Sleep disturbances in hospitalized children: a wake-up call.

Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1-12 years, admitted to a tertiary center, and compared this with home 6-8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital. Conclusion: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.

Postoperative evaluation of special needs and healthy patients with endodontic treatment under general anesthesia: a retrospective research.

BACKGROUND: This retrospective clinical study was undertaken to comparatively evaluate the number of restorative treatments, endodontic treatments, and tooth extractions performed for patients under general anesthesia due to dental anxiety or special needs between 2015 and 2022 and to examine the pain, bleeding, nausea, and vomiting data of those patients. METHODS: In total, 1165 patients underwent dental treatment under general anesthesia in the faculty hospital. Those under the age of 15 and with no endodontic procedure planned (n = 918) were excluded, followed by those with incomplete data (n = 25) and those without endodontic treatment (n = 25). Patients who underwent at least one endodontic treatment were finally included in the study (n = 184). Patients were divided into two groups: healthy and with special needs. Dental treatments were recorded as endodontic, restorative, and teeth extractions. Endodontic treatments were classified according to the tooth type (premolar, molar, and incisors). The composite restorations were classified as anterior, occlusal (O), occluso-distal (OD) or occluso-mesial (OM), and mesio-occluso-distal (MOD) restorations and patients' post-treatment pain, nausea, vomiting, and bleeding were recorded. The data were analyzed statistically. RESULTS: Among the 184 patients included in the study, 70 (38%) were healthy, and 114 (62%) had special needs. Postoperative bleeding was observed more in patients with special needs (χ2 = 4.189, p < 0.05), whereas pain was observed more in healthy patients (U = 2922.00, p < 0.05). While the number of anterior, O, and MOD restorations was higher in patients with special needs, the number of OD or OM restorations was higher in healthy patients (χ2 = 74.877, p < 0.05). CONCLUSIONS: Patients with special needs undergo a greater number of restorative treatments compared to control patients, which may be associated with the inadequate oral hygiene care of such patients. However, restorative treatment is mostly indicated for such patients in our faculty hospital, which may indicate that a conservative approach is taken. Additionally, the finding that postoperative bleeding was more severe in this group of patients compared to the control group in this study may emphasize the need to consider more possible complications after general anesthesia in these patients.

Evaluation of post-operative pain following dental procedures under local anesthesia among pediatric patients at Al Rass, Saudi Arabia.

Evaluation of post-operative pain in children after receiving dental treatments under local anesthesia is of interest. Hence, a study consisting of 182 children aged from 4 to 12 years old, who received at least one of the following procedures: dental restoration, extraction, placement of stainless steel crown (SSC) with or without pulpotomy is completed. Parents were contacted by phone within 48 hours to assess post-operative pain by using Wong-Baker FACES Pain Rating Scale (WBF). Individuals who were reachable via phone (146 out of 182, response rate 80.2%). 30.8% of them reported experiencing pain or discomfort (WBF more than or equal 2). Pediatric patients who had SSC on their primary molars had a considerably higher incidence of reporting pain than any other dental procedures (44.8% at p < 0.001). However, there was no significant difference in reported pain between placements of SSC alone or SSC with pulpotomy (44.8% and 46.5%, respectively). Further, over-the-counter analgesics were administered in 19.9% of participants.

Low-load Resistance Exercise with Perceptually Primed Practical Blood Flow Restriction Induces Similar Motor Performance Fatigue, Physiological Changes, and Perceptual Responses Compared to Traditional Blood Flow Restriction in Males and Females.

In the recent past, practical blood flow restriction (pBFR) using non-pneumatic, usually elastic cuffs has been established as a cost-effective alternative to traditional blood flow restriction (BFR) using pneumatic cuffs, especially for training in large groups. This study investigated whether low-load resistance exercise with perceptually primed pBFR using an elastic knee wrap is suitable to induce similar motor performance fatigue as well as physiological and perceptual responses compared to traditional BFR using a pneumatic nylon cuff in males and females. In a randomized, counterbalanced cross-over study, 30 healthy subjects performed 4 sets (30-15-15-15 repetitions) of unilateral knee extensions at 20% of their one-repetition-maximum. In the pBFR condition, each individual was perceptually primed to a BFR pressure corresponding to 60% of their arterial occlusion pressure. Before and after exercise, maximal voluntary torque, maximal muscle activity, and cuff pressure-induced discomfort were assessed. Moreover, physiological (i.e., muscle activity, muscle oxygenation) and perceptual responses (i.e., effort and exercise-induced leg muscle pain) were recorded during exercise. Moderate correlations with no differences between pBFR and BFR were found regarding the decline in maximal voluntary torque and maximal muscle activity. Furthermore, no to very strong correlations between conditions, with no differences, were observed for muscle activity, muscle oxygenation, and perceptual responses during exercise sets. However, cuff pressure-induced discomfort was lower in the pBFR compared to the BFR condition. These results indicate that low-load resistance exercise combined with perceptually primed pBFR is a convenient and less discomfort inducing alternative to traditional BFR. This is especially relevant for BFR training with people who have a low cuff-induced discomfort tolerance.

