEAS group (P<0.05).@*CONCLUSION@#TEAS combined with EA can accelerate the recovery of gastrointestinal function in patients after abdominal surgery, relieve postoperative pain, and shorten hospital stay.

Different operation sequences between acupuncture and cupping therapy for lumbar muscle strain with cold and dampness: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy on lumbar muscle strain with cold and dampness between the different operation sequences of acupuncture and cupping therapy.@*METHODS@#Seventy-six patients with lumbar muscle strain with cold and dampness were randomly divided into an acupuncture + cupping group (A + C group, 38 cases) and a cupping + acupuncture group (C + A group, 38 cases, 1 case dropped off). In the A + C group, cupping therapy was delivered 10 min after the end of treatment with acupuncture, while in the C + A group, acupuncture therapy was exerted 10 min after the end of treatment with cupping. Acupuncture was applied to Mingmen (GV 4), Yaoyangguan (GV 3), ashi point and bilateral Shenshu (BL 23), Dachangshu (BL 25), Weizhong (BL 40) and Yanglingquan (GB 34), and the needles were retained for 30 min in each intervention. Flash cupping was operated along the bilateral sides of the lumbar spine for 3 min, and the cups were retained for 10 min at bilateral Shenshu (BL 23), Dachangshu (BL 25) and ashi points. The intervention was delivered once every two days, 3 times weekly, for 3 weeks totally in each group. The scores of visual analogue scale (VAS) and Oswestry disability index (ODI), TCM syndrome score and the mean temperature of the lumbar region before and after treatment were compared between the two groups. The safety and the clinical efficacy were assessed for the interventions of the two groups.@*RESULTS@#Compared with the values before treatment, except for the sleep score of ODI, the VAS scores, ODI scores and TCM syndrome scores were decreased after treatment (P<0.01, P<0.05); while the mean temperature of the lumbar region was increased (P<0.01) in both groups. After treatment, the VAS score and the pain score of ODI in the C + A group were lower than those in the A + C group (P<0.05). The incidence rate of adverse reactions of the C + A group was lower than that of the A + C group (P<0.01). The effective rate in the A+C group was 92.1% (35/38), that in the C+A group was 94.6%(35/37), there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#Different operation sequences between acupuncture and cupping therapy obtain the similar efficacy on lumbar muscle strain with cold and dampness, but cupping therapy delivered prior to acupuncture has certain advantages in relieving pain and improving safety.

Study on the influence of inflatable tourniquet on postoperative rehabilitation of meniscoplasty and suture surgery under arthroscopy / 中国医学装备

Objective:To investigate the influence of using tourniquet on the postoperative pain,the muscle injury,the meniscal healing and the rehabilitation of meniscus function after surgery of meniscus suture and repair under arthroscopy.Methods:A total of 144 patients who underwent surgery of suture and repair for meniscus of knee joint in hospital were selected and they were divided into tourniquet group(81 cases)and non-tourniquet group(63 cases)according to whether used tourniquet.Postoperative muscle injury was assessed according to postoperative serum creatine kinase(CK),and postoperative pain was assessed by using visual analogue scale(VAS).The international k nee documentation committee(IKDC)scoring system,Lysholm knee joint score and Tegner knee joint score system were used to assess the rehabilitation effect of the function of knee joint of patient after surgery,and the clinical healing after the surgery of meniscus suture was evaluated according to Barrett standard.Results:There were no significant differences in CK levels between the two groups before surgery,2 days and 8 days after surgery,and at the last follow-up(t=1.667,t=-2.143,t=-4.461,t=-6.380,P>0.05),respectively.There were no significant differences in VAS scores between the two groups before surgery,2 days and 8 days after surgery,and at the last follow-up(Z=-1.121,Z=-1.364,Z=0.745,Z=-0.894,P>0.05),respectively.There were no significant differences in IKDC scores and Lysholm scores before and after surgery between the two groups(tIKDC=-1.680,t=0.533,tLysholm=-3.162,t=-2.543,P>0.05),respectively.There were no significant differences in Tegner score before and after operation between the two groups(Z=-0.803,Z=-0.370,P>0.05),respectively.There was no significant difference in the healing rate of meniscus after surgery between the two groups(Z=-0.247,P>0.05).Conclusion:The use of tourniquet in the surgery of meniscus suture under arthroscopy would not cause muscle injury,and would not aggravate pain,and does not affect healing rate and rehabilitation of meniscus function of patients.

The clinical effect of multimodal analgesia by transversus abdominis plane block combined with patient controlled intervenous analgesia in postoperative patients with splenectomy based on enhanced recovery after surgery theory / 中国中西医结合急救杂志

Objective To observe the effect of transversus abdominis plane block(TAPB)combined with patients controlled intravenous analgesia(PCIA)on the analgesia of patients after splenectomy.Methods A retrospective study method was conducted.A total of 63 patients who underwent splenectomy+pericardial vascular dissection in the department of general surgery of Nanchang No.9 Hospital from January to December 2021 were selected as the study objects.The patients were divided into TAPB combined with PCIA group(33 cases)and alone PICA group(30 cases)according to different postoperative analgesia techniques,and the postoperative analgesia effect was compared between the two groups.Results There was no significant difference between the two groups in sex,age,height,body mass,Child-Pugh grade and American Society of Anesthesiologists(ASA)grade.The operation time,intraoperative blood loss and intraoperative blood transfusion volume in TAPB combined with PCIA group were increased compared with alone PICA group[operation time(minutes):85.0(32.5)vs.82.5(40.0),intraoperative blood loss(mL):500(300)vs.425(500),intraoperative blood transfusion(mL):400(300)vs.300(525)],the incidence of postoperative abdominal infection and incisional infection tended to decrease compared with alone PICA group[abdominal infection:18.2％(6/33)vs.20.0％(6/30),incisional infection:21.2％(7/330)vs.23.3％(7/30)],but there was no significant difference between the two groups(both P>0.05).The visual analogue score(VAS)decreased gradually over time in both groups,and VAS in TAPB combined with PCIA group was significantly lower than that in PICA group at 6,12,24,48 and 72 hours after operation[4.0(1.0)vs.6.0(3.0),3.0(2.0)vs.4.0(2.0),2.0(1.5)vs 3.5(1.5),1.0(1.0)vs.2.0(1.5),1.0(1.0)vs.2.0(2.0),all P<0.05],the total number of PCIA compressions in TAPB combined with PCIA group was significantly lower than that of alone PICA group(times:2.64±1.19 vs.3.67±1.67,P<0.05).Conclusion The analgesic effect of TAPB combined with PCIA after splenectomy and devascularization is better than that of PCIA alone.