Comparison between the Efficacy of Sacral Erector Spina Plane Block and Pudendal Block on Catheter-Related Bladder Discomfort: A Prospective Randomized Study.

Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block (SESPB) and pudendal nerve block (PNB) in reducing the incidence and score of CRBD. Methods: This study was conducted between November and December 2023. ASA I-III, fifty-four TURP patients were divided into two groups: Group 1 received SESPB (n = 27) and Group 2 received PNB (n = 27) under ultrasound guidance at the end of surgery. The incidence of CRBD, CRBD score, numerical rating scale (NRS) score, use of rescue analgesics, block performance time, first call for analgesics, patient satisfaction, and side effects were recorded for 24 h. Results: The incidence of CRBD was lowest at 33.3% and highest at 48.1% in Group 1 and lowest at 25.9% and highest at 48.1% in Group 2, with no significant difference between the groups at all measurement times. CRBD scores and NRS scores were low and similar between the two groups. Block performance times were 9 ± 1.7 min in SESPB and 20 ± 2.5 min in PNB, and there was a significant difference between the mean times (p < 0.001). Patient satisfaction was adequate and similar in both groups. Conclusions: SESPB demonstrated a similar decreasing effect to PNB on the incidence and scores of CRBD in the first 24 h following TURP operations. The duration of SESPB administration was shorter than PNB.

Accelarated Orthodontic Treatment Using Microosteoperforations: A Comparative Study.

Background: Accelerated orthodontic treatment has gained popularity in recent years as patients seek shorter treatment durations. Microosteoperforations (MOPs) have emerged as a minimally invasive technique to expedite tooth movement. This study aims to compare the effectiveness of MOPs in accelerating orthodontic treatment with conventional methods. Materials and Methods: A randomized controlled trial was conducted on 60 orthodontic patients requiring dental alignment. The participants were divided into two groups: Group A (MOPs) and Group B (conventional orthodontic treatment). In Group A, MOPs were performed at the beginning of the treatment. Both groups received monthly orthodontic adjustments. Treatment duration, rate of tooth movement, and patient discomfort were measured and compared between the two groups. Results: The study found that in Group A, the treatment duration was reduced by 30% compared to Group B (P < 0.05). The rate of tooth movement in the MOPs group was 1.5 times higher than the conventional group (P < 0.01). Additionally, patient-reported discomfort levels were similar between the two groups. No adverse events related to MOPs were observed during the study. Conclusion: MOPs significantly accelerate orthodontic treatment, reducing treatment duration by 30% and increasing the rate of tooth movement by 1.5 times compared to conventional methods. Importantly, MOPs are well-tolerated by patients, making them a valuable option for expediting orthodontic treatment with minimal discomfort. This study highlights the potential benefits of integrating MOPs into orthodontic practice to improve treatment efficiency and patient satisfaction.

Exploring the link between occupationally relevant whole body vibration and headache and neck pain: is elevated muscle tension an intermediary factor?

Whole body vibration (WBV) is linked to short- and longer-term adverse health outcomes, including cognitive impairment, stress and memory loss, loss of balance, reduced proprioception, visual and vestibular disturbances, gastrointestinal problems, and musculoskeletal disorders. Epidemiological evidence supports the link between WBV and headache and head discomfort, but few experimental studies have examined this relationship, particularly with increased muscle tension, as an intermediary. This study aimed to investigate the relationship between muscle tension and vibration intensity, between perceived neck pain and headache/head discomfort and vibration intensity, and between muscle tension and reported neck pain and headache symptoms from simulated WBV based on field measurements of all-terrain vehicle operation on farm terrain. We observed significantly higher electromyography amplitude in the High condition (equivalent to EU Directive's Exposure Limit Value) compared to both Low (equivalent to EU Directive's Exposure Action Value) and Control (quiet sitting) conditions at the left upper trapezius muscle but there were no significant time effects. Neck pain and headache/head discomfort significantly increased after both Low (91% increase from baseline) and High (154% increase from baseline) vibration conditions but there were no significant differences between conditions. Based on simple regression modeling, the relationship between muscle activity and neck pain or headache was very weak (R2 = 0-0.093). Given the possibility of multiple factors contributing to headache symptoms, future research should not only consider the role of muscle tension but also sensory conflict, excessive noise, biodynamic responses, and a combination of these factors.

Virtual Reality intervention to improve quality of care during Colonoscopy: A hybrid type 1 randomized controlled trial.

BACKGROUND AND AIMS: Effective management of patients' pain, anxiety, and discomfort during colonoscopy is crucial for successful completion of the procedure, patient adherence to follow-up examinations, and patient satisfaction. Virtual Reality (VR) interventions, as a nonpharmacological and innovative solution, have demonstrated promising results in managing these outcomes. Nevertheless, there is limited evidence on their effectiveness and implementation. This trial aimed to test clinical effectiveness and identify factors to facilitate the implementation of VR during colonoscopy. METHODS: A hybrid type 1 effectiveness-implementation, parallel randomized controlled, open-label trial was conducted. Fifty patients were randomized (1:1) to a VR or a control group. The effectiveness (pain, anxiety, discomfort, medication usage, and satisfaction) and implementation (reach, adoption, implementation, and maintenance) outcomes were assessed before, during, and after colonoscopy. RESULTS: Patients in the VR group reported significantly lower pain (p=0.043) and discomfort (p<0.0001) during colonoscopy, had a higher number of completed colonoscopy without sedation (p=0.003), and showed higher satisfaction (p=0.032). The major barrier to the implementation and maintenance of the VR intervention was inadequate VR content design. Staff were most worried about altered patient communications, unclear responsibilities, increasing workload, and patient safety. Patients expressed willingness to reuse VR glasses and to suggest them to other patients. CONCLUSION: VR can be used as a nonpharmacological method for pain management and for overcoming anxiety and discomfort during colonoscopy. VR can improve patients' satisfaction and diminish the need for sedative medications; accordingly, it has the potential to promote cooperation and compliance among patients and increase screening colonoscopy rates. CLINICALTRIALS: gov NCT05723861.

Clinical Aspects of Chronic Idiopathic Postnasal Drip: An Entity Not to Be Overlooked.

BACKGROUND/AIM: Postnasal drip may be related to several diseases, but not all patients are clearly diagnosed. Patients with chronic, idiopathic postnasal drip symptoms are easily overlooked, and their clinical features are yet to be identified. This study aimed to analyze the clinical features and response to first generation antihistamine-decongestant therapy in patients with chronic idiopathic postnasal drip, suggesting it as a distinct entity. PATIENTS AND METHODS: A retrospective cohort study involving 157 chronic idiopathic postnasal drip patients was conducted, analyzing demographics, symptoms, and treatment response to first-generation antihistamines and nasal decongestants. RESULTS: Mean age of patients was 55.4±17.0 years old. Median duration of symptom was 36 months (range=12-66 months) and severity in the visual analogue scale was 7 (range=5-8). Throat discomfort was the most frequently associated symptom (73.7%). Cough was recorded in 30.3% of patients. Viscosity of postnasal drip was associated with rhinorrhea and throat discomfort. Of the patients, 71.6% responded positively to 1st generation antihistamine-decongestant medication. However, 25.9% of patients presented symptom re-occurrence. Patients with nasal stiffness or persistent symptoms presented a higher re-occurrence rate compared to others. CONCLUSION: This study outlines the clinical features of patients with chronic idiopathic postnasal drip and suggests it as a distinctive entity., This proposal aims to enhance diagnostic precision and promote further research in the field.

Perineal discomfort caused by the sitting position as a rare manifestation of ectopic testicle: About two cases.

BACKGROUND AND IMPORTANCE: Perineal ectopic testis (PET) is a rare congenital anomaly; the diagnosis is typically made by conducting a physical examination of the ectopic areas and noting an empty scrotum on the corresponding side. We report two pediatric cases of PET in whom this condition was diagnosed by a discomfort induced by the sitting position. CASES PRESENTATION: Two cases of PET were operated on in our pediatric surgery department over the past three years. Patients were referred for perineal discomfort in the sitting position. Children had difficulty staying seated at home or school, this was described by parents as an abnormal fussiness after sitting. The age at diagnosis was five and three years. The diagnosis of perineal testicular ectopia was made through physical examination. Orchidopexies to the corresponding scrotum were performed in both cases via an inguinal approach. No postoperative complication was noted with a follow-up of 24 months. CLINICAL DISCUSSION: PET is typically diagnosed through clinical examination, characterized by an empty scrotum and a palpable perineal mass. The exact aetiology is unclear, but it involves abnormalities in testicular descent mechanisms, particularly the gubernaculum. PET can cause perineal discomfort when sitting, a symptom observed in the two pediatric cases presented. Early surgical intervention via orchidopexy is crucial to prevent complications. Both reported cases were successfully treated with no postoperative complications and resolution of discomfort. Prompt diagnosis and treatment are essential for preserving testicular function. CONCLUSION: Perineal discomfort on sitting was the defining diagnostic element in our cases. In practice, this symptom should be a prompt for a thorough perineal examination in children with an empty scrotum. However, the patient's age and ability to express himself determine the significance of the symptom.

The use of DryShield versus rubber dam isolation systems among pediatric patients with different airway patency: A randomized clinical trial.

Objectives: This randomized clinical trial aimed to evaluate the impact of DryShield isolation (DSI) and rubber dam isolation (RDI) system usage on vital signs, behavior, pain and discomfort, and chairside time required among children with different airway patencies based on the Modified Mallampati Classification (MMC). Material and methods: Healthy, cooperative children who required fissure sealant in at least two contralateral, fully erupted, permanent first molars were included. Airway patency was determined by two trained and calibrated dentists using the MMC. The participants were categorized based on their MMC scores into patent airways (classes I and II) and non-patent airways (classes III and IV). The dental procedure was videotaped during treatment, and vital signs, including arterial oxygen saturation, heart rate, and blood pressure, were recorded every 3 min. The participants' subjective pain and discomfort were evaluated using a previously validated Arabic interview questionnaire and a validated Arabic version of the Wong-Baker Faces Pain Rating Scale. The participants' behavior and behavioral pain were evaluated utilizing the Frankl Behavior Scale and the face, legs, activity, cry, and consolability scales, respectively. Results: There were no significant differences in any of the vital signs between DSI and RDI. DSI use yielded a significant reduction in chairside time (P < 0.001) and was more bothersome (P < 0.001) than RDI use among all participants, regardless of airway patency. DSI was associated with significantly better behavior during the dental procedure (P = 0.002) and less behavioral pain (P < 0.001) among all participants, regardless of airway patency. Conclusion: Irrespective of airway patency, DSI outperformed RDI in terms of behavior, pain, and procedure duration; however, DSI was characterized by noise, pressure on soft tissues, and an increased tendency to induce gag reflexes.

Construction of a nomogram for predicting catheter-related bladder discomfort in patients with end-stage renal disease after renal transplantation: a retrospective study.

Background: The incidence of catheter-related bladder discomfort (CRBD) is relatively high in the end-stage renal disease (ESRD) patients who underwent renal transplantation (RT). This study was designed to establish a nomogram for predicting CRBD after RT among ESRD patients. Methods: In this retrospective study, we collected 269 ESRD patients who underwent RT between September 2019 and August 2023 in our hospital. The patients were divided into training set (n = 215) and test set (n = 54) based on a ratio of 8:2. Univariate and multivariate logistic regression analyses were utilized to identify the risk factors associated with CRBD after RT, and then a nomogram model was constructed. Receiver operating characteristic (ROC) and calibration curve were used to evaluate the predicting efficiency of the established nomogram. Results: Multivariate logistic regression analysis showed that aberrant body mass index (BMI) (underweight: OR = 5.25; 95% CI [1.25-22.15], P = 0.024; overweight: OR = 2.75; 95% CI [1.17-6.49], P = 0.021), anuria (OR = 2.86; 95% CI [1.33-5.88]) and application of double J (DJ) stent with a diameter of >5Fr (OR = 15.88; 95% CI [6.47-39.01], P < 0.001) were independent risk factors for CRBD after RT. In contrast, sufentanil utilization (>100 µg) [OR = 0.39; 95% CI [0.17-0.88], P = 0.023] was associated with decreased incidence of CRBD. A nomogram was then established based on these parameters for predicting the occurrence of CRBD after RT. Area under the ROC curve (AUC) values and calibration curves confirmed the prediction efficiency of the nomogram. Conclusion: A nomogram was established for predicting CRBD after RT in ESRD patients, which showed good prediction efficiency based on AUC and calibration curves.

A pancreatic pseudocyst sitting in the mediastinum-A case report of an unusual occurrence.

Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen but can rarely extend into the mediastinum. Atypical symptoms such as dyspnea, dysphagia, coughing, vomiting, abdominal or chest pain, and hemoptysis are usually the notable complaints. CT scan, MRI, and endoscopic ultrasound are valuable diagnostic modalities. Drainage and surgical removal of the pseudocyst are the treatment options. Herein, we outline the case of a young female with episodic chest and epigastric discomfort, dysphagia, and weight loss. Previously, she was incorrectly diagnosed with gastroesophageal reflux disease and peptic ulcer. A mediastinal pseudocyst secondary to chronic pancreatitis was found to be the cause. The patient underwent surgical removal of the pseudocyst and a pancreaticojejunostomy. Significant improvement was noticed at follow-up. This article highlights the possibility of such unusual conditions and the importance of a proper assessment while treating patients with epigastric pain.

Effect of two dynamic seat cushions on postural shift, trunk muscle activation and spinal discomfort in office workers.

We investigated the effect of two dynamic seat cushions on postural shift, trunk muscle activation and spinal discomfort. In this repeated-measures study, 30 healthy office workers were randomly assigned to a sequence of three conditions: sitting on a dynamic seat cushion-A, cushion-B and control (no seat cushion). The two dynamic seat cushions had different inflation levels. Participants typed a standard text for an hour and were monitored for postural shift by using a seat pressure mat, transversus abdominis/internal oblique and lumbar multifidus muscles activity by using surface EMG, spinal discomfort by using Borg's CR-10 scale. Two-way repeated ANOVAs showed no statistically significant interaction effects between condition and time on postural shift and muscle activation. Post hoc Bonferroni tests showed that postural shifts and lumbar multifidus activation during sitting on cushion-A were significantly higher (p < 0.01) than in the control and cushion-B conditions. Both cushions reduced spinal discomfort, compared to the control condition (p < 0.05).

Tear Cytokines as Predictive Biomarkers of Success in Contact Lens Discomfort Management.

PURPOSE: To analyze changes in tear levels of inflammatory mediators in symptomatic contact lens (CL) wearers after refitting with daily disposable CLs and to identify potential biomarkers of success in CL discomfort (CLD) management. METHODS: Symptomatic CL wearers (CLDEQ-8 ≥ 12) were refitted (V1) with daily disposable CLs (Delefilcon A). After one month (V2), participants were classified into the post-fitting non-symptomatic (CLDEQ <12) and symptomatic (CLDEQ ≥12) groups. At each visit, the participants were clinically evaluated, tears were collected, and 20 inflammatory mediators and substance P (SP) were measured using multiplex immunobead analysis and ELISA, respectively. The detection rates and concentrations were compared between visits and groups, and logistic regression models were performed. RESULTS: Forty-three subjects (32 women/11 men; mean age: 23.2 ± 4.9 years) were enrolled. The IL-1ß and IL-9 detection rates were higher at V2 (p ≤ 0.044). The detection rates of IL-1ß, IL-9, MIP-1α/CCL3, and MMP-9 at V1 (p ≤ 0.045) and IL-17A at V2 (p ≤ 0.014) were higher in the post-fitting symptomatic group. The tear IL-9 concentration was increased at V2 (p = 0.018). The tear concentrations of fractalkine/CX3CL1, IL-2, IL-6, IL-10, MCP-3/CCL7, MIP-1ß, NGF, RANTES/CCL5, and TNF-α were higher in the post-fitting symptomatic group (p ≤ 0.044). Additionally, levels of fractalkine/CX3CL1, IL-2, IL-6, IL-10, RANTES/CCL5, and TNF-α at V1 were significantly associated with the post-fitting grouping (p ≤ 0.044). CONCLUSIONS: Low tear concentrations of specific inflammatory mediators may be used as a predictive biomarker of success for refitting symptomatic CL wearers with daily disposable CLs. However, complementary treatments might be required for symptomatic CL wearers with higher levels of these inflammatory molecules.

Efficacy of specific exercises in general population with non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this systematic review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP). METHODS: We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach. RESULTS: Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (-0.37, 95% CI: -0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (-0.53, 95% CI: -1.13 to 0.08), and a large efficacy in favor of PNF exercises (-0.91, 95% CI: -1.62 to -0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (-0.61, CI: -1.02 to -0.19), and a large efficacy for PNF exercises (-1.26, 95% CI: -1.81 to -0.72) in improving disability, assessed using RMDQ or ODI questionnaires. The level of certainty in the evidence, as determined by the GRADE approach, was very low to low. CONCLUSION: These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.

Effects of Passiflora incarnata and Valeriana officinalis in the control of anxiety due to tooth extraction: a randomized controlled clinical trial.

OBJECTIVE: This study evaluated the efficacy of Valeriana officinalis L. and Passiflora incarnata L. to control anxiety, surgical discomfort, and changes in vital signs of patients undergoing extraction of two unilateral third molars. MATERIALS AND METHODS: This study is a randomized, triple-blinded clinical trial. Fifty-four patients were allocated into three groups (Valeriana officinalis L., Passiflora incarnata L., and placebo). Anxiety levels were assessed using the State-Trace Anxiety Inventory (STAI) index, surgical discomfort using the QCirDental, and through the measurement of vital signs. The surgical times evaluated were before (T0), during (T1), and after surgery (T2). RESULTS: There was evidence that both Valeriana officinalis L. and Passiflora incarnata L., reduced STAY-S scores between T0 and T2 (p < .05), unlike placebo (p = .129). There was no change in surgical discomfort in all groups over time, and vital signs presented variable results. CONCLUSION: Phytotherapy drugs showed a reduction in anxiety state compared to the placebo group during third molar extraction procedure.  CLINICAL TRIAL REGISTRATION: klRBR-6kcxvrc, March 10, 2022.

Discomfort/pain due to peri-implant probing at titanium and zirconium implants: A cross-sectional study.

OBJECTIVE: This study was designed to compare discomfort/pain after periodontal and peri-implant probing in patients with titanium compared with zirconium implants. METHODS: One examiner recruited and examined 70 patients, each of whom had a dental implant with a contralateral tooth; 37 patients had titanium implants of various types and 33 patients had zirconium implants; one implant was analyzed for each patient. Periodontal and peri-implant probing pocket depth (PPD) and clinical attachment level (CAL) were assessed. Immediately after probing, patients rated their discomfort/pain with a visual analog scale (VAS). The emergence profiles of implant crowns were assessed on periapical radiographs of the implants. RESULTS: Seventy patients with a median age of 55 years (interquartile range [IQR]: 42-65 years), including 43 females and 16 current smokers, were examined. The mean PPD and bleeding on probing (BOP) were higher around implants than around teeth (p < .001). CAL and suppuration were well-balanced between implants and teeth. Peri-implant probing caused significantly more discomfort/pain than periodontal probing [median VAS score: 12.5 (IQR 4-22) vs. 9 (2-15); p < .001]. Logistic regression revealed that discomfort/pain after peri-implant probing was less intense in patients who had taken analgesic medication (p = .021) and around titanium implants (p = .037). CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Patients who had taken analgesic medication experienced less discomfort and pain with peri-implant probing than those who had not; furthermore, titanium implants were associated with less pain than zirconium implants.

Population characteristics and self-assessment of speaking and singing voice in Polish contemporary commercial music singers-an exploratory, cross-sectional study.

Background: The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors. Materials and methods: The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm. Results: 412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency (r = 0.632, p < 0.001) and Severity (r = 0.611, p < 0.001). The relationships between most of the other variables studied were weak or negligible. Conclusion: The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS.

Difference thresholds for primary and secondary ride of a vehicle on a 4-poster test rig.

Not only is it important to know how large the overall change in vibration should be for occupants to perceive an improvement in comfort, but also how large this change should be in specific frequency bands. Relative difference thresholds (RDT) of primary (0.5-4 Hz) and secondary (9-80 Hz) ride are estimated for 14 automotive engineers seated in a vehicle on a 4-poster test rig over two roads. Resulting stimuli differed in magnitude and spectral shape. The median RDTs estimated for primary and secondary ride were 16.68% and 13.82% on the smooth road, and 9.50% and 24.67% over the rough road. Statistically significant differences were found in the medians of the RDTs between (1) primary and secondary ride on the two roads and (2) the two roads for changes in the primary and secondary ride, suggesting that Weber's law does not hold.

Relative difference thresholds of primary and secondary ride are estimated that can be used to evaluate whether modifications to vehicle characteristics result in perceivable changes of vehicle vibration. Results suggest that Weber's law does not hold implying that relative difference thresholds should be used that closely match the stimuli characteristics.